Pubmed Result

1. PLoS One. 2017 Dec 14;12(12):e0189199. doi: 10.1371/journal.pone.0189199.
eCollection 2017.
Inappropriate self-medication among adolescents and its association with lower

medication literacy and substance use.
Lee CH(1)(2), Chang FC(1), Hsu SD(3), Chi HY(4), Huang LJ(5), Yeh MK(6).
Author information:
(1)Department of Health Promotion and Health Education, National Taiwan Normal
University, Taipei, Taiwan, ROC.
(2)Department of Pharmacy Practice, Tri-Service General Hospital, National
Defense Medical Center, Taipei, Taiwan, ROC.
(3)Division of General Surgery, Department of Surgery, Tri-Service General
Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
(4)Department of Health Developing and Marketing, Kainan University, Taoyuan,
Taiwan, ROC.
(5)Chia Nan University of Pharmacy and Science, Tainan, Taiwan, ROC.
(6)Ministry of Health and Welfare, Taipei, Taiwan, ROC.
BACKGROUND: While self-medication is common, inappropriate self-medication has

potential risks. This study assesses inappropriate self-medication among
adolescents and examines the relationships among medication literacy, substance
use, and inappropriate self-medication.
METHOD: In 2016, a national representative sample of 6,226 students from 99
primary, middle, and high schools completed an online self-administered
questionnaire. Multiple logistic regression analysis was used to examine factors
related to inappropriate self-medication.
RESULTS: The prevalence of self-medication in the past year among the adolescents
surveyed was 45.8%, and the most frequently reported drugs for self-medication
included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence =
31.1%), cold or cough medicines (prevalence = 21.6%), analgesics (prevalence =
19.3%), and antacids (prevalence = 17.3%). Of the participants who practiced
self-medication, the prevalence of inappropriate self-medication behaviors
included not reading drug labels or instructions (10.1%), using excessive dosages
(21.6%), and using prescription and nonprescription medicine simultaneously
without advice from a health provider (polypharmacy) (30.3%). The results of
multiple logistic regression analysis showed that after controlling for school
level, gender, and chronic diseases, the participants with lower medication
knowledge, lower self-efficacy, lower medication literacy, and who consumed
tobacco or alcohol were more likely to engage in inappropriate self-medication.
CONCLUSION: Lower medication literacy and substance use were associated with
inappropriate self-medication among adolescents.
DOI: 10.1371/journal.pone.0189199
PMCID: PMC5730183
PMID: 29240799 [Indexed for MEDLINE]
2. Patient Prefer Adherence. 2017 Mar 1;11:401-413. doi: 10.2147/PPA.S131496.

eCollection 2017.
Self-medication practice in Ethiopia: a systematic review.
Ayalew MB(1).
Author information:
(1)Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and
Health Sciences, University of Gondar, Gondar, Ethiopia.
BACKGROUND: Self-medication patterns vary among different populations, and are

influenced by many factors. No review has been done that comprehensively
expresses self-medication practice in Ethiopia. The aim of this study was to
provide an overview of the literature on self-medication practice in Ethiopia.
MATERIALS AND METHODS: Databases (PubMed, Google Scholar, ResearchGate, and
Hinari) were searched for published studies on the practice of self-medication in
Ethiopia without restriction in the year of publication or methodology. Some
studies were also identified through manual Google search. Primary search terms
were "self medication", "Ethiopia", "self care", "non-prescription", "OTC drug
use", "drug utilization", and "drug hoarding". Studies that measured knowledge
only or attitude only or beliefs only and did not determine the practice of
self-medication were excluded.
RESULTS: The database search produced a total of 450 papers. After adjustment for
duplicates and inclusion and exclusion criteria, 21 articles were found suitable
for the review. All studies were cross-sectional in nature. The prevalence of
self-medication varied from 12.8% to 77.1%, with an average of 36.8%.
Fever/headache, gastrointestinal tract diseases, and respiratory diseases were
the commonest illnesses/symptoms for which self-medication was taken. The major
reasons for practicing self-medication were previous experience of treating a
similar illness and feeling that the illness was mild. Analgesics/antipyretics,
antimicrobials, gastrointestinal drugs, and respiratory drugs were the common
drug classes used in self-medication. Mainly, these drugs were obtained from
drug-retail outlets. The use of self-medication was commonly suggested by
pharmacy professionals and friends/relatives.
CONCLUSION: Self-medication practice is prevalent in Ethiopia and varies in
different populations and regions of the country. Some of the self-medication
practices are harmful and need prompt action. Special attention should be given
to educating the public and health care providers on the types of illnesses that
can be self-diagnosed and self-treated and the types of drugs to be used for
self-medication.
DOI: 10.2147/PPA.S131496
PMCID: PMC5338978
PMID: 28280312
Conflict of interest statement: Disclosure The author reports no conflicts of

interest in this work.
3. Pan Afr Med J. 2017 Jul 7;27:183. doi: 10.11604/pamj.2017.27.183.10030.

eCollection 2017.
Self-medication and its risk factors among women before and during pregnancy.
Ebrahimi H(1), Atashsokhan G(2), Amanpour F(3), Hamidzadeh A(2).
Author information:
(1)Center for Health Related Social and Behavioral Sciences Research, Shahroud
University of Medical Sciences, Shahroud, Iran.
(2)Department of Midwifery, School of Nursing & Midwifery, Shahroud University of
Medical Sciences, Shahroud, Iran.
(3)Department of Epidemiology and Biostatistics, School of Public Health,
Shahroud University of Medical Sciences, Shahroud, Iran.
INTRODUCTION: Self-medication can cause significant challenges for the

individuals and community, especially in women during pregnancy. This study was
aimed to compare the prevalence of self-medication before and during pregnancy
among women in Iran.
METHODS: in this cross-sectional study, a total of 384 pregnant women were
evaluated for the prevalence of self-medication and its associated factors before
and during pregnancy. Stratified random sampling was used as the sampling method.
Descriptive statistics and chi-square and logistic regression tests were used for
statistical analysis of data.
RESULTS: The results showed that the prevalence of self-medication, in women who
had become ill at least once, was 63.9% before pregnancy and 43.5% and during
pregnancy. Variables such as lack of insurance, high school education and not
having a child increased odds ratio of self-medication before pregnancy, while
the variables of lack of insurance, not having a child or fewer number of
children and no history of abortion increased the odds ratio of self-medication
during pregnancy.
CONCLUSION: Although the prevalence of self-medication during pregnancy was less
than that before pregnancy, but this prevalence during pregnancy was still
significant. Therefore, it seems necessary to provide public trainings for all
women of reproductive age and train them about the dangers and side effects of
self-medication.
DOI: 10.11604/pamj.2017.27.183.10030
PMCID: PMC5579420
4. BMC Geriatr. 2017 Sep 1;17(1):198. doi: 10.1186/s12877-017-0596-z.
Self-medication among the elderly in Iran: a content analysis study.
Mortazavi SS(1), Shati M(2), Khankeh HR(3)(4), Ahmadi F(5), Mehravaran S(6),
Malakouti SK(7).
Author information:
(1)Mental Health Research Center, Tehran Institute of Psychiatry-School of
Behavioral Sciences and Mental Health, Iran University of Medical Sciences,
Tehran, Iran.
(2)Department of Aging, University of Social Welfare & Rehabilitation Sciences,
Tehran, Iran.
(3)University of Social Welfare & Rehabilitation Sciences, Tehran, Iran.
(4)Department of Clinical Science and Education, Karolinska Institutet,
Stockholm, Sweden.
(5)Department of Nursing, Faculty of Medical Sciences, Tarbiat Modarres
University, Tehran, Iran.
(6)Department of Ophthalmology, Stein Eye Institute, David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
(7)Mental Health Research Center, Tehran Institute of Psychiatry-School of
Behavioral Sciences and Mental Health, Iran University of Medical Sciences,
Tehran, Iran. malakoutik@gmail.com.
BACKGROUND: Self-medication is described as the use of drugs without a

physician's prescription to treat self-recognized illness or symptoms, and an
important health issue among the elderly. Despite the wide range of different
definitions, recognizing all forms of self-medication among older adults,
particularly, in developing countries, help healthcare professionals and
providers to reduce harmful effects of self-medication. The purpose of this study
is to describe the practice of self-medication and its related factors among
elderly people in Iran based on the experiences of people who are involved in
this phenomenon.
METHODS: This qualitative study was conducted using content analysis. Purposive
sampling was used to select the participants and continued until saturation. The
participants were the elderly, their care-givers, physicians, and pharmacists.
Data was collected using semi-structured interviews, and analysis was done using
an inductive approach. The theory of planned behavior was used as a framework to
explain the role of the emerged factors in the occurrence of self-medication
behavior.
RESULTS: Based on the expressed experiences of the participants, factors related
to the practice of self- medication among the elderly in Iran fit in these 5
categories: "patient's attitudes towards disease, treatment, and physicians",
"living with disease", "unfriendly environments", "enabling health system", and
"influential others".
CONCLUSIONS: Based on the results of this study, self-medication of the elderly
in Iran has commonalities with many countries in regard to over-the-counter
medications and complementary and alternative medicine; however, self-medication
is also seen with drugs that require a prescription but can easily be obtained
from pharmacies. Contributing factors, apart from the elderly themselves, include
their families, caregivers, and social circle, the physical environment where
they live, and the health system from which they receive services.
DOI: 10.1186/s12877-017-0596-z
PMCID: PMC5580436
5. Rev Saude Publica. 2016 Dec;50(suppl 2):13s. doi:

10.1590/S1518-8787.2016050006117.
Prevalence of self-medication in Brazil and associated factors.
[Article in English, Portuguese]
Arrais PS(1), Fernandes ME(1), Pizzol TD(2), Ramos LR(3), Mengue SS(4), Luiza
VL(5), Tavares NU(6), Farias MR(7), Oliveira MA(5), Bertoldi AD(8).
Author information:
(1)Departamento de Farmácia. Faculdade de Farmácia, Odontologia e Enfermagem.
Universidade Federal do Ceará. Fortaleza, CE, Brasil.
(2)Departamento de Produção e Controle de Medicamentos. Faculdade de Farmácia.
Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil.
(3)Departamento de Medicina Preventiva. Escola Paulista de Medicina. Universidade
Federal de São Paulo. São Paulo, SP, Brasil.
(4)Departamento de Medicina Social. Universidade Federal do Rio Grande do Sul.
Porto Alegre, RS, Brasil.
(5)Departamento de Política de Medicamentos e Assistência Farmacêutica. Escola
Nacional de Saúde Pública Sérgio Arouca. Fundação Oswaldo Cruz. Rio de Janeiro,
RJ, Brasil.
(6)Departamento de Farmácia. Faculdade de Ciências da Saúde. Universidade de
Brasília. Brasília, DF, Brasil.
(7)Departamento de Ciências Farmacêuticas. Centro de Ciências da Saúde.
Universidade Federal de Santa Catarina. Florianópolis, SC, Brasil.
(8)Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal
de Pelotas. Pelotas, RS, Brasil.
OBJECTIVE: To analyze the prevalence and associated factors regarding the use of
medicines by self-medication in Brazil.
METHODS: This cross-sectional population-based study was conducted using data
from the PNAUM (National Survey on Access, Use and Promotion of Rational Use of
Medicines), collected between September 2013 and February 2014 by interviews at
the homes of the respondents. All people who reported using any medicines not
prescribed by a doctor or dentist were classified as self-medication
practitioners. Crude and adjusted prevalence ratios (Poisson regression) and
their respective 95% confidence intervals were calculated in order to investigate
the factors associated with the use of self-medication by medicines. The
independent variables were: sociodemographic characteristics, health conditions
and access to and use of health services. In addition, the most commonly consumed
medicines by self-medication were individually identified.
RESULTS: The self-medication prevalence in Brazil was 16.1% (95%CI 15.0-17.5),
with it being highest in the Northeast region (23.8%; 95%CI 21.6-26.2). Following
the adjusted analysis, self-medication was observed to be associated with
females, inhabitants from the North, Northeast and Midwest regions and
individuals that have had one, or two or more chronic diseases. Analgesics and
muscle relaxants were the therapeutic groups most used for self-medication, with
dipyrone being the most consumed medicines. In general, most of the medicines
used for self-medication were classified as non-prescriptive (65.5%).
CONCLUSIONS: Self-medication is common practice in Brazil and mainly involves the
use of non-prescription medicines; therefore, the users of such should be made
aware of the possible risks.
OBJETIVO: Analisar a prevalência e os fatores associados à utilização de
medicamentos por automedicação no Brasil.
MÉTODOS: Este estudo transversal de base populacional foi realizado com dados da
Pesquisa Nacional de Acesso, Utilização e Promoção do Uso Racional de
medicamentos (PNAUM), coletados de setembro de 2013 a fevereiro de 2014, por meio
de entrevistas em domicílio. Todas as pessoas que referiram usar qualquer
medicamento sem prescrição por médico ou dentista foram classificadas como
praticantes de automedicação. Foram calculadas razões de prevalência bruta e
ajustada (regressão de Poisson) e seus respectivos intervalos de confiança de 95%
na investigação dos fatores associados ao consumo de medicamentos por
automedicação. As variáveis independentes foram: aspectos sociodemográficos, de
condições de saúde e de acesso e utilização de serviços de saúde. Adicionalmente,
foram identificados os medicamentos mais consumidos por automedicação.
RESULTADOS: A prevalência da automedicação no Brasil foi de 16,1% (IC95%
15,0-17,5), sendo maior na região Nordeste (23,8%; IC95% 21,6-26,2). Após análise
ajustada, automedicação mostrou-se associada a ser do sexo feminino, pertencer às
faixas etárias 10-19 anos, 20-29 anos, 40-59 anos e 60 anos ou mais, residir na
região Norte, Nordeste ou Centro-Oeste, e ter uma ou duas ou mais doenças
crônicas. Os analgésicos e os relaxantes musculares foram os grupos terapêuticos
mais utilizados por automedicação, sendo a dipirona o fármaco mais consumido. No
geral, a maioria dos medicamentos usados por automedicação foram classificados
como isentos de prescrição (65,5%).
CONCLUSÕES: A automedicação é prática corrente no Brasil e envolve,
principalmente, o uso de medicamentos isentos de prescrição, devendo os usuários
ficarem atentos aos seus possíveis riscos.
DOI: 10.1590/S1518-8787.2016050006117
PMCID: PMC5157904
Conflict of interest statement: The authors declare no conflict of interest.
6. J Environ Public Health. 2017;2017:9145193. doi: 10.1155/2017/9145193. Epub 2017
Apr 5.
Self-Medication in University Students from the City of Mansoura, Egypt.
Helal RM(1), Abou-ElWafa HS(1).
Author information:
(1)Public Health and Community Medicine Department, Faculty of Medicine, Mansoura
University, Mansoura, Egypt.
Background. Self-medication is a common practice in developed and developing

countries. Objectives. To explore the prevalence of self-medication practices
among university students, probable reasons, symptoms requiring self-medication,
and sources of advice. Methods. A descriptive cross-sectional study was carried
out in Mansoura University, Egypt, and included 1st and last year students of
both medical and nonmedical faculties. Results. Prevalence of self-medication was
62.9%. Younger age, female, medical, and ever-married students and those having
home pharmacy tended to self-medicate more than their peers with significant
difference between them. Being medical student, being from urban area, having
good current health condition, being careless about health, and having drugs
stored at home pharmacy were independently associated with the likelihood of
self-medicating. Conclusion. Prevalence of self-medication among university
students is high which constitutes a health problem that needs intervention.
DOI: 10.1155/2017/9145193
PMCID: PMC5396441
7. BMC Public Health. 2015 Aug 1;15:742. doi: 10.1186/s12889-015-2109-3.
Household antimicrobial self-medication: a systematic review and meta-analysis of

the burden, risk factors and outcomes in developing countries.
Ocan M(1), Obuku EA(2)(3), Bwanga F(4), Akena D(5), Richard S(6), Ogwal-Okeng
J(7), Obua C(8).
Author information:
(1)Department of Pharmacology & Therapeutics, College of Health Sciences,
Makerere University, P.O. Box 7072, Kampala, Uganda. mss_ocan@yahoo.co.uk.
(2)Africa Centre for Systematic Reviews and Knowledge Translation, College of
Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
ekwaro@gmail.com.
(3)Faculty of Epidemiology and Population Health, London School of Hygiene and
Tropical Medicine, London, WC1E 7HT, UK. ekwaro@gmail.com.
(4)Department of Microbiology, College of Health Sciences, Makerere University,
P.O Box 7072, Kampala, Uganda. fxb18@case.edu.
(5)Department of Psychiatry, College of Health Sciences, Makerere University, P.O
Box 7072, Kampala, Uganda. akenadickens@yahoo.co.uk.
(6)Infectious Disease Institute, College of Health Sciences, Makerere University,
P.O Box 22418, Kampala, Uganda. ssenorichard@gmail.com.
Makerere University, P.O. Box 7072, Kampala, Uganda. jogwal.okeng@gmail.com.
Makerere University, P.O. Box 7072, Kampala, Uganda. cobua1953@gmail.com.
BACKGROUND: Antimicrobial self-medication is common in most low and middle income

countries (LMICs). However there has been no systematic review on
non-prescription antimicrobial use in these settings. This review thus intended
to establish the burden, risk factors and effects of antimicrobial
self-medication in Low and Middle Income Countries.
METHODS: In 2012, we registered a systematic review protocol in PROSPERO
(CRD42012002508). We searched PubMed, Medline, Scopus, and Embase databases using
the following terms; "self-medication", "non-prescription", 'self-treatment',
"antimicrobial", "antimalarial", "antibiotic", "antibacterial" "2002-2012" and
combining them using Boolean operators. We performed independent and duplicate
screening and abstraction of study administrative data, prevalence, determinants,
type of antimicrobial agent, source, disease conditions, inappropriate use, drug
adverse events and clinical outcomes of antibiotic self-medication where
possible. We performed a Random Effects Meta-analysis.
RESULTS: A total of thirty four (34) studies involving 31,340 participants were
included in the review. The overall prevalence of antimicrobial self-medication
was 38.8 % (95 % CI: 29.5-48.1). Most studies assessed non-prescription use of
antibacterial (17/34: 50 %) and antimalarial (5/34: 14.7 %) agents. The common
disease symptoms managed were, respiratory (50 %), fever (47 %) and
gastrointestinal (45 %). The major sources of antimicrobials included, pharmacies
(65.5 %), leftover drugs (50 %) and drug shops (37.5 %). Twelve (12) studies
reported inappropriate drug use; not completing dose (6/12) and sharing of
medicines (4/12). The main determinants of antimicrobial self-medication include,
level of education, age, gender, past successful use, severity of illness and
income. Reported negative outcomes of antimicrobial self-medication included,
allergies (2/34: 5.9 %), lack of cure (4/34: 11.8 %) and causing death (2/34: 5.9
%). The commonly reported positive outcome was recovery from illness (4/34: 11.8
%).
CONCLUSION: The prevalence of antimicrobial self-medication is high and varies in
different communities as well as by social determinants of health and is
frequently associated with inappropriate drug use.
DOI: 10.1186/s12889-015-2109-3
PMCID: PMC4522083
8. Indian J Dermatol. 2017 Mar-Apr;62(2):178-183. doi: 10.4103/ijd.IJD_243_16.
Self-medication for Acne among Undergraduate Medical Students.
Karamata VV(1), Gandhi AM(1), Patel PP(1), Desai MK(1).
Author information:
(1)Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India.
AIMS: This study aims to evaluate the knowledge and pattern of self-medication
for acne among undergraduate medical students at a tertiary care teaching
hospital.
MATERIALS AND METHODS: This cross-sectional study was conducted in II MBBS (Group
A), III MBBS Part I (Group B), and III MBBS Part II (Group C) students.
Prevalidated questionnaire about knowledge, attitude, and practice of
self-medication were administered to participants. Data were analyzed using
one-way analysis of variance and Chi-square test.
RESULTS: Out of 582 students who responded to questionnaire, 518 suffered from
acne. Self-medication practice was observed in 59.2% students. Significantly
higher number of female students practiced self-medication (P < 0.0001). Most
common source of information was seniors/friends/family members (34.2%). The
mildness of illness (42.3%) was the most common reason of self-medication. A
total mean score of knowledge was significantly higher in Group C as compared to
Group A (P < 0.001) and Group B (P < 0.05). Allopathic medication was preferred
by 69.8% students. Seventy-five percentage students read leaflet/package
insert/label instruction and expiry date of the medicines.
CONCLUSIONS: The participating students lack the knowledge about self-medication
for acne. Adequate knowledge and awareness about the appropriate use of
medication will reduce the practice of self-medication and improve rational
prescribing.
DOI: 10.4103/ijd.IJD_243_16
PMCID: PMC5363142
PMID: 28400638
Conflict of interest statement: There are no conflicts of interest. What is new?

We have studied the drugs used for self-medication by undergraduate medical
students in detail. More than 90% of medical students used antimicrobials. The
majority of the students preferred topical application (236 [76.9%]) as and when
required (45.3% students). Antimicrobial even if used topically may increase
resistance. [15] Hence, awareness about self-medication is important in
undergraduate medical students which will prevent adverse drug reactions and
antimicrobial resistance. Awareness about self-medication and its effect will
improve rational prescribing in future.
9. Curr Opin Behav Sci. 2016 Jun;9:78-83.
Self-medication with sucrose.
Ulrich-Lai YM(1).
Author information:
(1)Department of Psychiatry and Behavioral Neuroscience, University of
Cincinnati, Cincinnati, OH 45140 USA.
For many individuals, stress promotes the consumption of sweet, high-sugar foods
relative to healthier alternatives. Daily life stressors stimulate the overeating
of highly-palatable foods through multiple mechanisms, including altered
glucocorticoid, relaxin-3, ghrelin and serotonin signaling in brain. In turn, a
history of consuming high-sugar foods attenuates the psychological (anxiety and
depressed mood) and physiological (HPA axis) effects of stress. Together the
metabolic and hedonic properties of sucrose contribute to its stress relief,
possibly via actions in both the periphery (e.g., glucocorticoid receptor
signaling in adipose tissue) and in the brain (e.g., plasticity in brain reward
regions). Emerging work continues to reveal the bidirectional mechanisms that
underlie the use of high-sugar foods as 'self-medication' for stress relief.
DOI: 10.1016/j.cobeha.2016.02.015
PMCID: PMC4787559
PMID: 26977424
10. Rev Gaucha Enferm. 2017 May 18;38(1):e65111. doi:

10.1590/1983-1447.2017.01.65111.
Self-medication among nursing students in the state of Amazonas - Brazil.
Gama ASM(1), Secoli SR(2).
Author information:
(1)Universidade Federal do Amazonas (UFAM), Instituto de Saúde e Biotecnologia.
Coari, Amazonas, Brasil.
(2)Universidade de São Paulo (USP), Escola de Enfermagem, Programa de
Pós-graduação em Enfermagem na Saúde do Adulto. São Paulo, São Paulo, Brasil.
Objective: To determine the prevalence of self-medication and associated factors

among nursing students.
Method: This is a cross-sectional study with 116 nursing students from the public
university in the state of Amazonas, Brazil, from March to April 2014. Data were
collected using a questionnaire with socioeconomic and medicine use variables.
The data were subjected to bivariate analysis and logistic regression at a
significance level of 5%.
Results: The prevalence of self-medication was 76.0%, chiefly motivated by the
belief that the health condition did not require a medical appointment (46.6%).
Half of the students reported pain-related complaints. The most commonly used
pharmacological groups were non-steroidal anti-inflammatory drugs (63.2%) and
antibiotics (11.1%). Lack of awareness of the negative implications of
self-medication was associated with self-medication (OR = 6.0).
Conclusion: The high prevalence of self-medication that may lead to adverse
reactions reveals the students' irrational use of medicines, especially
considering the role of these future professionals in patient safety.
DOI: 10.1590/1983-1447.2017.01.65111
11. Pharmacol Res Perspect. 2017 Aug;5(4). doi: 10.1002/prp2.323.
Self-medication misuse in the Middle East: a systematic literature review.
Khalifeh MM(1)(2), Moore ND(1), Salameh PR(2).
Author information:
(1)INSERM U 1219 - Pharmaco-épidémiologie et évaluation de l'impact des produits
de santé sur les populations, University de Bordeaux, Bordeaux, France.
(2)Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy,
Lebanese University, Beirut, Lebanon.
Regulations usually distinguish between prescription-only (POM) and

over-the-counter (OTC) medicines. The former requires medical prescription; the
latter are available for SM of common minor or easily treated ailments. However,
in the Eastern Mediterranean countries, theoretical prescription medicines can
easily be purchased without a prescription, as self-medication (SM) resulting in
potential misuse and unnecessary risk for patients. The magnitude of this
activity is uncertain. The aim of this article, therefore, is to undertake a
comprehensive review to identify the different types of medicines that can easily
be purchased as SM in Middle East and recognized as misused. An extensive review
of the published literature (1990-2015) was conducted using Pubmed, web of
science, Cochrane, and Google Scholar databases, for OTC medicine misuse in the
Middle East. A total of 72 papers were identified. Medicines involved in misuse
included: codeine containing products, topical anesthetics, topical
corticosteroids, antimalarial, and antibiotics. Self-medication misuse of
medicines seemed widespread. Individual treatment patterns were not clearly
identified. Studies were not standardized, limiting the comparability between
studies and the estimation of the scale of misuse. Pharmacists, friends, or
parents were found to be the main sources of SMs. Knowledge and attitudes are an
important contributing factor in the misuse of these medications. Strategies and
interventions to limit misuse were rarely identified in literature. In
conclusion, a massive problem involving a range of medicines was found in Middle
East. Standardization of studies is a prerequisite to the understanding and
prevention of misuse of self-medication.
© 2017 The Authors. Pharmacology Research & Perspectives published by John Wiley
& Sons Ltd, British Pharmacological Society and American Society for Pharmacology
and Experimental Therapeutics.
DOI: 10.1002/prp2.323
PMCID: PMC5684864
PMID: 28805984
12. BMC Res Notes. 2017 Jul 27;10(1):337. doi: 10.1186/s13104-017-2688-4.
Pharmacology education and antibiotic self-medication among medical students: a

cross-sectional study.
Rathish D(1), Wijerathne B(2), Bandara S(3), Piumanthi S(3), Senevirathna C(3),
Jayasumana C(3), Siribaddana S(4).
Author information:
(1)Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata
University of Sri Lanka, Saliyapura, Sri Lanka. rathishdeva@gmail.com.
(2)Department of Community Medicine, Faculty of Medicine and Allied Sciences,
Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
(3)Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata
University of Sri Lanka, Saliyapura, Sri Lanka.
(4)Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata
University of Sri Lanka, Saliyapura, Sri Lanka.
OBJECTIVE: Pharmacology teaches rational prescribing. Self-medication among

medical students is recognised as a threat to rational prescribing. Antibiotic
self-medication could cause antibiotic resistance among medical students. We
aimed to find an association between pharmacology education and antibiotic
self-medication.
RESULTS: Overall, 39% [(110/285) 95% CI 32.9-44.3] of students were found to have
antibiotic self-medication. The percentage for antibiotic self-medication
progressively increased with the year of study. The percentage of antibiotic
self-medication was significantly high in the "Formal Pharmacology Education"
group (47%-77/165) in comparison to the "No Formal Pharmacology Education" group
(28%-33/120) (P = 0.001032). Overall, the most common self-prescribed antibiotic
was amoxicillin (56%-62/110).
DOI: 10.1186/s13104-017-2688-4
PMCID: PMC5530969
13. Int J Environ Res Public Health. 2017 Sep 29;14(10). pii: E1152. doi:
10.3390/ijerph14101152.
Antibiotic Self-Medication among Non-Medical University Students in Punjab,

Pakistan: A Cross-Sectional Survey.
Gillani AH(1)(2)(3)(4), Ji W(5)(6)(7)(8), Hussain W(9), Imran A(10), Chang

J(11)(12)(13)(14), Yang C(15)(16)(17)(18), Fang Y(19)(20)(21)(22).
Author information:
(1)Department of Pharmacy Administration and Clinical Pharmacy, School of
Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
hassangillaniali@yahoo.com.
(2)Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an
710061, China. hassangillaniali@yahoo.com.
(3)The Global Health Institute, Xi'an Jiaotong University, Xi'an 710061, China.
hassangillaniali@yahoo.com.
(4)Shaanxi Centre for Health Reform and Development Research, Xi'an 710061,
China. hassangillaniali@yahoo.com.
Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China. yfyx_8312@163.com.
710061, China. yfyx_8312@163.com.
yfyx_8312@163.com.
China. yfyx_8312@163.com.
(9)Faculty of Pharmacy, Bahauddin Zakariya University Multan, Multan 66000,
Pakistan. dr.waqarwarraich@gmail.com.
(10)Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan.
aliimran1232002@gmail.com.
jiechang@mail.xjtu.edu.cn.
710061, China. jiechang@mail.xjtu.edu.cn.
jiechang@mail.xjtu.edu.cn.
China. jiechang@mail.xjtu.edu.cn.
yangcj@mail.xjtu.edu.cn.
710061, China. yangcj@mail.xjtu.edu.cn.
yangcj@mail.xjtu.edu.cn.
China. yangcj@mail.xjtu.edu.cn.
yufang@mail.xjtu.edu.cn.
710061, China. yufang@mail.xjtu.edu.cn.
yufang@mail.xjtu.edu.cn.
China. yufang@mail.xjtu.edu.cn.
Background: Antibiotic resistance is a global threat. Scarce knowledge about safe

and appropriate antibiotic use is coupled with frequent self-administration,
e.g., in China. This repeated self-medication poses potential risk in terms of
antibiotic resistance. Low-resource countries are facing an elevated burden of
antibiotic self-medication as compared to developed ones. Thus, this study
focused on evaluating the pervasiveness of antibiotic self-medication in 3
universities of Southern Punjab, Pakistan. Methods: We conducted a descriptive
cross-sectional survey in three government sector universities of Southern
Punjab, Pakistan. The study was carried out with self-administered paper-based
questionnaires. Data was analyzed using SPSS version 18.0 (IBM, Chicago, IL,
USA). Results: Seven hundred twenty-seven students out of 750 (response rate 97%)
with a mean age ± SD of 23.0 ± 3.4 years agreed to participate in the study. The
proportion of females was slightly greater (52%) compared with males (48%), and
almost one-third of the respondents (36%) were in their 2nd year of university.
Out of the total, 58.3% practiced self-medication in the preceding six months,
and 326 (45%) confirmed the use of antibiotics. Metronidazole was the most
frequently self-medicated antibiotic (48%). Out of the total, 72% demonstrated
awareness regarding the side effects of antibiotics. Diarrhea was the well-known
adverse effect (38%). Forty-three percent affirmed having antibiotic resistance
knowledge, and 30% knew that the irregular use of antibiotics would lead to
increased antibiotic resistance. Conclusion: Despite having ample awareness of
the adverse antibiotic reactions, self-medication among the university students
was high and antibiotic resistance was a fairly unknown term.
DOI: 10.3390/ijerph14101152
PMCID: PMC5664653
Conflict of interest statement: The authors disclose no conflict of interests.
14. Saudi J Biol Sci. 2017 May;24(4):808-812. doi: 10.1016/j.sjbs.2017.01.004. Epub

2017 Jan 9.
Self-medication and antibiotic resistance: Crisis, current challenges, and

prevention.
Rather IA(1), Kim BC(2), Bajpai VK(1), Park YH(1)(2).
Author information:
(1)Department of Applied Microbiology and Biotechnology, School of Biotechnology,
Yeungnam University, Gyeongsan, Gyeongbuk 38541, Republic of Korea.
(2)Probionic Institute, Jeonju-si, Jeollabuk-do, Republic of Korea.
The present study aims to explore the crisis of antibiotic resistance and
discover more about the current challenges related to self-medication. The
current challenges related to antibiotic resistance are unique and differ from
the challenges of the past since new bacterial pathogens are involved and
continue to evolve. Strains with resistance to multiple antibiotic classes have
emerged which the discovery of new antibiotics has failed to match. The
consequences of antibiotic resistance are grave with mortality and morbidity
continually on the rise. This paper also highlights the possible interventions
that can be effective at the micro or individual level in the prevention of
development of antibiotic resistance.
DOI: 10.1016/j.sjbs.2017.01.004
PMCID: PMC5415144
PMID: 28490950
15. Int J Infect Dis. 2017 Apr;57:3-12. doi: 10.1016/j.ijid.2017.01.014. Epub 2017
Jan 19.
Self-medication and self-prescription with antibiotics in the Middle East-do they

really happen? A systematic review of the prevalence, possible reasons, and
outcomes.
Alhomoud F(1), Aljamea Z(2), Almahasnah R(2), Alkhalifah K(2), Basalelah L(2),
Alhomoud FK(3).
Author information:
(1)Department of Clinical and Pharmacy Practice, School of Clinical Pharmacy,
University of Dammam, Dammam 31952, Saudi Arabia. Electronic address:
f.k.alhomoud@gmail.com.
(2)Department of Clinical and Pharmacy Practice, School of Clinical Pharmacy,
University of Dammam, Dammam 31952, Saudi Arabia.
(3)Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University,
Mecca, Saudi Arabia.
OBJECTIVES: There has been no review on the prevalence, possible causes, and
clinical outcomes of self-medication with antibiotics (SMA) in the Middle East.
METHODS: Databases were searched (January 2000 through June 2016) for articles on
SMA among adults aged ≥18 years living in the Middle East. A hand search for
relevant citations and key journals was also performed.
RESULTS: Twenty-two studies were found. The prevalence of SMA ranged from 19% to
82%. Age, sex, and educational and income levels were the main determinants of
SMA. Socio-cultural, economic, and regulatory factors were the most commonly
cited reasons for SMA. Penicillins were the antibiotics most commonly used; the
antibiotics were obtained mainly via stored leftover drugs, pharmacies without
prescriptions, and friends/relatives. SMA was mainly for upper respiratory tract
problems. The primary sources of drug information included relatives/friends and
previous successful experience. Inappropriate drug use such as wrong indication,
short and long duration of treatment, sharing of antibiotics, and storing
antibiotics at home for use at a later time were reported. Negative and positive
outcomes of SMA were identified.
CONCLUSIONS: It is important to understand the links between different factors
promoting SMA and to assess the changing trends in order to derive strategies
aimed at reducing drug-related health risks.
Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
DOI: 10.1016/j.ijid.2017.01.014
16. J Pharm (Cairo). 2017;2017:8680714. doi: 10.1155/2017/8680714. Epub 2017 Jan

16.
Self-Medication Pattern among Social Science University Students in Northwest

Ethiopia.
Gelayee DA(1).
Author information:
(1)Department of Pharmacology, College of Medicine and Health Sciences,
University of Gondar, Gondar, Ethiopia.
Background. Inappropriate self-medication causes wastage of resources among

others. Method. This survey study was conducted to determine self-medication
pattern of 404 social science university students in Northwest Ethiopia, who were
selected through stratified random sampling technique. Data were collected using
self-administered questionnaire and analyzed with SPSS version 20 statistical
software. Binary Logistic Regression analysis was employed with P value < 0.05
considered statistically significant. Result. At 95.3% response rate, mean age of
21.26 ± 1.76 years, and male/female ratio of 1.26, the prevalence of
self-medication during the six month recall period was 32.7%. Headache (N = 87,
69.1%) was the primary complaint that prompted the practice and hence analgesics
(N = 67, 53.2%) were the mostly used drugs followed by antimicrobials (N = 50,
39.7%). The top two reasons driving the practice were nonseverity of the illness
(N = 41, 32.5%) and suggestions from friends (N = 33, 26.2%). Female sex (P =
0.042) and higher income (P = 0.044) were associated with the practice.
Conclusion. Self-medication practice, involving the use of both nonprescription
and prescription drugs such as antimicrobials, among the social science
university students is high. Therefore health education interventions regarding
the risks of inappropriate self-medication are essential.
DOI: 10.1155/2017/8680714
PMCID: PMC5278208
PMID: 28191360
Conflict of interest statement: The author declares that there is no conflict of

interests regarding the publication of this paper.
17. Saudi Pharm J. 2018 Jul;26(5):719-724. doi: 10.1016/j.jsps.2018.02.018. Epub

2018
Feb 6.
Self-medication with antibiotics in Saudi Arabia.
Alghadeer S(1), Aljuaydi K(2), Babelghaith S(1), Alhammad A(1), Alarifi MN(1).
Author information:
(1)Department of Clinical Pharmacy, College of Pharmacy, King Saud University,
Riyadh, Saudi Arabia.
(2)College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Introduction: Despite of the global dilemma of antibiotics resistance, this issue

is more worsen in developing countries or places where the antibiotics can be
dispensed or purchased without prescription such as in Saudi Arabia. Most health
awareness campaigns and published studies regarding the self-medication with
antibiotics in Saudi Arabia are conducted within hospitals. The prevalence and
reasons of self-medication with antibiotics were not well studied from community
perspective in Saudi Arabia. This study was conducted to investigate the
prevalence of self-medication with antibiotics in Saudi Arabia.
Methodology: A cross-sectional study using online survey and snowball technique
was conducted during the period from January 2017 to May 2017 targeting people
who are living in Saudi Arabia.
Results: A total of 1264 respondent completed the questionnaire and included in
the study. About 34% of respondents have used antibiotic without a prescription,
and 81.3% of them knew that it might be harmful to health. The most antibiotic
used for self-medication was Amoxicillin/clavulanic acid (45.1%) followed by
amoxicillin (39.9%). The most common illness and reasons for seeking antibiotic
without prescription were tonsillitis (76.7%) and the previous experience of
using a particular antibiotic (52.1%) respectively. The major source of
self-medication with antibiotic was previous doctor's prescription (36.6%).
Conclusion: The relative high prevalence of self-medication with antibiotics
necessitates taking serious steps by health authorities to implement the law of
forbidding the sale of antibiotics without prescription.
DOI: 10.1016/j.jsps.2018.02.018
PMCID: PMC6035317
PMID: 29991916
18. East Mediterr Health J. 2017 Mar 30;23(2):87-93.
Prevalence of self-medication among university students in Baghdad: a

cross-sectional study from Iraq.
Al-Ameri RJ(1), Abd Al-Badri HJ(2), Lafta RK(3).
Author information:
(1)Al-Dora Health-Care Centre for Family Medicine, Al-Karkh Health Directorate,
Ministry of Health, Baghdad, Iraq.
(2)Noncommunicable Diseases Control Department, Public Health Directorate,
Ministry of Health, Baghdad, Iraq.
(3)College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq.
The objective of this study is to find out the prevalence and determinants of
self-medication among college students in Baghdad, Iraq. A cross-sectional survey
was conducted in Al-Mustansiriyah and Al-Nahrain universities, Baghdad, from
January to April 2015. A multistage random sampling technique was adopted to
collect data from 1435 college students using a questionnaire form. The mean age
of the joining students was 19.8 years. Females form 53% of the sample.
Self-medications use was prevalent among 92.4% of students. Antipyretics and
antibiotics were the most used medicines. Self-medication was higher among urban
residents (OR= 7.99, P < 0.001). Students living with their families practiced
self-medication more than others (OR= 2.501, P = 0.037). Students at
health-related colleges showed greater resilience to self-medication (OR=0.455, P
= 0.001). Despite free access to healthcare institutions, nine out of ten college
students from Baghdad universities have practiced self-medication. Education of
students about the safe use of medications and supervision of pharmacies are
effective ways to control this malpractice.
Publisher: ‫ دراسة مستعررضة‬:‫معدل انتشار التطبيب الذاتي بين طلب الجامعة في بغداد‬
‫الهدف من هذه‬.‫ رياض خضير لفتة‬،‫ هشام جاسم عبد البدري‬،‫رؤى جعفر العامري‬.‫من العراق‬
‫الدراسة هو معرفة معددل انتشار التطبيب الذاتي ومحددداته بن طاب الجامعات في بغداد‬،
‫ في الفرة من‬،‫ في بغداد‬،‫ أجريت دراسة مقطعية في جامعتريي المستنصرية والنهرين‬.‫العراق‬
‫ واعتمد الباحثون أسلوب أخذ العينات‬.2015 ‫نيسان‬/‫كانون الثاني إلى أبريل‬/‫يناير‬
‫ طالبا ا من طاب الجامعات باستخدام‬1435 ‫العشوائية المتعددة المراحل لجمع البيانات من‬
‫ عاما ا‬19.8 ‫ وكان متوسط العمر لدى الطاب الذين انضموا إلى الدراسة‬.‫نموذج الستبيان‬.
‫ من‬٪92.4 ‫ وكان استخدام الدوية الذاتية منترا ا بن‬.‫ من العينة‬٪ 53 ‫وشكل الناث‬
‫ وكانت الدوية الخافضة للحرارة والمضادات الحيوية هي الدوية الكثر‬.‫الطاب‬
‫ وكان معددل انتشار التطبيب الذاتي أعى بن سكان الحر‬.‫( استخداما ا‬OR=7.99, P <
0.001). ‫وكان الطاب الذين يعيشون مع أسرهم يمارسون التطبيب الذاتي أكثر من غيرهم‬
(OR=2.501, P = 0.037). ‫وأظهر الطاب في الكليات ذات الصلة بالصحة مرونة أكر للعاج‬
‫( الذاتي‬OR=0.455, P = 0.001). ‫وعى الرغم من أن الحصول عى الرعاية الصحية من‬
‫ فإن تسعة من كل عشرة طاب من جامعات بغداد قد مارسوا التطبيب‬،‫المؤسسات مجانية‬
‫ ويعتر تعليم الطاب للستخدام المن للدوية والشراف عى الصيدليات من‬.‫الذاتي‬
‫الوسائل الفدعالة لمكافحة هذه الممارسات الخاطئة‬.Publisher: Prévalence de
l’automédication parmi les étudiants à l’Université de Bagdad : étude
transversale iraquienne.La présente étude a pour objectif d’estimer la prévalence
de l’automédication et d’en identifier les déterminants parmi les étudiants à
l’Université de Bagdad (Iraq). Une étude transversale a été menée dans les
universités d’Al- Mustansiriyah et d’Al-Nahrain à Bagdad, entre janvier et avril
2015. Une technique d’échantillonnage aléatoire à plusieurs degrés a été adoptée
afin de collecter les données auprès de 1435 étudiants à l’aide d’une
questionnaire. L’âge moyen des étudiants ayant participé à l’étude était de 19,8
ans, et 53 % étaient des femmes dans l'échantillon. L’automédication était
prévalente pour 92,4 % des étudiants. Les médicaments les plus utilisés étaient
les antipyrétiques et les antibiotiques. L’automédication était plus élevée parmi
les citadins (OR = 7,99, p < 0,001). Les étudiants vivant encore chez leurs
parents pratiquaient davantage l’automédication que les autres (OR = 2,501, p =
0,037). Les étudiants qui suivaient des études dans le domaine de la santé
avaient moins tendance à recourir à l’automédication (OR = 0,455, p = 0,001).
Malgré un accès libre aux établissements de soins de santé, neuf étudiants sur
dix des universités de Bagdad avaient déjà pratiqué l’automédication. Éduquer les
étudiants à une consommation sans risque des médicaments et mettre en place une
surveillance des pharmacies constituent des moyens efficaces pour remédier à
cette mauvaise pratique.

19. Biomed Res Int. 2015;2015:580650. doi: 10.1155/2015/580650. Epub 2015 Jan 20.
Self-medication practices among parents in Italy.
Garofalo L(1), Di Giuseppe G(1), Angelillo IF(1).
Author information:
(1)Department of Experimental Medicine, Second University of Naples, Naples,
Italy.
The aims of this cross-sectional survey were to document the prevalence, the
determinants, and the reasons of oral medication use without the prescription of
a physician among a random sample of 672 parents of students attending randomly
selected public schools in Italy. A total of 69.2% practiced self-medication at
least once. The odds of having performed a self-medication were higher in
females, in younger population, and in those who have had a health problem in the
preceding year and were lower in respondents with a middle or lower school level
of education. Among those reporting experience of self-medication, 53.4% have
practiced at least once in the last year and this was more likely for those who
have had a health problem. Nonsteroidal anti-inflammatory drugs were more
frequently used without a prescription in the last year. Two-thirds
inappropriately self-medicated in the last year at least once. Of those who did
not report a self-medication, 13.1% were willing to practice it. Females were
more willing and those with a secondary school level of education less willing to
practice self-medication. The frequency of oral self-medication was quite high
and in most cases inappropriate with a potential impact on the health status and
educative programs are needed.
DOI: 10.1155/2015/580650
PMCID: PMC4320888
20. Glob J Health Sci. 2015 Jan 21;7(2):360-5. doi: 10.5539/gjhs.v7n2p360.
Prevalence of self-medication among the elderly in Kermanshah-Iran.
Jafari F, Khatony A(1), Rahmani E.
Author information:
(1)Kermanshah University of Medical Sciences. akhatony@kums.ac.ir.
INTRODUCTION: Self-medication is consumption of one or several medications

without the physician's prescription. Given the risks of self-medication, this
study was carried out to assess the prevalence of self-medication and its related
factors among the elderly in Kermanshah-Iran
METHOD: In this descriptive cross-sectional study, 272 elderly visiting the
private offices in Kermanshah were selected through convenience sampling method.
The instrument for data collection was a researcher made self-medication
questionnaire. Data were analyzed using descriptive and analytic statistical
methods (Chi-Square and Fisher exact test).
RESULTS: The prevalence of self-medication was 83%. The most common reasons for
self-medication were certainty of its safety (93%), prior consumption of the drug
(87.6%), busy offices of physicians (82%), non-seriousness of the illness (77.8%)
and prior experience of the disease (73%).The most common drugs used for
self-medication were analgesics (92%), cold drugs (74%), vitamins (61%),
digestive drugs (54%) and antibiotics (43%). There was a significant correlation
between self-medication and gender (p=0.001), education level (p=008), drug
information (p=0.01), marital status (p=0.002), and medical insurance (p=0.001)
variables.
CONCLUSION: considering the relatively high rates of self-medication among the
elderly as well as its side effects, designing and performing educational
programs are suggested for the elderly people.
DOI: 10.5539/gjhs.v7n2p360
PMCID: PMC4796481
21. Rural Remote Health. 2017 Apr-Jun;17(2):3893. doi: 10.22605/RRH3893. Epub 2017
Apr 7.
Patients' use of and attitudes towards self-medication in rural and remote

Slovenian family medicine practices: a cross-sectional multicentre study.
Klemenc-Ketis Z(1), Mitrovic D(2).
Author information:
(1)Taborska 8, 2000 Maribor, Slovenia. zalika.klemenc.ketis@gmail.com.
(2)Poljanski nasip 58, 1000 Ljubljana, Slovenia. daca.nbanja@gmail.com.
INTRODUCTION: Self-medication is very common in the general population, but its

prevalence can differ according to the place of residence. The aim of this study
was to determine the prevalence of self-medication in patients attending rural
and remote family physicians, and to detect the important factors that are
associated with it.
METHODS: A cross-sectional multicentre study was performed in 24 rural and remote
family medicine practices in Slovenia was performed. The aim was to include 720
patients who visited their family physicians on a particular day. The authors
used a validated questionnaire on self-medication, which consisted of questions
about demographic characteristics (sex, age, education and working status),
questions about health status, questions about self-medication practices, and
questions about attitudes towards self-medication. The level of participants'
trust in different sources of medical information was measured by a five-point
Likert scale. The participants were asked to take into account the year 2013 when
completing the questionnaire.
RESULTS: Of 720 invited patients, 371 (51.5%) completed the questionnaire. There
were 233 (62.8%) women in the sample. The mean age of the participants was 48.1
(±15.1) years. Self-medication was practised by 300 (80.9%) participants. In
multivariate analysis, the variables independently associated with
self-medication were information on self-medication obtained from pharmacists,
and information on self-medication obtained from relatives. Additionally, some
other variables had high odds ratios such as information on self-medication
obtained from books, information on self-medication obtained from media, and
reason for self-medication: burdening physicians.
CONCLUSIONS: The practices of self-medication in rural Slovenia as reported by
patients can be defined as moderately safe. People tend to seek more information
on self-medication but the main sources for this are lay informants. Further
studies are needed to explore the safety of such practices.
DOI: 10.22605/RRH3893
22. BMC Res Notes. 2017 Oct 30;10(1):533. doi: 10.1186/s13104-017-2865-5.
Epidemiology of self-medication with modern medicines among health care

professionals in Nekemte town, western Ethiopia.
Sado E(1), Kassahun E(2), Bayisa G(3), Gebre M(3), Tadesse A(3), Mosisa B(4).
Author information:
(1)Pharmacoepidemiology and Social Pharmacy Unit, Department of Pharmacy, College
of Health Sciences, Wollega University, P.O.Box 395, Nekemte, Ethiopia.
edaosd6@gmail.com.
(2)Boru Meda Hospital, Amhara National Regional State, Dessie, Ethiopia.
(3)Clinical Pharmacy Unit, Department of Pharmacy, College Health of Sciences,
Wollega University, Nekemte, Ethiopia.
(4)Pharmaceutics Unit, Department of Pharmacy, College Health of Sciences,
Wollega University, Nekemte, Ethiopia.
OBJECTIVE: Self-medication is defined as use of medicines to treat

self-recognized illnesses. It is widely used in Ethiopia. However, its extent of
use is unknown among health professionals. This study aimed to assess prevalence
and reasons of self-medication with modern medicines among health professionals.
A cross-sectional study was conducted on the health professionals, working in the
public health facilities. Data were collected from March to May, 2016 using
semi-structured questionnaire. Data were entered and analyzed using statistical
package for the social sciences. A chi square test was used as test of
significance at 95% of confidence interval.
RESULTS: A total of 154 health professionals were enrolled, with 53% were being
females. The finding revealed that prevalence of self-medication with modern
medicines was 67.5%. Financial constraints (32.5%) and familiarity with medicines
(24%) were the major reasons of self-medication. It also showed that
self-medication with modern medicines was significantly associated with marital
status (χ2 = 19.57, P = 0.00). Analgesics (53%) and antibiotics (36%) were the
most commonly used categories of medicines. Self-medication with modern medicines
was highly practiced among health professionals. Financial constraints and
familiarity with medicines were the two major reasons of practicing.
DOI: 10.1186/s13104-017-2865-5
PMCID: PMC5663131
23. Pan Afr Med J. 2017 Sep 4;28:4. doi: 10.11604/pamj.2017.28.4.12589. eCollection
2017.
Evaluation of antibiotic self-medication among outpatients of the state

university hospital of Port-Au-Prince, Haiti: a cross-sectional study.
Moise K(1), Bernard JJ(1), Henrys JH(1).
Author information:
(1)Université Notre-Dame d'Haïti, Faculté de Médecine et des Sciences de la Santé
6, Rue Sapotille, Port-au-Prince, Haiti.
In Haiti, where all drugs are available over the counter, self-medication with
antibiotics appears as a common practice. Inappropriate use of beta-lactams and
macrolides is likely to contribute to the development of antimicrobial
resistance. This study aimed to (i) assess the extent of self-medication with
antibiotics, (ii) explore the contributing factors (age, gender and educational
background) and (iii) identify specific antibiotic drug classes used among
patients attending the outpatient clinic of the State University Hospital of
Port-au-Prince. A cross-sectional survey among 200 outpatients of the State
University Hospital of Port-au-Prince was conducted in December 2014.
Face-to-face interviews were conducted using a standardized questionnaire.
Parents of pediatric patients were allowed to answer to questions on their
behalf. Among the study sample, 45.5% practiced self-medication with antibiotics.
It was less prevalent among patients with the highest education level (23.1%; OR:
0.89 (0.5-1.75), p = 0.001). Mild symptoms (28.6%) and vaginal itching (44.4%)
were the main reasons for self-medication with antibiotics. Self-medication using
amoxicillin was reported by 67.0%. Self-medication with antibiotics is a common
practice among Haitian patients and is more common among the less educated.
Amoxicillin for urinary tract infections is the most commonly used medication. It
is crucial to raise awareness on the dangers of the practice in the population
and inforce the current law regarding the use of over the counter antibiotics.
DOI: 10.11604/pamj.2017.28.4.12589
PMCID: PMC5681018
24. J Clin Diagn Res. 2016 Dec;10(12):FC07-FC11. doi: 10.7860/JCDR/2016/22504.8953.

Epub 2016 Dec 1.
Analgesics Self-Medication and its Association with Sleep Quality among Medical
Undergraduates.
Kumar A(1), Vandana(2), Aslami AN(3).
Author information:
(1)Assistant Professor, Department of Pharmacology, Narayan Medical College and
Hospital , Sasaram, Bihar, India .
(2)Assistant Professor, Department of Physiology, Narayan Medical College and
Hospital , Sasaram, Bihar, India .
(3)Assistant Professor, Department of Community Medicine, Narayan Medical College
and Hospital , Sasaram, Bihar, India .
INTRODUCTION: Self medication especially with analgesics is a common practice

among undergraduate medical students. Variation in analgesic self medication
prevalence and pattern is often seen due to geographical and target population
differences. The mutual influence of pain and sleep quality might persuade
students self medication behaviour.
AIM: To assess analgesic self medication and its association with sleep quality
among the medical undergraduates.
MATERIALS AND METHODS: A cross-sectional questionnaire based study was conducted
from December 2015 to February 2016 among 320 medical undergraduates. The
information about socio-demographic profile, symptoms, types of analgesics,
source of information and reason for analgesic self medication was collected. The
sleep quality of students was assessed by Pittsburgh Sleep Quality Index (PSQI).
The qualitative variables were expressed as percentages. Odds Ratio (OR) with 95%
Confidence Interval (CI) was also calculated. Chi-square test was used.
RESULTS: Analgesic self medication prevalence was 49.7%, more prevalence seen
among males, seniors, urban residents and students of working parents. Headache
(48.4%) was the most common cause and paracetamol (79.7%) was most frequent drug
used, based on knowledge obtained through textbook and internet (47.1%). Mildness
of symptoms (49.1%) was the most important motivation behind self medication.
Analgesic use was more (57.4%) among "poor sleepers" compared to "normal
sleepers" (45.2%).
CONCLUSION: Despite having easy accessibility to expert consultations, high
prevalence of analgesic self medication among medical students and its
association with poor sleep quality is a distressing issue. This indicates an
urgent need of awareness programmes about harmful effects of self medication and
healthy sleep practices.
DOI: 10.7860/JCDR/2016/22504.8953
PMCID: PMC5296445
PMID: 28208872
25. J Res Pharm Pract. 2016 Apr-Jun;5(2):121-5. doi: 10.4103/2279-042X.179576.
Self-medication of irritable bowel syndrome and dyspepsia: How appropriate is it?
Niknam R(1), Mousavi S(2), Safarpour A(3), Mahmoudi L(4), Mahmoudi P(5).
Author information:
(1)Gastroenterohepatology Research Center, Shiraz, Fasa, Iran; Department of
Internal Medicine, Fasa University of Medical Sciences, Fasa, Iran.
(2)Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of
Medical Sciences, Isfahan, Iran.
(3)Gastroenterohepatology Research Center, Shiraz, Fasa, Iran.
(4)Department of Clinical Pharmacy, Shiraz University of Medical Sciences,
Shiraz, Iran.
(5)Pharmaceutical Science Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran.
OBJECTIVE: Self-medication is common among patients with gastrointestinal (GI)

symptoms. This study was performed to evaluate self-medication among patients who
fulfilled irritable bowel syndrome (IBS) and dyspepsia diagnostic criteria and to
investigate the appropriateness of self-medication with chemical and herbal
drugs.
METHODS: A prospective, descriptive cross-sectional study was conducted in
outpatient's GI clinics at Shiraz from November 2011 to May 2012. A GI specialist
visited the patients and recruited those who had IBS (base on Rome III adapted
criteria) or functional dyspepsia. We surveyed self-medication among these
patients, using a questionnaire containing specific questions about
self-medication.
FINDINGS: One thousand four hundred and forty-seven patients visited by the GI
specialist during the study period. Seven hundred and forty-seven patients had
the inclusion criteria, 337 of them fulfilled criteria for IBS, with IBS-mixed
(52%) being the most prevalent subtype, and 410 patients had dyspepsia. Overall,
78.8% of the total participants had recently sought medical attention for their
GI complaint. Twenty-eight percent of patients selected inappropriate medication
for their GI complaints. The H2-blockers class were most common medicines
reportedly used. We did not find any significant relationship between age,
gender, level of education, marital status, and self-medication frequency.
CONCLUSION: Patients who fulfilled criteria for IBS had a high tendency to
self-treat their GI symptoms, use of acid-suppressive agents was common among
patients. Around one-third of patients self-treated GI symptoms inappropriately.
Consequently, the concept of self-medication among patients has to be revised. We
recommend conduction of educational programs to improve self-medications
selection and attitude among patients to reduce the burden on other health care
resources.
DOI: 10.4103/2279-042X.179576
PMCID: PMC4843581
PMID: 27162806
26. J Obstet Gynaecol India. 2017 Oct;67(5):382-383. doi: 10.1007/s13224-017-1005-

4.
Epub 2017 May 12.
Self-Medication for Abortion: Safety Issues.
Anjum D(1)(2)(3), Mehta S(1), Grover A(1), Mann A(1).
Author information:
(1)Deparment of Obstetrics and Gynecology, Babu Jagjivan Ram Memorial Hospital,
Delhi, India.
(2)Sanjibani-321, Sunderban, Phase 2, Iqra Colony, Mango, Jamshedpur, Jharkhand
832110 India.
(3)Babu Jagjivan Ram Memorial Hospital, Delhi, India.
Comment on
J Obstet Gynaecol India. 2017 Feb;67(1):37-41.
DOI: 10.1007/s13224-017-1005-4
PMCID: PMC5561750
PMID: 28867892
27. Pan Afr Med J. 2016 Aug 16;24:312. doi: 10.11604/pamj.2016.24.312.8146.

eCollection 2016.
Self-medication among health workers in a tertiary institution in South-West

Nigeria.
Babatunde OA(1), Fadare JO(2), Ojo OJ(1), Durowade KA(3), Atoyebi OA(4), Ajayi
PO(1), Olaniyan T(1).
Author information:
(1)Department of Community Medicine, Federal Medical Center, Ido-Ekiti, Nigeria.
(2)Department of Pharmacology, College of Medicine, Ekiti State University,
Ado-Ekiti, Nigeria.
(3)Department of Community Medicine, Unilorin Teaching Hospital, Ilorin, Nigeria.
(4)Department of Community Medicine, Federal Medical Center, P.M.B 201,
Ido-Ekiti, Nigeria.
INTRODUCTION: Inappropriate self-medication results in wastage of resources,

resistance to pathogen and generally entails serious health hazard. This study
was undertaken to determine the knowledge, practice and reasons for practice of
self-medication among health workers in a Nigerian tertiary institution.
METHODS: This was a cross-sectional descriptive study conducted among staff of
Federal Medical Center Ido-Ekiti, Nigeria. Simple random sampling technique was
used to select 305 respondents that were interviewed via a pretested
semi-structured questionnaire. Analysis was done using SPSS version 15 and while
chi-square test was used to test significance between variables, significant (p
value set<0.05).
RESULTS: Among the 305 respondents interviewed, the age range was 18-52yrs with
greater proportion being males (51.8%). Majority of respondents were aware of
self-medication (94.8%), but only 47.2% had good knowledge of it. Reasons for
practicing self-medication were financial problem (10.8%), mild sickness (10.8%),
lack of time (13.4%), knowledge of diagnosis (5.6%), convenience (2.3%) and
non-availability of doctors (3.0%). The drugs used by respondents without
prescription included analgesics (38.2%), antibiotics (19.0%) anti-malaria drugs
(13.3%), and others (29.4%). Conditions for which respondents self-medicated were
body pains (14.9%), catarrh (14.9%), headache (14.3%), sore throat (11.5%),
diarrhea (11.2%), fever (9.0%) and toothache (5.6%).
CONCLUSION: The study demonstrates that the prevalence of self-medication is
relatively high. There is need for health education on the implication and danger
of self-medication. There is also need for government to pass and enforce law to
restrict free access to drugs.
DOI: 10.11604/pamj.2016.24.312.8146
PMCID: PMC5267862
Conflict of interest statement: The authors declare no competing interest.
28. PeerJ. 2017 Sep 12;5:e3803. doi: 10.7717/peerj.3803. eCollection 2017.
Awareness about antibiotic resistance in a self-medication user group from

Eastern Romania: a pilot study.
Topor G(#)(1), Grosu IA(#)(1), Ghiciuc CM(1), Strat AL(1)(2), Lupuşoru CE(1).
Author information:
(1)Department of Pharmacology-Morphofunctional Sciences II, University of
Medicine and Pharmacy Grigore T. Popa, Iasi, Romania.
(2)Laboratory of Microbiology, Hospital of Infectious Diseases Saint Parascheva,
Iasi, Romania.
(#)Contributed equally
BACKGROUND: Awareness about antibiotic resistance depends on the attitudes and

information about antibiotic resistance of both patients and physicians. Persons
who practice self-medication are at high risk of also self-medicating with
antibiotics. The purpose of the present study was to evaluate the awareness about
antibiotic resistance by investigating the practice in a group of self-medication
users in a sample of adults in Romania and the variables associated with such
practice.
MATERIAL AND METHODS: A cross-sectional self-filled questionnaire based study was
conducted from December 2016 through January 2017 amongst 218 self-medication
users (SMUG). The attitudes, the level of knowledge, the perceptions, about
antibiotic use (ABU) and about antibiotic resistance (ABR) were compared to a
reference group represented by medical residents group in their specialty
training (MRG) considered to have a higher level of knowledge and awareness about
ABU and ABR.
RESULTS: The response rate was 87.2% in the SMUG group and 100% in the MRG group.
The SMUG group reported self-medication practices for antibiotics with a high
frequency at any time in life (72%), but with a very low frequency from the month
previous to the date of the study (12%), comparative with the MRG group (75% and
7%, respectively). The multivariate logistic regression analysis showed that
self-medication with antibiotics at any time in life in the SMUG group could be
predicted by the answers to two questions regarding the practices and knowledge
about ABU (Q13 and Q20). On the other hand, in the MRG group, a question about
ABR perception (Q23), could be predictor for self-medication with antibiotics.
Self-medication with antibiotics in the month previous to the date of the study
in the SMUG group could be predicted with three questions: one about ABU practice
(Q14), one about ABR perception (Q26) and one referring to ABR knowledge (Q28).
On the other hand, in the MRG group, a question about ABR knowledge (Q32) could
be predictor for self-medication with antibiotics. The reduced awareness about
ABR in the SMUG group, is revealed by the reduced number of subjects (38%), who
did not know that missing an antibiotic dose during a medical treatment
contributes to ABR, comparative with the MRG group (84%). Indirectly, low ABR
awareness in the SMUG group is revealed by the confusion about the appropriate
use of antibiotics in bacterial or viral infections (that antibiotics are not
used against viruses).
CONCLUSIONS: The findings from our study on the awareness about antibiotic
resistance in the SMUG group might help the policy makers and regulatory
authorities to develop educational programs directed to change the perceptions
and attitudes about the appropriate use of antibiotics in order to diminish
self-medication practices with antibiotics.
DOI: 10.7717/peerj.3803
PMCID: PMC5600173
PMID: 28924507
Conflict of interest statement: The authors declare there are no competing

interests.

eCollection 2017.
Predisposing factors to the practice of self-medication in Brazil: Results from

the National Survey on Access, Use and Promotion of Rational Use of Medicines
(PNAUM).
Pons EDS(1), Knauth DR(1), Vigo Á(1); PNAUM Research Group, Mengue SS(1).
Author information:
(1)Graduate Program in Epidemiology, Federal University of Rio Grande do Sul,
Porto Alegre, Rio Grande do Sul, Brazil.
OBJECTIVE: To understand the predisposing factors that lead to the practice of

self-medication and the factors associated with the use of medicines via
self-medication in the adult population of Brazil.
METHODS: The analyzed data are part of the National Survey on Access, Use and
Promotion of Rational Use of Medicines (PNAUM), a survey whose population
consisted of individual residents permanently domiciled in urban areas in Brazil.
In this work, the data references the 31 573 respondents aged 20 or higher (76.2%
of the final PNAUM sample). Poisson regression models with robust variance were
used for estimating the independent effect of each variable with medicine use via
self-medication.
RESULTS: Of the interviewees, 73.6% stated they had used some medication without
medical recommendation if they had previously used the same product; 73.8% stated
they had used non-prescribed medicine when the medicine was already present at
home; and 35.5% stated they had used some non-prescribed medication when they
knew someone who had already taken the same medication. The prevalence of
self-medication was 18.3%. The variables associated with the highest probability
of using medicine via self-medication were: geographic region within Brazil,
gender, age group, per capita income, self-assessment of health, self-reported
use of previously used non-prescribed medication, and self-reported use of
non-prescribed medication when that medication was already present at home.
CONCLUSIONS: The use of medicines via self-medication in Brazil is relatively
frequent and influenced by previous experience and familiarity with the
medications, and is more common among women and individuals with low
self-assessment of health.
PMCID: PMC5722370
30. PeerJ. 2017 Nov 1;5:e3990. doi: 10.7717/peerj.3990. eCollection 2017.
Self-medication practices and rational drug use habits among university students:
a cross-sectional study from Kahramanmaraş, Turkey.
Okyay RA(1), Erdoğan A(1).
Author information:
(1)Faculty of Medicine, Department of Public Health, Kahramanmaraş Sütçü İmam
University, Kahramanmaraş, Turkey.
Background: Self-medication refers to the use of medicines to treat

self-diagnosed diseases without consulting any healthcare professionals.
Irrational drug use and self-medication have serious negative consequences both
on health and economy. Therefore, the aim of this study is to assess the habits
related to rational use of drugs (RUD) and to estimate the prevalence of
self-medication practices among university students.
Methods: This cross-sectional study was conducted on university students in
Kahramanmaraş. From May 2017 to June 2017 a total of 960 students filled a
"Rational Use of Drugs Questionnaire".
Results: The prevalence of practicing self-medication in students was 63.4%. The
most common medicines that the students had consumed without prescription were
analgesics by 39.5%, antibiotics by 36.9% and cold remedies by 24.0%. The rate of
students who declared that they were familiar with RUD and "rational use of
antibiotics" (RUA) was 45.9%. Reading/checking the instructions in the prospectus
(OR = 1.529, 95% CI [1.176-1.990]), understanding the context of the prospectus
(OR = 1.893, 95% CI [1.387-2.584]), compliance with the duration of antibiotic
treatment (OR = 1.597, 95% CI [1.231-2.071]) and consulting a physician in case
of a side effect (OR = 1.350, 95% CI [1.037-1.757]) were significantly higher
among students who were familiar with RUD as compared to who were not.
Discussion: Since the awareness of RUD among university students was found to be
inadequate, it has critical importance to hold educational activities with the
cooperation of physicians, health organizations, universities, non-governmental
organizations and media to avoid negative consequences of irrational drug use and
self-medication.
DOI: 10.7717/peerj.3990
PMCID: PMC5671114
PMID: 29109916
Conflict of interest statement: The authors declare there are no competing

interests.
31. J Clin Diagn Res. 2016 May;10(5):OC08-13. doi: 10.7860/JCDR/2016/18294.7730.

Epub
2016 May 1.
Self-Medication with Antibiotics among People Dwelling in Rural Areas of Sindh.
Bilal M(1), Haseeb A(2), Khan MH(3), Arshad MH(3), Ladak AA(4), Niazi SK(4),
Musharraf MD(5), Manji AA(5).
Author information:
(1)Faculty, Department of Medicine, Dow Medical College. Dow University of Health
Sciences , Karachi, Pakistan .
(2)Faculty, Department of Medicine, Dow Medical College, Dow University of Health
Sciences , Karachi, Pakistan .
(3)Faculty, Department of Medicine, Medical College, Aga Khan University Hospital
, Karachi, Pakistan .
(4)Pre-Medical Student, Department of Biological Sciences, The Lyceum , Karachi,
Pakistan .
(5)Pre-Medical Student, Department of Biological Sciences, Karachi Grammar School
, Karachi, Pakistan .
INTRODUCTION: Self-medication with antibiotics is becoming increasingly common

due to multiple factors. The public who are using these antibiotics generally do
not have full information regarding their proper use, especially the dosages and
possible side-effects. Hence, unregulated use of such medicines may cause
dangerous adverse effects in the patients.
AIM: The study was aimed to evaluate the prevalence and practice of
self-medication with antibiotics among people dwelling in the rural areas of
province Sindh.
MATERIALS AND METHODS: A cross-sectional survey was performed at Outpatient
Department of Civil Hospital Karachi, from January to March 2015. Four hundred
rural dwellers who lived in the outskirts of Karachi city area of province Sindh
were recruited for the study in the aforementioned time period through
non-probability convenience sampling.
RESULTS: The investigation reported a prevalence of 81.25% among rural dwellers
of Sindh with regards to self-medication of antibiotics. The most common reason
behind self-medication were economic reasons (88.0%). Amoxicillin (52.0%) was
found to be the most self-prescribed antibiotic. Majority of the participants
(74.7%) didn't know about the phenomena of antibiotic resistance associated with
inadequate use of antibiotics and only 25 subjects identified correctly that the
situation would lead to increase resistance.
CONCLUSION: The self-medication rates with antibiotic are higher in rural areas
of Sindh. There is an urgent need for the government to enforce stricter laws on
pharmacies dispensing medications, especially antibiotics, without prescriptions.
Lastly, provision of cost effective treatment from public sector can
significantly reduce self-medication with antibiotics among rural dwellers of
Sindh.
DOI: 10.7860/JCDR/2016/18294.7730
PMCID: PMC4948439
PMID: 27437263
32. Pharmacy (Basel). 2017 Sep 4;5(3). pii: E51. doi: 10.3390/pharmacy5030051.
Prevalence of Self-Medication among Students of Pharmacy and Medicine Colleges of

a Public Sector University in Dammam City, Saudi Arabia.
Albusalih FA(1), Naqvi AA(2), Ahmad R(3), Ahmad N(4).
Author information:
(1)College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University
(University of Dammam), Dammam 31441, Saudi Arabia. ph.fatimahali582@gmail.com.
(2)Department of Pharmacy Practice, College of Clinical Pharmacy, Imam
Abdulrahman Bin Faisal University (University of Dammam), Dammam 31441, Saudi
Arabia. aaghulam@uod.edu.sa.
(3)Natural Products and Alternative Medicines, College of Clinical Pharmacy, Imam
Abdulrahman Bin Faisal University (University of Dammam), Dammam 31441, Saudi
Arabia. rizvistar_36@yahoo.com.
(4)Department of Pharmaceutics, College of Clinical Pharmacy, Imam Abdulrahman
Bin Faisal University (University of Dammam), Dammam 31441, Saudi Arabia.
niyazpharma@gmail.com.
Pharmacy and medical students are expected to be more knowledgeable regarding

rational use of medications as compared to the general public. A cross-sectional
study was conducted among students of pharmacy and medicine colleges of Imam
Abdulrahman Bin Faisal University in Dammam, Saudi Arabia using a survey
questionnaire. The duration of the study was six months. The aim was to report
self-medication prevalence of prescription and non-prescription drugs among
pharmacy and medical students. The prevalence of self-medication in the pharmacy
college was reported at 19.61%. Prevalence of self-medication at the medical
college was documented at 49.3%. The prevalence of multivitamin use was reported
at 30.53%, analgesics; 72.35%, antihistamines; 39.16%, and antibiotic use at
16.59%. The prevalence of anti-diarrheal medicines and antacids use among
students was found to be 8.63% and 6.64%, respectively. The variable of college
and study year was statistically associated with the nature of the medicines. The
most common justifications given by students indulging in self-medication were
'mild problems' and 'previous experience with medicines'. Our study reported that
prevalence of self-medication in the College of Clinical Pharmacy was low, i.e.,
19.61%. The figure has been reported for the first time. Students were mostly
observed self-medicating with OTC drugs, however, some reported using
corticosteroids and isotretenoin, which are quite dangerous if self-medicated.
Students have a positive outlook towards pharmacists as drug information experts.
DOI: 10.3390/pharmacy5030051
PMCID: PMC5622363
PMID: 28970463
33. Int J Environ Res Public Health. 2018 Jan 4;15(1). pii: E68. doi:
10.3390/ijerph15010068.
Self-Medication Practice and Associated Factors among Residents in Wuhan, China.
Lei X(1), Jiang H(2)(3), Liu C(4), Ferrier A(5), Mugavin J(6).
Author information:
(1)School of Management, Hubei University of Chinese Medicine, Wuhan 430065,
China. xslei@hbtcm.edu.cn.
(2)Centre for Alcohol Policy Research, School of Psychology and Public Health, La
Trobe University, Melbourne, VIC 3086, Australia. Jason.Jiang@latrobe.edu.au.
(3)Melbourne School of Population and Global Health, University of Melbourne,
Melbourne, VIC 3010, Australia. Jason.Jiang@latrobe.edu.au.
(4)Department of Public Health, School of Psychology and Public Health, La Trobe
University, Melbourne, VIC 3086, Australia. C.Liu@latrobe.edu.au.
(5)Department of Public Health, School of Psychology and Public Health, La Trobe
University, Melbourne, VIC 3086, Australia. adamm.ferrier@latrobe.edu.au.
(6)Centre for Alcohol Policy Research, School of Psychology and Public Health, La
Trobe University, Melbourne, VIC 3086, Australia. J.Mugavin@latrobe.edu.au.
BACKGROUND: This study aims to examine the prevalence and predictors associated
with self-medication, and related consequences in Wuhan, China.
METHODS: Two-hundred-sixty residents were interviewed from randomly selected four
districts of Wuhan, China. A modified version of Anderson's health behavioral
model was used in the survey to collect information of self-medication behavior.
Multivariable logistic regression analyses were used to measure correlates of the
prevalence of self-medication.
RESULTS: Nearly half of the respondents would select self-medication, and 39.1%
would see a doctor if they felt sick. The most common self-medicated illnesses
were cold and cough, cardiovascular disease and gastrointestinal disease. The
main reasons for self-medication were that the illness was not severe (enough) to
see the doctor (45%); the patient did not think that the trouble of seeing a
doctor was worth the effort (23%); the patient had no time to see the doctor
(12%), and the patient did not want to pay high medical costs (15%). Logistic
regression results suggested that respondents tended to select self-medication if
the illness was minor or short-term (less than seven days).
CONCLUSIONS: Our findings suggest that more strict regulation on over-the-counter
medicines may be required to reduce health risks related to self-medication.
Targeted health education on the risks of self-medication should be considered.
DOI: 10.3390/ijerph15010068
PMCID: PMC5800167
Conflict of interest statement: The authors declare no conflicts of interest.
34. Sci Rep. 2017 Nov 30;7(1):16653. doi: 10.1038/s41598-017-16621-w.
Self-medication by orang-utans (Pongo pygmaeus) using bioactive properties of

Dracaena cantleyi.
Morrogh-Bernard HC(1)(2), Foitová I(3), Yeen Z(4), Wilkin P(5), de Martin R(6),
Rárová L(7), Doležal K(7), Nurcahyo W(8), Olšanský M(9).
Author information:
(1)The Orang-utan Tropical Peatland Project (OuTrop), Palangkaraya, Central
Kalimantan, Indonesia.
(2)Centre for Ecology & Conservation, College of Life and Environmental Sciences
University of Exeter, Penryn Campus, Penryn, Cornwall, TR10 9FE, United Kingdom.
(3)Department of Botany and Zoology, Masaryk University, Kotlářská 2, 611 37,
Brno, Czech Republic. foitova@sci.muni.cz.
(4)The Centre for International Cooperation in Sustainable Management of Tropical
Peatlands (CIMTROP), University of Palangka Raya, Central Kalimantan, Indonesia.
(5)Royal Botanic Gardens, Kew, Richmond, Surrey, UK.
(6)Department of Vascular Biology and Thrombosis Research, Medical University of
Vienna, A-1090, Vienna, Austria.
(7)Department of Chemical Biology and Genetics & Laboratory of Growth Regulators,
Centre of the Region Haná for Biotechnological and Agricultural Research, Faculty
of Science, Palacký University and Institute of Experimental Botany, Academy of
Sciences of Czech Republic, 78371, Olomouc-Holice, Czech Republic.
(8)Department of Parasitology, Faculty of Veterinary Medicine, Gadjah Mada
University, Yogyakarta, Indonesia.
(9)Foundation UMI-Saving of Pongidae, Brno, Czech Republic.
Animals self-medicate using a variety of plant and arthropod secondary

metabolites by either ingesting them or anointing them to their fur or skin
apparently to repel ectoparasites and treat skin diseases. In this respect, much
attention has been focused on primates. Direct evidence for self-medication among
the great apes has been limited to Africa. Here we document self-medication in
the only Asian great ape, orang-utans (Pongo pygmaeus), and for the first time,
to our knowledge, the external application of an anti-inflammatory agent in
animals. The use of leaf extracts from Dracaena cantleyi by orang-utan has been
observed on several occasions; rubbing a foamy mixture of saliva and leaf onto
specific parts of the body. Interestingly, the local indigenous human population
also use a poultice of these leaves for the relief of body pains. We present
pharmacological analyses of the leaf extracts from this species, showing that
they inhibit TNFα-induced inflammatory cytokine production (E-selectin, ICAM-1,
VCAM-1 and IL-6). This validates the topical anti-inflammatory properties of this
plant and provides a possible function for its use by orang-utans. This is the
first evidence for the deliberate external application of substances with
demonstrated bioactive potential for self-medication in great apes.
DOI: 10.1038/s41598-017-16621-w
PMCID: PMC5709421
35. Rev Saude Publica. 2015;49:36.
Prevalence of self-medication in the adult population of Brazil: a systematic

review.
Domingues PH, Galvão TF, Andrade KR, Sá PT, Silva MT, Pereira MG.
OBJECTIVE: To evaluate the prevalence of self-medication in Brazil's adult

population.
METHODS: Systematic review of cross-sectional population-based studies. The
following databases were used: Medline, Embase, Scopus, ISI, CINAHL, Cochrane
Library, CRD, Lilacs, SciELO, the Banco de teses brasileiras (Brazilian theses
database) (Capes) and files from the Portal Domínio Público (Brazilian Public
Domain). In addition, the reference lists from relevant studies were examined to
identify potentially eligible articles. There were no applied restrictions in
terms of the publication date, language or publication status. Data related to
publication, population, methods and prevalence of self-medication were extracted
by three independent researchers. Methodological quality was assessed following
eight criteria related to sampling, measurement and presentation of results. The
prevalences were measured from participants who used at least one medication
during the recall period of the studies.
RESULTS: The literature screening identified 2,778 records, from which 12 were
included for analysis. Most studies were conducted in the Southeastern region of
Brazil, after 2000 and with a 15-day recall period. Only five studies achieved
high methodological quality, of which one study had a 7-day recall period, in
which the prevalence of self-medication was 22.9% (95%CI 14.6;33.9). The
prevalence of self-medication in three studies of high methodological quality
with a 15-day recall period was 35.0% (95%CI 29.0;40.0, I2 = 83.9%) in the adult
Brazilian population.
CONCLUSIONS: Despite differences in the methodologies of the included studies,
the results of this systematic review indicate that a significant proportion of
the adult Brazilian population self-medicates. It is suggested that future
research projects that assess self-medication in Brazil standardize their
methods.
DOI: 10.1590/s0034-8910.2015049005709
PMCID: PMC4544343
36. Indian J Pharmacol. 2016 Sep-Oct;48(5):515-521.
Drug-related problems associated with self-medication and medication guided by

prescription: A pharmacy-based survey.
Panda A(1), Pradhan S(1), Mohapatra G(2), Mohapatra J(3).
Author information:
(1)Department of Pharmacology, MKCG Medical College, Berhampur, Odisha, India.
(2)Department of Community Medicine, MKCG Medical College, Berhampur, India.
(3)Department of Pharmacology, S.C.B. Medical College, Cuttack, Odisha, India.
OBJECTIVES: The objective of this study is to identify and compare the nature of
the drug-related problems (DRPs) associated with self-medication and
non-self-medication (drug use guided by a prescription).
MATERIALS AND METHODS: The cross-sectional, observational study was conducted on
1100 adult participants at a convenience sample of six retail private pharmacy
counters. The data collection form was based on the Pharmaceutical Care Network
Europe version 6.2 classification for DRPs. Descriptive statistics was used to
represent the prevalence of DRPs. Chi-square test was used to find out the
association between the type of medication and DRPs. Odds ratio (OR) with
confidence interval (CI) was computed to find the factors determining the
occurrence of DRPs. P < 0.05 was considered to be statistically significant. Data
were analyzed using SPSS version 16.0.
RESULTS: The prevalence of self-medication was 18.72%. The prevalence of DRPs was
17.36%. In the self-medication group, the prevalence of DRPs was high (40.78%) as
compared to the non-self-medication group (11.97%). DRP related to inappropriate
drug dosing was observed in 44.83% and 40.45% subjects in self-medication and
non-self-medication group, respectively (P < 0.001). The subjects in the
self-medication group were about 5 times likely to have a DRP (OR: 5.06, CI:
3.59-7.14, P < 0.001).
CONCLUSIONS: Self-medication is associated with a higher risk of various DRPs.
Since retail pharmacy outlet is often the first point of contact between the
patient and the health care system in a developing country, interventions like
drug information activities at the retail pharmacy is likely to bring down the
DRPs associated with self-medication.
DOI: 10.4103/0253-7613.190728
PMCID: PMC5051244
37. BMC Res Notes. 2015 Dec 9;8:763. doi: 10.1186/s13104-015-1737-0.
Self-medication among medical and pharmacy students in Bangladesh.
Alam N(1), Saffoon N(2), Uddin R(3).
Author information:
(1)Department of Business Administration (Statistics), Stamford University
Bangladesh, Dhaka-1217, Bangladesh. nazninalam@gmail.com.
(2)Marketing Division, Renata Limited, Dhaka-1216, Bangladesh.
nsaffoon@gmail.com.
(3)Department of Pharmacy, Stamford University Bangladesh, Dhaka-1217,
Bangladesh. kp_ruddin@yahoo.com.
BACKGROUND: This cross-sectional survey examined the pattern of self-medication

and factors associated with this practice among medical and pharmacy students in
context to Bangladesh.
METHODS: The study used a self-administered questionnaire. A total of 500; 250
medical and 250 pharmacy, students participated in the study. As it is a
comparative analysis between the medical and pharmacy students, we used
independent t test and Chi square test.
RESULTS: The findings indicated that the impact of self-medication is almost
similar in medical and pharmacy students. It was found that medical students were
more careful about getting advice from a physician or seeking professional help
from some healthcare personnel. About the safety of self-medication pharmacy
students were more aware than medical students were. The study also showed that
female and younger medical or pharmacy students were more aware about
self-medication.
CONCLUSIONS: The current study presents a comprehensive picture of
self-medication in medical and pharmacy students in Bangladesh. It is clear from
the findings that practice of self-medication is highly prevalent in medical and
pharmacy students in the country. This may potentially increase misuse or
irrational use of medicines.
DOI: 10.1186/s13104-015-1737-0
PMCID: PMC4675016
A descriptive study of self-medication practices among Sri Lankan national level

athletes.
Fernando ADA(1), Bandara LMH(2), Bandara HMST(2), Pilapitiya S(3), de Silva A(2).
Author information:
(1)Department of Physiology, Faculty of Medicine, University of Colombo, No 25,
Kynsey Road, Colombo 8, Sri Lanka. dinithianush@gmail.com.
(2)Department of Physiology, Faculty of Medicine, University of Colombo, No 25,
Kynsey Road, Colombo 8, Sri Lanka.
(3)Sri Lanka Anti-doping Agency, Institute of Sports Medicine, Independence
Avenue, Colombo 7, Sri Lanka.
BACKGROUND: Intake of medicines and supplements is widespread among the

professional athletes in developed countries and there are reports to suggest
inappropriate self-administration of medicine. Data from South Asia on this area
is lacking. This study examined self-medication practices with regard to use of
allopathic and herbal/traditional medicines among national -level Sri Lankan
athletes.
RESULTS: 209 athletes from 15 national sport teams were assessed using an
anonymous, interviewer administered questionnaire. Self-medication practices
during the 3 months before data collection were evaluated. 60.8% athletes
practiced self-medication. 58.3 and 9.4% consumed western and herbal/traditional
medicines respectively, while a third used both. The most common symptom for
which self-medication was practiced was musculoskeletal pain (73.2%). Oral
non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics were used by 15.7
and 7.1% respectively. Musculoskeletal pain was the predominant symptom that
prompted the use of allopathic medicines, while the majority of athletes with
upper respiratory tract symptoms being the predominant symptoms, consumed
herbal/traditional medicines. Two different commercially available preparations
of herbal mixtures were consumed by 15.7 and 15%. Pain prophylaxis during or
prior to a sport event was reported by 20.1%, mainly with topical medicines.
Medicines were obtained by direct request from a pharmacy without an authorized
prescription by a majority (77.2%), followed by using an old prescription in
12.6%.
CONCLUSIONS: This study finds that self-medication with both allopathic and
herbal/traditional preparations among athletes in a Sri Lanka is high. The use of
oral NSAIDs without an authorized prescription in a significant number of
athletes is a potential health risk. Frequency of oral NSAID use is lower than
that is reported in non-Asian studies from developed countries. The use of
herbal/traditional medications increases the likelihood of inadvertent doping.
Enhancing awareness regarding risk of such practices among athletes, trainers,
pharmacists and prescribers is essential.
DOI: 10.1186/s13104-017-2579-8
PMCID: PMC5501524
39. J Pharm Bioallied Sci. 2016 Jul-Sep;8(3):217-22. doi: 10.4103/0975-7406.172662.

Self-medication practices among female students of higher educational
institutions in Selangor, Malaysia: A quantitative insight.
Jamshed SQ(1), Wong PS(2), Yi HC(2), Yun GS(2), Khan MU(2), Ahmad A(3).
Author information:
(1)Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic
University Malaysia, Kuantan Campus, Pahang 25200, Malaysia.
(2)Department of Pharmacy Practice, School of Pharmacy, International Medical
University, Cheras-56000, Kuala Lumpur, Malaysia.
(3)Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI
University, Cheras-56000, Kuala Lumpur, Malaysia.
BACKGROUND: World Health Organization has defined self-medication as the

selection and use of medications (including herbal and traditional product) by
individuals to treat self-recognized illnesses or symptoms. The prevalence of
self-medication is reported to be higher among female students.
OBJECTIVE: To investigate the awareness and self-medication practices among
female students of higher education institutions in Malaysia.
METHOD: A descriptive, cross-sectional study was conducted in four higher
education institutes of Selangor, Malaysia. Convenience sampling approach was
used to collect data from a sample 475 students. A "pretested" questionnaire was
used as a study instrument.
RESULTS: A total of 461 questionnaires were returned (response rate 97.05%). The
prevalence of self-medication among female students in higher educational
institutions was 57.2% (n = 262). The most common source of self-prescribed
medicine was a pharmacy or clinics (n = 206; 45%). It was found that antipyretics
were the most common medications used without doctor's consultation (n = 212;
89.1%). Analgesics and antipyretics (n = 79; 62.7%) were highly recommended by
students to their family and friends. The common reason for self-medication was
prior successful experience (n = 102, 81.0%). The majority of respondents (n =
280; 61.1%) reported that they believed over-the-counter medications were as
effective as medications prescribed by a doctor.
CONCLUSION: The prevalence of self-medication practice among female students in
the sample of the four higher education institutions was moderate. More studies
are required to generalize these findings across Malaysia.
DOI: 10.4103/0975-7406.172662
PMCID: PMC4929961
PMID: 27413350
40. Rev Bras Epidemiol. 2016 Jul-Sep;19(3):594-608. doi:

10.1590/1980-5497201600030010.
Use of prescription drugs and self-medication among men.
Prado MA(1)(2), Francisco PM(1), Bastos TF(1), Barros MB(1).
Author information:
(1)Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade
Estadual de Campinas - Campinas (SP), Brasil.
(2)Centro de Ciências da Vida, Faculdade de Ciências Farmacêuticas, Pontifícia
Universidade Católica - Campinas (SP), Brasil.
Objective:: To estimate the prevalence, investigate factors associated with the

use of medication according to prescription, identify the main pharmaceuticals
consumed through self-medication, and the reason for this use among adult men.
Methods:: This cross-sectional population-based study with stratified clustered
two-stage sampling was conducted in Campinas, São Paulo, Brazil, in 2008/2009.
Results:: Of the 1,063 men, 45.3% reported using at least 1 drug in the last 3
days. From them, 32.9% reported using exclusively prescribed medication, and
11.2% reported self-medication. The results revealed different profiles among
subgroups. Positive associations with the use of prescription medication was
found for age (40 - 59 and ≥ 60 years), failure to perform paid work, body mass
index (25 - 30 kg/m2), having sought health services over the last 15 days,
dental care in the last year, morbidity, and chronic diseases. Lower use of
prescription medication was found among men who reported doing physical
activities in their leisure time. Independent and positive associations with the
use of nonprescription medications in the 15 days prior to the survey were found
for reported morbidity and frequent headaches/migraine. Furthermore, there was an
independent and inverse association for hospitalization within the last year.
Over-the-counter medications consumed by men were dipyrone, paracetamol,
acetylsalicylic acid, and diclofenac.
Conclusion:: The findings of this study provide information that can guide
actions aimed at promoting the rational use of medication in a poorly
investigated population subgroup regarding this topic.
DOI: 10.1590/1980-5497201600030010
41. PLoS One. 2018 Mar 22;13(3):e0194240. doi: 10.1371/journal.pone.0194240.

eCollection 2018.
Pattern of medication selling and self-medication practices: A study from Punjab,

Pakistan.
Aziz MM(1)(2)(3)(4), Masood I(5), Yousaf M(6), Saleem H(7), Ye D(1)(2)(3)(4),

Fang Y(1)(2)(3)(4).
Author information:
Pharmacy, Xi'anJiaotong University, Xi'an, China.
(2)Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an,
China.
(3)The Global Health Institute, Xi'an Jiaotong University, Xi'an, China.
(4)Shaanxi Center for Health Reform and Development Research, Xi'an, China.
(5)Faculty of Pharmacy and Alternative Medicine, The Islamia University of
Bahawalpur, Bahawalpur, Punjab, Pakistan.
(6)Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan.
(7)Institute of Pharmaceutical Sciences, University of Veterinary & Animal
Sciences, Lahore, Pakistan.
BACKGROUND: Access to medicines without prescription is a major contributing

factor for self-medication practices. This study was designed to examine the
ratio of non-prescribed medicines sales and self-medication practices in Punjab,
Pakistan. This study also evaluates the reasons for self-medication within its
communities.
METHODS: An observational study was conducted in 272 systemically selected
pharmacies to analyze medicines-related sales, with or without prescription. A
cross-sectional survey was performed between June 2015 and November 2016.
Consumers were interviewed about their self-medication practices.
RESULTS: Of the pharmacies surveyed, 65.3% participated in the study. A total of
4348 medicines were purchased for self-medication by 3037 consumers (15.2% of all
study participants), of which 873 (28.7%) participated in an interview. Majority
(81.2%) medicine purchaser, (90.9%) interview participants, and (59.4%) drug
users were male. On average, each community pharmacy sold 7.9 medicines without
prescription each day, to an average of 5.5 customers. Many participants (28.9%)
had matriculation in their formal education. The medicines most often sold for
self-medication were analgesics and antipyretics(39.4%). More than 25% of
participants reported fever symptoms and 47.8% assumed their illness was too
trivial to consult a doctor. Media advertisements were the most common source of
information for participants (46.7%).
CONCLUSION: Many types of medicines were often sold without prescription from
community pharmacies. Self-medication was common practice for a wide range of
illnesses. Pakistan also needs effective implementation of policies to monitor
medication sales. Public education about rational medication and limits to
advertising medicine are very necessary.
PMCID: PMC5863987
42. Saudi Pharm J. 2018 Sep;26(6):886-890. doi: 10.1016/j.jsps.2018.03.008. Epub

2018
Mar 15.
Self-medication practice in pregnant women from central Mexico.
Alonso-Castro AJ(1), Ruiz-Padilla AJ(1), Ruiz-Noa Y(2), Alba-Betancourt C(1),

Domínguez F(3), Ibarra-Reynoso LDR(2), Maldonado-Miranda JJ(4), Carranza-Álvarez
C(4), Blanco-Sandate C(5), Ramírez-Morales MA(1), Zapata-Morales JR(1),
Deveze-Álvarez MA(1), Mendoza-Macías CL(1), Solorio-Alvarado CR(6),
Rangel-Velázquez JE(1).
Author information:
(1)Departamento de Farmacia, División de Ciencias Naturales y Exactas,
Universidad de Guanajuato, Guanajuato, Mexico.
(2)Departamento de Ciencias Médicas, División de Ciencias de la Salud,
Universidad de Guanajuato, León, Guanajuato, Mexico.
(3)Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro
Social, Metepec, Puebla, Mexico.
(4)Unidad Académica Multidisciplinaria de la Zona Huasteca, Universidad Autónoma
de San Luis Potosí, Ciudad Valles, San Luis Potosí, Mexico.
(5)Hospital General, Instituto de Seguridad y Servicios Sociales de los
Trabajadores del Estado, San Luis Potosí, Mexico.
(6)Departamento de Química, División de Ciencias Naturales y Exactas, Universidad
de Guanajuato, Guanajuato, Mexico.
Self-medication during pregnancy represents a serious threat for mother and child
health. The objective of this study was to evaluate the prevalence and the
factors associated with self-medication among Mexican women living in the central
region of Mexico. This is a descriptive interview-study of 1798 pregnant women or
women who were pregnant no more than 3 years ago, when the interview was carried
out. Data analysis was carried out with chi-square analysis and odds ratio. The
prevalence of self-medication (allopathic drugs, medicinal plants, and other
products, including vitamins, food supplements, among others) was 21.9%. The
factors associated (p < 0.05) with self-medication were: higher education
(college and postgraduate), smoking, and consumption of alcohol. Smoking was the
strongest factor (OR: 2.536; 1.46-4.42) associated to self-medication during
pregnancy, followed by consumption of alcohol (OR: 2.06; 1.38-3.08), and higher
education (OR: 1.607; 1.18-2.19). Medicinal plant consumption was associated with
nausea, constipation, migraine, and cold (p < 0.05), whereas he self-medication
of allopathy was associated with gastritis and migraine (p < 0.05).
Self-medication was influenced mainly by a relative or friend, who recommended
the use of herbal medicine/allopathic medication. Two of the most common
medicinal plants (arnica and ruda) here informed are reported to induce abortion
or toxicity during pregnancy. The findings showed that self-medication (medicinal
plants and allopathic medication) is a common practice among pregnant women from
central Mexico. Adequate counselling of pregnant women by healthcare
professionals about the potential risks of self-medication with herbal medicine
and allopathic drugs during pregnancy is strongly warranted.
DOI: 10.1016/j.jsps.2018.03.008
PMCID: PMC6128711
PMID: 30202232
43. J Pak Med Assoc. 2018 Sep;68(9):1363-1367.
Implications of self-medication among medical students-A dilemma.
Kanwal ZG(1), Fatima N(1), Azhar S(1), Chohan O(2), Jabeen M(3), Yameen MA(1).
Author information:
(1)Department of Pharmacy, COMSATS.
(2)Department of Mathematics, COMSATS.
(3)Faculty of Contemporary Institute of Information Technology, Abbottabad.
OBJECTIVE: To evaluate the knowledge, attitude and practice of self-medication in

medical undergraduate students.
METHODS: This cross-sectional questionnaire-based survey was conducted from
January to June, 2017, among undergraduate students of Ayub Teaching Hospital,
Women Medical College, International Medical College and Frontier Medical College
in Abbottabad, Pakistan. The sample comprised students of first, second, third,
fourth and fifth professional year. Data was collected using self-generated
questionnaire.
RESULTS: Of the 400 subjects approached, 300(75%) returned the questionnaire
fully completed. Of them, 208 (69.3%) were females and 92(30.66%) were males. The
most common age group was 22-25 years 182(60.7%). Self-medication was found to be
prevalent among 297(99%) subjects and 139(46.3%) respondents had practised
self-medication in the preceding 6 months more than two times. Over-the-counter
drugs were commonly used for the self-medication in 295(98.3%) cases. Overall,
285(95%) respondents had a positive attitude towards self-medication. Media was
found to be the most common source of information for 93(31%) cases.
CONCLUSIONS: High prevalence of self-medication was noticed, with
over-the-counter drugs being the most commonly used. Proper educational awareness
programmes about self-medication can control the issue.
PMID: 30317266
44. Arq Bras Cir Dig. 2014 Nov-Dec;27(4):294-7. doi: 10.1590/S0102-

67202014000400016.
Acute liver failure and self-medication.
de Oliveira AV(1), Rocha FT(1), Abreu SR(1).

Author information:
(1)Centro Universitário Cesmac, Maceió, AL, Brazil.
INTRODUCTION: Not responsible self-medication refers to drug use in high doses

without rational indication and often associated with alcohol abuse. It can lead
to liver damage and drug interactions, and may cause liver failure.
AIM: To warn about how the practice of self-medication can be responsible for
acute liver failure.
METHOD: Were used the Medline via PubMed, Cochrane Library, SciELO and Lilacs,
and additional information on institutional sites of interest crossing the
headings acute liver failure [tiab] AND acetaminophen [tiab]; self-medication
[tiab] AND acetaminophen [tiab]; acute liver failure [tiab] AND dietary
supplements [tiab]; self-medication [tiab] AND liver failure [tiab] and
self-medication [tiab] AND green tea [tiab]. In Lilacs and SciELO used the
descriptor self medication in Portuguese and Spanish. From total surveyed were
selected 27 articles and five sites specifically related to the purpose of this
review.
CONCLUSIONS: Legislation and supervision disabled and information inaccessible to
people, favors the emergence of cases of liver failure drug in many countries. In
the list of released drugs that deserve more attention and care, are some herbal
medicines used for the purpose of weight loss, and acetaminophen. It is
recommended that institutes of health intensify supervision and better orient
their populations on drug seemingly harmless, limiting the sale of products or
requiring a prescription for release them.
DOI: 10.1590/S0102-67202014000400016
PMCID: PMC4743226
45. J Pharm (Cairo). 2018 Jul 25;2018:2757108. doi: 10.1155/2018/2757108.

eCollection
2018.
Self-Medication Practices among Community of Harar City and Its Surroundings,

Eastern Ethiopia.
Mamo S(1), Ayele Y(2), Dechasa M(2).
Author information:
(1)Wollo Tertiary Care and Teaching Hospital, Wollo, Ethiopia.
(2)Department of Clinical Pharmacy, School of Pharmacy, College of Health and
Medical Sciences, Haramaya University, Harar, Ethiopia.
Purpose: Self-medication practice is often associated with irrational medication

use. The aim of this study was to assess self-medication practices among
community of Harar City and its surroundings, Eastern Ethiopia.
Methods: A cross-sectional study was conducted through exit interview in selected
drug outlets of Harar City among 370 clients from March to April, 2017. The data
was coded and entered into epi-data and processed and analyzed using SPSS version
20.
Results: Many participants practiced self-medication to alleviate their headache
(30.30%), to treat their respiratory disorders (29.50%), and to treat their
gastrointestinal disorders (27%). More than half (57.8%) of study participants
declared that they were practicing self-medication due to prior experience and
seeking less expensive service (20.50%). Two-fifths of them (40.3%) reported
pharmacy professionals as source of information while 18.9% of respondents were
advised by neighbors, friends, or relatives. About one-third (31.9%) of them did
not have any source of information for self-medication practice. The most common
type of drug used for self-medication by the participants was analgesic (42.2%).
Approximately one-third (31.1%) of the subjects were expecting to be counseled by
the pharmacy professionals about the drug side effects and to be helped in
selecting their self-medication drug (30.3%).
Conclusion: Varieties of medications were used among study participants ranging
from antipain to that of antibiotics for different complaints including headache,
respiratory complaints, and gastrointestinal problems. Experience with drugs and
diseases as well as affordability were frequently reported reasons for
self-medication practice. Participants had different views toward the role of
pharmacy professionals. Hence, it is very important to educate patients on
responsible use of medications and create awareness on the role of pharmacist in
self-selected medication use in community.
DOI: 10.1155/2018/2757108
PMCID: PMC6083478
PMID: 30147983
46. Public Health. 2016 Jan;130:78-83. doi: 10.1016/j.puhe.2015.04.005. Epub 2015

May
23.
Self-medication practices with antibiotics among Chinese university students.
Zhu X(1), Pan H(2), Yang Z(3), Cui B(4), Zhang D(5), Ba-Thein W(6).
Author information:
(1)Medical Simulation Center, School of Clinical Medicine, Jiangsu University,
Zhenjiang, Jiangsu, 212013, PR China. Electronic address: 372113325@qq.com.
(2)Shantou-Oxford Clinical Research Unit, Shantou University Medical College,
Shantou, Guangdong, 515041, PR China. Electronic address: michaelpan@stu.edu.cn.
Shantou, Guangdong, 515041, PR China. Electronic address: fsyz30147@163.com.
(4)Pediatric Department, The First Affiliated Hospital of Shantou University
Medical College, Shantou, Guangdong, 515041, PR China. Electronic address:
binglincui@stu.edu.cn.
(5)Research Center of Translational Medicine, The Second Affiliated Hospital of
Shantou University Medical College, Shantou, Guangdong, 515041, PR China.
Electronic address: danguizhang@stu.edu.cn.
Shantou, Guangdong, 515041, PR China; Department of Microbiology and Immunology,
Shantou University Medical College, Shantou, Guangdong, 515041, PR China.
Electronic address: wbathein@stu.edu.cn.
OBJECTIVES: Self-medication with antibiotics (SMA) is a serious global health

problem. We sought to investigate SMA behaviors and risk factors among Chinese
university students, and further explore the association between SMA practices
and adverse drug events (ADEs).
STUDY DESIGN: Cross-sectional study.
METHODS: An online survey was conducted at Jiangsu University (JSU) in eastern
China in July 2011 using a pretested questionnaire.
RESULTS: Out of 2608 website visitors, 1086 participated in the survey (response
rate: 41.6%), 426 respondents were excluded for not being a JSU student or repeat
participation, 660 (2.2% of JSU students) were included in analysis, and 316
students (47.9%) had a lifetime history of SMA. Among self-treated students,
43.5% believed that antibiotic was suitable for viral infections, 65.9% had more
than one SMA episode in the previous year, 73.5% self-medicated with at least two
different antibiotics, 57.1% and 64.4% changed antibiotic dosage and antibiotics
during the course, respectively. Female gender, older age, and prior knowledge of
antibiotics (PKA) were identified as independent risk factors of SMA. There was
no difference between students with and without PKA regarding SMA frequency, use
of polyantibiotics, and switching antibiotic dosage or antibiotics. ADEs happened
to 13.3% of self-medicated students. Frequent change of dosage and simultaneous
use of the same antibiotic with different names were independent risk practices
associated with an ADE.
CONCLUSIONS: Our findings substantiate high SMA prevalence among Chinese
university students. Older age and PKA are independent SMA risk factors common to
Chinese university students and female gender is exclusive SMA risk factor for
JSU students. Poor SMA practices are associated with ADEs. Strict regulations on
antibiotic sales and public education reinforced by further health care reform
are recommended.
Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
DOI: 10.1016/j.puhe.2015.04.005
47. Cureus. 2018 Apr 5;10(4):e2428. doi: 10.7759/cureus.2428.
Self-medication with Antibiotics in WHO Southeast Asian Region: A Systematic

Review.
Nepal G(1), Bhatta S(1).
Author information:
(1)Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine.
Antibiotics are essential treatments, especially in the developing world like

World Health Organization (WHO) Southeast Asian region where infectious diseases
are still the most common cause of death. In this part of the world, antibiotics
are purchased and used without the prescription of a physician. Self-medication
of antibiotics is associated with the risk of inappropriate drug use, which
predisposes patients to drug interactions, masking symptoms of an underlying
disease, and development of microbial resistance. Antibiotic resistance is
shrinking the range of effective antibiotics and is a global health problem. The
appearance of multidrug-resistant bacterial strains, which are highly resistant
to many antibiotic classes, has raised a major concern regarding antibiotic
resistance worldwide. Even after decades of economic growth and development in
countries that belong to the WHO Southeast Asian region, most of the countries in
this region still have a high burden of infectious diseases. The magnitude and
consequence of self-medication with antibiotics is unknown in this region. There
is a need for evidence from well-designed studies on community use of antibiotics
in these settings to help in planning and implementing specific strategies and
interventions to prevent their irrational use and consequently to reduce the
spread of antibiotic resistance. To quantify the frequency and effect of
self-medication with antibiotics, we did a systematic review of published work
from the Southeast Asian region.
DOI: 10.7759/cureus.2428
PMCID: PMC5988199
PMID: 29876150
Conflict of interest statement: The authors have declared that no competing

interests exist.
48. J Clin Diagn Res. 2016 May;10(5):IC01-IC04. doi: 10.7860/JCDR/2016/18018.7847.
Epub 2016 May 1.
The Prevalence and Affecting Factors on Self-Medication Among Students of

Kermanshah University of Medical Science in 2014.
Ahmadi SM(1), Jamshidi K(2), Sadeghi K(3), Abdi A(4), Vahid MP(5).
Author information:
(1)PhD Student of Clinical Psychology, Department of Psychiatry, Kermanshah
University of Medical Sciences , Kermanshah, Iran .
(2)Student of Public Health, The Student Research Committee, Kermanshah
University of Medical Sciences , Kermanshah, Iran .
(3)Assistance Professor of Psychology, Department of Psychiatry, Kermanshah
University of medical sciences , Kermanshah, Iran .
(4)PhD Student of Nursing, Nursing and Midwifery School, Shahid Beheshti
University of Medical Sciences , Tehran, Iran .
(5)Student, Department of Clinical Psychology, Kermanshah University of Medical
Sciences , Kermanshah, Iran .
INTRODUCTION: Self-medication is an increasingly growing health problem, which

has many adverse effects on human and the cost used in the production of
medications.
AIM: The current study was conducted to estimate the prevalence of
self-medication among student of Kermanshah University of Medical Sciences in
2014.
MATERIALS AND METHODS: In a descriptive-cross-sectional study, 364 students of
Kermanshah University of Medical Sciences were recruited through stratified
random sampling method. Data collection was done by researcher-made
questionnaire, entered to SPSS22 software and analysed by descriptive and
inferential statistics.
RESULTS: Of the 364 students, prevalence of self-medication was 123 (33.7%) the
mean age was 21.63±1.92, among them 64.2% took the medication from the pharmacy
and 34.95% have faced complications of self-medication. The main cause of
self-medication among students were the history of a disease of taking medication
(44.71%), deemed no importance of the disease (34.95%), and easy accessibility of
the medication (20.32%).
CONCLUSION: With regard to the high prevalence of self-medication among the
students, it is suggested to provide educational programs on the adverse effects
of self-medication, and appropriate measures to control and prevent easy access
to the medications.
DOI: 10.7860/JCDR/2016/18018.7847
PMCID: PMC4948418
PMID: 27437242
49. Iran J Public Health. 2015 Dec;44(12):1580-93.
Prevalence and Cause of Self-Medication in Iran: A Systematic Review and

Meta-Analysis Article.
Azami-Aghdash S(1), Mohseni M(2), Etemadi M(3), Royani S(4), Moosavi A(5),
Nakhaee M(6).
Author information:
(1)Road Traffic Injury Research Center, Tabriz University of Medical Sciences,
Tabriz, Iran.
(2)Health Management and Economics Research Center, Isfahan University of Medical
Sciences, Isfahan, Iran; School of Public Health, Tehran University of Medical
Sciences, Tehran, Iran.
(3)Health Management and Economics Research Center, Iran University of Medical
(4)School of Health Management and Information Sciences, Iran University of
Medical Sciences, Tehran, Iran.
(5)Dept. of Health and Community Medicine, Dezful University of Medical Sciences,
Dezful, Iran.
(6)Health Services Management Research Center, Institute for Futures Studies in
Health, Kerman University of Medical Sciences, Kerman, Iran.
BACKGROUND: Nowadays self-medication is one of the most common public health

issues in many countries, as well as in Iran. According to need to
epidemiological information about self-medication, the aim of this study was to
systematic review and meta-analysis of prevalence and cause of self-medication in
community setting of Iran.
METHODS: Required data were collected searching following key words: medication,
self-medication, over-the-counter, non-prescription, prevalence, epidemiology,
etiology, occurrence and Iran in Google Scholar, PubMed, Scopus, Magiran, SID and
IranMedex (from 2000 to 2015). To estimate the overall self-medication
prevalence, computer software CMA: 2 applied. In order to report the results,
forest plot was employed.
RESULTS: Out of 1256 articles, 25 articles entered to study. The overall
prevalence of self-medication based on the random effect model was estimated to
be 53% (95% CI, lowest= 42%, highest=67%). The prevalence of self-medication in
students was 67% (95% CI, lowest=55%, highest=81%), in the household 36% (95% CI,
lowest=17%, highest= 77%) and in the elderly people 68% (95% CI, lowest=54%,
highest=84%). The most important cause of self-medication was mild symptoms of
disease. The most important group of disease in which patients self-medicated was
respiratory diseases and the most important group of medication was analgesics.
CONCLUSION: The results show a relatively higher prevalence of self-medication
among the Iranian community setting as compared to other countries. Raising
public awareness, culture building and control of physicians and pharmacies'
performance can have beneficial effects in reduce of prevalence of
self-medication.
PMCID: PMC4724731
PMID: 26811809
50. Risk Manag Healthc Policy. 2018 Sep 12;11:169-176. doi: 10.2147/RMHP.S170181.
eCollection 2018.
Patterns of self-medication among medical and nonmedical University students in

Jordan.
Alshogran OY(1), Alzoubi KH(1), Khabour OF(2), Farah S(2).
Author information:
(1)Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of
Science and Technology, Irbid, Jordan, oyalshogran@just.edu.jo.
(2)Department of Medical Laboratory Sciences, Faculty of Applied Medical
Sciences, Jordan University of Science and Technology, Irbid, Jordan.
Comment in
Risk Manag Healthc Policy. 2019 Jan 15;12:1-3.
Background and objective: Self-medication practice involves consumption of

medicines by one's own initiative or on the consultation of others without the
guidance of a physician. Self-medication and use of over-the-counter drugs are
prevalent worldwide public health concerns. University students of medical and
nonmedical disciplines may have different levels of health education. This study
evaluated the prevalence and patterns of self-medication and the attitudes toward
this practice among medical and nonmedical university students in Jordan.
Methods: A descriptive cross-sectional study was conducted in 504 students
(medical: 248 and nonmedical: 256). The students were invited to complete a
questionnaire that included questions primarily related to patterns of physician
visits, self-medication practice, symptoms provoking self-medication, and sources
of advice.
Results: Self-medication was highly prevalent and comparable between medical and
nonmedical students (~96%). Headache (81.9%), cold (58.3%), and flu (53%) were
the frequent symptoms provoking self-medication among students. Self-medication
for headache (86.7% vs 77.3%) and tooth pain (53.1% vs 27%) was significantly
higher among medical vs nonmedical students, respectively. Self-treatment with
painkillers (82.3% vs 73%) or antiallergy (11.3% vs 5.9%) drugs was significantly
higher among medical students, while the use of anti-flu decongestants (47.6% vs
60.2%) was lower compared to nonmedical students, respectively. Nonmedical vs
medical students were significantly more dependent on friends (14.8% vs 7.7%) and
own experience (7.4% vs 2.4%) as a source of self-medication advice.
Conclusion: Self-medication is common among Jordanian university students of
medical and nonmedical disciplines. This practice, if used irrationally, may
constitute a health problem that needs awareness and interventions by health care
regulators in Jordan. Future studies are warranted to examine the impact of
self-medication on students' health.
DOI: 10.2147/RMHP.S170181
PMCID: PMC6143637
PMID: 30254501
Conflict of interest statement: Disclosure The authors report no conflicts of

51. Epidemiol Serv Saude. 2017 Apr-Jun;26(2):319-330. doi:

10.5123/S1679-49742017000200009.
Prevalence and associated factors of self-medication in adults living in the

Federal District, Brazil: a cross-sectional, population-based study.
Domingues PHF(1), Galvão TF(2), Andrade KRC(1), Araújo PC(3), Silva MT(4),
Pereira MG(1).
Author information:
(1)Universidade de Brasília, Faculdade de Medicina, Brasília-DF, Brasil.
(2)Universidade Estadual de Campinas, Faculdade de Ciências Farmacêuticas,
Campinas-SP, Brasil.
(3)Universidade Federal de Uberlândia, Faculdade de Odontologia, Uberlândia-MG,
Brasil.
(4)Universidade de Sorocaba, Programa de Pós-Graduação em Ciências Farmacêuticas,
Sorocaba-SP, Brasil.
OBJECTIVE: to assess the prevalence of self-medication and to investigate its

associated factors in adults living in the Federal District, Brazil.
METHODS: this is a cross-sectional population-based study conducted with adults
selected through probabilistic sampling; self-medication prevalence was obtained
from those who reported having used any medicine in the previous seven days;
Poisson regression model with robust variance was applied to adjust the
prevalence ratios.
RESULTS: 1,820 individuals were interviewed, of which 646 had taken at least one
medicine; self-medication prevalence was of 14.9% (95%CI: 12.6%;17.5%); the
adjusted analysis showed negative association in people aged 50 to 65 years
(PR=0.26; 95%CI: 0.15;0.47) and with chronic diseases (PR=0.38; 95%CI:
0.28;0.51); adults with difficulties in performing daily activities (PR=2.25;
95%CI: 1.43;3.53) practiced more self-medication.
CONCLUSION: self-medication was associated to young adults and those with
problems in performing daily activities.
DOI: 10.5123/S1679-49742017000200009
52. Pharm Pract (Granada). 2017 Jul-Sep;15(3):991. doi:

10.18549/PharmPract.2017.03.991. Epub 2017 Aug 16.
Assessment of health seeking behaviour and self-medication among general public

in the state of Penang, Malaysia.
Dawood OT(1), Hassali MA(2), Saleem F(3), Ibrahim IR(4), Abdulameer AH(5), Jasim
HH(6).
Author information:
(1)Department of Medical Services, Ministry of Science and Technology. Baghdad (
Iraq ). othd2000@yahoo.com.
(2)Discipline of Social and Administrative Pharmacy, School of Pharmaceutical
Sciences, Universiti Sains Malaysia. Penang ( Malaysia ). azmihassali@gmail.com.
(3)Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta (
Pakistan ). fahaduob@gmail.com.
Sciences, Universiti Sains Malaysia. Penang ( Malaysia ). phm.enas@yahoo.com.
(5)Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti
Sains Malaysia. Penang ( Malaysia ). ahmed2010y66@yahoo.com.
(6)Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti
Sains Malaysia. Penang ( Malaysia ). hananpharm83@yahoo.com.
BACKGROUND: Patients' behaviour in making decisions regarding health is currently

changing from passive recipients to recipients who play an active role in taking
action to control their health and taking self-care initiatives.
OBJECTIVES: This study was conducted to evaluate the health seeking behaviour
among general public and its associated factors; and to evaluate the medicine
taking behaviour in public and the practice of self-medication.
METHODS: A cross-sectional study was undertaken among general public in Penang
Island, Malaysia. A convenience sampling of 888 participants successfully
completed the survey. Self-administered questionnaires were distributed among the
residents in the north east of Penang Island.
RESULTS: This study showed that most of the participants chose to consult the
physician when they experience any health problems (66.7%), followed by
self-medication (20.9%). The first action for consulting the physician was
significantly predicted by Malay respondents and retired people (OR 3.05, 95% CI
1.04-8.89). The prevalence of self-medication was 54%. The practice of
self-medication was significantly associated with Chinese participants, educated
people, people with alone living status and people with more self-care
orientation.
CONCLUSION: Increasing the awareness of the public about the rational choice of
getting medical assistance is a very important issue to control their health. A
health education program is needed to increase the awareness about the use of
medicines among the general public and to enable them to make the right decisions
relating to health problems.
DOI: 10.18549/PharmPract.2017.03.991
PMCID: PMC5597809
PMID: 28943981
Conflict of interest statement: CONFLICT OF INTEREST The authors declare no

conflict of interests.
53. Trop Med Health. 2018 May 1;46:10. doi: 10.1186/s41182-018-0091-z. eCollection
2018.
Self-medication practice and associated factors among pregnant women in Addis

Ababa, Ethiopia.
Beyene KG(1), Beza SW(2).
Author information:
(1)Ethiopian Food, Medicine and Healthcare Administration and Control Authority,
Addis Ababa, Ethiopia.
(2)GAMBY College of Medical Sciences, Addis Ababa, Ethiopia.
Background: Self-medication which is the act of obtaining and using one or more
medicines without medical supervision is a common practice among pregnant women.
Unless proper caution is taken, it may result in maternal and fetal adverse
outcomes. In Ethiopia, information on self-medication practice during pregnancy
is scanty. Hence, this study aimed to assess self-medication practice and
associated factors among pregnant women in government health centers in Addis
Ababa.
Methods: An institution-based mixed study design using a sequential explanatory
approach was employed among 617 pregnant women and nine key informants in Addis
Ababa from May 8, 2017, to June 30, 2017. Multi-stage sampling technique was used
to select study participants, and purposive sampling technique was used to select
the key informants. The quantitative data were collected using a structured
interview questionnaire and analyzed using Statistical Product and Service
Solutions (SPSS) version 23.0 whereas semi-structured questionnaire was used for
in-depth interviews. Binary logistic regression was used for quantitative data
analysis, and thematic analysis method was used for qualitative data.
Results: The prevalence of self-medication practice was 26.6%. Previous
medication use (Adjusted odds ratio (AOR) = 4.20, 95% CI 2.70-6.53), gestational
period (AOR = 0.63, 95% CI 0.41-0.98), education on self-medication (AOR = 0.36,
95% CI 0.21-0.62), previous pregnancy and delivery related problems (AOR = 1.71,
95% CI 1.06-2.76), and knowledge about risk of self-medication (AOR = 0.64, 95%
CI 0.42-0.97) were significantly associated with self-medication practice. Lack
of attention and priority of program designers, absence of strategies and
guidelines; weak screening mechanisms, and regulatory enforcement were cited by
the key informants as contributing factors for self-medication practices.
Conclusions: Considerable proportion of pregnant women practiced self-medication,
including medicines categorized to have high risks. Gestational period, previous
medication use, education on self-medication, previous pregnancy- and
delivery-related problems, and knowledge were significantly associated with
self-medication practice. In addition, there are correctable gaps in program
designing, screening of pregnant women, regulatory enforcement, and strategies
and guidelines. Hence, necessary measures at all levels must be taken to reduce
risks of self-medication during pregnancy.
DOI: 10.1186/s41182-018-0091-z
PMCID: PMC5928590
PMID: 29743807
Conflict of interest statement: KG is Senior Advisor in Ethiopian Food, Medicine

and Healthcare Administration and Control Authority. KG has Bachelor Degree in
pharmacy, Masters of Business Administration specialization in Leadership and
Masters Degree in Public Health. SW is an assistant professor of public health at
GAMBY Medical College. SW has degree of Doctor of Medicine and International
Masters Degree in Public Health.The study was approved by GAMBY College of
Medical Sciences (GAMBY, IRERC, 2017) and Addis Ababa Health Bureau (Ref. No:
AAHB/6191/227) research ethics review committees. Supportive letter was obtained
from Addis Ababa Health Bureau. Furthermore, prior to data collection permission
was obtained from all sub-cities of Addis Ababa, all health centers and
organizations selected for this study. Written consent was taken from study
participants and the key informants after telling the objective of the study.
Participants were informed that participation is voluntary and they could
withdraw from the study at any time. The privacy of participants was fully
respected during data collection and personal identifiers were not used to ensure
anonymity. Finally, the collected data and audio records as well as transcripts
were kept in a safe place and were accessible only to the research team.The
consent for publication was obtained from each study participants during data
collection.The authors declared that they have no competing interests.Springer
Nature remains neutral with regard to jurisdictional claims in published maps and
institutional affiliations.
54. Electron Physician. 2016 Nov 25;8(11):3205-3213. doi: 10.19082/3205.

eCollection
2016 Nov.
Self-medication and its Effective Modifiable Factors among Elderly Referred

Health Care Centers in Shahr-e-Kord in 2015.
Motavali ZS(1), Abedi H(2), Davaridolatabadi E(3).
Author information:
(1)M.Sc. of Nursing, Faculty of Nursing and Midwifery, Isfahan (Khorasgan)
Branch, Islamic Azad University, Isfahan, Iran.
(2)Ph.D. of Nursing, Professor, Faculty member, Faculty of Nursing and Midwifery,
Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
(3)M.Sc. of Critical Care Nursing, Faculty member, Faculty of Nursing and
Midwifery, Young Researchers and Elite Club, Isfahan (Khorasgan) Branch, Islamic
Azad University, Isfahan, Iran.
INTRODUCTION: Drug overuse is a serious problem for health care, and one of the
biggest problems for the socio-economic well-being of different communities. The
elderly tend to use more drugs due to changes in their cognitive and
physiological factors. One of the best ways to evaluate the health level of
elderly people is to evaluate their self-medication. This study was conducted to
investigate self-medication among the elderly in Shahr-e-Kord.
METHODS: This cross-sectional study was conducted on 350 people older than 65 in
Shahr-e-Kord in 2015. Sampling was done in two stages. In the first stage, the
city of Shahr-e-Kord was divided into four areas using geographical maps.
Eighty-eight people were selected from each area. The research instrument was a
questionnaire called the Health Belief Model (HBM). The data were analyzed using
SPSS version 20, the chi-squared test, the independent-samples t-test, and the
Pearson correlation coefficient.
RESULTS: No significant relationship was observed between the prevalence of
self-medication with demographic variables and level of awareness. But there was
a significant difference between sensitivity, perceived severity, and perceived
barriers and educational level. There also was a significant difference between
the perceived benefits and their income level. There also was a significant
difference between the level of awareness, sensitivity, severity, benefits, and
barriers of people with and without a history of self-medication (p < 0.05).
CONCLUSION: Due to the adverse effects of self-medication and the high prevalence
of this activity among the elderly, it is recommended that a training program be
developed and implemented to change the knowledge and beliefs of the elderly
about self-medication.
DOI: 10.19082/3205
PMCID: PMC5217812
PMID: 28070253
Conflict of interest statement: There is no conflict of interest to be declared.
55. J Pak Med Assoc. 2016 Feb;66(2):235-7.
Practices of self-medication with antibiotics among nursing students of Institute

of Nursing, Dow University of Health Sciences, Karachi, Pakistan.
Ali AS(1), Ahmed J(1), Ali AS(1), Sonekhi GB(1), Fayyaz N(1), Zainulabdin Z(2),
Jindani R(3).
Author information:
(1)Nursing Student, Bachelor of Science in Nursing, Dow University of Health
Sciences, Ojha Campus, Karachi, Pakistan.
(2)Nursing Student, Bachelor of Science in Nursing, Indus College of Nursing,
Islamic Mission Hospital, Karachi, Pakistan.
(3)Nursing Student, Master of Science in Nursing, Institute of Nursing, Dow
University of Health Sciences, Ojha Campus, Karachi, Pakistan.
Self-medication practice among nursing students is of growing concern. Access to

drugs and handling them in their future practices make nursing students
susceptible to self-prescription and self-medication. This cross-sectional study
assesses the prevalence and pattern of self-medication with antibiotics among
nursing students of Institute of Nursing, Dow University of Health Sciences,
Karachi, Pakistan. A random sample of convenience of 160 nursing students
underwent a predesigned questionnaire. More than half of nursing students 79
(52.7%) experienced self-medication with antibiotics. It was more prevalent among
males 49 (62%) . Knowledge about the drug 59 (74.7%) and convenience 13 (16.5%)
were the key reasons to self-medicate. Fever 37 (46.8%) and sore throat 27
(34.2%) were the common symptoms predisposing to self-medication. Beta-lactam
group of antibiotics 35 (44.3%) was most frequent used. Only 26 (32.9%)
respondents completed the entire antibiotic course. Efforts must be directed
towards educating nursing students about responsible and informed self-medication
practices.
56. Open Dent J. 2018 Apr 30;12:347-353. doi: 10.2174/1874210601812010347.

eCollection 2018.
Self-medication Among Myofascial Pain Patients: A Preliminary Study.

Pastore GP(1)(2)(3), Goulart DR(3)(4), Pastore PR(5), Prati AJ(1), de Moraes
M(6).
Author information:
(1)Department of Oral and Maxillofacial Surgery, Paulista University - UNIP, São
Paulo, Brazil.
(2)Institute of Education and Research - IEP / Sírio Libanês Hospital, São Paulo,
Brazil.
(3)Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil.
(4)Department of Dentistry, UNIEURO University Center, Brasília, Brazil.
(5)Instituto de Ensino e Pesquisa - IEP / Hospital Sírio Libanês, São Paulo,
Brazil.
(6)Department of Oral Diagnosis, Oral and Maxillofacial Surgery Division, State
University of Campinas, Piracicaba Dental School, Piracicaba, Brazil.
Background: Self-medication has been reported as an option which people choose to

relieve the suffering of conditions that cause pain, however, this could delay
the correct diagnosis and therapy.
Objective: The aim of the present study was to determine the prevalence of
self-medication among patients with Temporomandibular Disorder (TMD), and to
analyze correlations with the severity of the disease.
Methods: A prospective study was conducted with patients who had been diagnosed
with TMD. The patients were submitted to anamnesis and a physical examination.
This research also used the Fonseca`s Anamnestic Index (FAI) and a questionnaire
that was developed specifically for this study, containing questions related to
the first health professional contacted and self-medication. The data were
analyzed using comparative and correlative analysis (Version 18.0 of SPSS
software), with the level of significance set at p<0.05.
Results: Thirty-four patients were included, with a prevalence of females (91.2%)
and a mean age of 39.76 years. Half of the patients claimed to have chosen their
own medications at time, especially analgesics. Sodium dipyrone was used by 12 of
the participants. Dentists were the most commonly contacted health professionals
(55.5%). No correlation was found between self-medication and the severity of TMD
according to the FAI. Furthermore, the time period between the onset of symptoms
and the first consultation was not affected by self-medication.
Conclusion: Self-medication seems to be highly prevalent among patients with TMD,
although this practice does not seem to alter the severity of the disease.
DOI: 10.2174/1874210601812010347
PMCID: PMC5958295
PMID: 29875887
57. Int J Community Based Nurs Midwifery. 2018 Oct;6(4):272-284.
Prevalence and Reasons of Self-Medication in Pregnant Women: A Systematic Review

and Meta-Analysis.
Mohseni M(1), Azami-Aghdash S(2), Gareh Sheyklo S(3), Moosavi A(4), Nakhaee M(1),
Pournaghi-Azar F(5), Rezapour A(6)(7).
Author information:
(1)Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
(2)Tabriz Health Services Management Research Center, Health Management and
Safety Promotion Research Institute, Tabriz University of Medical Sciences,
Tabriz, Iran.
(3)Department of Obstetrics and Gynecology, Dezful University of Medical
Sciences, Dezful, Iran.
(4)Department of Health and Community Medicine, Dezful University of Medical
Sciences, Dezful, Iran.
(5)Dental and Periodental Research Centre, Tabriz University of Medical Sciences,
Tabriz, Iran.
(7)Department of Health Economics, School of Health Management and Information
Sciences, Iran University of Medical Sciences, Tehran, Iran.
Background: Given the importance of having valid information about the prevalence
and reasons of self-medication among pregnant women for preventing
self-medication during this period, this study aimed to systematically review and
perform a meta-analysis on the prevalence and reasons of self-medication during
pregnancy.
Methods: This systematic review and meta-analysis was conducted in 2018 to
estimate the overall self-medication prevalence based on the database sources
PubMed, Scopus, Google Scholar, MagIran, IranMedex and SID. Required data were
collected using keywords: medication, self-medication, over-the-counter,
non-prescription, prevalence, etiology, and occurrence and pregnant. Descriptive
and cross-sectional studies in English and Persian languages were included. There
was no time limitation for search. R software was applied for meta-analysis.
Random-effects model was applied to estimate the self-medication prevalence with
95% confidence interval. Q statistics and I2 were used to measure the
heterogeneity.
Results: Out of 490 retrieved articles, finally 13 studies were included in
meta-analysis, 6 studies of which reported the cause of self-medication. The
overall estimated prevalence of self-medication based on the random effect model
was 32% (95% CI, 22% - 44%). The most important reasons of self-medication were
previous experience of the disease. The most important group of disease in which
patients self-medicated was anemia. Also, the most important group of medication
was herbal.
Conclusion: The results of this study showed that the prevalence of
self-medication among pregnant women was relatively high and required effective
interventions to reduce and prevent self-medication among this group. Providing
required information and raising awareness about complications resulting from
self-medication, in particular herbal medicines and dietary supplements, should
be taken into account.
PMCID: PMC6226611
PMID: 30465000
58. BMJ Case Rep. 2017 Aug 2;2017. pii: bcr-2017-219907. doi:
10.1136/bcr-2017-219907.
Self-medication complicating pseudo membranous conjunctivitis.
Singh P(1), Bhalerao S(1), Rani PK(1).
Author information:
(1)Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye
care, LV Prasad Eye Institute, Hyderabad, India.
We aim to highlight the prevalence of using local medications for curing eye
ailments in a rural population and the harmful consequence of resultant disease,
ranging from something as mild as conjunctivitis to sight-threatening conditions.
This case report will address one such incidence where in a local village, the
doctor known as a registered medical practitioner) in the rural community, uses
local remedies for his conjunctivitis and ends up in a condition where he cannot
see anything beyond perceiving light. The membrane removal and treatment with
topical antibiotic cured his infection, restoring complete recovery of vision.
This incidence inspired the local village doctor to become an eye health
educator. He was motivated to spread awareness about the ill effects of
self-medication on eye health. He is also determined to bring all blind people
and others who need eye care from his remote village to our centre.
© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article)
2017. All rights reserved. No commercial use is permitted unless otherwise
expressly granted.
DOI: 10.1136/bcr-2017-219907
PMCID: PMC5614090
Conflict of interest statement: Competing interests: None declared.
59. World J Psychiatry. 2015 Mar 22;5(1):35-46. doi: 10.5498/wjp.v5.i1.35.
Smoking in schizophrenic patients: A critique of the self-medication hypothesis.
Manzella F(1), Maloney SE(1), Taylor GT(1).
Author information:
(1)Francesca Manzella, George T Taylor, Behavioral Neuroscience Program,
Department of Psychological Sciences, University of Missouri-St. Louis, St.
Louis, MO 63121, United States.
A common remark among laypeople, and notably also among mental health workers, is
that individuals with mental illnesses use drugs as self-medication to allay
clinical symptoms and the side effects of drug treatments. Roots of the
self-medication concept in psychiatry date back at least to the 1980s.
Observations that rates of smokers in schizophrenic patients are multiple times
the rates for regular smoking in the general population, as well as those with
other disorders, proved particularly tempting for a self-medication explanation.
Additional evidence came from experiments with animal models exposed to nicotine
and the identification of neurobiological mechanisms suggesting self-medication
with smoking is a plausible idea. More recently, results from studies comparing
smoking and non-smoking schizophrenic patients have led to the questioning of the
self-medication hypothesis. Closer examination of the literature points to the
possibility that smoking is less beneficial on schizophrenic symptomology than
generally assumed while clearly increasing the risk of cancer and other
smoking-related diseases responsible for early mortality. It is a good time to
examine the evidence for the self-medication concept as it relates to smoking.
Our approach is to focus on data addressing direct or implied predictions of the
hypothesis in schizophrenic smokers.
DOI: 10.5498/wjp.v5.i1.35
PMCID: PMC4369547
PMID: 25815253
60. J Environ Public Health. 2018 Dec 20;2018:5439079. doi: 10.1155/2018/5439079.

eCollection 2018.
Assessment of Self-Medication Practices and Its Associated Factors among

Undergraduates of a Private University in Nigeria.
Esan DT(1), Fasoro AA(2), Odesanya OE(1), Esan TO(3), Ojo EF(1), Faeji CO(4).
Author information:
(1)Department of Nursing, College of Medicine and Health Sciences, Afe Babalola
University, Ado-Ekiti, Nigeria.
(2)Department of Public Health, College of Medicine and Health Sciences, Afe
Babalola University, Ado-Ekiti, Nigeria.
(3)Depatment of E.N.T., Federal Teaching Hospital, Ido-Ekiti, Nigeria.
(4)Department of Medical Microbiology and Parasitology, College of Medicine and
Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria.
Background: Self-medication is the use of drugs to treat self-diagnosed disorders

or symptoms or the intermittent or continued use of prescribed drug for chronic
or recurrent disease or symptoms, and it is mostly common in developing
countries. This study therefore assessed the practice of self-medication among
undergraduate students of a private university in Nigeria.
Methods: The study employed a descriptive cross-sectional design. A pretested
questionnaire was self-administered to 384 undergraduate students of the
university. Data were analysed and summarised using descriptive and inferential
statistics such as chi-squared and Fisher's exact tests.
Results: Overall, 297 (81.8%) undergraduate students practiced self-medication.
About 71% of the students had used analgesic, antibiotics (10.5%), and
antimalarial drugs (33%) without prescription within one month prior to the
survey. The most commonly used drug for self-medication was paracetamol (75.1%).
Furthermore, self-medication was found to be significantly associated with age
(p=0.021), gender (p < 0.001), college (p=0.025), and year of study (p=0.004).
Some of the reasons why undergraduate students practiced self-medication were
because of the unfriendly attitude of health care workers (27.7%), lack of time
to go to school clinic (26.7%), school clinic is too far from hostel (15.3%), and
drugs prescribed in the school clinic do not improve health condition (15.3%).
Conclusion: Majority of the students attributed the practice of self-medication
to unfriendly attitude of health care workers in the university clinic.
DOI: 10.1155/2018/5439079
PMCID: PMC6317103
61. Drug Alcohol Depend. 2018 May 1;186:10-15. doi:

10.1016/j.drugalcdep.2018.01.009.
Epub 2018 Mar 2.
Self-medication of mood and anxiety disorders with marijuana: Higher in states

with medical marijuana laws.
Sarvet AL(1), Wall MM(2), Keyes KM(3), Olfson M(1), Cerdá M(4), Hasin DS(5).
Author information:
(1)Department of Psychiatry, College of Physicians and Surgeons, Columbia
University, 722 W 168(th) St., New York, NY 10032, USA; New York State
Psychiatric Institute, 722 W 168th St., New York, NY 10032, USA.
Psychiatric Institute, 722 W 168th St., New York, NY 10032, USA; Department of
Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th
St., New York, NY 10032, USA.
University, 722 W 168(th) St., New York, NY 10032, USA; Department of
Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th
St., New York, NY 10032, USA.
(4)Department of Emergency Medicine, University of California, Davis, 2315
Stockton Blvd., Sacramento, CA 95817, USA.
Psychiatric Institute, 722 W 168th St., New York, NY 10032, USA; Department of
Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th
St., New York, NY 10032, USA. Electronic address: dsh2@cumc.columbia.edu.
BACKGROUND: Self-medication with drugs or alcohol is commonly reported among

adults with mood or anxiety disorders, and increases the risk of developing
substance use disorders. Medical marijuana laws (MML) may be associated with
greater acceptance of the therapeutic value of marijuana, leading individuals to
self-medicate.
METHODS: The study utilized data from Wave 2 of the National Epidemiologic Survey
on Alcohol and Related Conditions (2004-2005). Participants were sampled from
households in the general population and included adults with a mood or anxiety
disorder in the past 12 months (n = 7418), and the subset of those who used
marijuana and no other drug (n = 314). Weighted logistic regression models
predicted the prevalence of self-medication with drugs in U.S. states with and
without MML, adjusting for individual and state-level covariates. As a negative
control, analyses were repeated for self-medication with alcohol.
RESULTS: Overall, self-medication with drugs was 3.73 percentage points higher
(95% confidence interval [CI]: 0.93-6.53) among those living in MML states
(p = 0.01). For the subpopulation that only used marijuana, self-medication with
drugs was 21.22 percentage points higher (95% CI: 3.91-38.53) among those living
in MML states (p = 0.02). In contrast, self-medication with alcohol had nearly
identical prevalence in MML and non-MML states, overall and for drinkers.
CONCLUSIONS: Among adults with mood or anxiety disorders, living in a medical
marijuana law state is associated with self-medication with marijuana. While
additional research is needed to determine the reasons for this association,
clinical screening for self-medication with marijuana may be particularly
important in states with medical marijuana laws.
Copyright © 2018 Elsevier B.V. All rights reserved.
DOI: 10.1016/j.drugalcdep.2018.01.009
PMCID: PMC5911228
62. Int J Prev Med. 2015 Jul 20;6:66. doi: 10.4103/2008-7802.161264. eCollection
2015.
Associations between Self-medication, Health Literacy, and Self-perceived Health

Status: A Community-Based Study.
Kamran A(1), Sharifirad G(2), Shafaeei Y(3), Mohebi S(4).
Author information:
(1)Department of Public Health, Khalkhal Faculty of Medical Sciences, Ardabil
University of Medical Sciences, Ardabil, Iran.
(2)Department of Health Education and Promotion, School of Health, Qom University
of Medical Sciences, Qom, Iran.
(3)Department of Plastic Surgery, Faculty of Medicine, Iran University of Medical
(4)Department of Public Health, School of Health, Qom University of Medical
Sciences, Qom, Iran.
BACKGROUND: Although the frequency of self-medication has been well-documented in
the public health literature, but no study has examined the relationship between
health literacy and self-medication yet. This study was aimed to investigating
the relationship between health literacy and self-medication in a community-based
study.
METHODS: This cross-sectional study was conducted on 924 adults to survey
association between health literacy and self-medication among peoples in Ardabil
city in 2014 who were selected using a multi-stage random sampling method. Health
literacy was measured by the test of functional health literacy in adults and
general health status was measured by the 12-item General Health Questionnaire,
and self-reported self-medication (overall, sedative, antibiotic and herbal) in
last 3 months was assessed. All statistical analysis was performed using the SPSS
version 18 and a P < 0.05 was considered significant.
RESULTS: The mean age and weight of respondents were 37 years and 74.7 kg,
respectively. The prevalence of self-medication was 61.6%, and the percentage of
self-administering antibiotics, sedative, and herbal medicines were 40%, 54.4%,
and 59.1% in the last 3 months, respectively. Significant relationship was found
between of total health literacy and general health status with self-medication.
The prevalence of self-medication among participants with poor and very poor
self-rated physical and mental health was significantly higher than other
participants (P < 0.001).
CONCLUSIONS: Self-medication had a significant relationship with health literacy
and health status. Therefore, the design and implementation of training programs
are necessary to increase the perception on the risk of self-medication.
DOI: 10.4103/2008-7802.161264
PMCID: PMC4521301
PMID: 26288710
63. Saudi Med J. 2015 Mar;36(3):328-34. doi: 10.15537/smj.2015.3.10523.
Self-medication in Central Saudi Arabia. Community pharmacy consumers'

perspectives.
Aljadhey H(1), Assiri GA, Mahmoud MA, Al-Aqeel S, Murray M.
Author information:
(1)Department of Clinical Pharmacy, College of Pharmacy, King Saud University, PO
Box 2475, Riyadh 11451, Kingdom of Saudi Arabia. E-mail. haljadhey@ksu.edu.sa.
OBJECTIVES: To determine the prevalence of self-medication and assess the

knowledge, attitudes, and perception of consumers toward self-medication.
METHODS: This cross-sectional survey was conducted over 4 weeks in May 2011 in
Riyadh city, Kingdom of Saudi Arabia. Community pharmacies within 5 areas of the
city (North, South, West, East, and Middle) were randomly selected for the study.
All consumers were approached to participate in the study, with the exception of
those buying cosmetic and medicinal equipments. A validated self-administered
questionnaire was used to collect the data.
RESULTS: A total of 538 out of 707 consumers attending community pharmacies in
Riyadh city, agreed to participate in the study. Most responders were male (73%),
23-33 years old (35%), and college graduates (42%). A total of 285 medications
were bought without a prescription. Of these, 149 (49%) medications should be
dispensed by prescription only, and 155 (51%) were over the counter medications.
The most common prescription medications dispensed without prescriptions were
antibiotics (22%) and analgesics/antipyretics (19%). The most common reasons for
buying medications without a prescription were that the symptoms were too minor
to visit a doctor (54%), time saving (40%), and minor illnesses for which the
participants knew the required treatment (40%). Overall, most participants had
poor knowledge, and negative perceptions regarding self-medication. More than 68%
of participants did not know whether the medicine they bought is a
prescription-only or over the counter medication.
CONCLUSION: Irresponsible self-medication is common in Saudi Arabia. Future
studies should focus on improving the consumers' awareness of self-medication and
the proper use of medications.
DOI: 10.15537/smj.2015.3.10523
PMCID: PMC4381018
64. BMC Pharmacol Toxicol. 2018 Apr 10;19(1):15. doi: 10.1186/s40360-018-0205-6.
Self-medication practice and associated factors among adult household members in

Meket district, Northeast Ethiopia, 2017.
Kassie AD(1), Bifftu BB(2), Mekonnen HS(3).
Author information:
(1)Boru Meda District Hospital, South Wollo Zone, Amhara Region, Southeast,
Ethiopia.
(2)University of Gondar, College of Medicine and Health Science, School of
Nursing, Gondar, Ethiopia.
(3)University of Gondar, College of Medicine and Health Science, School of
Nursing, Gondar, Ethiopia. habtsew@ymail.com.
BACKGROUND: Self-medication practice (SMP) is the use of medication without the

prescription of health care professionals. The major problems associated with
self-medication practice have been drug resistance, drug side effects, wastage of
resources, and serious health hazards including death. Thus, the main purpose of
this study was to assess the prevalence of self-medication practice and its
associated factors among adult household members in Meket District, Northeast
Ethiopia.
METHODS: A community based cross-sectional study was conducted among 722 adult
household members in Meket District, from April 5 to May 5, 2017. The systematic
random sampling method was used to select study participants. A pre-tested,
structured questionnaire was used for data collection using an
interviewer-administered technique. Epi-info version and SPSS version 22 were
utilized for data entry and analysis, respectively. Univariate and multivariate
logistic regression was used to identify association factors.
RESULTS: The overall prevalence of self-medication was found to be 35.9%.
Unmarried status (AOR = 2.17, 95% CI = 1.18, 4.01), previous experience of
self-medication (AOR = 1.78, 95% CI = 1.22, 2.61), accessibility of pharmacies
(AOR = 3.71, 95% CI = 1.31, 10.51), peer/family pressure (AOR = 2.88, 95%
CI = 1.98, 4.18) and presence of medication at home (AOR = 1.80, 95% CI = 1.11,
2.92) were factors associated with self-medication practices.
CONCLUSION: More than one-third of the study participants practiced
self-medication. Thus, strengthening communities awareness on drug side effects
and integrated efforts of individuals, communities, health facilities, and
regulatory bodies are highly necessary.
DOI: 10.1186/s40360-018-0205-6
PMCID: PMC5894137
65. BMC Pharmacol Toxicol. 2018 Jul 3;19(1):36. doi: 10.1186/s40360-018-0231-4.

Prevalence of self-medication practice among health sciences students in
Kermanshah, Iran.
Abdi A(1), Faraji A(1), Dehghan F(1), Khatony A(2).
Author information:
(1)Department of Nursing, School of Nursing and Midwifery, Kermanshah University
of Medical Sciences, Kermanshah, Iran.
(2)Social Development and Health Promotion Research Center, Kermanshah University
of Medical Sciences, Kermanshah, Iran. Akhatony@gmail.com.
BACKGROUND: The possibility of self-medication is higher in health sciences

students than other students because of easy access to drug information resources
and relatively sufficient familiarity with various kinds of drugs. The current
study was aimed to determine the prevalence of self-medication and its related
factors among the health sciences students.
METHODS: A total of 250 health sciences students were included in this
cross-sectional study via random sampling. Data were collected by a
researcher-made self-medication questionnaire. The collected data were analyzed
by SPSS-20 software using descriptive and inferential statistics (chi-square
test).
RESULTS: The prevalence of self-medication was 89.6%. Prior experience about the
illness, non-seriousness of the illness and availability of drugs were the most
prevalent reasons for self-medication. The most commonly used medications
included common cold drugs, analgesics and antibiotics. The most frequently used
medications were cold pill, acetaminophen pill and amoxicillin capsule. Most
students obtained their pharmaceutical information from the pharmacist physician
and online sources. Self-medication did not show a significant difference in
terms of variables such as age, gender, marital status, insurance status and
residence.
CONCLUSION: Given the high prevalence of self-medication among the health
sciences students, training courses about the self-medication risks, more
supervision over prohibition of over-the-counter drugs and adequate facilities
for students' access to medical services are suggested to be provided.
DOI: 10.1186/s40360-018-0231-4
PMCID: PMC6029137
66. Einstein (Sao Paulo). 2018 Nov 29;16(4):eAO4372. doi:

10.31744/einstein_journal/2018AO4372.
Profile of drugs used for self-medication by elderly attended at a referral

center.
Oliveira SBV(1), Barroso SCC(1), Bicalho MAC(1)(2), Reis AMM(3).
Author information:
(1)Instituto Jenny de Andrade Faria de Atenção à Saúde do Idoso e da Mulher,
Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG,
Brazil.
(2)Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte,
MG, Brazil.
(3)Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte,
MG, Brazil.
OBJECTIVE: To determine the profile of medications used for self-medication by
the elderly.
METHODS: A cross-sectional study based on interviews with elderly seen at a
reference center for Elderly Health of a teaching hospital, from July 2014 to
July 2015. Clinical, demographic and pharmacotherapeutic data were collected.
RESULTS: A total of 170 elderly were interviewed, 85.9% female, and the median
age was 76 years. The frequency of self-medication was 80.5%. The most used
medications for self-medication were central acting muscle relaxants, analgesics
and antipyretics, non-steroidal anti-inflammatory and antirheumatic agents. Among
the elderly who practiced self-medication, 55.5% used drugs that were
inappropriate for the elderly, according to Beers criteria of 2015, and 56.9%
used medications that showed therapeutic duplicity with the prescribed drugs. We
identified 57 drugs used for self-medication, of which 30 (52.6%) were classified
as over-the-counter and 27 (47.4%) as prescription drugs. Approximately 68.6% of
elderly had at least one interaction involving drugs prescribed and those used
for self-medication.
CONCLUSION: The practice of self-medication was frequent in the elderly studied.
The widespread use of over-the-counter drugs and/or potentially inappropriate
medications for elderly increases the risk of drug interactions and adverse
events.
DOI: 10.31744/einstein_journal/2018AO4372
PMCID: PMC6276811
67. Pak J Med Sci. 2015 Jan-Feb;31(1):14-8. doi: 10.12669/pjms.311.6526.
Self-medication with analgesics among medical students and interns in King

Abdulaziz University, Jeddah, Saudi Arabia.
Ibrahim NK(1), Alamoudi BM(2), Baamer WO(3), Al-Raddadi RM(4).
Author information:
(1)Prof. Nahla Khamis Ibrahim, MBBS, MPH, DHPE, PhD.Family and Community Medicine
Department, King Abdulaziz University, Jeddah, Saudi Arabia. Epidemiology Dept.,
High Institute of Public Health,Alexandria University, Alexandria, Egypt.
(2)Dr. Banan Mohammad Alamoudi, MBBS. Family and Community Medicine Department,
King Abdulaziz University, Jeddah, Saudi Arabia.
(3)Dr. Wejdan Omar Baamer, MBBS. Intern, King Abdulaziz University, Jeddah, Saudi
Arabia.
(4)Dr. Rajaa Mohammad Al-Raddadi, MBBS, PhD. Consultant Community Medicine,
Ministry of Health, Jeddah, Saudi Arabia.
OBJECTIVES: To determine the prevalence and predictors of self-medication with

analgesics among senior medical students and interns in King Abdulaziz University
(KAU), Jeddah, Saudi Arabia.
METHODS: A cross-sectional study was conducted among 504 participants in 2013. A
multistage stratified random sampling was used. A confidential, anonymous &
self-administered questionnaire was used to collect personal & socio-demographic
data. Data about self-medication and self-medication with analgesics during the
preceding 6 months were also inquired. Both descriptive and analytical statistics
were done by SPSS version 18 & Epi-Info.
RESULTS: During the 6 months preceding the study, 75.2% and 55.4% of participants
used self -medication & analgesic self-medication, respectively. The first
predictor of utilization of analgesic self-medication was living with family
(aOR; 1.96, 95% CI: 1.22-3.14), followed by age >21 years & non- professional
jobs of fathers.
CONCLUSION: Alarming high rates of self medication and self-medication with
analgesics were observed among medical students and interns. Self-medication
needs improvement through educational, regulatory and managerial strategies.
DOI: 10.12669/pjms.311.6526
PMCID: PMC4386150
PMID: 25878607
68. BMC Pharmacol Toxicol. 2018 Sep 10;19(1):56. doi: 10.1186/s40360-018-0248-8.
Epidemiology of self-medication in Ethiopia: a systematic review and

meta-analysis of observational studies.
Sisay M(1), Mengistu G(2), Edessa D(3).
Author information:
(1)Department of Pharmacology and Toxicology, School of Pharmacy, College of
Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
mekonnensisay27@yahoo.com.
(2)Pharmacology Unit, Department of Pharmacy, College of Medicine and Health
Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia.
(3)Department of Pharmacy Practice, School of Pharmacy, College of Health and
Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
BACKGROUND: Self-medication is the use of drugs to treat self-diagnosed disorders

and/or symptoms, or the intermittent or continued use of a prescribed drug for
recurrent disease or symptoms. This phenomenon is alarmingly increasing over time
despite the occurrence of health-related hazards. This study is, therefore, aimed
to quantitatively estimate self-medication practice and possible reasons for it
in Ethiopia.
METHODS: Data were identified from major databases and indexing services
including EMBASE (Ovid), PubMed, MEDLINE (Ovid), and Google Scholar. Both
published and unpublished records addressing self medication practice in Ethiopia
without time limit were included for the study. Data were extracted with
structured format prepared in Microsoft Excel and exported to OpenMeta[analyst]
version 3.3 software for analyses. Pooled estimation of outcomes was performed
with DerSimonian-Laird random-effects model at 95% confidence level. Sensitivity
and subgroup analyses were also considered. Degree of heterogeneity of studies
was presented with I2 statistics. Publication bias was also performed with the
help of Comprehensive Meta-Analysis version-3 software and presented with funnel
plots of standard error supplemented by Begg's and Egger's tests. The study
protocol is registered on PROSPERO with reference number ID: CRD42018093790.
RESULTS: A total of 27 studies with 9586 participants were included for the
study. The pooled prevalence of self-medication in Ethiopia was found to be 44.0%
(95% confidence interval [CI]: 35.1, 52.8). Geographical-based subgroup analysis
revealed that the highest prevalence was observed at the capital of Ethiopia,
Addis Ababa, 62.8% (95% CI: 42.3, 83.2). Population based analysis indicated that
healthcare professionals and students were the main practitioners of
self-medication. Besides, the prevalence of self-medication practice in pregnant
women is approximately 22.9% (95% CI: 9.8, 36). The most common reasons to
practice self-medication were previous experience of clients and/or familiarity
of treatments, 31.3% (95% CI: 21.5, 41.1) and perceived mildness of the illness,
31.1% (95% CI: 26.0, 36.2). The pooled prevalence of analgesics, antimicrobial
agents and gastrointestinal drugs were 46.1% (95% CI: 36.2, 56.1), 28.2% (95% CI:
19.6, 36.8), and 14.9% (95% CI: 7.8, 21.9), respectively.
CONCLUSION: Self-medication practice becomes a common phenomenon in Ethiopia. The
use of prescription-only medications including antimicrobial agents without
medical consult has become alarmingly high. This practice will come with
potential health related hazards including emergence of antimicrobial resistance.
Therefore, there must be a multitude of strategies for reversing the current
worrying trends of self-medication.
DOI: 10.1186/s40360-018-0248-8
PMCID: PMC6131789
69. Pharmacy (Basel). 2018 Jan 15;6(1). pii: E6. doi: 10.3390/pharmacy6010006.
Assessing the Perceptions and Practice of Self-Medication among Bangladeshi

Undergraduate Pharmacy Students.
Seam MOR(1), Bhatta R(2), Saha BL(3), Das A(4), Hossain MM(5), Uddin SMN(6),
Karmakar P(7), Choudhuri MSK(8), Sattar MM(9).
Author information:
(1)Department of Pharmacy, Noakhali Science and Technology University, Sonapur,
Noakhali 3814, Bangladesh. omarrezaseam@gmail.com.
Noakhali 3814, Bangladesh. phar_rita@yahoo.com.
Noakhali 3814, Bangladesh. bijoylaxmi.saha@yahoo.com.
Noakhali 3814, Bangladesh. abhijitdas@nstu.edu.bd.
Noakhali 3814, Bangladesh. monirjupharmacy@gmail.com.
(6)Department of Pharmacy, University of Chittagong, Chittagong 4331, Bangladesh.
pharma.naim@yahoo.com.
Noakhali 3814, Bangladesh. pk@nstu.edu.bd.
(8)Department of Pharmacy, Jahangirnagar University, Savar, Dhaka 1342,
Bangladesh. mskchoudhuri@juniv.edu.
(9)Department of Pharmacy, Jahangirnagar University, Savar, Dhaka 1342,
Bangladesh. mafruhi1968@yahoo.com.
Objectives: To evaluate the perceptions and extent of practicing self-medication

among undergraduate pharmacy students. Methods: This cross-sectional,
questionnaire-based study was conducted over a six month period (January to June
2016) among undergraduate pharmacy students in five reputable public universities
of Bangladesh. It involved face-to-face interviews regarding self-medication of
250 respondents selected by simple random sampling. Results: Self-medication was
reported by 88.0% of students. Antipyretics (58.40%) were mostly preferred for
the treatment of fever and headaches. The major cause for self-medication was
minor illness (59.60%, p = 0.73) while previous prescriptions were the main
source of knowledge as well as the major factor (52.80%, p = 0.94) dominating the
self-medication practice. The results also demonstrated 88.80% of students had
previous knowledge on self-medication and 83.60% of students always checked the
information on the label; mainly the expiry date before use (85.60%). A
significant (p < 0.05) portion of the students (51% male and 43% female)
perceived it was an acceptable practice as they considered self-medication to be
a segment of self-care. Furthermore, students demonstrated differences in their
response level towards the adverse effect of drugs, the health hazard by a higher
dose of drug, a physician's help in case of side effects, taking medicine without
proper knowledge, and stopping selling medicine without prescription.
Conclusions: Self-medication was commonly used among pharmacy students primarily
for minor illnesses using over-the-counter medications. Although it is an
inevitable practice for them it should be considered an important public health
problem as this practice may increase the misuse or irrational use of medicines.
DOI: 10.3390/pharmacy6010006
PMCID: PMC5874545
PMID: 29342983
Conflict of interest statement: The author reports no conflict of interests in

this work.

eCollection 2014.
Self-medication practices and risk factors for self-medication among medical

students in Belgrade, Serbia.
Lukovic JA(1), Miletic V(2), Pekmezovic T(1), Trajkovic G(3), Ratkovic N(4),
Aleksic D(4), Grgurevic A(1).
Author information:
(1)Institute of Epidemiology, School of Medicine, University of Belgrade,
Belgrade, Serbia.
(2)Association for Mental Health Promotion, Belgrade, Serbia.
(3)Institute of Medical Statistics and Informatics, School of Medicine,
University of Belgrade, Belgrade, Serbia.
(4)Clinical Centre of Serbia, Belgrade, Serbia.
INTRODUCTION: Self-medication among future health care professionals can

represent a serious threat to professionalism in medicine and it has potential to
put at risk public trust into this profession. The aim of this research was to
investigate prevalence and risk factors for self-medication among population of
medical students, because it was previously shown that their attitudes towards
pharmacotherapy could affect the way they could prescribe medication in the
future.
MATERIAL AND METHODS: Research was performed as a cross-sectional study and it
included 1296 (84.1%) 1st, 3rd and 6th year students of School of Medicine,
University of Belgrade. Students filled out a demographic and self-medication
questionnaire created for the purpose of this research and the Physical Health
Questionnaire - 9 (PHQ-9). Questions about self-medication were related to the
period of the previous year.
RESULTS: Self-medication was reported by 79.9% students. The most frequently
self-prescribed medications were analgesics (55.4%). Independent risk factors for
self-medication were possession of home-pharmacies (OR = 5.3, CI 95% 3.89-7.23),
lower level of father's education (OR = 1.6, CI 95% 1.18-2.25), consumption of
alcoholic beverages (OR = 1.5, CI 95% 1.13-2.08), less than 1 hour spent in
physical activity per week (OR = 1.4, CI 95% 1.00-2.02), female gender (OR = 1.4,
CI 95% 1.02-1.89), older age (OR = 1.1, CI 95% 1.07-1.21) and higher PHQ-9 score
(OR = 1.09, CI 95% 1.05-1.12).
CONCLUSIONS: Self-medication is an important issue among population of medical
students. Prevalence of self-medication could be controlled through regulatory
authorities and further education.
PMCID: PMC4263675
71. Front Pharmacol. 2018 Sep 25;9:1063. doi: 10.3389/fphar.2018.01063. eCollection

2018.
Self-Medication and Contributing Factors Among Pregnant Women Attending Antenatal
Care at Public Hospitals of Harar Town, Ethiopia.
Jambo A(1), Mengistu G(2), Sisay M(3), Amare F(1), Edessa D(1).
Author information:
(1)Department of Clinical Pharmacy, School of Pharmacy, College of Health and
Medical Sciences, Haramaya University, Harar, Ethiopia.
(2)Department of Pharmacy, College of Medicine and Health Sciences, Wollo
University, Dessie, Ethiopia.
(3)Department of Pharmacology and Toxicology, School of Pharmacy, College of
Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
Background: Self-medication has been increasing in many developing and developed

countries. Its use during pregnancy presents a major challenge due to potential
undesirable effects on mother and the fetus. So the aim of this study was to
assess the prevalence of self-medication and contributing factors, among pregnant
women. Methodology: Institution based cross sectional study was conducted among
244 pregnant women attending antenatal care at Hiwot Fana Specialized University
Hospital and Jugal Hospital from February to March, 2017. A structured
questionnaire based interview was used to collect data from each study subject.
Then, data were categorized and analyzed using SPSS version 20 software. Logistic
regression analysis was used to determine the significance of the association
between the outcome and independent variables. P-value <0.05 was considered as a
statistically significant in multivariate analysis. Results: The prevalence of
self-medication during current pregnancy was 69.4%; out of which, 40.6% uses only
herbal medicines to self-medicate. Time saving (50.7%) and prior experience of
the drug (25.35%) were the main reasons for self-medication using conventional
medicines while fewer side effects (59.86%) and effectiveness (35.92%) were the
common reasons for self-medication using herbal medicines. Common cold and
headache were among the common indications for self-medication. Friends (28.17%)
and the pharmacist/druggist (23.94%) were the commonest source of information for
conventional medicines while family/friends (69.72%) and neighbors (26.76%) were
the common source of information for herbal medicines. Community drug retail
outlets and neighbors were the commonly used sources of conventional medicines;
while market place and self-preparation were the common sources of herbal
medicines. Previous history of self-medication was significantly associated (P <
0.05) with current self-medication with conventional drugs and being a farmer by
occupation and poor monthly income were significantly associated with herbal
medicine use during pregnancy (P < 0.05). Conclusion: The prevalence of
self-medication during pregnancy was very high in this study which showed a need
for public trainings for all women of reproductive age about the risks of
inappropriate self-medication.
DOI: 10.3389/fphar.2018.01063
PMCID: PMC6178140
PMID: 30337871
72. Depress Anxiety. 2018 Sep;35(9):851-860. doi: 10.1002/da.22771. Epub 2018 Jul
12.
Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative
review of the epidemiological literature.
Turner S(1), Mota N(2), Bolton J(3), Sareen J(3).
Author information:
(1)Department of Psychiatry and Community Health Sciences, University of
Manitoba, Winnipeg, Manitoba, Canada.
(2)Department of Clinical Health Psychology, University of Manitoba, Winnipeg,
Manitoba, Canada.
(3)Department of Psychiatry, Psychology and Community Health Sciences, Winnipeg,
Manitoba, Canada.
BACKGROUND: The comorbidity of mood and anxiety disorders (MD and AD) with
substance use disorders (SUD) is common. One explanation for this comorbidity is
the self-medication hypothesis, which posits that individuals with MD or AD use
substances to cope with the difficult symptoms associated with the disorder. Over
time, self-medication (SM) can develop into an independent SUD. This narrative
review will present the prevalence and correlates of SM with alcohol and/or drugs
for MD and AD and the relationship between SM and subsequent SUD using both
cross-sectional and longitudinal epidemiological data.
METHODS: Scopus and PsycINFO were searched from January 1997 to April 2018 to
identify original research articles that examined the prevalence and correlates
of SM and the temporal relationship between MD/AD and SUD in the general
population (n = 22).
RESULTS: The prevalence of SM with alcohol and/or drugs among those with MD or AD
ranged from 21.9% to 24.1%. Male sex, younger age, being separated, divorced or
widowed, and being Caucasian were characteristics associated with higher
proportions of respondents endorsing SM with alcohol/drugs for MD and AD.
Longitudinal data supports the temporal onset of primary MD/AD and secondary SUD
among those who self-report SM.
CONCLUSION: Providing and promoting alternate coping strategies for those with
MD/AD may reduce SM, the development of SUD, and the comorbidity of MD/AD with
SUD. The concurrent treatment of MD/AD and substance use is the current "gold
standard" model of care, and the results of this review support its use.
© 2018, The Authors. Depression and Anxiety published by Wiley Periodicals, Inc.
DOI: 10.1002/da.22771
PMCID: PMC6175215
73. BMC Pregnancy Childbirth. 2018 Jan 8;18(1):16. doi: 10.1186/s12884-017-1642-8.
Self-medication among pregnant women attending antenatal clinic at Makongoro

health centre in Mwanza, Tanzania: a challenge to health systems.
Marwa KJ(1), Njalika A(2), Ruganuza D(3), Katabalo D(2), Kamugisha E(4).
Author information:
(1)Department of Pharmacology, Catholic University of Health and Allied Sciences,
Mwanza, Tanzania. carol_maro@yahoo.com.
(2)School of Pharmacy, Catholic University of Health and Allied Sciences, Mwanza,
Tanzania.
(3)Department of Parasitology, Catholic University of Health and Allied Sciences,
Mwanza, Tanzania.
(4)Department of Biochemistry, Catholic University of Health and Allied Sciences,
Mwanza, Tanzania.
BACKGROUND: Self-medication is a universal challenge that requires attention

because of the potential threat not only to the pregnant women but also to unborn
child. Data on self-medication practice and predictors among pregnant women is
lacking in Tanzania. Information on the effects of this practice to the pregnant
woman and the foetus globally is also scanty.
METHODS: This was a cross sectional study which was conducted using face to face
interview with 372 pregnant women at Makongoro health centre. Semi-structured
questionnaires were used. Data were analysed using STATA 13 (Statistical
Corporation, College Station, Texas, US).
RESULTS: A total of 372 pregnant women participated in the study. The prevalence
of self-medication among pregnant women was 172 (46.24%). There was a significant
statistical association between self-medication and occupation (P value =0.01),
gestation age (P < 0.01) and education (P < 0.01). Age, marital status and
gravidity were not associated with self-medication (P = 0.809, P = 0.243 and
P = 0.922) respectively. When bivariate logistic regression was performed,
occupation and education were the only determining factors for self-medication.
Pregnant women who were unemployed, doing business and house wife were most
likely to practice self-medication than employed pregnant women (P = 0.03;
OR = 2.33; 95% CI, 1.06-5.31, P = 0.01; OR = 2.31; CI 1.21-4.41, P = <0.01,
OR = 2.73, 95% CI 0.52-2.43) respectively. Pregnant women with no formal
education, incomplete primary education, primary education and secondary
education were most likely to practice self-medication than pregnant women with
college or university education (P < 0.01, OR = 6.37 95% CI 2.37-19.03, P < 0.01,
OR = 6.58, 95% CI 2.36-18.25, P < 0.01, OR = 3.78, 95% CI 1.89-7.56, P < 0.01,
OR = 2.59 95% CI = 1.30-5.17). The leading illness/symptoms which led to
self-medication among pregnant women attending clinic were malaria 56 (32.56%,
morning sickness 44 (25.55%) and headache 33(19.19%). Drugs commonly used in
self-medication among pregnant women were ant malarial 42 (24.42%), antiemetics
59 (34.30%) and analgesics 33 (19.19%).
CONCLUSION: Prevalence of self-medication among pregnant women is high in
Tanzania. This is a threat to the safety of the developing foetus and the
pregnant woman. Therefore there is a need of interventions to minimize the
practice among pregnant women.
DOI: 10.1186/s12884-017-1642-8
PMCID: PMC5759229
74. Pharm Pract (Granada). 2016 Jan-Mar;14(1):648. doi:

10.18549/PharmPract.2016.01.648. Epub 2016 Mar 15.
Determinants of self-medication with NSAIDs in a Portuguese community pharmacy.
Nunes AP(1), Costa IM(2), Costa FA(3).
Author information:
(1)Center for Interdisciplinary Research Egas Moniz (CiiEM). Almada ( Portugal ).
ana.pd.nunes@gmail.com.
(2)Institute of Health Sciences Egas Moniz (ISCSEM). Center for Interdisciplinary
Research Egas Moniz (CiiEM). Almada ( Portugal ). imargaridac@gmail.com.
(3)Institute of Health Sciences Egas Moniz (ISCSEM). Center for Interdisciplinary
Research Egas Moniz (CiiEM). Almada ( Portugal ). Alvesdacosta.f@gmail.com.
BACKGROUND: Non-steroid anti-inflammatory drugs (NSAIDs) are a widely used

therapeutic group in the world, and particularly in the Portuguese population.
OBJECTIVE: To compare NSAID's use by prescription and self-medication acquisition
and to determine the pattern of indication of NSAIDs, their usage profile and
possible implications for patients' safety.
METHODS: A cross-sectional design was used where individuals presenting at a
community pharmacy requesting NSAIDs during the study period (one month) were
invited to answer a face-to-face interview where socio-demographic
characteristics, the indication pattern and previous experience of side effects
were assessed. A follow-up interview was performed one week later to assess the
incidence of adverse effects. The study was ethically approved.
RESULTS: A sample of 130 NSAIDs users was recruited, comprising mostly women
(n=87; 66.9%), actively employed (n=77; 59.2%) and presenting a mean age of 49.5
years old (SD=20.49). An equal proportion of individuals acquired NSAIDs by
self-medication and with medical prescription (n=65; 50%). Over 4/5 of patients
(n=57; 87.7%) acquiring NSAIDs without a prescription were self-medicated by
their own initiative, and only 10.8% (n=7) had been advised by the pharmacist.
The most commonly acquired active substances were ibuprofen and diclofenac.
Self-medicated users more frequently resorted to topical NSAIDs following short
term treatments. The major underlying condition motivating NSAIDs sought were
musculoskeletal disorders (45.0%), regardless of the regimen. An important
proportion of prevalent users of NSAIDs reported previous experience of adverse
effects (11.3%). One week after initiating NSAID therapy, a small proportion of
patients reported incidence of adverse effects.
CONCLUSION: Self-medication with NSAIDs is sought for numerous medical
conditions. Reported adverse effects (prevalent and incident) confirm the need
for a more rational use of NSAIDs and ongoing pharmacovigilance.
DOI: 10.18549/PharmPract.2016.01.648
PMCID: PMC4800012
PMID: 27011773
75. Ceylon Med J. 2017 Mar 31;62(1):70-72. doi: 10.4038/cmj.v62i1.8439.
Practice of self-medication with antibiotics in the Colombo district, Sri Lanka
Senadheera GP, Sri Ranganathan Sh, Gunawardane NS, Fernando GH, Fernandopulle BM.
DOI: 10.4038/cmj.v62i1.8439
PMID: 28390337
76. Int J Pediatr Adolesc Med. 2017 Mar;4(1):19-25. doi:

10.1016/j.ijpam.2016.05.001.
Epub 2016 Jul 13.
The self medication use among adolescents aged between 13-18 years old;
Prevalence and behavior, Riyadh - Kingdom of Saudi Arabia, from 2014-2015.
Albatti TH(1), Alawwad S(2), Aldueb R(2), Alhoqail R(2), Almutairi R(2).
Author information:
(1)Child and Adolescents Psychiatry Department, King Khalid University Hospital,
Saudi Arabia.
(2)College of Medicine, King Saud University, Saudi Arabia.
Background and objectives: In Saudi Arabia, people have easy access to medication
and can purchase prescribed medications, such as anti-acne medications and
antibiotics, over the counter without the need for a prescription from a
physician.Our research is focused on estimating the prevalence of self-medication
and understanding the reason for self-medication because previous studies have
shown an increase in the practice of self-medication globally and locally.The aim
of this study is to estimate the prevalence of self-medication among adolescents
aged 13-18 years of both genders in Riyadh, Saudi Arabia. In addition, we aim to
identify the indications and external and internal factors behind
self-medication, including the effects of gender, peer influence and parental
supervision on the decision of adolescents to self-medicate.
Patients and Methods: An observational and cross-sectional adolescent-based study
was performed to estimate the degree of self-medication among 400 intermediate
and high school students in private and governmental schools living in Riyadh
between 2014 and 2015 using a multistage random sampling technique. A validated
self-administered questionnaire was used for data collection, and data were
tabulated and analyzed with the SPSS version 21 computer program.
Results: We found that the rate of self-medication among adolescents was high
(94.5%). Analgesics were the most common medication used (87.3%), and the least
common medication used was hormones (5%). A majority of the students reported
that headache was the reason for using analgesics. The sources of the medications
included the pharmacy (51.64%), followed by parents (34.33%). The results showed
that self-medication was significantly associated with the type of school that
the adolescents attended (P < 0.011) and the health status of the adolescents (P
-value <0.035).
Conclusion: Self-medication is highly prevalent in Riyadh, particularly among
adolescents. Easy access to pharmacies was found to be the leading cause for
self-medication. The use of these drugs was associated with inappropriate drug
use and the deterioration of health status. Self-medication should be closely
monitored and awareness should be increased with educational programs among
students.
DOI: 10.1016/j.ijpam.2016.05.001
PMCID: PMC6372571
PMID: 30805495
77. Pharmacy (Basel). 2018 Feb 1;6(1). pii: E15. doi: 10.3390/pharmacy6010015.
Patterns of Self-Medication Behavior for Oral Health Problems Among Adults Living
in Riyadh, Saudi Arabia.
Aldeeri A(1), Alzaid H(2), Alshunaiber R(3), Meaigel S(4), Shaheen NA(5)(6),
Adlan A(7)(8).
Author information:
(1)College of Dentistry, Riyadh Elm University, Riyadh 12734, Saudi Arabia.
ArwaAldeeri@gmail.com.
(2)College of Dentistry, Riyadh Elm University, Riyadh 12734, Saudi Arabia.
HayaAlzaid@gmail.com.
(3)College of Dentistry, King Saud Bin-Abdulaziz University for Health Sciences,
Riyadh 14811, Saudi Arabia. RenadAbdullaziz@gmail.com.
(4)College of Dentistry, King Saud Bin-Abdulaziz University for Health Sciences,
Riyadh 14811, Saudi Arabia. ShahadMeaigel@gmail.com.
(5)Department of Biostatistics and Bioinformatics, King Abdullah International
Medical Research Center, Riyadh 14611, Saudi Arabia. AshrafNa@ngha.med.sa.
(6)King Saud Bin-Abdulaziz University for Health Sciences, Riyadh 14811, Saudi
Arabia. AshrafNa@ngha.med.sa.
(7)King Saud Bin-Abdulaziz University for Health Sciences, Riyadh 14811, Saudi
Arabia. AdlanA@ngha.med.sa.
(8)Department of Biomedical Ethics, King Abdullah International Medical Research
Center, Riyadh 14611, Saudi Arabia. AdlanA@ngha.med.sa.
Self-medication is a widespread behavior worldwide. It is defined as the practice

of self-diagnosis and drug prescription without proper professional consultation.
Aim: To determine the prevalence and predictors of self-medication for oral
health problems among adults living in Riyadh city. Methods: A cross-sectional
study based on a structured close-ended questionnaire was distributed among
adults visiting shopping malls in all different five regions of Riyadh. A
two-stage sampling technique was used: cluster and simple random sampling. The
questionnaire was composed of two main sections: demographic characteristics and
questions assessing the behavior of self-medication. Results: The prevalence of
self-medication was found to be 63.25%, with a higher prevalence among females
than males. Gender and nationality were significantly associated with
self-medication. Salt in hot water locally (52.57%) and acetaminophen (47.43%), a
type of an analgesic, were, systemically, the most frequently used. Pharmacy
shops were the main source of these medicaments (66.01%). Similarly, the advice
for using them was mainly given by pharmacists (53.36%). Lack of time was claimed
to be the main reason for practicing self-medication (54.55%) with abscess,
toothache, and gingival bleeding being the main predictors. Conclusions:
Self-medication was found to be a common practice among the population of Riyadh
city.
DOI: 10.3390/pharmacy6010015
PMCID: PMC5874554
PMID: 29389869
Conflict of interest statement: The authors declare no conflict of interests.
78. J Nat Sci Biol Med. 2016 Jul-Dec;7(2):143-8. doi: 10.4103/0976-9668.184700.
Self-medication practice and factors influencing it among medical and paramedical

students in India: A two-period comparative cross-sectional study.
Kumar R(1), Goyal A(1), Padhy BM(2), Gupta YK(1).
Author information:
(1)Department of Pharmacology, All India Institute of Medical Sciences, New
Delhi, India.
(2)Department of Pharmacology, All India Institute of Medical Sciences,
Bhubaneswar, Odisha, India.
AIM: Self-medication is widely practiced with varying dimensions in India. This

practice has many implications, especially among medical and paramedical students
having some knowledge and good exposure to drugs. We conducted a two-period
observational study to evaluate the change in knowledge and practice of
self-medication, over 5 years of time period, among medical and paramedical
students from different parts of India.
MATERIALS AND METHODS: A structured questionnaire was administered to medical
(MBBS), dental (BDS), and paramedical students, who come to attend pan India
annual cultural, literary, and sports event at New Delhi. The study was conducted
in two phases (2007 and 2012) in different respondents of same categories
(medical and paramedical) of students. Three-hundred and thirty students from 39
colleges in 2007 and 356 students from 38 colleges in 2012 participated in the
study.
RESULTS: The prevalence of self-medication remained high in both 2007 and 2012
(74.6% and 69.4%), although no significant difference was observed between the
two phases (P = 0.14%). Oral antibacterial agents, oral anti-inflammatory agents,
and antipyretics were the most common group of drugs used in both phases of
study. A significant increase was observed in number of students who took
complete course of oral antibiotics (28.3-38.3%, P = 0.01).
CONCLUSION: The prevalence of self-medication among undergraduate students
remains unaltered over the span of 5 years. Nevertheless, there was a better
sensitization toward appropriate antibiotic usage and the practice of responsible
self-medication needs to be promoted among future healthcare providers.
DOI: 10.4103/0976-9668.184700
PMCID: PMC4934103
PMID: 27433064
79. PLoS One. 2017 Aug 22;12(8):e0183461. doi: 10.1371/journal.pone.0183461.
eCollection 2017.
Use of traditional eye medicine and self-medication in rural India: A

population-based study.
Gupta N(1), Vashist P(1), Tandon R(1), Gupta SK(2), Kalaivani M(3), Dwivedi
SN(3).
Author information:
(1)Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of
Medical Sciences, New Delhi, India.
(2)Centre for Community Medicine, All India Institute of Medical Sciences, New
Delhi, India.
(3)Department of Biostatistics, All India Institute of Medical Sciences, New
Delhi, India.
OBJECTIVE: To determine the type and nature of traditional eye medicine (TEM),
their sources and use and practices related to self-medication for ophthalmic
diseases in a rural Indian population.
METHODS: A population-based, cross-sectional study was conducted in 25 randomly
selected clusters of Rural Gurgaon, Haryana, India as part of CORE (Cornea
Opacity Rural Epidemiological) study. In addition to comprehensive ophthalmic
examination, health-seeking behavior and use of self-medication and TEM was
assessed in the adult population using a semi-structured questionnaire. Physical
verification of available ophthalmic medications in the enumerated households was
conducted by the study team. Descriptive statistics were computed along with
multivariable logistic regression analysis to determine associated factors for
use of self-medication and TEM.
RESULTS: Of the 2160 participants interviewed, 396 (18.2%) reported using
ophthalmic medications without consulting an ophthalmologist, mainly for symptoms
like watering (37.1%), redness (27.7%), itching (19.2%) and infection (13.6%). On
physical verification of available eye drops that were being used without
prescription, 26.4% participants were practicing self-medication. Steroid,
expired/unlabeled and indigenous eye drops were being used by 151(26.5%),
120(21.1%) and 75 (13.2%) participants respectively. Additionally, 25.7% (529)
participants resorted to home remedies like 'kajal'(61.4%), honey (31.4%), ghee
(11.7%) and rose water (9.1%).
CONCLUSION: Use of TEM is prevalent in this population. The rampant use of
steroid eye drops without prescription along with use of expired or unlabelled
eye drops warrants greater emphasis on safe eye care practices in this
population. Public awareness and regulatory legislations must be implemented to
decrease harmful effects arising due to such practices.
PMCID: PMC5567472
80. Eur J Hosp Pharm. 2017 Jul;24(4):200-203. doi: 10.1136/ejhpharm-2015-000733.

Epub
2016 May 24.
Assessment of antibiotic self-medication practice among public in the

northwestern region of Pakistan.
Nazir S(1), Azim M(2).

Author information:
(1)Kohat University of Science and Technology, Kohat, KPK, Pakistan.
(2)Department of Pharmaceutical Sciences, Kohat University of Science and
Technology, Kohat, Khyber Pakhtunkhwa (KPK), Pakistan.
Background: Self-medication with antibiotics is a common practice, which may lead

to the development of antimicrobial resistance (AMR)-a major health concern
worldwide. The most common reason for the development of AMR is a lack of
education and regulatory policies and the lack of community pharmacists.
Objective: To assess various factors that lead to self-medication with
antibiotics, which might cause AMR and hinder effective healthcare.
Methods: A cross-sectional study was carried out using a predesigned
questionnaire to collect data from 800 respondents. The respondents were selected
by simple random sampling during November 2014 to January 2015 from different
regions of Khyber Pakhtunkhwa (KPK), Pakistan. Only properly completed
questionnaires were assessed for different variables. The collected data were
analysed using SPSS V.16.
Results: 527 people completed and returned the questionnaire-a response rate of
66%. Self-medication with antibiotics was reported by 135 participants (26%),
with a higher prevalence of men than women (48% vs 38%, respectively). The main
reason for self-medication was previous experience with the same antibiotic
(68%). The most commonly used antibiotics were amoxicillin-clavulanate (40%) and
major indications for self-medication were sore throat (29%) and flu (24%). Of
the 527 respondents, only 104 (20%) were aware of AMR.
Conclusions: This study is the first to evaluate self-medication with antibiotics
in KPK, Pakistan. In view of the high prevalence of self-medication, introduction
of a public health policy through drug regulatory authorities, public awareness
programmes/campaigns, patient education about AMR and appropriate use of
antibiotics are critically required. The role of community pharmacists needs to
be strengthened.
DOI: 10.1136/ejhpharm-2015-000733
PMCID: PMC6451461
PMID: 31156941

eCollection 2018.
Association between beliefs about medicines and self-medication with analgesics

among patients with dental pain.
Mittal P(1), Chan OY(1), Kanneppady SK(2), Verma RK(1), Hasan SS(3)(4).
Author information:
(1)Department of Pharmacy Practice, International Medical University, Kuala
Lumpur, Malaysia.
(2)School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
(3)Department of Pharmacy, University of Huddersfield, Huddersfield, West
Yorkshire, United Kingdom.
(4)School of Biological Sciences and Pharmacy, University of Newcastle,
Newcastle, New South Wales, Australia.
Self-medication with analgesics in dental pain management is a common practice as

most of these medicines are available over-the-counter (OTC). The study aims to
examine the relationship between beliefs about medicines and self-medication with
analgesics in dental pain management in Malaysia. This cross-sectional study was
conducted among conveniently sampled patients attending dental clinics, located
in Kuala Lumpur, Malaysia to assess association between self-medication with
analgesics and patient's beliefs about medicines via Beliefs about Medicines
Questionnaire. Participants were evaluated for their self-medication practices
via 4 items. Further assessment was done via Quantitative Analgesic Questionnaire
(QAQ) regarding the analgesics taken. Statistical analyses were performed using
SPSS version 24, with 0.05 as level of significance. The prevalence of
self-medication with analgesics was 29.4%, with 95.6% of the participants took
analgesics when necessary. Participants practising self-medication for dental
pain reported more positive beliefs in General-Necessity (13.04 vs. 9.98, p =
0.001) than those not practising self-medication. However, these participants had
weaker beliefs in General-Harm (12.00 vs. 10.29, p = 0.006) and General-Overuse
(11.38 vs. 10.31, p = 0.032) than those not practising self-medication.
Participants beliefs in General-Harm (r = -0.243; p = 0.003) and General-Overuse
(r = -0.203; p = 0.012) were negatively correlated with total QAQ point. The
study found that individuals who practised self-medication had stronger beliefs
about the benefits of medicines and weaker beliefs in viewing medicines as
harmful and overused. Findings can guide public education to improve the safety
aspects of self-medication with analgesics in dental practice.
PMCID: PMC6072109

interests exist.
82. Front Public Health. 2018 Dec 17;6:370. doi: 10.3389/fpubh.2018.00370.

eCollection 2018.
Determinants of Self-Medication With Antibiotics in European and Anglo-Saxon

Countries: A Systematic Review of the Literature.
Lescure D(1), Paget J(2), Schellevis F(3)(4), van Dijk L(2).
Author information:
(1)Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.
(2)Department of Primary Care, Netherlands Institute for Health Services Research
(NIVEL), Utrecht, Netherlands.
(3)Department of General Practice and Elderly Care Medicine, Netherlands
Institute for Health Services Research (NIVEL), Utrecht, Netherlands.
(4)EMGO Institute for Health and Care Research, VU University Medical Center
Amsterdam, Amsterdam, Netherlands.
Background: Self-medication with antibiotics, which comes in different forms

[e.g., leftover or over-the-counter (OTC) use], contributes to antimicrobial
resistance as it often happens in a non-prudent manner. In order to tackle this
persistent public health problem, its drivers need to be known. The aim of this
study was therefore to identify determinants of self-medication with antibiotics
via a systematic literature review. Methods: A comprehensive search on
determinants of self-medication with antibiotics in the ambulatory care was
conducted in PubMed, Scopus, and Embase for studies published between January
2000 and March 2017. There was no limit on the language nor on the type of study.
The search was restricted to European and Anglo-Saxon countries. Pairs of
reviewers independently screened the abstracts and full texts and performed a
quality assessment. Results: From the initial 664 abstracts, 54 publications that
included 44 countries were retrieved of which most identified patient related
determinants. Important determinants include storing antibiotics at home, poor
access to healthcare, and having the intention to self-medicate. Healthcare
professionals contribute to the practice of self-medication when catering for
demanding and socially vulnerable patients. Healthcare system related
determinants include dispensing antibiotics in whole packages and the lack of
enforcement of medicine regulations. For some determinants (e.g., patients' age)
contradictory results were found. Conclusion: Self-medication with antibiotics is
driven by a variety of determinants on the patient, healthcare professional, and
system levels. Policy makers should recognise the complexity of self-medication
in order to develop multifaceted interventions that target healthcare
professionals and patients simultaneously.
DOI: 10.3389/fpubh.2018.00370
PMCID: PMC6304439
PMID: 30619809
83. Eur J Rheumatol. 2015 Jun;2(2):52-56. Epub 2015 Mar 31.
Prevalence and factors associated with self-medication in rheumatology in

Sub-Saharan Africa.
Ouédraogo DD(1), Zabsonré/Tiendrebeogo JW(1), Zongo E(1), Kakpovi KG(2), Kaboré

F(1), Drabo JY(3), Guissou IP(4).
Author information:
(1)Department of Rheumatology, Yalgado Ouedraogo University Hospital,
Ouagadougou, Burkina Faso.
(2)Department of Rheumatology, Sylvanus Olympio University Hospital, Lomé, Togo.
(3)Department of Internal Medicine, Yalgado Ouedraogo University Hospital,
(4)Department of Clinical Pharmacology, Yalgado Ouedraogo University Hospital,
OBJECTIVE: We sought to determine the prevalence of and factors associated with

self-medication in patients with rheumatic diseases.
MATERIAL AND METHODS: An analytical cross-sectional study was conducted from
February to July 2013 in the rheumatology department. We included all patients
who consulted for a rheumatic disease during the study period and who gave their
consent.
RESULTS: In total, 203 patients were included; of these, 146 patients (71.92%)
had practiced self-medication. Furthermore, 99 patients (48.8%) had practiced
self-medication for rheumatologic problems. The mean age of the patients was 45.5
years (range: 18-75 years). State officials accounted for 44.4% of patients.
Eighty-one patients were schooled. Low back pain (29.29%) was the main reason for
consultation, followed by polyarthralgia (12.12%). Using a visual analogue scale,
the level of pain for which patients had used self-medication was rated as >70
out of 100 in 57.6% of patients. Fifty-five patients often self-medicated and 28
patients rarely. Drugs were bought from the pharmacy in 97% of cases. The main
channel of self-medication was word of mouth (43.4%). The drugs used were mainly
anti-inflammatory drugs (diclofenac: 54.54% and ibuprofen: 57.57%). Ten patients
were unaware of the risks of self-medication. In multivariate analysis, sex,
education level, and occupation were statistically associated with
self-medication.
CONCLUSION: Self-medication for a specific rheumatologic symptom appears less
common than self-medication in general. The procedures for responsible
self-medication should be defined in Burkina Faso in order to minimize the risks.
DOI: 10.5152/eurjrheum.2015.0091
PMCID: PMC5047262
PMID: 27708926
84. Dermatol Res Pract. 2017;2017:7521831. doi: 10.1155/2017/7521831. Epub 2017 Nov
12.
Prevalence and Factors Associated with Self-Medication in Dermatology in Togo.
Kombaté K(1), Técléssou JN(1), Saka B(1), Akakpo AS(1), Tchangai KO(1),
Mouhari-Toure A(2), Mahamadou G(1), Gnassingbé W(1), Abilogun-Chokki A(1), Pitché
P(1).
Author information:
(1)Service de Dermatologie et IST, CHU Lomé, Université de Lomé, Lomé, Togo.
(2)Service de Dermatologie et IST, CHU de Kara, Université de Kara, Kara, Togo.
Objective: This study aimed to determine the prevalence of and factors associated
with self-medication in dermatology in Lomé, Togo.
Methods: We conducted an analytical cross-sectional study from February to April
2016 in 2 dermatology departments in Lomé. Univariate and multivariate logistic
regression models were carried out to identify possible factors associated with
self-medication.
Results: A total of 711 patients were included in the study. The mean age (±SD)
of the patients was 26.6 ± 6.9 years and the sex ratio (male/female) was 0.6. The
main dermatologic diseases recorded were immunoallergic dermatoses (39.7%) and
infectious skin diseases (22.6%). Two-thirds (481/711; 66.7%) of the patients had
practiced self-medication before consultation in dermatology units. In
multivariate analysis, factors associated with self-medication were female sex
(aOR = 1.44; 95% CI = [1.01, 2.05]), duration of dermatologic disease more than
one year (aOR = 1.79; IC = [1.19, 2.68]), adnexal dermatoses (aOR = 2.31; 95% IC
= [1.03-5.21]), keratinization disorders (aOR = 4.23; 95% CI = [1.36-13.13]), and
fungal skin infections (aOR = 5.43; 95% CI = [2.20, 13.38]).
Conclusion: Our study confirms that self-medication practice is very common among
patients with dermatologic diseases in Lomé and has identified associated
factors.
DOI: 10.1155/2017/7521831
PMCID: PMC5702392
PMID: 29259625
85. East Mediterr Health J. 2015 Jun 9;21(4):256-65.
Self-medication with drugs and complementary and alternative medicines in

Alexandria, Egypt: prevalence, patterns and determinants.
El-Nimr NA(1), Wahdan IM(1), Wahdan AM(2), Kotb RE(3).
Author information:
(1)Department of Epidemiology, High Institute of Public Health, University of
Alexandria, Alexandria, Egypt.
(2)Department of Biostatistics, High Institute of Public Health, University of
Alexandria, Alexandria, Egypt. imanwahdan@yahoo.com.
(3)Department of Primary Health Care, High Institute of Public Health, University
of Alexandria, Alexandria, Egypt.
This study aimed to describe the prevalence, pattern and reasons for
self-medication among adults in Alexandria, Egypt. In a community-based survey
during 2012, a representative sample of 1100 adults completed a predesigned
interview questionnaire on self-medication practices by drugs and complementary
or alternative medicines (CAM). A majority of them practised self-medication
(86.4%), mostly using both drugs and CAM (77.5%). The most commonly used drugs
were analgesics (96.7%), and cough and cold preparations (81.9%), but 53.9% of
respondents reported self-medication with antibiotics. The most frequently used
CAM were herbs (91.6%), followed by spiritual healing (9.4%) and cupping and
acupuncture (6.4%). CAM improved the condition according to 95.2% of users.
Logistic regression analysis revealed that age, occupation and the presence of
chronic conditions were the independent factors significantly affecting the
practice of self-medication with drugs.
Publisher: ‫التطبيب الذاتي بالعقاقير والدوية التكميلية والبديلة في السكندرية‬

‫ أشرف‬،‫ إيمان محمد حلمي وهدان‬،‫نسرين أحمد النمر‬.‫ النتشار والنماط والمحددددات‬:‫بمصر‬
‫تباع مجموعة واسعة من أدوية الوصفات الطبية بدون‬.‫ ريهام السيد قطب‬،‫محمد حلمي وهدان‬
‫ وقد هدفت هذه الدراسة إلى وصف انتشار التطبيب‬.‫وصفة في كثير من البلدان النامية‬
‫ ففي مسح مجتمعي أجري خلل‬.‫الذاتي وأنماطه وأسبابه بين البالغين في السكندرية بمصر‬
‫ بالغ باستكمال استبيان مصمم مسبقا ا عن‬1100 ‫ قامت عينة ممدثلة تتألف من‬2012 ‫عام‬
‫ ولقد أظهرت‬.‫ممارسات التطبيب الذاتي بواسطة العقاقير والدوية التكميلية أو البديلة‬
‫ في الغالب باستخدام العقاقير‬،(% 86.4) ‫النتائج أن معظمهم مارسوا التطبيب الذاتي‬
‫ ولقد كانت الشكوى من الصابة بالمشاكل‬.(% 77.5) ‫وكذلك الدوية التكميلية أو البديلة‬
‫ وكانت الدوية الكثر استخداما ا‬.‫الهضمية الكثر شيوعا ا لممارسة التطبيب الذاتي‬
‫ من المستطرلعين‬% 53.9 ‫ ولكن‬،(% 81.9) ‫( ومستحضرات السعال والبرد‬% 96.7) ‫المسكنات‬
‫ وكانت الدوية التكميلية أو البديلة الكثر‬.‫أبلغوا عن تطبيب ذاتي بالمضادات الحيوية‬
‫( والحجامة والوخز بالبر‬% 9.4) ‫ يليها العلج الروحي‬، (%91.6) ‫استخداما ا العشاب‬
(6.4 %). ‫ من‬% 95.2 ‫ولقد تحسنت الحالة بفعل الدوية التكميلية أو البديلة وفقا ا لـ‬
‫ وكشف تحليل النحدار اللوجستي أن العمر والمهنة ووجود أمراض مزمنة كانت‬.‫المستخددمين‬
‫العوامل المستقلة التي تؤثر بشكل كبير على ممارسة التطبيب الذاتي‬
‫بالعقاقير‬.Publisher: Automédication avec recours aux médicaments conventionnels,
complémentaires et alternatifs à Alexandrie (Égypte) : prévalence, tendances et
déterminants.La présente étude avait pour objectif de décrire la prévalence, les
tendances ainsi que les motifs de l’automédication chez des adultes à Alexandrie
(Égypte). Dans une enquête communautaire en 2012, un échantillon représentatif de
1100 adultes a répondu à un questionnaire prédéfini au cours d’un entretien sur
leurs pratiques d’automédication à base de médicaments conventionnels,
complémentaires et alternatifs. Une majorité d’entre eux pratiquait
l’automédication (86,4 %), et la plupart consommait à la fois des médicaments
conventionnels et des médicaments complémentaires et alternatifs (77,5 %). Les
médicaments conventionnels les plus utilisés étaient les analgésiques (96,7 %),
et les préparations contre la toux et le rhume (81,9 %), tandis que 53,9 % des
répondants indiquaient consommer des antibiotiques en automédication. Dans la
catégorie de la médecine complémentaire et alternative, le recours aux
médicaments à base de plantes (91,6 %) arrivait en tête, suivi par les soins
spirituels (9,4 %), l’application de ventouses et l’acupuncture (6,4 %). La
consommation de médicaments complémentaires et alternatifs permet d’améliorer
l’état de santé selon 95,2 % des utilisateurs. L’analyse de régression logistique
a révélé que l’âge, l’emploi occupé et la présence de maladies chroniques étaient
les facteurs indépendants qui influaient significativement sur la pratique de
l’automédication à base de médicaments conventionnels.
86. Psychol Addict Behav. 2016 Nov;30(7):771-777. Epub 2016 Jun 6.
A population-based study of help seeking and self-medication among trauma-exposed

individuals.
Sheerin C(1), Berenz EC(2), Knudsen GP(3), Reichborn-Kjennerud T(3), Kendler

KS(4), Aggen SH(4), Amstadter AB(4).
Author information:
(1)Mental Illness Research Education and Clinical Center, Richmond Veterans
Affairs Medical Center.
(2)University of Virginia.
(3)Division of Mental Health, Norwegian Institute of Public Health.
(4)Department of Psychiatry, Virginia Institute of Psychiatric and Behavioral
Genetics, Virginia Commonwealth University.
Epidemiologic studies of trauma highlight the imbalance between prevalence of

psychiatric diagnoses and help seeking. We investigated prevalence and correlates
of help seeking and self-medication in Norwegian adults with trauma history with
a focus on common posttrauma outcomes of posttraumatic stress disorder (PTSD) and
substance use disorders (alcohol or drug). Participants reporting at least 1 PTSD
symptom (n = 307) were asked if they consulted with a doctor/another professional
(help seeking) or used drugs/alcohol (self-medication) for trauma-related
problems. PTSD, alcohol abuse or dependence (AUD), and drug use or dependence
(DUD) were assessed via structured diagnostic interviews. Help seeking and
self-medication were endorsed by 37.4% and 10.4% of the sample, respectively. As
compared to the full sample, help seeking was endorsed at a greater rate in
individuals with PTSD (χ2 = 8.59, p = .005) and at a lower rate in those with AUD
(χ2 = 7.34, p < .004). Self-medication was more likely to be endorsed by
individuals with PTSD than without PTSD (χ2 = 25.68, p < .001). In regression
analyses, PTSD was associated with increased likelihood of self-medication (odds
ratio [OR] = 4.56) and help seeking (OR = 2.29), while AUD was associated with
decreased likelihood of help-seeking (OR = .29). When self-medication was
included as a predictor, PTSD was no longer associated with help seeking,
although AUD remained inversely associated. PTSD and AUDs have a nuanced
relationship with formal help seeking as well as the use of substances to cope.
Trauma-exposed individuals are likely engaging in adaptive and maladaptive coping
strategies, the latter of which may be compounding distress. (PsycINFO Database
Record
(c) 2016 APA, all rights reserved).
DOI: 10.1037/adb0000185
PMCID: PMC5114150
Conflict of interest statement: The authors have no financial relationships or

conflicts of interest to disclose
87. J Multidiscip Healthc. 2019 Jul 2;12:493-502. doi: 10.2147/JMDH.S211420.

eCollection 2019.
Self-medication practices among Vietnamese residents in highland provinces.
Ha TV(1), Nguyen AMT(2), Nguyen HST(3).
Author information:
(1)Department of Health Insurance, Ministry of Health of Vietnam, Hanoi 100000,
Vietnam.
(2)Department of Planning and Financing, Ministry of Health of Vietnam, Hanoi
100000, Vietnam.
(3)Department of Pharmacoeconomics and Management, Hanoi University of Pharmacy,
Hanoi 100000, Vietnam.
Background: Monitoring self-medication practice, which refers to individuals
using medicine without instructions of physicians, is critical to control its
harmful effects. However, in Vietnam, evidence about self-medication among
individuals in highland areas is constrained. This study examined self-medication
practice among residents living in highland areas in Vietnam and determined
associated factors. Materials and methods: A cross-sectional study was performed
in five highland provinces with 1000 individuals. Information about individual
and household's socioeconomic status and self-medication practice in the last 12
months was surveyed. Multivariate logistic and Poisson regressions were used to
identify associated factors with self-medication. Results: 83.3% reported
self-medication in the last 12 months, with the mean times of self-medication
being 4.5 times (SD=4.1). Female (OR=0.62, p<0.01), ethnic minorities, higher
number of members having health insurance in family (OR=0.82, p<0.01) and higher
annual household income (OR=0.78, p<0.05) were associated with the lower
likelihood of "Only buy medicines at pharmacy stores when having illness in the
last 12 month". Moreover, people who were females (OR=0.59, p<0.05), white-collar
worker (OR=0.25, p<0.01) and had higher number of children in the family
(OR=0.68, p<0.05) were less likely to practice self-medication. People who were
ethnic minorities, white-collar worker (Coef.=-0.32, p<0.01) and higher number of
members having health insurance in family had lower times of self-medication in
the last 12 months compared to other groups. Meanwhile, individuals having higher
number of members in the family (Coef.=0.07, p<0.01) and higher annual household
income (Coef.=0.08, p<0.01) had highertimes of self-medication in the last 12
months. Conclusion: Residents in highland areas in Vietnam had a considerably
high 12-month prevalence of self-medication. Medical products quality management
and self-medication guideline are potential to maximize the effects of
self-medication. Moreover, promoting the use of health insurance should also be
concerned as a solution to address this issue.
DOI: 10.2147/JMDH.S211420
PMCID: PMC6620316
PMID: 31456640
Conflict of interest statement: The author reports no conflicts of interest in

this work.
88. J Addict Med. 2015 Jan-Feb;9(1):61-7. doi: 10.1097/ADM.0000000000000090.
Low dispositional mindfulness predicts self-medication of negative emotion with

prescription opioids.
Garland EL(1), Hanley AW, Thomas EA, Knoll P, Ferraro J.
Author information:
(1)From the University of Utah (ELG, EAT), Salt Lake City, UT; Florida State
University (AWH), Tallahassee, FL; and Tallahassee Memorial Hospital Recovery
Center (PK, JF), Tallahassee, FL.
OBJECTIVES: Although evidence is mounting that opioids are abused to

self-medicate negative emotions, little is known about the traits and factors
linked to opioid self-medication. One potentially crucial psychological correlate
is dispositional mindfulness. Thus, the purpose of this study was to describe the
prevalence of opioid self-medication among a treatment-seeking sample of
prescription opioid-dependent individuals and specifically examine the
relationship between dispositional mindfulness and opioid self-medication.
METHODS: Participants in acute detoxification or intensive outpatient treatment
for prescription opioid dependence (n = 79) were recruited from a regional
hospital's addictions treatment unit for this cross-sectional study.
Sociodemographic data were collected along with surveys of opioid
self-medication, pain level, and dispositional mindfulness.
RESULTS: Self-medication of negative affective states with opioids was quite
common, with 94.9% of individuals sampled reporting self-medication behaviors. In
adjusted analyses, individuals engaging in more frequent opioid use tended to
self-medicate negative emotions with opioids more often than those engaging in
more intermittent opioid use (β = 0.33; P < 0.05). Importantly, irrespective of
opioid use frequency and other clinical and sociodemographic covariates,
dispositional mindfulness was inversely associated with opioid self-medication (β
= -0.42; P < 0.001), such that less mindful individuals reported using opioids
more frequently to self-medicate negative emotions.
CONCLUSIONS: Self-medication of negative emotions with opioids was prevalent in
this sample and related to low dispositional mindfulness. Plausibly, increasing
mindfulness may decrease opioid self-medication. Addictive automaticity and
emotion regulation are discussed as potential mechanisms linking low
dispositional mindfulness and self-medication.
DOI: 10.1097/ADM.0000000000000090
PMCID: PMC4310788
89. Niger Postgrad Med J. 2019 Jul-Sep;26(3):189-194. doi: 10.4103/npmj.npmj_87_19.
Self-medication practice in Akuse, a rural setting in Ghana.
Mensah BN(1), Agyemang IB(2), Afriyie DK(3), Amponsah SK(4).
Author information:
(1)Ghana Health Service, School of Pharmacy, University of Ghana, Accra, Ghana.
(2)USAID|DELIVER Project, School of Pharmacy, University of Ghana, Accra, Ghana.
(3)Ghana Police Hospital, School of Pharmacy, University of Ghana, Accra, Ghana.
(4)Department of Pharmacology and Toxicology, School of Pharmacy, University of
Ghana, Accra, Ghana.
Objective: In most resource-poor settings, there is a paucity of data on

self-medication and possible factors that influence this practice. The current
study assesses self-medication among the people of Akuse, a rural setting in the
Eastern Region of Ghana.
Methods: A quantitative cross-sectional study was carried out in Akuse from 4th
January 2016 to 27th February 2016. Using a questionnaire, interviews were
conducted to assess self-medication: class of drugs taken, sources of drugs,
knowledge of potential adverse effects, among others.
Results: Of the 363 participants enrolled, 361 completed questionnaires
administered. Of the 361 respondents, 58.4% were female. A majority of the
respondents were within the ages of 30 and 45 years. Respondents were mainly
farmers (40.2%), and a majority (44.6%) had primary level as the highest
education. One major reason for self-medication was influence from family and
friends (32.7%). Antibiotics (32.1%) and analgesics (21.0%) were the most common
self-medicated drugs, and these drugs were mostly obtained from licenced chemical
sellers (32.5%). A little more than a third (39.9%) of the respondents said that
their condition did not change after self-medication. A greater number of the
respondents (81.7%) did not have knowledge of potential adverse reactions
associated with self-medicated drugs. However, respondents with high educational
level had the most knowledge of adverse drug reactions.
Conclusion: The study found self-medication as a common practice among a number
of residents of Akuse. Findings from this study provide data that could be used
for targeted education and sensitisation of self-medication and its demerits in
similar resource-poor rural settings.
DOI: 10.4103/npmj.npmj_87_19
PMID: 31441458
Conflict of interest statement: None
90. Nepal J Epidemiol. 2016 Jun 30;6(2):574-581. eCollection 2016 Jun.
Self-medication practice among preclinical university students in a medical

school from the city of Pokhara, Nepal.
Banerjee I(1), Sathian B(2), Gupta RK(3), Amarendra A(4), Roy B(5),
Bakthavatchalam P(6), Saha A(7), Banerjee I(8).
Author information:
(1)Assistant Professor, Department of Pharmacology, SSR Medical College, Belle
Rive, Mautitius, ; Assistant Professor, Department of Pharmacology, Manipal
College of Medical Sciences, Pokhara, Nepal.
(2)Assistant Professor, Department of Community Medicine, Manipal College of
Medical Sciences, Pokhara, Nepal.
(3)Professor and Head of the Department, Department of Pharmacology, SSR Medical
College, Belle Rive, Mautitius.
(4)Lecturer, Department of Pharmacology, SSR Medical College, Belle Rive,
Mautitius.
(5)Assistant Professor, Department of Physiology, Manipal College of Medical
Sciences, Pokhara, Nepal.
(6)Lecturer, Faculty of medicine, Quest International University, Perek,
Malaysia.
(7)Professor and Head of the Department, Department of Pharmacology, Manipal
College of Medical Sciences, Pokhara, Nepal.
(8)Post Doctorate Trainee, M.Ch Urology, SMS Medical College, Rajasthan, India.
BACKGROUND: In developing countries like Nepal medicines can be acquired from the
chemist's without of a prescription which sometime may have many drawbacks due to
intake of excessive drugs without a proper diagnosis. The primary objective of
the study was to find out the pattern of self-medication practice among the
preclinical medical students at Manipal College of Medical Sciences.
MATERIALS AND METHODS: This was a cross sectional study carried out using
structured questionnaire at Manipal College of Medical Sciences, Pokhara, Nepal
between November 2012- July 2014.
RESULTS: The overall response rate of this study was 95.31%. 81.35% of the
students were practicing self-medication in this institution. Most common group
of drugs that were consumed were antipyretics 31%, antibiotics 26.2%, analgesics
18.89%, antihistaminics 10.1% respectively. Paracetamol was the most common drug
used for self-medication 31%, followed by Azithromycin 17.6% and combination of
Paracetamol and Ibuprofen 15.6%, Cetirizine 8.6%, Amoxicillin 6.5%, Omeprazole
6.3%, Albendazole 3.3%, Mefenemic acid 2.8%, Cefpodoxime2% respectively.
CONCLUSION: Medical student should be educated through awareness programme
regarding pros and cons of self-medication practice and they should be motivated
regarding the rationale use of antibiotics. .
DOI: 10.3126/nje.v6i2.15165
PMCID: PMC5073175
PMID: 27774346

91. Indian J Pharm Sci. 2015 Mar-Apr;77(2):178-82.
Self Medication Practices among Medical Students of a Private Institute.
Kasulkar AA(1), Gupta M(2).
Author information:
(1)Department of Forensic Medicine, N. K. P. Salve Institute of Medical Sciences
and Research Centre, Digdoh Hills, Hingana Road, Nagpur-440 019, India.
(2)Department of Biochemistry, N. K. P. Salve Institute of Medical Sciences and
Research Centre, Digdoh Hills, Hingana Road, Nagpur-440 019, India.
The study was undertaken to evaluate various aspects of self-medication in

medical students. A prospective, cross-sectional, questionnaire-based study was
carried out among 488 medical students selected by simple random sampling from
January 2013 to June 2013. Data was collected and analyzed for counts and
percentage. Students reported self-medication in the preceding one year was 71.7
% and the prevalence was more in final year students. Fever and headache were the
most frequently reported illnesses, commonly used drugs were antipyretics and
analgesics, obtained information through reading material, and reasons quoted
were minor ailments and quick relief. Majority students agreed that medical
knowledge is necessary for administration of medicine by self. Self-medication is
highly prevalent in medical students, which is quite alarming.
PMCID: PMC4442466
PMID: 26009650
92. BMC Pharmacol Toxicol. 2015 Apr 27;16:11. doi: 10.1186/s40360-015-0011-3.
Comparing antibiotic self-medication in two socio-economic groups in Guatemala

City: a descriptive cross-sectional study.
Ramay BM(1), Lambour P(2), Cerón A(3).
Author information:
(1)Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala,
Guatemala City, Guatemala. bramay@uvg.edu.gt.
(2)Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala,
Guatemala City, Guatemala. lambourpaola@gmail.com.
(3)Department of Anthropology, University of Denver, Denver, Colorado, USA.
alejandro.ceronvaldes@du.edu.
BACKGROUND: Self-medication with antibiotics may result in antimicrobial

resistance and its high prevalence is of particular concern in Low to Middle
Income Countries (LMIC) like Guatemala. A better understanding of self-medication
with antibiotics may represent an opportunity to develop interventions guiding
the rational use of antibiotics. We aimed to compare the magnitude of antibiotic
self-medication and the characteristics of those who self-medicate in two
pharmacies serving disparate socio-economic communities in Guatemala City.
METHODS: We conducted a descriptive, cross-sectional study in one Suburban
pharmacy and one City Center pharmacy in Guatemala City. We used a questionnaire
to gather information about frequency of self-medication, income and education of
those who self-medicate. We compared proportions between the two pharmacies,
using two-sample z-test as appropriate.
RESULTS: Four hundred and eighteen respondents completed the survey (221 in the
Suburban pharmacy and 197 in the City Center pharmacy). Most respondents in both
pharmacies were female (70%). The reported monthly income in the suburban
pharmacy was between $1,250.00-$2,500.00, the city-center pharmacy reported a
monthly income between $125.00- $625.00 (p < 0.01). Twenty three percent of
Suburban pharmacy respondents and 3% in the City Center pharmacy completed high
school (p < 0.01). Proportion of self-medication was 79% in the Suburban pharmacy
and 77% in City Center pharmacy. In both settings, amoxicillin was reported as
the antibiotic most commonly used.
CONCLUSIONS: High proportions of self-medication with antibiotics were reported
in two pharmacies serving disparate socio-economic groups in Guatemala City.
Additionally, self-medicating respondents were most often women and most commonly
self-medicated with amoxicillin. Our findings support future public health
interventions centered on the regulation of antibiotic sales and on the potential
role of the pharmacist in guiding prescription with antibiotics in Guatemala.
DOI: 10.1186/s40360-015-0011-3
PMCID: PMC4418049
93. Balkan Med J. 2016 Sep;33(5):559-562. Epub 2016 Sep 1.
Oleander Poisoning as an Example of Self-Medication Attempt.
Bavunoğlu I(1), Balta M(1), Türkmen Z(2).
Author information:
(1)Department of Internal Medicine, İstanbul University Cerrahpaşa School of
Medicine, İstanbul, Turkey.
(2)Institute of Forensic Sciences, İstanbul University, Istanbul, Turkey.
BACKGROUND: There is an increasing interest in herbal products as a

self-medication method in recent years. Some plant extracts either turn into
drugs over time or are consumed directly without treatment. One of these plants
is Nerium oleander L., which is a potentially lethal plant, since it has cardiac
glycosides. However, numerous researches of its extracts have been performed
against cancer cell lines in recent literature. This contradiction leads to
misinterpretation and induces the prevalence of intoxication or fatal cases.
CASE REPORT: This case is associated with an oleander-poisoned patient, who was
admitted to the Emergency unit 20 hours after the first dose, and 8 hours after
the second dose. Although she lives in a metropolis and has a higher level of
education and numerous hospital facilities available, she had decided to take
self-medication for her Hashimoto's thyroiditis and malignant thyroid disease
which was caused by her apprehensive thoughts. Oleandrin was detected in the
urine at a concentration of 3.2 ng/mL and in the serum at a concentration of 8.4
ng/mL by chromatographic analysis at the time of admission.
CONCLUSION: This case represents the misunderstanding of herbal treatments by the
community. Promoting awareness of the potential toxicity of this plant among the
public may help to reduce the incidence of poisoning due to Nerium species.
DOI: 10.5152/balkanmedj.2016.150307
PMCID: PMC5056662
PMID: 27761287
Conflict of interest statement: The authors declare that there is no conflict of

interest regarding the publication of this paper.
94. J Clin Diagn Res. 2014 Dec;8(12):HC20-3. doi: 10.7860/JCDR/2014/10579.5313.

Epub
2014 Dec 5.
Self-medication practice and perceptions among undergraduate medical students: a
Patil SB(1), S H V(2), B V P(3), Santoshkumar J(4), Binjawadgi AS(4), Kanaki

AR(5).
Author information:
(1)Post Graduate Resident, Department of Pharmacology, M.R. Medical College ,
Gulbarga, Karnataka, India .
(2)Professor and Head, Department of Pharmacology, M.R. Medical College ,
(3)Professor, Department of Pharmacology, M.R. Medical College , Gulbarga,
Karnataka, India .
(4)Associate Professor, Department of Pharmacology, M.R. Medical College ,
(5)Assistant Professor, Department of Pharmacology, M.R. Medical College ,
BACKGROUND: Self-medication practice is widespread in many countries and the

irrational use of drugs is a cause of concern.It assumes a special significance
among medical students as they are exposed to knowledge about diseases and drugs.
AIM: To assess practice and perception of self medication among undergraduate
medical students.
MATERIALS AND METHODS: It is a cross-sectional study in which study population
consisted of undergraduate medical students of Mahadevappa Rampure Medical
College Gulbarga, Karnataka, India. This study was conducted from March to April
2014. Total 448 students were taken. Out of which 8 incomplete questionnaires
were excluded and 440 were analysed. The students who took self-medication during
last six months were included. Written informed consent was obtained from each
volunteer prior to the study. Students were given a questionnaire that include
both open and close ended questions about self-medication practice. Ethical
Approval: Ethics Committee approval was obtained from the Institutional Ethics
Committee of Mahadevappa Rampure Medical College, Gulbarga, India, prior to the
commencement of the study.
STATISTICAL ANALYSIS: Data was analysed and presented as counts and percentages.
RESULTS: It was found that 388 (88.18%) students practiced self medication. The
principal morbidity for seeking self medication was cold and cough as reported by
304 (78.35%) students. Antibiotics were most commonly self medicated as reported
by 248 (63.91%) students, out of which only 92 (37.1%) students completed the
full course of antibiotic regimen. Only 176 (40%) students opined that self
medication is part of self care.
CONCLUSION: Self-medication is widely practiced among undergraduate medical
students. In this situation, we should educate the students about advantages and
disadvantages of self medication.
DOI: 10.7860/JCDR/2014/10579.5313
PMCID: PMC4316275
PMID: 25653969
95. Int J Appl Basic Med Res. 2018 Jan-Mar;8(1):3-8. doi:

10.4103/ijabmr.IJABMR_46_17.
Assessment of Nature, Reasons, and Consequences of Self-medication Practice among

General Population of Ras Al-Khaimah, UAE.
Sridhar SB(1), Shariff A(1), Dallah L(2), Anas D(2), Ayman M(2), Rao PG(1).
Author information:
(1)Department of Clinical Pharmacy and Pharmacology, RAK Medical and Health
Sciences University, Ras Al-Khaimah, UAE.
(2)RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences
University, Ras Al-Khaimah, UAE.
Aim: The aim of this study is to assess the nature, reasons, and consequences of
self-medication practice among the general population of Ras Al-Khaimah, UAE.
Materials and Methods: This was a prospective, cross-sectional, survey-based
study. Data with respect to knowledge, awareness, and practices regarding
self-medication were collected through an interviewer-assisted questionnaire
answered by the study participants. Thus, collected data from 413 survey
respondents were analyzed using SPSS version 24.0.
Results: The prevalence of self-medication practices among our study respondents
was 52.1%. A headache (155 [37.5%]) was the most common clinical condition
treated through self-medication practice. Familiarity with the
treatment/medication (198 [48%]) was the most common cited reasons, whereas the
advertisement and friend's advice were the most (182 [44%]) cited sources of
information for self-medication usage. The majority (265 [64.1%]) of the
respondents were considered self-medication practice as safe. However, 19
respondents reported side-effects or complications during the due course of
self-medication. It was observed that there is a statistically significant
association (P < 0.05) between age and employment status of this study
participants with self-medication practices.
Conclusion: The data from this study show that the self-medication practice is
very common among the study population. Variables such as younger age group and
occupation status were significantly associated with self-medication practice. We
emphasize the role of pharmacist in educating the community regarding safe
medication practices such as harmful effects of self-medicating and inappropriate
practices such as sharing the medications among family members and friends.
DOI: 10.4103/ijabmr.IJABMR_46_17
PMCID: PMC5846215
PMID: 29552527
Conflict of interest statement: There are no conflicts of interest.
96. PLoS One. 2018 Oct 31;13(10):e0206623. doi: 10.1371/journal.pone.0206623.

eCollection 2018.
Prevalence, determinants and knowledge of antibacterial self-medication: A cross

sectional study in North-eastern Tanzania.
Horumpende PG(1)(2)(3), Said SH(1), Mazuguni FS(4), Antony ML(5), Kumburu

HH(1)(2), Sonda TB(1)(2), Mwanziva CE(3), Mshana SE(6), Mmbaga BT(2)(7), Kajeguka
DC(1), Chilongola JO(1)(2).
Author information:
(1)Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro
Christian Medical University College, Moshi, Kilimanjaro, Tanzania.
(2)Department of Microbiology, Immunology and Molecular Biology, Kilimanjaro
Clinical Research Institute, Moshi, Kilimanjaro, Tanzania.
(3)Department of Preventive Medicine and Research, Lugalo General Military
Hospital, Dar es Salaam, Tanzania.
(4)Department of Public Health and Research, Ifakara Health Institute, Dar es
Salaam, Tanzania.
(5)Department of Parasitology and Entomology, National Health Laboratory Quality
Assurance and Training Centre, Dar es Salaam, Tanzania.
(6)Department of Microbiology and Immunology, Catholic University of Health and
Allied Sciences, Mwanza, Tanzania.
(7)Department of Paediatrics and Child Health, Kilimanjaro Christian Medical
Centre, Moshi, Kilimanjaro, Tanzania.
Self-medication is very common especially in developing countries and is

documented to be associated with many health risks including antibiotic
resistance. This study investigated the prevalence, determinants and knowledge of
self-medication among residents of Siha District in Tanzania. A cross-sectional
study was conducted among 300 residents in a rural District of Kilimanjaro
region, North-eastern Tanzania from 1st to 28th April 2017. A semi-structured
questionnaire was used to collect information regarding drugs used, knowledge,
history and reasons for antibiotic self-medication. Log-binomial regression
analysis was done using STATA 13 to examine factors associated with
self-medication. A slightly majority of the respondents (58%) admitted to
self-medication. Antibiotics most commonly utilized were amoxycillin (43%) and an
antiprotozoal drug metronidazole (10%). The most common symptoms that led to
self-medication were cough (51.17%), headache/ fever/ malaria (25.57%) and
diarrhoea (21.59%). The most common reasons for self-medication were emergency
illness (24.00%), health facility charges (20.33%), proximity of pharmacy to home
(17.00%) and no reason (16.66%). Almost all reported that self-medication is not
better than seeking medical consultation, 98% can result into harmful effects and
96% can result to drug resistance. The level of self-medication in this study is
comparable with findings from other studies in developing countries. Pharmacies
were commonly used as the first point of medical care. There is therefore a need
for educative antibiotic legislative intervention to mitigate the adverse effects
of antibiotic self-medication in Siha district in Tanzania.
PMCID: PMC6209340

interests exist.
97. J Antimicrob Chemother. 2018 Jan 1;73(1):231-239. doi: 10.1093/jac/dkx343.
Predictors of antimalarial self-medication in illegal gold miners in French

Guiana: a pathway towards artemisinin resistance.
Douine M(1)(2), Lazrek Y(3), Blanchet D(4), Pelleau S(3), Chanlin R(4), Corlin
F(1), Hureau L(1), Volney B(3), Hiwat H(5), Vreden S(6), Djossou F(2)(7), Demar
M(2)(4), Nacher M(1)(2), Musset L(3).
Author information:
(1)Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne
Hospital, French Guiana.
(2)Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne,
French Guiana.
(3)Laboratoire de Parasitologie, WHO Collaborating Center for Surveillance of
Anti-Malarial Drug Resistance, Centre National de Référence du Paludisme,
Institut Pasteur de la Guyane, Cayenne, French Guiana.
(4)Academic Laboratory of Parasitology - Mycology, Cayenne Hospital, Cayenne,
French Guiana.
(5)Ministry of Health, Malaria Program, Paramaribo, Suriname.
(6)Foundation for Scientific Research Suriname (SWOS), Paramaribo, Suriname.
(7)Infectious and Tropical Diseases Department, Cayenne Hospital, Cayenne, French
Guiana.
Background: Malaria is endemic in French Guiana (FG), South America. Despite the
decrease in cases in the local population, illegal gold miners are very affected
by malaria (22.3% of them carried Plasmodium spp.). Self-medication seems to be
very common, but its modalities and associated factors have not been studied. The
aim of this study was to evaluate parasite susceptibility to drugs and to
document behaviours that could contribute to resistance selection in illegal gold
miners.
Methods: This multicentric cross-sectional study was conducted in resting sites
along the FG-Surinamese border. Participating gold miners working in FG completed
a questionnaire and provided a blood sample.
Results: From January to June 2015, 421 illegal gold miners were included. Most
were Brazilian (93.8%) and 70.5% were male. During the most recent malaria
attack, 45.5% reported having been tested for malaria and 52.4% self-medicated,
mainly with artemisinin derivatives (90%). Being in FG during the last malaria
attack was the main factor associated with self-medication (adjusted OR = 22.1).
This suggests that access to malaria diagnosis in FG is particularly difficult
for Brazilian illegal gold miners. Treatment adherence was better for persons who
reported being tested. None of the 32 samples with Plasmodium falciparum
presented any mutation on the pfK13 gene, but one isolate showed a resistance
profile to artemisinin derivatives in vitro.
Conclusions: The risk factors for the selection of resistance are well known and
this study showed that they are present in FG with persons who self-medicated
with poor adherence. Interventions should be implemented among this specific
population to avoid the emergence of artemisinin resistance.
© The Author 2017. Published by Oxford University Press on behalf of the British
Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions,
please email: journals.permissions@oup.com.
DOI: 10.1093/jac/dkx343
98. BMJ Open. 2017 Dec 19;7(12):e017306. doi: 10.1136/bmjopen-2017-017306.
Socioeconomic differences in self-medication among middle-aged and older people:

data from the China health and retirement longitudinal study.
Chang J(1)(2), Wang Q(3), Fang Y(1)(2).
Author information:
Pharmacy, Xi'an Jiaotong University, Xi'an, China.
(2)Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an,
China.
(3)School of Business, Dalian University of Technology, Panjin, China.
OBJECTIVES: Self-medication with over-the-counter medicines (OTCs) and

prescription-only medicines (POMs) are both pervasive in China, although the
latter is an inappropriate practice. We examined the relationship between
socioeconomic status (SES) and self-medication with OTCs versus POMs.
METHODS: Multivariate logistic regressions based on the Andersen framework were
estimated using a subsample of respondents aged 45 years and over from the China
Health and Retirement Longitudinal Study collected between 2011 and 2013
(n=23 699). As dependent variables, we used OTC and POM consumption without a
medical prescription. SES was operationalised by household income per capita and
education. Control variables included health indicators, demographic
characteristics, and health behaviours.
RESULTS: In our study sample, 32.69% and 15.02% of people aged 45 years and over
had self-medicated with OTCs and POMs in the 4 weeks before the survey,
respectively. OTC use by income exhibited an inverse U shape. Respondents from
middle income groups were more likely to self-medicate with OTCs compared with
those from the lowest and highest income groups. In contrast, respondents from
the lowest income group were more inclined to self-medicate with POMs. There was
a clear trend towards more self-medication with OTCs, but not POMs, among those
with higher educational attainment.
CONCLUSION: People with low income tended to rely on self-medication with POMs
for treatment, which is risky and of low quality. A health education programme
for older people, particularly those living in low-income households, aimed at
improving the quality of self-medication behaviour is warranted. Urgent measures
are needed to address the issue of easy access to POMs at community pharmacies,
and to improve access to formal medical care among the low-income population.
© Article author(s) (or their employer(s) unless otherwise stated in the text of
the article) 2017. All rights reserved. No commercial use is permitted unless
otherwise expressly granted.
DOI: 10.1136/bmjopen-2017-017306
PMCID: PMC5778336
99. Version 3. F1000Res. 2015 Mar 19 [revised 2015 May 26];4:73. doi:
10.12688/f1000research.6262.2. eCollection 2015.
Behavioural evidence for self-medication in bumblebees?
Baracchi D(1), Brown MJ(2), Chittka L(1).
Author information:
(1)Department of Biological and Experimental Psychology, School of Biological and
Chemical Sciences, Queen Mary University of London, Mile End Road, London, E1
4NS, UK.
(2)School of Biological Sciences, Royal Holloway University of London, Egham,
Surrey, TW20 0EX, UK.
The presence of antimicrobial secondary metabolites in nectar suggests that

pollinators, which are threatened globally by emergent disease, may benefit from
the consumption of nectars rich in these metabolites. We tested whether nicotine,
a nectar secondary metabolite common in Solanaceae and Tilia species, is used by
parasitized bumblebees as a source of self-medication , using a series of
toxicological, microbiological and behavioural experiments. Caged bees infected
with Crithidia bombi had a slight preference for sucrose solution laced with the
alkaloid and behavioural tests showed that the parasite infection induced an
increased consumption of nicotine during foraging activity, though nicotine had
an appetite-reducing effect overall. When ingested, nicotine delayed the
progression of a gut infection in bumblebees by a few days, but dietary nicotine
did not clear the infection, and after 10 days the parasite load approached that
of control bees. Moreover, when pathogens were exposed to the alkaloid prior to
host ingestion, the protozoan's viability was not directly affected, suggesting
that anti-parasite effects were relatively weak. Nicotine consumption in a single
dose did not impose any cost even in starved bees but the alkaloid had
detrimental effects on healthy bees if consistently consumed for weeks. These
toxic effects disappeared in infected bees, suggesting that detoxification costs
might have been counterbalanced by the advantages in slowing the progression of
the infection. Nicotine consumption did not affect bee lifespan but the reduction
in the parasite load may have other likely unexplored subtle benefits both for
individual bees and their colony. Potential evidence for self-medication is
discussed. The contention that secondary metabolites in nectar may be under
selection from pollinators, or used by plants to enhance their own reproductive
success, remains to be confirmed.
DOI: 10.12688/f1000research.6262.2
PMCID: PMC4406194
PMID: 25949807
100. BMC Public Health. 2019 Aug 1;19(1):1033. doi: 10.1186/s12889-019-7302-3.
Risk factors associated with self-medication among women in Iran.
Karimy M(1), Rezaee-Momtaz M(2), Tavousi M(3), Montazeri A(3), Araban M(4)(5).
Author information:
(1)Social Determinants of Health Research Center, Saveh University of Medical
Sciences, Saveh, Iran.
(2)Department of Health Education and Promotion, Public Health School, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran.
(3)Health Metrics Research Center, Iranian Institute for Health Sciences
Research, ACECR, Tehran, Iran.
(4)Department of Health Education and Promotion, Public Health School, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran. arabanm@ajums.ac.ir.
(5)Social Determinants of Health Research Center, Ahvaz Jundishapur University of
Medical Sciences, Ahvaz, Iran. arabanm@ajums.ac.ir.
BACKGROUND: Self-medication is a public health concern that may create several

problems such as increase in drug resistance, raise in drug use per capita, and
creating side effects. This study was conducted to determine predictors of
self-medication based on the theory of planned behavior (TPB) among the Iranian
women.
METHODS: This was a cross sectional study. A sample of married women completed a
validated, anonymous, self-administered questionnaire. The questionnaire included
items on demographic variables, knowledge, and TPB structures, and the checklist
of women's self-medication practices. The study was conducted in six urban health
centers of Shush and Zarandieh in Iran during January to July 2016. Data were
analyzed using SPSS 23.0 applying t-test and logistic regression.
RESULTS: A total of 360 women took part in the study. The results showed that 76%
of women had a history of self-medication and 98.9% stored drugs at home. The
most important reasons for self-medication were perceived self-medication
harmless (41%), having history of a disease (35.5%), and availability of
medications at home (34%). The most frequent diseases for self-medication were
fatigue, weakness, and anxiety (24%), and fever (20%). The results obtained form
logistic regression analysis indicated that age, place of residence, education
level, health insurance status, as well as all constructs of the TPB were
significant predictors for self-medication.
CONCLUSION: The findings indicated that the prevalence of self-medication among
Iranian women was high. Since women have important role in shaping the family
health, the issue of high prevalence among this population should be considered
as a serious problem in Iran. In this regard, it is recommended to consider
factors affecting self-medication among women to reduce this health threatening
factors.
DOI: 10.1186/s12889-019-7302-3
PMCID: PMC6676788
PMID: 31370891
101. Diseases. 2018 Jun 8;6(2). pii: E49. doi: 10.3390/diseases6020049.
Prevalence and Determinants of Antibiotic Self-Medication among Adult Patients

with Respiratory Tract Infections in the Mboppi Baptist Hospital, Douala,
Cameroon: A Cross-Sectional Study.
Ngu RC(1)(2)(3)(4), Feteh VF(5)(6), Kika BT(7)(8), F EKN(9)(10)(11), Ayeah

CM(12)(13), Chifor T(14), Njim T(15)(16), Fankem AM(17), Yengo FKF(18).
Author information:
(1)Medical Doctors Research Group (MDRG), Douala 15161, Cameroon.
crolandn@cbchealthservices.org.
(2)Mboppi Baptist Hospital Douala, Douala 15161, Cameroon.
(3)Health and Human Development (2HD) Research Network, Douala 4856, Cameroon.
(4)Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, UK.
vitalfeteh@gmail.com.
vitalfeteh@gmail.com.
belmondkika@gmail.com.
(8)District Hospital Ekondo-Titi, Ekondo-Titi 281, Cameroon.
belmondkika@gmail.com.
emadenericek@gmail.com.
emadenericek@gmail.com.
(11)School of Public Health ⁻ University of Brussels, Brussels CP 598, B-1070,
Belgium. emadenericek@gmail.com.
ayeahmarkchiatoh@yahoo.com.
ayeahmarkchiatoh@yahoo.com.
chifor.terry@gmail.com.
tsi.njim@lstmed.ac.uk.
(16)Department of International Public Health, Liverpool School of Tropical
Medicine, Liverpool L3 5QA, UK. tsi.njim@lstmed.ac.uk.
manuelafankem@gmail.com.
(18)Mboppi Baptist Hospital Douala, Douala 15161, Cameroon. faiyo.fy@gmail.com.
Antibiotic self-medication in patients with respiratory tract infections (RTI) is

increasing globally and has been reported to be one of the prime contributors to
antimicrobial resistance (AMR). Our study aims to provide data on the prevalence
of antibiotic self-medication and identify the factors contributing to
self-medication in adult patients with respiratory tract infection in an urban
setting in Cameroon. This was cross-sectional study carried out at Mboppi Baptist
Hospital, Douala, Cameroon. A validated structured questionnaire was administered
to 308 consenting participants with diagnosed RTIs, to collect data on
socio-demographic characteristics and history of antibiotic self-medication.
Significance was set at a p-value < 0.05. The prevalence of antibiotic
self-medication amongst individuals with RTIs was 41.9% (95% CI 36.5% to 47.5%).
Patients with a history of pulmonary tuberculosis (TB) were significantly less
likely to self-medicate with antibiotics (p-value = 0.043). The most common
source of antibiotic self-medication was pharmacies (62%) and Cotrimoxazole and
Amoxicillin were the most commonly used antibiotics (38.8% (50), 26.4% (34),
respectively). Self-medication with antibiotics in adult patients with RTIs is
common in Cameroon. Control of the use of antibiotics, organisation of medication
stewardship programs, and education of the general population on the adverse
consequences of antibiotic self-medication are required.
DOI: 10.3390/diseases6020049
PMCID: PMC6023369
PMID: 29890712
102. J Sports Sci Med. 2016 May 23;15(2):387-8. eCollection 2016 Jun.
Self-Medication Practice among Amateur Runners: Prevalence and Associated

Factors.
Locquet M(1), Beaudart C(1), Larbuisson R(2), Buckinx F(1), Kaux JF(3), Reginster
JY(4), Bruyère O(1).
Author information:
(1)Department of Public Health, Epidemiology and Health Economics, University of
Liège, Belgium; Support Unit in Epidemiology and Biostatistics, University of
Liège , Belgium.
(2)Department of Anesthesiology-Reanimation, University of Liège , Belgium.
(3)Department of Physical Medicine and Sport Traumatology, University of Liège,
Belgium; Department of Motricity Sciences, University of Liège , Belgium.
Liège , Belgium.
PMCID: PMC4879456
PMID: 27274680
103. BMC Health Serv Res. 2016 May 13;16:179. doi: 10.1186/s12913-016-1425-3.
Factors influencing the current practice of self-medication consultations in

Eastern Indonesian community pharmacies: a qualitative study.
Brata C(1)(2), Fisher C(3), Marjadi B(4), Schneider CR(5), Clifford RM(6).
Author information:
(1)Centre of Medicine Information and Pharmaceutical Care, The University of
Surabaya, Surabaya, Indonesia. cecilia.brata@gmail.com.
(2)Pharmacy, School of Medicine and Pharmacology, The University of Western
Australia, Perth, Australia. cecilia.brata@gmail.com.
(3)School of Population Health, The University of Western Australia, Perth,
Australia.
(4)School of Medicine, The University of Western Sydney, Campbelltown, Australia.
(5)Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
Australia, Perth, Australia.
BACKGROUND: Research has shown that the current practice of pharmacy staff when
providing self-medication consultations in Indonesia is suboptimal. To improve
the performance of pharmacy staff when providing self-medication consultations in
community pharmacies, the factors that influence current practice need to be
understood. The aim of this study is to identify the factors that influence
current practice of pharmacy staff when handling self-medication consultations in
Eastern Indonesian community pharmacies.
METHODS: Fifteen in-depth interviews were conducted with pharmacists, pharmacy
technicians, pharmacy owners, and counter attendants. Thematic analysis was used
to generate findings.
RESULTS: The current practice of pharmacy staff when handling self-medication
consultations is directly influenced by the professionalism of pharmacy staff and
patient responses to the consultations. These factors are in turn affected by the
organisational context of the pharmacy and the external pharmacy environment. The
organisational context of the pharmacy includes staffing, staff affordability,
and the availability of time and facilities in which to provide consultations.
The external pharmacy environment includes the number of trained pharmacy staff
in the research setting, the relevance of pharmacy education to the needs of
pharmacy practice, the support offered by the Indonesian Pharmacists Association,
a competitive business environment, and the policy environment.
CONCLUSION: Complex and inter-related factors influence the current practice of
pharmacy staff when providing self-medication consultations in community
pharmacies in this research setting. Multiple strategies will be required to
improve consultation practices.
DOI: 10.1186/s12913-016-1425-3
PMCID: PMC4866032
104. Ann Afr Med. 2018 Apr-Jun;17(2):70-74. doi: 10.4103/aam.aam_28_17.
Topical ear drop self-medication practice among the Ear, Nose, and Throat
patients in Ido Ekiti, Nigeria: A cross - sectional study.
Olajide TG(1), Aremu KS(1), Esan OT(1), Dosunmu AO(1), Raji MM(1).
Author information:
(1)Department of Ear, Nose and Throat Surgery, Federal Teaching Hospital
Ido-Ekiti, Ekiti State, / Afe Babalola University Ado Ekiti (ABUAD), Nigeria.
Background: Self-medication is a common habit in our country; Nigeria, especially

among patients with otorhinolaryngological disorders. Medication when taken
wrongly may bring dire consequences to the individual, such as masking developing
diseases and may cause many other undesirable effects. The aim of this study was
to determine the prevalence and to analyze topical ear drop self-medication
practices among respondents attending the Ear, Nose, and Throat Clinic of Federal
Teaching Hospital Ido Ekiti, Nigeria.
Design and Methodology:: A 6-month hospital based cross-sectional study was
conducted among patients who were seen in the Ear, Nose, and Throat facility of
Federal Teaching Hospital, Ido Ekiti from July to December 2016 to determine
topical ear drop self-medication practices. A pretested semi-structured
questionnaire was used to obtained information from respondents.
Results:: A total of 162 respondents out of 493 patients seen during the study
had otological problems. Of which 107 (66%) respondents had engaged in
self-medication with topical ear drops. Their ages ranged between 2 and 83 years
with a mean age of 36.6 ± 19.1 years. There were 75 males and 87 females. The
major reason for self-medication was that their ailments were minor in about
40.2% and the most common indication for self-medication was ear blockage with
hearing impairment (33.6%). Pharmacy/chemist shops (42%) were major sources of
information for those that self-medicated. Chloramphenicol and gentamycin were
the major drugs that were used by the respondents.
Conclusion: Majority of the respondents in this study practiced self-medication
using different topical ear drops. Major source of information on the topical ear
drops used was from pharmacy/chemist shops. There is a need for adequate public
health education to create awareness among people on the danger of
self-medication and to enact or enforce the law to reduce access to over the
counter drugs. Healthcare should be made available and avoidable at primary
health-care level.
Publisher: Contexte: L'automédication est une habitude courante dans notre pays;
Nigéria, en particulier chez les patients présentant des troubles
oto-rhino-laryngologiques. Les médicaments pris à tort peuvent avoir des
conséquences désastreuses pour l'individu, comme masquer des maladies en
développement et causer de nombreuses autres effets indésirables. Le but de cette
étude était de déterminer la prévalence et d'analyser les pratiques
d'automédication les participants à la clinique de l'oreille, du nez et de la
gorge de l'hôpital fédéral d'enseignement Ido Ekiti, au Nigeria. Conception et
Méthodologie: 6 mois étude transversale en milieu hospitalier a été menée auprès
de patients qui ont été vus dans l'établissement Oreille, Nez et Gorge de
l'Enseignement Fédéral Hôpital, Ido Ekiti de juillet à décembre 2016 pour
déterminer les pratiques d'automédication topique des gouttes auriculaires. Un
questionnaire semi-structuré prétesté a été utilisé pour obtenir des informations
auprès des répondants. Résultats: Un total de 162 répondants sur 493 patients vus
au cours de l'étude avaient problèmes otologiques. Dont 107 (66%) répondants se
sont engagés dans l'automédication avec des gouttes auriculaires topiques. Leur
âge variait entre 2 et 83 ans avec un âge moyen de 36,6 ± 19,1 ans. Il y avait 75
hommes et 87 femmes. La principale raison de l'automédication était que leur les
troubles étaient mineurs dans environ 40,2% des cas et l'indication la plus
fréquente d'automédication était un blocage de l'oreille avec déficience auditive
(33,6%). Les pharmacies / pharmacies (42%) étaient les principales sources
d'information pour ceux qui se soignaient eux-mêmes. Le chloramphénicol et la
gentamycine médicaments importants qui ont été utilisés par les répondants.
Conclusion: La majorité des répondants à cette étude pratiquaient
l'automédication en utilisant différents gouttes auriculaires topiques. La
principale source d'information sur les gouttes auriculaires topiques utilisées
provenait des pharmacies / pharmacies. Il y a un besoin de l'éducation en matière
de santé publique pour sensibiliser les gens au danger de l'automédication et
pour promulguer ou appliquer la loi afin de réduire l'accès à des médicaments en
vente libre. Les soins de santé devraient être disponibles et évitables au niveau
des soins de santé primaires. Mots-clés: Automédication, Nigeria, pratique,
gouttes auriculaires topiques.
DOI: 10.4103/aam.aam_28_17
PMCID: PMC5875122
Conflict of interest statement: There are no conflicts of interest
105. Indian J Pharmacol. 2015 Sep-Oct;47(5):524-9. doi: 10.4103/0253-7613.165195.
Trends in self-medication for dental conditions among patients attending oral

health outreach programs in coastal Karnataka, India.
Simon AK(1), Rao A(2), Rajesh G(2), Shenoy R(2), Pai MB(2).
Author information:
(1)Department of Public Health Dentistry, Vivekanandha Dental College for Women,
Elayampalayam, Tiruchengode, Tamil Nadu, India.
(2)Department of Public Health Dentistry, Manipal College of Dental Sciences,
Manipal University, Mangalore, Karnataka, India.
OBJECTIVES: To determine the prevalence, pattern, and awareness of

self-medication practices among patients presenting at oral health outreach
programs in coastal Karnataka, India.
MATERIALS AND METHODS: The cross-sectional study, based on an interview conducted
in randomly selected 400 study subjects from the patients presenting at these
oral health outreach programs. Data were collected regarding demographic
information and the interview schedule consisting of 14 questions was
administered.
RESULTS: Prevalence of self-medication was 30%. Respondents' gender (χ(2) =
5.095, P < 0.05), occupation (χ(2) = 10.215, P < 0.05), the time from the last
dental visit (χ(2) = 8.108, P < 0.05), recommendation of drug(s) to family
members or friends (χ(2) = 75.565, P < 0.001), and the likelihood of
self-medication in the next 6 months (χ(2) = 80.999, P < 0.001) were
significantly associated with self-medication. Male respondents were less likely
to have undertaken self-medication (odds ratio = 0.581 [0.361, 0.933]). The
frequently self-medicated drug was analgesics (42.5%) for toothache (69.2%). The
regression model explained 39.4% (Nagelkerke R(2)) of the variance in
self-medication practices.
CONCLUSIONS: Prevalence of self-medication was 30% with demographic influence.
Hence, this study highlights the policy implications for drug control by
government agencies and stresses on the need for dental health education to
discourage irrational drug use.
DOI: 10.4103/0253-7613.165195
PMCID: PMC4621674
106. Ther Adv Psychopharmacol. 2015 Jun;5(3):172-8. doi: 10.1177/2045125315583820.
Revisiting the 'self-medication' hypothesis in light of the new data linking low
striatal dopamine to comorbid addictive behavior.
Awad AG(1), Voruganti LL(2).
Author information:
(1)Department of Psychiatry and Institute of Medical Science, University of
Toronto, Humber River Hospital, 2175 Keele Street, Room 243A, Toronto, Ontario
M6M 3Z4, Canada.
(2)Department of Psychiatry, Oakville-Trafalgar Memorial Hospital, Oakville,
Canada.
Persons with schizophrenia are at a high risk, almost 4.6 times more likely, of
having drug abuse problems than persons without psychiatric illness. Among the
influential proposals to explain such a high comorbidity rate, the
'self-medication hypothesis' proposed that persons with schizophrenia take to
drugs in an effort to cope with the illness and medication side effects. In
support of the self-medication hypothesis, data from our earlier clinical study
confirmed the strong association between neuroleptic dysphoria and negative
subjective responses and comorbid drug abuse. Though dopamine has been
consistently suspected as one of the major culprits for the development of
neuroleptic dysphoria, it is only recently our neuroimaging studies correlated
the emergence of neuroleptic dysphoria to the low level of striatal dopamine
functioning. Similarly, more evidence has recently emerged linking low striatal
dopamine with the development of vulnerability for drug addictive states in
schizophrenia. The convergence of evidence from both the dysphoria and
comorbidity research, implicating the role of low striatal dopamine in both
conditions, has led us to propose that the person with schizophrenia who develops
dysphoria and comorbid addictive disorder is likely to be one and the same.
DOI: 10.1177/2045125315583820
PMCID: PMC4502591
PMID: 26199720
107. BMC Res Notes. 2018 Oct 10;11(1):713. doi: 10.1186/s13104-018-3821-8.
Self-medication during pregnancy and associated factors among pregnant women in

Goba town, southeast Ethiopia: a community based cross sectional study.
Zewdie T(1), Azale T(2), Shimeka A(3), Lakew AM(4).
Author information:
(1)Department of Nursing, Alkan University College Goba, Addis Ababa, Ethiopia.
(2)Department of Health Education and Behavioral Science, College of Medicine and
(3)Department of Epidemiology and Biostatistics, College of Medicine and Health
Sciences, University of Gondar, Gondar, Ethiopia.
(4)Department of Epidemiology and Biostatistics, College of Medicine and Health
Sciences, University of Gondar, Gondar, Ethiopia. mayenew15@gmail.com.
OBJECTIVE: The use of self-medications during pregnancy results in serious

structural as well as functional adverse effects on mothers and unborn children.
But little is known about the practice of self-medication used during pregnancy
in Ethiopia. Therefore, this research aimed to assess the prevalence of
self-medication practice and associated factors during pregnancy among pregnant
women in Goba town, southeast Ethiopia.
RESULTS: The prevalence of self-medication was 15.5% (95% CI 0.116, 0.195) in
Goba town. Women who had health problems during pregnancy (AOR = 6.1, 95% CI
2.67, 13.9), women unable to read and write (AOR = 8.87, 95% CI 1.84, 41.95),
those who can read and write (AOR = 5.26, 95% CI 1.34, 20.66) and had primary
education (AOR = 3.57, 95% CI 1.42, 9.02) were more likely to use
self-medication, while women who visited ANC for pregnancy (AOR = 0.028, 95% CI
0.09, 0.87) were less likely to indulge on such practices. In conclusion, the
prevalence of self-medication noted in this work is medium compared to the react
of other studies. Health institutions have to give health education to all
pregnant women attending ANC services regardless of gestational age and types of
health problem.
DOI: 10.1186/s13104-018-3821-8
PMCID: PMC6180449
108. BMC Pharmacol Toxicol. 2014 Dec 23;15:74. doi: 10.1186/2050-6511-15-74.
Self-medication with antibiotics among non-medical university students of

Karachi: a cross-sectional study.
Shah SJ, Ahmad H, Rehan RB, Najeeb S, Mumtaz M, Jilani MH, Rabbani MS, Alam MZ,
Farooq S, Kadir MM(1).
Author information:
(1)Department of Community Health Sciences, Aga Khan University, Karachi,
Pakistan. masood.kadir@aku.edu.
BACKGROUND: The prevalence of self -medication with antibiotics is quite high in
developing countries as opposed to developed countries. Antibiotics are often
taken erroneously for certain ailments, without having the appropriate knowledge
of their use. This carries potential risks for the individual as well as the
community, in form of several side effects such as antibiotic resistance.
Therefore the prevalence of self-medicated antibiotics in developing countries
needs to be studied.
METHODS: A descriptive cross-sectional study was carried out at six different
non-medical universities of Karachi. 431 students were included in the study.
Data was collected using self-administered questionnaires and analyzed using SPSS
version 19.
RESULTS: 50.1% students reported having self-medicated themselves in the past
6 months and 205 (47.6%) reported self-medication with antibiotics. Amoxicillin
was the most self-prescribed antibiotic (41.4%). Awareness of the adverse effects
of antibiotics was demonstrated by 77.3% of the students and sleep disturbance
was the most commonly known (46.5%) side effect. 63.1% denied having any
knowledge about antibiotic resistance and only 19.9% correctly knew that
indiscriminate use of antibiotics can lead to increased antibiotic resistance.
CONCLUSION: The prevalence of self-medication with antibiotics among the
non-medical university students was high despite the awareness of adverse
effects. Antibiotic resistance was a relatively unknown terminology.
DOI: 10.1186/2050-6511-15-74
PMCID: PMC4320599
109. J Psychoactive Drugs. 2018 Apr-Jun;50(2):177-186. doi:

10.1080/02791072.2017.1397304. Epub 2017 Nov 10.
Understanding Postdisaster Substance Use and Psychological Distress Using

Concepts from the Self-Medication Hypothesis and Social Cognitive Theory.
Alexander AC(1), Ward KD(2).
Author information:
(1)a Graduate Assistant, Division of Social and Behavioral Sciences, School of
Public Health , University of Memphis , Memphis , TN , USA.
(2)b Professor, Division of Social and Behavioral Sciences, School of Public
Health , University of Memphis , Memphis , TN , USA.
This article applies constructs from the Self-Medication Hypothesis and Social
Cognitive Theory to explain the development of substance use and psychological
distress after a disaster. A conceptual model is proposed, which employs a
sequential mediation model, identifying perceived coping self-efficacy,
psychological distress, and self-medication as pathways to substance use after a
disaster. Disaster exposure decreases perceived coping self-efficacy, which, in
turn, increases psychological distress and subsequently increases perceptions of
self-medication in vulnerable individuals. These mechanisms lead to an increase
in postdisaster substance use. Last, recommendations are offered to encourage
disaster researchers to test more complex models in studies on postdisaster
psychological distress and substance use.
DOI: 10.1080/02791072.2017.1397304
PMCID: PMC6101235
PMID: 29125424
110. Indian J Pharmacol. 2018 Jul-Aug;50(4):192-196. doi: 10.4103/ijp.IJP_760_16.

Cutaneous adverse drug reactions with fixed-dose combinations: Special reference
to self-medication and preventability.
Tripathy R(1), Pattnaik KP(2), Dehury S(3), Patro S(4), Mohanty P(3), Sahoo
SS(2), Mohanty S(3).
Author information:
(1)Department of Pharmacology, Kalinga Institute of Medical Sciences,
Bhubaneswar, Odisha, India.
(2)ADR Monitoring Centre, Department of Pharmacology, Cuttack, Odisha, India.
(3)Department of Pharmacology and Dermatology, SCB Medical College, Cuttack,
Odisha, India.
(4)Department of Dermatology, MKCG Medical College, Berhampur, Odisha, India.
OBJECTIVES: To identify the association of cutaneous adverse drug reactions

(CADRs) with use of fixed-dose combinations (FDCs) and to compare the occurrence
of preventable CADRs between self-medication and prescribed medication of FDCs.
PATIENTS AND METHODS: All cases of suspected CADRs with the use of FDCs were
collected, and causality assessment was carried out using the WHO UMC scale. The
burden of CADRs on self-medication and prescribed medication was found out.
Preventability status was analyzed by Schumock and Thornton Criteria and compared
between self-medication and prescribed medication.
RESULTS: A total of 74 CADRs were detected; 68.91% were detected with
antimicrobial and 31.09% with nonsteroidal anti-inflammatory drug-based FDCs.
Fluoroquinolones + nitroimidazole was the most commonly suspected medications.
Majority of CADRs (44.59%) were fixed-drug eruptions, which was significantly
higher than others (P = 0.002). Analysis of preventability showed that there was
a significantly higher occurrence of definitely preventable CADRs in
self-medication group (40%) in comparison to prescribed group (6.81%), P = 0.028.
CONCLUSIONS: Self-medication with FDCs is quite common and associated with a
higher rate of preventable CADRs in comparison to that in prescribed medication.
DOI: 10.4103/ijp.IJP_760_16
PMCID: PMC6234708
111. Ger Med Sci. 2015 Jul 9;13:Doc10. doi: 10.3205/000214. eCollection 2015.
Media influence on risk competence in self-medication and self-treatment.
Schweim H(1), Ullmann M(2).
Author information:
(1)Drug Regulatory Affairs, Rheinische Friedrich-Wilhelm-University, Bonn,
Germany.
(2)Committee of Research into Natural Medicines, Munich, Germany.
Media play an important role in the reception of health risks; thus, media
competence is important for enhancing the risk competence of patients and
consumers. In addition to life-long health education, risk competence
particularly requires careful handling of health information because, at present,
the key problem is not the lack of sufficient information on health topics but
the quality of such information. Patients and consumers of health procedures and
health products also require information which relates to their daily life and
matches their life style.
Publisher: Medien spielen bei der Rezeption von gesundheitlichen Risiken eine
wichtige Rolle. Zur Stärkung der Risikokompetenz von Patienten und Verbrauchern
gehört deshalb eine Medienkompetenz. Sie erfordert neben einer lebenslangen
Gesundheitsbildung besonders einen differenzierten Umgang mit
Gesundheitsinformationen, weil nicht die Informationsmenge über gesundheitliche
Themen derzeit ein Problem darstellt, sondern deren Qualität. Patienten bzw.
Anwender gesundheitlicher Verfahren und Produkte brauchen außerdem Informationen,
die sich auf ihren Alltag beziehen bzw. ihren Lebensstil treffen.
DOI: 10.3205/000214
PMCID: PMC4507062
112. PLoS One. 2018 Nov 19;13(11):e0207523. doi: 10.1371/journal.pone.0207523.

eCollection 2018.
Using machine learning to investigate self-medication purchasing in England via

high street retailer loyalty card data.
Davies A(1), Green MA(1), Singleton AD(1).
Author information:
(1)Geographic Data Science Lab, Department of Geography & Planning, University of
Liverpool, Liverpool, United Kingdom.
The availability alongside growing awareness of medicine has led to increased

self-treatment of minor ailments. Self-medication is where one 'self' diagnoses
and prescribes over the counter medicines for treatment. The self-care movement
has important policy implications, perceived to relieve the National Health
Service (NHS) burden, increasing patient subsistence and freeing resources for
more serious ailments. However, there has been little research exploring how
self-medication behaviours vary between population groups due to a lack of
available data. The aim of our study is to evaluate how high street retailer
loyalty card data can help inform our understanding of how individuals
self-medicate in England. Transaction level loyalty card data was acquired from a
national high street retailer for England for 2012-2014. We calculated the
proportion of loyalty card customers (n ~ 10 million) within Lower Super Output
Areas who purchased the following medicines: 'coughs and colds', 'Hayfever',
'pain relief' and 'sun preps'. Machine learning was used to explore how 50
sociodemographic and health accessibility features were associated towards
explaining purchasing of each product group. Random Forests are used as a
baseline and Gradient Boosting as our final model. Our results showed that pain
relief was the most common medicine purchased. There was little difference in
purchasing behaviours by sex other than for sun preps. The gradient boosting
models demonstrated that socioeconomic status of areas, as well as air pollution,
were important predictors of each medicine. Our study adds to the self-medication
literature through demonstrating the usefulness of loyalty card records for
producing insights about how self-medication varies at the national level. Big
data offer novel insights that add to and address issues that traditional studies
are unable to consider. New forms of data through data linkage may offer
opportunities to improve current public health decision making surrounding at
risk population groups within self-medication behaviours.
PMCID: PMC6242371

interests exist.
113. Pak J Med Sci. 2015 Sep-Oct;31(5):1241-5. doi: 10.12669/pjms.315.8216.
Prevalence and pattern of self-medication in Karachi: A community survey.
Afridi MI(1), Rasool G(2), Tabassum R(3), Shaheen M(4), Siddiqullah(5),

Shujauddin M(6).
Author information:
(1)Prof. M. Iqbal Afridi, FCPS, FRCP. Head, Dept. of Psychiatry & Behavioural
Sciences, Head, Dept. of Neurology, Secretary, Faculty of Psychiatry, College of
Physicians & Surgeons, Pakistan. Jinnah Post Graduate Medical Centre (JPMC),
Karachi, Pakistan.
(2)Dr. Ghulam Rasool, MBBS. Postgraduate FCPS-II Trainee, Dept. of Psychiatry &
Behavioural Sciences, Jinnah Post Graduate Medical Centre (JPMC), Karachi,
Pakistan.
(3)Dr. Rabia Tabassum, MBBS.
(4)Dr. Marriam Shaheen, MBBS. Dow University of Health Sciences, Karachi,
Pakistan.
(5)Dr. Siddiqullah, MBBS. Dow University of Health Sciences, Karachi, Pakistan.
(6)Dr. M. Shujauddin, MBBS. Dow University of Health Sciences, Karachi, Pakistan.
OBJECTIVE: To study the prevalence and pattern of self-medication among adult

males and females in Karachi, Pakistan.
METHODS: This cross-sectional community- based survey was carried out at five
randomly selected towns of Karachi (Defence, Gulshan-e-Iqbal, North Nazimabad,
Malir, Orangi town) over a period of 3 months (October, November & December
2012). A sample size of 500 adult cases (250 males & 250 females), with systemic
random selection from different towns of Karachi were inducted in this study. The
city was divided in 5 zones and one town from each zone was selected by systemic
randomization. First available male and female from each randomly selected house
were included in the study. After consent and confidentiality assurance they were
interviewed on semi-structured Performa designed for this purpose. Results were
analyzed and tabulated through SPSS v14.0.
RESULT: The prevalence of self-medication in males and females in Karachi is
found to be 84.8% (males 88.4% and females 81.2%). The most frequent symptoms for
which self-medication used were headache (32.7%), fever (23.3%) and the medicines
used were painkillers (28.8%), fever reducer medicines (19.8%). The most common
reason 33.3% was previous experience with similar symptom.
CONCLUSION: Self-medication is highly prevalent (84.8%) in Karachi. It was
frequently used for headache followed by fever. Predominantly painkillers, fever
reducer and cough syrups were used in the form of tablets and syrups. Main source
of medicines for males were friends and for females were relatives.
DOI: 10.12669/pjms.315.8216
PMCID: PMC4641291
PMID: 26649022
114. J Pharm Policy Pract. 2019 Feb 19;12:3. doi: 10.1186/s40545-019-0165-2.

eCollection 2019.
Self medication practice and associated factors among students of Asmara College
of Health Sciences, Eritrea: a cross sectional study.
Araia ZZ(1), Gebregziabher NK(2), Mesfun AB(3).

Author information:
(1)National TB and Leprosy Control Program, Communicable Disease Control
Division., Ministry of Health, Asmara, Eritrea.
(2)School of Public Health, Asmara College of Health Sciences, Asmara, Eritrea.
(3)Communicable Diseases Control Division, Ministry of Health, Asmara, Eritrea.
Background: Self-medication is a common practice globally and the resulting

irrational drug use is raising concerns. Up-to-date there is no systematic study
conducted on self medication practice among students or the general community in
Eritrea. The present study aimed to determine the prevalence of self-medication
practice and its influencing factors among students of Asmara College of Health
Science.
Methods: A cross sectional study was conducted from 21st May -15th June 2018.
Data on self medication practice and its associated factors was collected using a
self-administered questionnaire. Data analysis was done using SPSS - 23 and
explained with descriptive and inferential statistics.
Results: A total of 313 students responded to the questionnaire with a response
rate of 93.6%. The overall prevalence of self-medication practice was 79.2%.
Headache and fever were reported as the most common complaint related to
self-medication practice. Among the reasons for self medication practice, prior
experience was the most frequently reported. Analgesics, antipyretic and
antibacterial were the leading class of medicine used in self-medication practice
while adverse drug reactions were reported by 9.2% of respondents. In this study,
sex, income, and school of study were found to be the independent predictors for
self-medication practice.
Conclusion: National guideline on medicine access should be developed and strong
measures should be implemented to halt the selling of medications without a
proper prescription. In addition, students should be educated on the consequences
of self-medication practices.
DOI: 10.1186/s40545-019-0165-2
PMCID: PMC6381702
PMID: 30828458
Conflict of interest statement: The study was approved by the research clearance
committee of the Research department of the Ministry of Health, Eritrea. The
participants of the study were informed on the aim and objectives of the study
and written informed consents were obtained from all the participants prior to
data collection. Participants had the right to withdraw from participating in the
study anytime during data collection and confidentiality of the data was assured
by collecting information anonymously and not including personal identifiers.Not
applicable.The authors declare that they have no competing interests.Springer
115. J Pharmacol Pharmacother. 2016 Oct-Dec;7(4):182-183. doi:

10.4103/0976-500X.195903.
Analgesics self-medication among undergraduate students of a Rural Medical

College.
Kumar A(1), Vandana(2), Aslami AN(3).
Author information:
(1)Department of Pharmacology, Narayan Medical College and Hospital, Sasaram,
Bihar, India.
(2)Department of Physiology, Narayan Medical College and Hospital, Sasaram,
Bihar, India.
(3)Department of Community Medicine, Narayan Medical College and Hospital,
Sasaram, Bihar, India.
DOI: 10.4103/0976-500X.195903
PMCID: PMC5242032
PMID: 28163540
116. Int J High Risk Behav Addict. 2015 Jun 20;4(2):e26155. doi:
10.5812/ijhrba.4(2)2015.26155. eCollection 2015 Jun.
Self-Medication With Analgesics and Helicobacter pylori Infection.
Metanat M(1).
Author information:
(1)Infectious Diseases and Tropical Medicine Research Center, Boo-Ali Hospital,
Zahedan University of Medical Sciences, Zahedan, IR Iran.
DOI: 10.5812/ijhrba.4(2)2015.26155
PMCID: PMC4464574
PMID: 26097839
117. J Educ Health Promot. 2014 Nov 29;3:112. doi: 10.4103/2277-9531.145904.

eCollection 2014.
Self-medication among students in Isfahan University of Medical Sciences based on

Health Belief Model.
Pirzadeh A(1), Mostafavi F(1).
Author information:
(1)Department of Health Education and Promotion, School of Health, Isfahan
University of Medical Sciences, Isfahan, Iran.
BACKGROUND: The prevalence of self-medication is high all over the world,

especially in Iran. But there is a paucity of studies to explore self-medication
activities among the university students. Therefore, the present study was
undertaken to determine the self-medication among student in Isfahan University
of Medical Sciences, based on Health Belief Model (HBM).
MATERIALS AND METHODS: This cross-sectional study was conducted in 197 medical
students of Isfahan University of Medical Sciences who were randomly chosen by a
stratified random sampling method in 2009. The data were collected using a
validated and reliable questionnaire based on HBM. Statistical analysis was
performed using SPSS software (ver. 16). Descriptive and analytical statistics
(independent t-test and test) were used. A two-tailed P value lower than 0.05 was
considered statistically significant.
RESULTS: The mean and standard deviation of participants' age was 22.00 ± 2.77
years. 67.3% of the sample consisted of females. The mean scores of knowledge,
perceived susceptibility, perceived severity, perceived benefits, and perceived
barrier were 80.36 ± 18.29, 40.92 ± 13.89, 61.48 ± 19.03, 59.11 ± 18.46, and
30.36 ± 12.40, respectively. According to the results, 84.98% of students had
experienced self-medication at least for one disease during the past 6 months.
CONCLUSIONS: The prevalence of self-medication in medical students is high and we
can consider it as a health problem. So, we need educational interventions for
the students, using HBM constructs.
DOI: 10.4103/2277-9531.145904
PMCID: PMC4275614
PMID: 25540785
118. Drug Discov Ther. 2017 Mar 22;11(1):35-40. doi: 10.5582/ddt.2016.01075. Epub
2017
Feb 8.
Ability of community pharmacists to promote self-care and self-medication by

local residents [I]: Improvements in bone mineral density.
Wada Y(1), Wada Y, Ennyu S, Shimokawa KI, Ishii F.
Author information:
(1)Department of Pharmaceutical Sciences, Meiji Pharmaceutical University.
This study was conducted in order to establish a health management method for the
elderly in a community through follow-ups of bone mineral density (BMD)
measurement results over a 1-year period based on BMD measurements performed by
pharmacists and a guidance program. Regarding BMD measurement results, the
percent young adult mean (%YAM: mean BMD in healthy persons of the same sex aged
between 51 and 82 years old) significantly increased in Period I, during which
the intervention by pharmacists was performed (6 months after the start of
measurements), but significantly decreased in Period II, during which this
intervention was not performed (between 7 and 12 months after the start of
measurements). Based on these results, lifestyle improvements were effective in
Period I regardless of sex or age; however, it may be important to maintain an
improved diet and subject motivation in the future. The results of this study
suggest that community pharmacists play an important role in community medicine
through positive intervention for local residents' health support.
DOI: 10.5582/ddt.2016.01075
119. Pan Afr Med J. 2015 Mar 20;20:276. doi: 10.11604/pamj.2015.20.276.4243.

eCollection 2015.
Factors associated with self medication practice among pregnant mothers attending
antenatal care at governmental health centers in Bahir Dar city administration,
Northwest Ethiopia, a cross sectional study.
Abeje G(1), Admasie C(2), Wasie B(1).
Author information:
(1)Bahir Dar University, College of Medicine and Health Sciences, Bahir Dar,
Ethiopia.
(2)Ethiopian Red Cross Society Essential drug Program, Bahir Dar, Ethiopian.
INTRODUCTION: Studies in different parts of the world indicate that there is high
level use of self medication among pregnant women. But there are no scientific
evidences on it and factors associated with it in Bahir Dar city administration.
The aim of this study was therefore to assess level of self medication and
identify factors associated with it among pregnant women attending ANC service at
governmental health centers in Bahir Dar city administration.
METHODS: Institution based cross-sectional study was conducted from June 20-July
10, 2013. Data were collected using structured questionnaire and analyzed using
SPSS version 16.0. Back ward logistic regression model was used to assess level
of association with self medication practice.
RESULTS: A total of 510 pregnant women were included in the study. Of these,
25.1% reported self-medication during the current pregnancy. Self medication
during pregnancy was significantly associated with gravida (AOR = 2.1, 95% CI:
1.3-3.4), maternal illness on the date of interview (AOR = 4.8, 95% CI: 2.9-8.0)
and location of health facility (AOR = 4.6; 95% CI: 2.9-7.4).
CONCLUSION: A considerable proportion of pregnant women practiced self-medication
during their pregnancy with modern medications or traditional herbs. Mothers who
were multi gravida, who had maternal illness on the date of interview and who
were attending antenatal care were more likely to practice self medication.
DOI: 10.11604/pamj.2015.20.276.4243
PMCID: PMC4483357
120. Saudi Pharm J. 2017 Sep;25(6):884-890. doi: 10.1016/j.jsps.2017.02.002. Epub

2017
Feb 10.
Prevalence of self-medication practice with herbal products among non-psychotic

psychiatric patients from southeastern Serbia: A cross-sectional study.
Stojanović NM(1), Samardžić L(2), Randjelović PJ(3), Radulović NS(4).
Author information:
(1)Faculty of Medicine, University of Niš, Zorana Đinđića 81, 18000 Niš, Serbia.
(2)Clinic for Mental Health, Clinical Center Niš, 18000 Niš, Serbia.
(3)Department of Physiology, Faculty of Medicine, University of Niš, Zorana
Đinđića 81, 18000 Niš, Serbia.
(4)Department of Chemistry, Faculty of Science and Mathematics, University of
Niš, Višegradska 33, 18000 Niš, Serbia.
The aim of this study was to evaluate the usage prevalence of herbal products
(HP) and to ascertain the identity, mode and adverse effects of plant taxa used
in self-medication practice for anxiety, depression and insomnia in patients with
non-psychotic disorders originating from southeastern Serbia. Also, we compared
HP users and non-users on the variables of socio-demographic characteristics,
information source and origin of HP. The study was done by a face-to-face
interview with a trained psychiatrist using a structured questionnaire
administered to 136 adult patients suffering from non-psychotic mental disorders.
A typical herbal-product user among non-psychotic psychiatric patients from
southeastern Serbia is a middle-aged married woman, with a secondary level of
education, unemployed and living in an urban area. Non-psychotic psychiatric
patients, although not living predominantly in rural areas, were familiar with a
variety of ethno-medicines and were often using HP primarily without the
consultation of their psychiatrists/physicians. HP stated to be most frequently
used for psychiatry-related symptoms included: Melissa officinalis,
Mentha × piperita, Hypericum perforatum and Valeriana officinalis. The
interviewees rarely stated adverse reactions related to the HP usage; however,
this should not be generalized, since HP are known to vary in the content of
their adverse reaction-causing constituents.
DOI: 10.1016/j.jsps.2017.02.002
PMCID: PMC5605899
PMID: 28951674
121. J Adolesc Health. 2017 Apr;60(4):380-387. doi:
10.1016/j.jadohealth.2016.09.019.
Epub 2016 Nov 30.
Victimization, Suicidal Ideation, and Alcohol Use From Age 13 to 15 Years:

Support for the Self-Medication Model.
Marschall-Lévesque S(1), Castellanos-Ryan N(2), Parent S(3), Renaud J(4), Vitaro

F(5), Boivin M(6), Tremblay RE(7), Séguin JR(8).
Author information:
(1)Psychology Department, Université de Montréal, Montréal, Québec, Canada.
(2)School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada.
Electronic address: natalie.castellanos.ryan@umontreal.ca.
(3)School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada.
(4)Department of Psychiatry, McGill University, and Douglas Mental Health
University Institute, Montréal, Québec, Canada.
(5)School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada;
Centre de recherche du CHU Ste-Justine, Montréal, Québec, Canada.
(6)Psychology Department, Université Laval, Québec, Québec, Canada.
(7)Centre de recherche du CHU Ste-Justine, Montréal, Québec, Canada; Department
of Pediatrics and Psychology, Université de Montréal, Québec, Canada; Institute
of Genetic, Neurobiological, Social Foundations of Child Development, Tomsk State
University, Russian Federation; School of Public Health and Population Science,
University College, Dublin, Ireland.
(8)Centre de recherche du CHU Ste-Justine, Montréal, Québec, Canada; Department
of Psychiatry, Université de Montréal, Montréal, Québec, Canada.
Comment in
J Adolesc Health. 2017 Apr;60(4):357.
PURPOSE: Recent years have seen increased coverage of adolescent victimization

and suicide. Both adolescent peer victimization and substance use have been
associated with suicidal ideation, with evidence suggesting that all three
factors are interrelated. There are at least four models which can explain the
associations between these factors (i.e., self-medication, secondary mental
disorder, bidirectional, and common factor). However, none of them is being
empirically supported as the dominant model because few longitudinal studies have
explored the association between these factors.
METHODS: The present study compared longitudinal paths of all four models
simultaneously using a cross-lagged model. This was done using self-reported
measures of peer victimization, suicidal ideation, and alcohol use at age 13, 14,
and 15 years in a longitudinal sample of 238 adolescents.
RESULTS: All three variables were moderately stable across time. Significant
cross-lagged associations were found, showing that frequent peer victimization at
age 13 years was associated with higher odds of having suicidal ideation at age
14 years (odds ratio, 1.82; p < .05). In turn, presence of suicidal ideation at
age 14 years was significantly associated with higher alcohol use frequency at
age 15 years (β = .13; p < .05).
CONCLUSIONS: Results support previous literature suggesting that peer
victimization predates alcohol use and extends it by showing clear directionality
between suicidal ideation and alcohol use over 1 year, supporting the
self-medication model. Clarifying the empirical basis of these underlying models
could allow for earlier prevention strategies, by targeting the risk factor that
appears the earliest in the model.
Copyright © 2016 Society for Adolescent Health and Medicine. Published by

Elsevier Inc. All rights reserved.
DOI: 10.1016/j.jadohealth.2016.09.019
PMCID: PMC5366256

eCollection 2018.
Who self-medicates? Results from structural equation modeling in the Greater

Paris area, France.
Vanhaesebrouck A(1), Vuillermoz C(1)(2), Robert S(1)(3), Parizot I(2), Chauvin

P(1).
Author information:
(1)Department of Social Epidemiology, Institut Pierre Louis d'Epidémiologie et de
Santé Publique (UMRS 1136), INSERM, Sorbonne Université, Paris, France.
(2)Research team on social inequalities, Centre Maurice Halbwachs (UMR 8097),
CNRS, EHESS, ENS, Paris, France.
(3)Department of General Practice, Sorbonne Université, Paris, France.
OBJECTIVES: Our study aimed to describe the prevalence of self-medication among

the Paris adult population and to identify the factors associated with
self-medication.
MATERIALS AND METHODS: This cross-sectional study was based on data collected
from the SIRS cohort (a French acronym for "Health, inequalities and social
ruptures") in 2005 in the Paris metropolitan area using a face-to-face
administration questionnaire among a representative sample of 3,023
French-speaking adults. Structural equation models were used to investigate the
factors associated with self-medication in the overall population and according
to income.
RESULTS: The prevalence of self-medication in the past four weeks was 53.5% in
the Paris metropolitan area. Seven factors were directly associated with
self-medication in the structural equation model. Self-medication was found more
common among women, young people, in active employment or student, with a high
income, but also among people with a health information seeking behavior, with a
high daily mobility, and/or with a history of unmet healthcare needs due to
economic reasons. When looking at these coefficients according to income, the
association between self-medication and daily mobility appeared stronger in the
bottom quartile of income whereas it was no longer significant in the rest of the
survey population.
CONCLUSION: Self-medication is a frequent practice in the Paris metropolitan
area. This study confirms the role of some factors found to be associated with
self-medication in the literature such as age or gender and draws attention to
other factors rarely explored such as daily mobility, especially among people
with a low income, or health information seeking behavior.
PMCID: PMC6296538

interests exist.
123. J Clin Diagn Res. 2015 Dec;9(12):FC17-22. doi: 10.7860/JCDR/2015/16553.6988.

Epub
2015 Dec 1.
Knowledge, Attitude and Practice of Self-Medication Among Basic Science
Undergraduate Medical Students in a Medical School in Western Nepal.
Gyawali S(1), Shankar PR(2), Poudel PP(3), Saha A(4).
Author information:
(1)Assistant Professor, Department of Pharmacology, Manipal College of Medical
Sciences (MCOMS) , Deep height, Pokhara, Nepal .
(2)Professor, Department of Pharmacology, Xavier University School of Medicine ,
Oranjestad, Aruba, Kingdom of the Netherlands .
(3)Assistant Professor, Department of Anatomy, Manipal College of Medical
(4)Professor and Head, Department of Pharmacology, Manipal College of Medical
INTRODUCTION: Studies have shown self-medication to be common among medical

students. These studies are however, few in Nepal. The present study assessed
knowledge, attitude, and practice of self-medication among second and fourth
semesters' undergraduate medical students and studied differences in knowledge
and attitude (if any) among different subgroups of the respondents.
MATERIALS AND METHODS: A cross-sectional survey was conducted using a
questionnaire among basic science medical students of Manipal College of Medical
Sciences, Nepal. Semester of study, gender, age, nationality, and the profession
of their parents were noted. Students' knowledge and attitude about
self-medication was studied by noting their degree of agreement with a set of 40
statements using a Likert-type scale. The average scores and frequency of
occurrence of particular behaviors among different categories of respondents were
compared using appropriate statistical tests.
RESULTS: Two hundred and seventy-six of the 295 (93.6%) students participated.
The mean (SD) knowledge, attitude, and total scores were 74.54 (6.92), 67.18
(5.68), and 141.73 (10.76) with maximum possible scores 100, 100 and 200,
respectively. There was no significant difference in scores according to
respondents' gender, age, and the profession of their parents. However, the mean
knowledge, attitude and total scores were significantly different among students
of different nationalities. Mean scores of fourth semester students were
significantly higher compared to second semester students. There were differences
in knowledge and total scores among students of different nationalities. Eighty
two percent of respondents had self-medicated during the one year period
preceding the study; 149 respondents (54%) shared that previous experience with
the medicine was one of the information sources for self-medication. Prevalence
of self-medication among respondents according to semester of study, gender, age,
and profession of the parents was not significantly different. The use of
self-medication was more common among Sri Lankan respondents compared to
Nepalese. Painkillers (73.2%), antipyretics (68.8%), and antimicrobials (56.2%)
were most commonly used for self-medication.
CONCLUSION: Students' knowledge and attitude about self-medication is good. The
prevalence of self-medication among medical students was high.
DOI: 10.7860/JCDR/2015/16553.6988
PMCID: PMC4717826
PMID: 26816912
124. J Pharm Bioallied Sci. 2015 Apr-Jun;7(2):109-15. doi: 10.4103/0975-

7406.154432.
Antibiotics self-medication among medical and nonmedical students at two

prominent Universities in Benghazi City, Libya.
Ghaieth MF(1), Elhag SR(1), Hussien ME(1), Konozy EH(1).
Author information:
(1)Department of Biochemistry, Faculty of Basic Medical Sciences, Libyan
International Medical University, Benghazi, Libya.
BACKGROUND: Trivial use of antibiotics is a major reason for the spread of

antibiotics resistance. The aim behind undertaking this investigation was to
study the prevalence antibiotics self-medication among university students in
Benghazi city.
METHODS: A questionnaire-based cross-sectional, survey was conducted at both
Libyan International Medical University and Benghazi University. A total of 665
copies of questionnaires was distributed. A total of 363 forms were completed and
returned (response rate 55%). Remaining responses were either with no antibiotics
use history within the past 1 year or were provided incomplete.
RESULTS: Among the respondents, 45% were males and 55% females. Males practiced
self-medication more compared to females. Approximately, 43% and 46% from medical
and nonmedical students, respectively, were antibiotics self-medicated. A total
of 153 students (42%) out of total respondents administered antibiotics for
symptoms related to respiratory problems, among which 74 students (48%) took
antibiotics based on doctor's prescription. Among the respondents, 94 students
(27%) who had antibiotics, were covered under medical insurance, and 19 (29%) of
the medically insured students had antibiotics without doctor's prescription.
About 14% of students did not complete their antibiotics course. Of these, 57%
were medical students, and 43% were nonmedical students. The rate of
self-medication among higher classes was more as compared to lower classes. About
58% of students overdosed the antibiotic, while 15% had antibiotics for <3 days,
for treatment of ailments such as acne, toothache, diarrhea, earache, and
tonsillitis. About 75% of students purchased the antibiotics in consultation with
a pharmacist.
CONCLUSION: Self-medication is a frequent problem among university students in
Benghazi city. There is a need for an immediate intervention to address this
malpractice among both students and medical practitioners.
DOI: 10.4103/0975-7406.154432
PMCID: PMC4399008
PMID: 25883514
125. Integr Pharm Res Pract. 2015 Jun 24;4:57-65. doi: 10.2147/IPRP.S70403.
eCollection 2015.
Role of community pharmacists in patients' self-care and self-medication.
Rutter P(1).
Author information:
(1)School of Pharmacy, University of Wolverhampton, Wolverhampton, UK.
This review highlights the growing prominence of self-care and explores the
contribution of community pharmacy. Firstly, background to self-care is
discussed, followed by placing self-care in context with regard to the general
public and accessing community pharmacy. From this perspective the contribution
community pharmacy currently makes is assessed, paying particular attention to
the factors that negatively impact on the ability of community pharmacy to
facilitate self-care.
DOI: 10.2147/IPRP.S70403
PMCID: PMC5741028
PMID: 29354520
Conflict of interest statement: Disclosure The author declares no conflicts of

126. Addiction. 2016 Jul;111(7):1160-74. doi: 10.1111/add.13324. Epub 2016 Mar 18.
Gabapentin misuse, abuse and diversion: a systematic review.
Smith RV(1)(2)(3), Havens JR(1)(2), Walsh SL(1)(4)(5).
Author information:
(1)Center on Drug and Alcohol Research, Department of Behavioral Science,
University of Kentucky College of Medicine, Lexington, KY, USA.
(2)Department of Epidemiology, University of Kentucky College of Public Health,
Lexington, KY, USA.
(3)Department of Biostatistics, University of Kentucky College of Public Health,
Lexington, KY, USA.
(4)Department of Pharmacology, University of Kentucky College of Medicine,
Lexington, KY, USA.
(5)Department of Pharmaceutical Sciences, University of Kentucky College of
Pharmacy, Lexington, KY, USA.
Comment in
Addiction. 2016 Jul;111(7):1175-6.
BACKGROUND AND AIMS: Since its market release, gabapentin has been presumed to
have no abuse potential and subsequently has been prescribed widely off-label,
despite increasing reports of gabapentin misuse. This review estimates and
describes the prevalence and effects of, motivations behind and risk factors for
gabapentin misuse, abuse and diversion.
METHODS: Databases were searched for peer-reviewed papers demonstrating
gabapentin misuse, characterized by taking a larger dosage than prescribed or
taking gabapentin without a prescription, and diversion. All types of studies
were considered; grey literature was excluded. Thirty-three papers met inclusion
criteria, consisting of 23 case studies and 11 epidemiological reports. Published
reports came from the United States, the United Kingdom, Germany, Finland, India,
South Africa and France, and two analyzed websites not specific to a particular
country.
RESULTS: Prevalence of gabapentin misuse in the general population was reported
to be 1%, 40-65% among individuals with prescriptions and between 15 and 22%
within populations of people who abuse opioids. An array of subjective
experiences reminiscent of opioids, benzodiazepines and psychedelics were
reported over a range of doses, including those within clinical recommendations.
Gabapentin was misused primarily for recreational purposes, self-medication or
intentional self-harm and was misused alone or in combination with other
substances, especially opioids, benzodiazepines and/or alcohol. Individuals with
histories of drug abuse were most often involved in its misuse.
CONCLUSIONS: Epidemiological and case report evidence suggests that the
anti-epileptic and analgesic medication gabapentin is being misused
internationally, with substance abuse populations at special risk for
misuse/abuse.
© 2016 Society for the Study of Addiction.
DOI: 10.1111/add.13324
PMCID: PMC5573873
127. BMC Nurs. 2018 Aug 3;17:35. doi: 10.1186/s12912-018-0302-2. eCollection 2018.
Exploring the perceived factors that affect self-medication among nursing

students: a qualitative study.
Soroush A(1), Abdi A(2), Andayeshgar B(1), Vahdat A(1), Khatony A(3)(4).
Author information:
(1)1Clinical Research Development Center of Imam Reza Hospital, Kermanshah
University of Medical Sciences, Kermanshah, Iran.
(2)2Students Research Committee, School of Nursing and Midwifery, Kermanshah
(3)3Social Development and Health Promotion Research Center, Kermanshah
(4)Nursing Department, School of Nursing and Midwifery, Doolat Abaad, Kermanshah,
Iran.
Background: Self-medication is the use of one or more medications without

physician's diagnosis, opinion, or prescription and supervision, which includes
the use of herbal or chemical drugs. Todays, self-medication is one of the
biggest socio-health and economic problems among nursing students of various
societies, including Iran, and because this issue can affected by contextual
factors, this study aimed to explore the perceived factors that affect
self-medication among nursing students.
Methods: In this qualitative study, a semi-structured interview was conducted
with 11 nursing students. The transcript of each interview was reviewed several
times and classified into main categories and sub-categories by content analysis.
To evaluate this study, Guba and Lincoln's four criteria, including credibility,
transferability, dependability, and confirmability were considered for
trustworthiness.
Results: After analyzing the qualitative content of the interviews, four main
categories, including educational backgrounds, nature of the disease, access to
the media, and beliefs and personal experiences, and ten subcategories, including
contact with clinical environment, relative knowledge about medications,
simplicity of the disease, recurrence of the disease, influence of the media, use
of the internet, believing in own knowledge, positive experiences of traditional
medicine, and using own and others' experiences, were extracted.
Conclusions: It seems that, having a relative awareness about various diseases
and medications, which is sometimes associated with taking a few educational
courses with an internship, creates a false confidence in student for
self-medication and prescribing drugs to others. It would be beneficial if the
education system and associated tutors could inform the students about the
possible consequences of this issue. By knowing the internal and subjective
factors that influence the self-medication, this arbitrary practice can be
largely prevented.
DOI: 10.1186/s12912-018-0302-2
PMCID: PMC6091042
PMID: 30123087
Conflict of interest statement: The study was approved by research ethics

committee of Kermanshah University of Medical Sciences. The written consent was
obtained from all the participants. No Applicable. The authors declare there are
no competing interests. Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
128. PLoS One. 2015 May 1;10(5):e0125093. doi: 10.1371/journal.pone.0125093.
eCollection 2015.
Is 'self-medication' a useful term to retrieve related publications in the

literature? A systematic exploration of related terms.
Mansouri A(1), Sarayani A(1), Ashouri A(2), Sherafatmand M(3), Hadjibabaie M(4),
Gholami K(4).
Author information:
(1)Research Center for Rational Use of Drugs, Tehran University of Medical
Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School Of
Public Health, Tehran University of Medical Sciences, Tehran, Iran.
(3)Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Sciences, Tehran, Iran; Faculty of Pharmacy, Tehran University of Medical
BACKGROUND: Self-Medication (SM), i.e. using medications to treat oneself, is a

major concern for health researchers and policy makers. The terms "self
medication" or "self-medication" (SM terms) have been used to explain various
concepts while several terms have also been employed to define this practice.
Hence, retrieving relevant publications would require exhaustive literature
screening. So, we assessed the current situation of SM terms in the literature to
improve the relevancy of search outcomes.
METHODS: In this Systematic exploration, SM terms were searched in the 6
following databases and publisher's portals till April 2012: Web of Science,
Scopus, PubMed, Google scholar, ScienceDirect, and Wiley. A simple search query
was used to include only publications with SM terms. We used Relative-Risk (RR)
to estimate the probability of SM terms use in related compared to unrelated
publications. Sensitivity and specificity of SM terms as keywords in search query
were also calculated. Relevant terms to SM practice were extracted and their
Likelihood Ratio positive and negative (LR+/-) were calculated to assess their
effect on the probability of search outcomes relevancy in addition to previous
search queries. We also evaluated the content of unrelated publications. All
mentioned steps were performed in title (TI) and title or abstract (TIAB) of
publications.
RESULTS: 1999 related and 1917 unrelated publications were found. SM terms RR was
4.5 in TI and 2.1 in TIAB. SM terms sensitivity and specificity respectively were
55.4% and 87.7% in TI and 84.0% and 59.5% in TIAB. "OTC" and "Over-The-Counter
Medication", with LR+ 16.78 and 16.30 respectively, provided the most conclusive
increase in the probability of the relevancy of publications. The most common
unrelated SM themes were self-medication hypothesis, drug abuse and
Zoopharmacognosy.
CONCLUSIONS: Due to relatively low specificity or sensitivity of SM terms,
relevant terms should be employed in search queries and clear definitions of SM
applications should be applied to improve the relevancy of publications.
PMCID: PMC4416799
129. PLoS One. 2019 Jun 28;14(6):e0218772. doi: 10.1371/journal.pone.0218772.

eCollection 2019.
Self-medication practice and associated factors among adult community members of

Jigjiga town, Eastern Ethiopia.
Amaha MH(1), Alemu BM(2), Atomsa GE(3).
Author information:
(1)Public Health Emergency Management, Ethiopian Somali Regional Health Bureau,
Jigjiga, Ethiopia.
(2)Departments of Environmental Health Science, Haramaya University, Harar,
Ethiopia.
(3)School of Public Health, Haramaya University, Harar, Ethiopia.
BACKGROUND: Self-medication is the use of any drug or medication to treat an

illness or ailment without the supervision of a licensed medical doctor/health
care providers. Self-medication practice in Eastern Ethiopia is quite common.
However, there is little information with regard to magnitude and associated
factors. The objective of this study was to assess the magnitude of
self-medication practice and associated factors among adult community members of
Jigjiga town, Eastern Ethiopia.
METHODS: A community based cross-sectional study was conducted from June 27- July
12, 2017. Multistage sampling method was used and the number of kebeles and
Sub-kebeles were selected using simple random sampling technique. Finally,
sampled households in the Sub-kebeles were selected using systematic random
sampling. Data were collected using face to face interview with 547 adult (≥18
years) participants. It was entered and cleaned using EPI-Data version 3.02 and
exported to Statistical Package for Social Science (SPSS) Version 23 for further
analysis. Bi-variable and multivariable logistic regression models were carried
out to identify factors associated with the self-medication.
RESULT: The magnitude of self-medication was found to be 37.5% (95% CI:
(33.6%-41.7%). Educational status of secondary school [(AOR = 0.46; 95% CI:
(0.22-0.98)], high income [(AOR = 3.00; 95% CI: (1.77-5.06)], advised by
neighbors, friends or relatives to take drug for their complaint [(AOR = 2.59;
95% CI: (1.62-4.14)], used old prescription /past experience to bought drugs
[(AOR = 12.19; 95% CI: (6.65-22.35)], follow advertisements of drugs by
television [(AOR = 0.21; 95% CI: (0.05-0.85)], and perception about Hospital
drugs (clinics, health centers and hospitals) do not work [(AOR = 2.36; 95% CI:
(1.39-3.99)] were significantly associated with self-medication.
CONCLUSION: High income, advice by neighbors, friends or relatives to take drug
for their complaint, old prescription/past experience use to bought drugs, and
perception of hospital drugs do not work was positively associated with
self-medication. Therefore, health education should be given to the community on
the importance of hospital drugs (clinics, health centers and hospitals) to shift
their perception.
PMCID: PMC6599130
PMID: 31251745

interests exist.
130. Pharm Pract (Granada). 2018 Jul-Sep;16(3):1332. doi:

10.18549/PharmPract.2018.03.1332. Epub 2018 Sep 26.
Management of allergic rhinitis in the community pharmacy: identifying the

reasons behind medication self-selection.
Tan R(1), Cvetkovski B(2), Kritikos V(3), Yan K(4), Price D(5), Smith P(6),
Bosnic-Anticevich S(7).
Author information:
(1)Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical
Research, University of Sydney. Sydney (Australia). stan6464@uni.sydney.edu.au.
(2)Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical
Research, University of Sydney. Sydney, NSW (Australia).
biljana.cvetkovski@sydney.edu.au.
(3)Clinical Researcher Pharmacist. Quality Use of Respiratory Medicines Group,
Woolcock Institute of Medical Research, University of Sydney; & Department of
Respiratory Medicine, Royal Prince Alfred Hospital. Sydney, NSW (Australia).
vicky.kritikos@sydney.edu.au.
(4)Department of Respiratory Medicine, Royal Prince Alfred Hospital. Sydney, NSW
(Australia). kwokyan@yansydney.com.
(5)Academic Primary Care, University of Aberdeen, Aberdeen (United Kingdom).
dprice@opri.sg.
(6)Institution: Clinical Medicine, Griffith University. Southport, QLD
(Australia). pksm@mac.com.
(7)Professor and Principal Research Fellow. Quality Use of Respiratory Medicines
Group, Woolcock Institute of Medical Research, University of Sydney; & Sydney
Local Health District, Sydney, NSW (Australia).
sinthia.bosnic-anticevich@sydney.edu.au.
Background: Community pharmacists have a key role to play in the management of

allergic rhinitis (AR). Their role is especially important because the majority
of medications used to treat AR are available for purchase over-the-counter
(OTC), allowing patients to self-select their own medications and bypass the
pharmacists. Patients' self-selection often results in suboptimal treatment
selection, undertreated AR and poor clinical outcomes. In order for pharmacists
to optimise the care for AR patients in the pharmacy, pharmacists need to be able
to identify patient cohorts who self-select and are at high risk of
mismanagement.
Objectives: This study aimed to compare the demographics, clinical
characteristics and medication selected, between pharmacy customers who choose to
self-select and those who speak with a pharmacist when purchasing medication for
their AR in a community pharmacy and identify factors associated with AR
patients' medication(s) self-selection behaviour.
Methods: A cross-sectional observational study was conducted in a convenience
sample of community pharmacies from the Sydney metropolitan area. Demographics,
pattern of AR symptoms, their impact on quality of life (QOL) and medication(s)
selected, were collected. Logistic regressions were used to identify factors
associated with participants' medication self-selection behaviour.
Results: Of the 296 recruited participants, 202 were identified with AR; 67.8%
were female, 54.5% were >40 years of age, 64.9% had a doctor's diagnosis of AR,
and 69.3% self-selected medication(s). Participants with AR who self-select were
4 times more likely to experience moderate-severe wheeze (OR 4.047, 95% CI
1.155-14.188) and almost 0.4 times less likely to experience an impact of AR
symptoms on their QOL (OR 0.369, 95% CI 0.188-0.727).
Conclusions: The factors associated with AR patients' self-selecting
medication(s) are the presence of wheeze and the absence of impact on their QOL
due to AR symptoms. By identifying this cohort of patients, our study highlights
an opportunity for pharmacists to engage these patients and encourage discussion
about their AR and asthma management.
DOI: 10.18549/PharmPract.2018.03.1332
PMCID: PMC6207357
PMID: 30416632
Conflict of interest statement: CONFLICT OF INTEREST Vicky Kritikos: Received

honoraria from AstraZeneca, GlaxoSmithKline and Pfizer. Kwok Yan: Received
honoraria for speaking and consulting from AstraZeneca, Boehringer Ingelheim,
GlaxoSmithKline, Meda, Mundipharma and Pfizer. Peter Smith: Has also been a
speaker for Meda, GlaxoSmithKline, Novartis, Mundipharma and AstraZeneca. David
Price: A board membership with Aerocrine, Amgen, AstraZeneca, Boehringer
Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, and Teva Pharmaceuticals;
consultancy agreements with Almirall, Amgen, AstraZeneca, Boehringer Ingelheim,
Chiesi, GlaxoSmithKline, Meda, Mundipharma, Napp, Novartis, Pfizer, Teva
Pharmaceuticals, and Theravance; grants and unrestricted funding for
investigator-initiated studies (conducted through Observational and Pragmatic
Research Institute Pte Ltd) from UK National Health Service, British Lung
Foundation, Aerocrine, AKL Research and Development Ltd, AstraZeneca, Boehringer
Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, Pfizer, Respiratory
Effectiveness Group, Takeda, Teva Pharmaceuticals, Zentiva, and Theravance;
payment for lectures/speaking engagements from Almirall, AstraZeneca, Boehringer
Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Meda, Merck, Mundipharma,
Novartis, Pfizer, Skyepharma, Takeda, and Teva Pharmaceuticals; payment for
manuscript preparation from Mundipharma and Teva Pharmaceuticals; payment for the
development of educational materials from Novartis and Mundipharma; payment for
travel/accommodation/meeting expenses from Aerocrine, Boehringer Ingelheim,
Mundipharma, Napp, Novartis, Teva Pharmaceuticals, and AstraZeneca; funding for
patient enrolment or completion of research from Chiesi, Teva Pharmaceuticals,
Zentiva, and Novartis; stock/stock options from AKL Research and Development Ltd,
which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum
Patient Care Ltd, UK, and 74% of Observational and Pragmatic Research Institute
Pte Ltd, Singapore; and is peer reviewer for grant committees of the Medical
Research Council, Efficacy and Mechanism Evaluation programme, and Health
Technology Assessment. Sinthia Bosnic-Anticevich: A member of the Teva
Pharmaceuticals Devices International Key Experts Panel; received research
support from Research in Real Life; payment for lectures/speaking engagements and
for developing educational presentations from Teva and Mundipharma; received
Honoria from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, for her
contribution to advisory boards/key international expert forum.
131. Anim Welf. 2018 Nov;27(4):327-341. doi: 10.7120/09627286.27.4.327.
Refinements to captive chimpanzee (Pan troglodytes) care: a self-medication

Paradigm.
Webb SN(1)(2), Hau J(2), Schapiro SJ(1)(2).
Author information:
(1)The University of Texas MD Anderson Cancer Center, Michale E Keeling Center
for Comparative Medicine and Research, 650 Cool Water Drive, Bastrop, TX 78602,
USA.
(2)Department of Experimental Medicine, University of Copenhagen, Faculty of
Health Sciences and University Hospital, 3B Blegdamsvej, DK-2200 Copenhagen,
Denmark.
In an effort to enhance welfare, behavioural management continually refines

methods of non-human primate (NHP) care. Chimpanzees (Pan troglodytes) are one of
the most cognitively complex captive NHPs and they have been observed to
self-medicate in the wild. The population of captive chimpanzees in the US is
aged (due to a breeding moratorium instituted in 1998) and will progressively
require more medical care as they get older. To functionally simulate natural
self-medication behaviour, provide chimpanzees with the opportunity to
voluntarily participate in their own healthcare, and open new avenues of
communication between caregivers and chimpanzees, we used a medication choice
paradigm that allowed chimpanzees to choose their daily arthritis medication. We
provided four arthritic, mobility-impaired chimpanzees with meloxicam or
ibuprofen in blue or green Gatorade® to establish associations between the
coloured drinks and the effects of the medications. We subsequently gave each
chimpanzee a choice between the two medications. Behaviour was recorded using
15-min focal animal observations. Mobility was assessed using interactive
mobility tests and a caregiver-rating system. One chimpanzee showed a medication
preference (ibuprofen over meloxicam). The chimpanzees exhibited no significant
behavioural or mobility differences over time, suggesting that ibuprofen and
meloxicam may not differ significantly in their ability to alleviate arthritic
symptoms. Whether or not the chimpanzees show a medication preference, the
opportunity to make meaningful choices and the functional simulation of a complex
behaviour, self-medication, is present when using this medication choice
technique. Furthermore, the paradigm itself could have potential applications for
additional medication options and treatment regimens.
DOI: 10.7120/09627286.27.4.327
PMCID: PMC6594570
PMID: 31244511

eCollection 2018.
Prevalence and determinants of self-medication practice among selected households

in Addis Ababa community.
Shafie M(1), Eyasu M(1), Muzeyin K(2), Worku Y(3), Martín-Aragón S(4).
Author information:
(1)Saint Paul's Hospital Millennium Medical College, Department of Pharmacology,
(2)Saint Paul's Hospital Millennium Medical College, Department of Nursing, Addis
Ababa, Ethiopia.
(3)Saint Paul's Hospital Millennium Medical College, Department of Public Health,
(4)Complutense University of Madrid, School of Pharmacy, Department of
Pharmacology, Madrid, Spain.
BACKGROUND AND AIM: Self-medication (SM) is one part of self-care which is known
to contribute to primary health care. If practiced appropriately, it has major
benefits for the consumers such as self-reliance and decreased expense. However,
inappropriate practice can have potential dangers such as incorrect
self-diagnosis, dangerous drug-drug interactions, incorrect manner of
administration, incorrect dosage, incorrect choice of therapy, masking of a
severe disease, and/or risk of dependence and abuse. The main objective of this
study was to assess the prevalence and determinants of the self-medication
practice (SMP) in Addis Ababa.
METHODOLOGY: A community based cross-sectional study was conducted among selected
households in Addis Ababa from April 2016 to May 2016, with a recall period of
two months before its conduction. Trained data collectors were employed to
collect the data from the 604 sampled participants using pre-tested and validated
questionnaires.
RESULT: Among the 604 participants involved in this study, 422 (69.9%) were
female and 182 (30.1%) were male and there was a mean age of 41.04 (± 13.45)
years. The prevalence of SM in this study was 75.5%. The three most frequently
reported ailments were headache 117 (25.7%), abdominal pain 59 (12.9%) and cough
54 (11.8%). The two main reasons for SM were mildness of illness 216 (47.4%) and
previous knowledge about the drug 106 (23.2%). The two most frequently consumed
medications were paracetamol 92 (20.2%) and traditional remedies 73 (16.0%),
while drug retail outlets 319 (83.3%) were the main source of drugs. The two most
frequently reported source of drug information were health professionals 174
(45.4%) and experience from previous treatment 82 (21.4%). Moreover, there were
statistically significant differences among respondents who reported practicing
SM based on income and knowledge about appropriate SMP.
CONCLUSION AND RECOMMENDATION: Self-medication was practiced with a range of
drugs from the conventional paracetamol and NSAIDs to antimicrobials. Being that
the practice of SM is inevitable, health authorities and professionals are highly
demanded to educate the public not only on the advantages and disadvantages of SM
but on its proper use.
PMCID: PMC5868796
133. Daru. 2019 Jun;27(1):83-89. doi: 10.1007/s40199-019-00244-9. Epub 2019 Jan 24.
Experiences of self-medication among people: a qualitative meta-synthesis.
Fereidouni Z(1), Kameli Morandini M(2), Najafi Kalyani M(3).
Author information:
(1)School of Nursing, Fasa University of Medical Sciences, Fasa, Iran.
(2)Department of Nursing, Faculty of Medicine, Sari Branch, Islamic Azad
University, Sari, Iran.
(3)Department of Medical-Surgical Nursing, School of Nursing and Midwifery,
Shiraz University of Medical Sciences, Shiraz, Iran. majidnajafi5@yahoo.com.
BACKGROUND: Self-medication is one of the major health-related problems in the

world, which causes many problems for people and health systems. No comprehensive
qualitative meta-synthesis has been done to understand the perceptions and
experiences of self-medication among people.
OBJECTIVES: This study aimed to analyze, re-interpret, and synthesize the
existing qualitative studies on perceptions and experiences of self-medication
among people around the world.
METHODS: In this meta-synthesis, all published qualitative studies in PubMed,
Scopus, CINAHL, and Web of Science databases were searched in May 2018. A total
of 543 articles were screened in the primary stage and finally five articles that
met the inclusion criteria were included in the meta-synthesis. The included
studies were analyzed using Noblit & Hare approach.
RESULTS: Initially, 115 codes were identified. In the second stage, the codes
were merged based on similarity and shared meanings. Finally, after checking by
two authors, the following five themes were emerged: cost-effectiveness,
affectivity, inefficiency of the healthcare system, previous experiences, and
oversimplification.
CONCLUSION: The findings of this first meta-synthesis provided a comprehensive
understanding of the perceptions and experiences of self-medication around the
world. The findings showed that the experiences of self-medication could be
classified into personal, social, organizational, and cultural categories. These
findings could help policymakers address these perceptions and experiences in
effective health planning.
DOI: 10.1007/s40199-019-00244-9
PMCID: PMC6593005 [Available on 2020-01-24]
PMID: 30680607
134. BMC Res Notes. 2019 Mar 19;12(1):153. doi: 10.1186/s13104-019-4195-2.

Self-medication practices and associated factors among households at Gondar town,
Northwest Ethiopia: a cross-sectional study.
Jember E(1), Feleke A(2), Debie A(3), Asrade G(2).
Author information:
(1)Department of Pharmacy, College of Medical and Business, Addis Ababa,
Ethiopia.
(2)Department of Health Systems and Policy, Institute of Public Health, College
of Medicine and Health Sciences, University of Gondar, P.O.Box 196, Gondar,
Ethiopia.
(3)Department of Health Systems and Policy, Institute of Public Health, College
of Medicine and Health Sciences, University of Gondar, P.O.Box 196, Gondar,
Ethiopia. debieayal@gmail.com.
OBJECTIVE: Self-medication practice is the selection and use of medicines by

individuals or a member of the individual's family without physician's order to
treat self-recognized or self-diagnosed conditions. It is highly prone to
inappropriate use and wastage of resources, increase drug resistance pathogens
and adverse reactions. Therefore, this study aimed to assess self-medication
practices and associated factors among households at Gondar town, Northwest
Ethiopia.
RESULTS: This community based cross-sectional study was conducted among
households at Gondar town from March to June, 2018. The overall prevalence of
self-medication practices among households at Gondar town were 50.2%. The odds of
self-medication practices among unmarried participants (AOR = 3.12; 95% CI 2.35,
5.34), influenced by peer (AOR = 3.58; 95% CI 2.89, 7.28), poor perceived quality
of health care services (AOR = 4.67; 95% CI 2.56, 7.96) and access to pharmacy
(AOR = 2.32; 95% CI 1.65, 6.76) were higher compared with their counterparts. In
the contrary, the lesser odd was observed among knowledgeable participants about
medications (AOR = 0.27; 95% CI 0.16, 0.39) compared with non-knowledgeable.
Therefore, improving perception of participants about quality of services,
conducting awareness creation and managing negative effects of peer may reduce
self-medication practices.
DOI: 10.1186/s13104-019-4195-2
PMCID: PMC6425615
135. Ann Med Health Sci Res. 2014 Nov;4(6):884-8. doi: 10.4103/2141-9248.144896.
Toothache and self-medication practices: a study of patients attending a niger

delta tertiary hospital in Nigeria.
Anyanechi C(1), Saheeb B(2).
Author information:
(1)Department of Dental Surgery, University of Calabar Teaching Hospital,
Calabar, Nigeria.
(2)Department of Oral and Maxillofacial Surgery, University of Benin Teaching
Hospital, Benin-City, Nigeria.
BACKGROUND: There is evidence that self-medication practices among dental

patients with toothache are common, and despite the adverse clinical
consequences, there is a paucity of literature on it, and only few programs are
available for its control.
AIM: The aim was to assess the self-medication practices among adult dental
patients suffering from toothache.
SUBJECTS AND METHODS: An instrument adapted from modified form of 117-item
self-report questionnaire based on world Health Organization guidelines for
students' substance use survey and open-ended questionnaire was administered to
adult patients attending the Dental and Maxillofacial Surgery Clinic of this
Health Institution for a period of 6 months.
RESULTS: The results show that 80.6% (287/356) subjects indulged in
self-medication practices. Majority of the patients 42.9% (123/287) were in the
2-4(th) decades of life, whereas the male: female ratio was 1.3:1. The most
commonly abused medications/substance was analgesics/non-steroidal
anti-inflammatory drug (243/287; 24.5%), antibiotics (233/287; 23.5%), "touch and
go" (187/287; 18.8%). The practice of self-medication cut across all social
strata, P < 0.01 (significant) and only 3.8% (11/287) subjects admitted knowledge
of the dosage and side-effects of the used medications/substances. The toothache
not being serious initially (112/287; 22.5%) and time constraints to attend
dental clinic (93/287; 18.7%) were the major reasons for self-medication.
CONCLUSION: This study suggests that the practice of self-medication is common
among adult dental patients with toothache in Nigeria. This should be reduced to
the barest minimum by dental health education, upgrading of dental health
facilities, and enforcement of drug control mechanisms.
DOI: 10.4103/2141-9248.144896
PMCID: PMC4250986
PMID: 25506481
136. Indian J Dermatol. 2016 May-Jun;61(3):340-1. doi: 10.4103/0019-5154.182431.
Pigmented Contact Dermatitis Resulting from Self-medication for Postherpetic

Neuralgia.
Neema S(1), Chatterjee M(1), Mukherjee T(2), Jha S(2).
Author information:
(1)Department of Dermatology, Command Hospital (EC), Kolkata, West Bengal, India.
E-mail: shekharadvait@gmail.com.
(2)Department of Pathology, Command Hospital (EC), Kolkata, West Bengal, India.
DOI: 10.4103/0019-5154.182431
PMCID: PMC4885198
PMID: 27293266
137. J Pharm (Cairo). 2018 Feb 20;2018:1749137. doi: 10.1155/2018/1749137.

eCollection
2018.
Self-Medication Practice in Limmu Genet, Jimma Zone, Southwest Ethiopia: Does

Community Based Health Insurance Scheme Have an Influence?
Begashaw Bekele B(1)(2), Tesema Berkesa S(3), Tefera E(3), Kumalo A(4).
Author information:
(1)Department of Public Health, College of Health Sciences, Mizan Tepi
University, Mizan Aman, Ethiopia.
(2)Institute of Public Health, College of Medicine and Health Sciences,
(3)Department of Pharmacy, Jimma University, Jimma, Ethiopia.
(4)Medical Laboratory Sciences Department, College of Medicine and Health
Sciences, Wolaita Sodo University, Sodo, Ethiopia.
Background: Self-medication, which is a form of self-care, is an important

initial response to illness, and many illnesses can be successfully treated at
this stage. It is practiced by a considerable proportion of the population and is
affected by sociodemographic and economic factors. This study was conducted to
assess the practice of self-medication and associated factors in Limmu Genet's
town households, Jimma Zone, Southwest Ethiopia.
Methods and Materials: A community based cross-sectional study was done.
Systematic sampling technique was used to select participants. Data was collected
by face-to-face interviews by using structured questionnaires. After checking the
completeness, missing values, and coding of questionnaires, data was tabulated
and calculated on SPSS version 20.0. Finally data was presented in tables, graphs
frequency, percentage, and cross-tabulation with different variables.
Result: In this study, both self-medication and the prevalence of diseases among
households were 78.1%. That constituted any kind of illness reported by
participants.
Conclusion: Self-medication practice is common among community members regardless
of being community based health insurance members. Therefore, it needs pertinent
health education on legal prescriptions and use of medicines as well as
strengthening the access of community based insurance.
DOI: 10.1155/2018/1749137
PMCID: PMC5838479
PMID: 29675282
138. Biomed Res Int. 2016;2016:3916874. doi: 10.1155/2016/3916874. Epub 2016 Jan 5.
Prevalence and Predictors of Self-Medication with Antibiotics in Al Wazarat

Health Center, Riyadh City, KSA.
Al Rasheed A(1), Yagoub U(2), Alkhashan H(1), Abdelhay O(2), Alawwad A(1), Al
Aboud A(3), Al Battal S(4).
Author information:
(1)Department of Family and Community Medicine, Prince Sultan Military Medical
City, P.O. Box 7897, Riyadh 11159, Saudi Arabia.
(2)Research Unit, Family and Community Medicine Department, Prince Sultan
Military Medical City, P.O. Box 7897, Riyadh 11159, Saudi Arabia.
(3)Al Wazarat Health Center, Prince Sultan Military Medical City, P.O. Box 7897,
Riyadh 11159, Saudi Arabia.
(4)Training and Research Unit of Family and Community Medicine Department, Prince
Sultan Military Medical City, P.O. Box 7897, Riyadh 11159, Saudi Arabia.
BACKGROUND: Antibiotics are responsible for most dramatic improvement in medical

therapy in history. These medications contributed significantly to the decreasing
mortality and morbidity when prescribed based on evidence of microbial infection.
OBJECTIVE: The aim of this study was to determine the prevalence and predictors
of self-prescription with antibiotics in Al Wazarat Health Center, Riyadh City,
Kingdom of Saudi Arabia.
MATERIAL AND METHODS: Cross-sectional study was conducted in Al Wazarat Health
Center between February 2014 and November 2014. Respondents were randomly
selected using a multistage clustered random sampling technique. Data was entered
into SPSS version 21 and analyzed. Descriptive statistics and multiple logistic
regression models were applied.
RESULTS: A total of 681 patients have participated in this study with a response
rate of 92%. The prevalence of self-prescription with antibiotics in Al Wazarat
Health Center was 78.7%. Amoxicillin was the most used self-prescribed antibiotic
with prevalence of (22.3%). Friend advice on self-prescription of antibiotics use
(p = 0.000) and pharmacy near to the participants (p = 0.002) were the most
common predictors for self-prescription with antibiotics.
CONCLUSION: The level of self-prescribing antibiotics is relatively high among
participants. Health education on the appropriate use of antibiotics is highly
recommended. The proper use of treatment guidelines for antibiotic therapy will
significantly reduce self-prescription with antibiotics.
DOI: 10.1155/2016/3916874
PMCID: PMC4736398
139. Rev Bras Epidemiol. 2019 Feb 4;21Suppl 02(Suppl 02):e180007. doi:
10.1590/1980-549720180007.supl.2.
Self-medication practice trend among the Brazilian elderly between 2006 and 2010:
SABE Study.
[Article in English, Portuguese; Abstract available in Portuguese from the

publisher]
Secoli SR(1), Marquesini EA(2), Fabretti SC(3), Corona LP(4), Romano-Lieber

NS(3).
Author information:
(1)Departamento de Enfermagem Médico-Cirúrgica, Escola de Enfermagem,
Universidade de São Paulo - São Paulo (SP), Brasil.
(2)Instituto do Coração, Universidade de São Paulo - São Paulo (SP), Brasil.
(3)Departamento de Prática de Saúde Pública, Faculdade de Saúde Pública,
(4)Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São
Paulo - São Paulo (SP), Brasil.
INTRODUCTION: Self-medication involves the concept of the spontaneous search by

the individual for some drug that he or she considers appropriate to solve a
health problem. Self-medication practice is little explored by the elderly
according to other studies based in population data.
OBJECTIVE: To examine the trends in self-medication practice among the Brazilian
elderly between 2006 and 2010.
METHODS: This is a population-based study whose data were obtained from the
Health, Well-being and Ageing Study (SABE Study). Thesample consisted of 1,257
elderly people in 2006 and 865 in 2010, who used drugs.
RESULTS: The findings showed self-medication reduction from 42.3% in 2006 to
18.2% in 2010. In both periods, predominant utilized therapeutic classes were
those acting on the nervous system (27.9% in 2006, and 29.6% in 2010) and on the
alimentary tract and metabolism (25.5% in 2006, and 35.9% in 2010). The most
commonly used medicines in 2006 and 2010 were analgesics, anti-inflammatories,
and vitamins. There was a tendency to decrease the use of potentially
inappropriate medicines between 2006 (26.4%) and 2010 (18.1%). The elderly
themselves were the main responsible for the decision about the drug use in 2006
(62.5%) and 2010 (66.5%).
CONCLUSION: Theextent of self-medication practice among the elderly who
participated in the study decreased between 2006 and 2010, but the use of
medicines that offer risks to health was still reported. Thus, the findings
reinforce the importance of monitoring, evaluating, and continuously educating
the elderly about risks and benefits of drug consumption, particularly
over-the-counter medicines.
Publisher: Automedicação retrata o princípio do próprio indivíduo buscar
espontaneamente por algum medicamento que considere adequado para resolver um
problema de saúde. Essa prática é ainda pouco explorada entre idosos de acordo
com outros estudos baseados em dados populacionais. Objetivo: Examinar as
tendências da prática de automedicação dos idosos do Estudo SABE entre 2006 e
2010.Estudode base populacional cujos dados foram obtidos do Estudo Saúde,
Bem-Estar e Envelhecimento (SABE). Aamostra de 2006 foi constituída de 1.258
idosos e a de 2010, de 865 idosos que utilizaram medicamentos.Observou-se redução
da automedicação de 42,3% em 2006 para 18,2% em 2010. Em ambos os períodos, as
classes terapêuticas predominantes foram as dos medicamentos com ação no sistema
nervoso (27,9% em 2006 e 29,6% em 2010) e trato alimentar e metabolismo (25,5% em
2006 e 35,9% em 2010). Entreos medicamentos mais usados nos anos de 2006 e 2010
estão os analgésicos/anti-inflamatórios e vitaminas. Houve tendência a declínio
da utilização de medicamentos potencialmente inapropriados entre 2006 (26,4%) e
2010 (18,1%). Oidoso foi o principal responsável pela indicação da automedicação
em 2006 (65,2%) e 2010 (66,5%).A extensão da prática de automedicação nos idosos
do SABE apresentou redução entre 2006 e 2010, porém o emprego de medicamentos que
oferecem risco à saúde ainda foi relatado. Desse modo, os achados reforçam a
importância de monitorar, avaliar e educar continuamente os idosos acerca dos
riscos e benefícios do consumo de medicamentos, sobretudo daqueles isentos de
prescrição.
DOI: 10.1590/1980-549720180007.supl.2
140. J Educ Health Promot. 2018 Aug 2;7:96. doi: 10.4103/jehp.jehp_175_17.

eCollection
2018.
Assessment of knowledge, attitude, and practice toward responsible

self-medication among students of pharmacy colleges located in Anantapur
district, Andhra Pradesh, India.
Susheela F(1), Goruntla N(1), Bhupalam PK(2), Veerabhadrappa KV(3), Sahithi B(1),
Ishrar SMG(1).
Author information:
(1)Department of Pharmacy Practice, Raghavendra Institute of Pharmaceutical
Education and Research, Anantapur, Andhra Pradesh, India.
(2)Department of Pharmacology, Raghavendra Institute of Pharmaceutical Education
and Research, Anantapur, Andhra Pradesh, India.
(3)Department of Pharmacognosy, Raghavendra Institute of Pharmaceutical Education
and Research, Anantapur, Andhra Pradesh, India.
INTRODUCTION: Responsible self-medication plays a vital role in appropriate use

of nonprescription drugs which will improve safety and reduces unwanted effects
of drugs.
AIM: This study is designed to assess knowledge, attitude, and practice (KAP)
toward responsible self-medication among pharmacy students.
SETTINGS AND DESIGN: A cross-sectional survey was conducted in pharmacy students
of various colleges located in Anantapur district, Andhra Pradesh, India.
MATERIALS AND METHODS: A total of 403 pharmacy students were enrolled and
subjected for interview using prevalidated KAP questionnaire on responsible
self-medication.
STATISTICAL ANALYSIS: Descriptive statistics were used to represent the
sociodemographic characteristics and KAP levels. Association of socio-demographic
variables with KAP levels are determined using the Chi-square test.
RESULTS AND DISCUSSION: A total of 403 pharmacy students are recruited in the
study, in these 19 (4.7%) diploma in pharmacy, 260 (64.5%) bachelor in pharmacy,
27 (6.7%) master in pharmacy, and 97 (24.1%) are doctor of pharmacy. Among 403
respondents, 150 (37.2%) good knowledge, 397 (98.5%) positive attitude, and 170
(42.2%) practice toward responsible self-medication. Respondent's age, pharmacy
division, residence, and their parents' profession were significantly associated
with good knowledge and rational practice toward responsible self-medication with
a P < 0.05.
CONCLUSION: The study concludes that pharmacy students are shown more positive
attitude toward responsible self-medication. However, students are lack of
knowledge and practice of responsible self-medication.
DOI: 10.4103/jehp.jehp_175_17
PMCID: PMC6088819
PMID: 30159342
141. BMC Health Serv Res. 2015 Jan 22;15:8. doi: 10.1186/s12913-014-0670-6.
Information-gathering for self-medication via Eastern Indonesian community

pharmacies: a cross-sectional study.
Brata C(1)(2), Marjadi B(3), Schneider CR(4), Murray K(5), Clifford RM(6).
Author information:
Australia, Perth, Australia. 20805921@student.uwa.edu.au.
(2)Centre of Medicine Information and Pharmaceutical Care, The University of
Surabaya, Surabaya, Indonesia. 20805921@student.uwa.edu.au.
(3)School of Medicine, The University of Western Sydney, Sydney, Australia.
B.Marjadi@uws.edu.au.
(4)Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
carl.schneider@sydney.edu.au.
(5)Centre for Applied Statistics, The University of Western Australia, Perth,
Australia. kevin.murray@uwa.edu.au.
Australia, Perth, Australia. rhonda.clifford@uwa.edu.au.
BACKGROUND: Gathering sufficient information when handling self-medication

requests in community pharmacies is an important factor in assisting patients to
obtain appropriate health outcomes. Common types of information usually gathered
include patient identity, signs and symptoms, action taken, medical history, and
current medications being used. The aims of the study were (1) to describe the
types and amount of information gathered by Eastern Indonesian community pharmacy
staff when handling self-medication requests, and (2) to identify factors
associated with the reported amount of information gathered.
METHODS: Patient simulation and pharmacy staff interviews were used. First,
patient simulation was conducted using 2 cough scenarios and 1 diarrhoea
scenario. Second, a structured interview was administered to eligible pharmacy
staff in the setting. The types and amount of information gathered during patient
simulation encounters and reported during pharmacy staff interviews were noted. A
regression analysis was performed to identify factors associated with the amount
of information gathered from the interview data.
RESULTS: The most frequent types of information gathered in patient simulation
encounters were the nature of symptoms (88% in one of the cough scenarios) and
patient identity (96% in the diarrhoea scenario). Other types of information were
gathered in <40% of encounters in each scenario. From the pharmacy staff
interviews, >90% of the 173 interviewees reported that they gathered information
on patient identity, nature of symptoms, and associated symptoms. Information on
medical history and medication used was gathered by 20% and 26% respectively of
the 173 interviewees. The majority of pharmacy staff asked 0 to 2 questions in
the patient simulation encounters compared to 5 questions pharmacy staff reported
as their usual practice during the interviews. Being qualified as a pharmacist or
a pharmacy technician was one of the factors positively associated with the
reported amount of information gathered.
CONCLUSION: There were deficits in the types of information gathered when
pharmacy staff handling self-medication requests. Having a pharmacy educational
background and additional work experience in the pharmacy was positively
associated with the reported amount of information gathered. There could be other
factors contributing to shortcomings in the actual practice which need to be
explored.
DOI: 10.1186/s12913-014-0670-6
PMCID: PMC4312435
142. Value Health. 2014 Nov;17(7):A515. doi: 10.1016/j.jval.2014.08.1595. Epub 2014

Oct 26.
Evaluating Prevalence of Self-Medication in Bahawalpur.
Masood I(1), Ahmad M(1), Khan MS(2), Minhas MU(1).
Author information:
(1)The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
(2)The Islamia University of Bahawalpur, Punjab-Pakistan, Bahawalpur, Pakistan.
DOI: 10.1016/j.jval.2014.08.1595
PMID: 27201598
143. J Nerv Ment Dis. 2017 May;205(5):372-379. doi: 10.1097/NMD.0000000000000668.
Attention Deficit Hyperactivity Disorder, Aggression, and Illicit Stimulant Use:

Is This Self-Medication?
Odell AP(1), Reynolds GL, Fisher DG, Huckabay LM, Pedersen WC, Xandre P, Miočević
M.
Author information:
(1)*School of Nursing, †Center for Behavioral Research and Services, and
‡Department of Psychology, California State University, Long Beach, CA; and
§Department of Psychology, Arizona State University, Tempe, AZ.
This study compares adults with and without attention deficit hyperactivity
disorder (ADHD) on measures of direct and displaced aggression and illicit drug
use. Three hundred ninety-six adults were administered the Wender Utah Rating
Scale, the Risk Behavior Assessment, the Aggression Questionnaire (AQ), and the
Displaced Aggression Questionnaire (DAQ). Those with ADHD were higher on all
scales of the AQ and DAQ, were younger at first use of amphetamines, and were
more likely to have ever used crack and amphetamines. A Structural Equation Model
found a significant interaction in that for those with medium and high levels of
verbal aggression, ADHD predicts crack and amphetamine. Follow-up logistic
regression models suggest that blacks self-medicate with crack and whites and
Hispanics self-medicate with amphetamine when they have ADHD and verbal
aggression.
DOI: 10.1097/NMD.0000000000000668
PMCID: PMC5439354
144. J Educ Health Promot. 2018 May 3;7:66. doi: 10.4103/jehp.jehp_143_17.

eCollection
2018.
Self-medication with antibiotics: A knowledge, attitude, and practice appraisal

of 610 dental patients in Chennai, India, from 2016 to 2017.
Shamsudeen SM(1), Priya RS(2), Sujatha G(1), Muruganandhan J(1), Manikandan K(3).
Author information:
(1)Department of Oral Pathology, Sri Venkateswara Dental College and Hospital,
Chennai, Tamil Nadu, India.
(2)Department of Periodontia, Sri Venkateswara Dental College and Hospital,
Chennai, Tamil Nadu, India.
(3)Department of Public Health Dentistry, Sri Venkateswara Dental College and
Hospital, Chennai, Tamil Nadu, India.
INTRODUCTION: Antibiotics are considered the most commonly sold drugs in

developing countries. In India, these drugs are very much accessible without a
prescription. This irrational and misuse of antibiotics results not only in the
emergence of resistance of bacterial strains but also leads to adverse reactions.
AIM: The aim of this study was to investigate the level of knowledge, attitude,
and practice of antibiotics usage among dental patients.
MATERIALS AND METHODS: Study design: This study was a cross-sectional design; a
prevalidated structured questionnaire comprising 24 questions was used.
SAMPLE SIZE: Six hundred and ten patients visiting a dental hospital, Chennai,
Tamil Nadu, India, were included in the study.
RESULTS: The dental patients involved in self-medication were more than 70%.
80.2% of the study group opted selection of antibiotics from their previous
prescription from dental or medical professional. Adverse effects were faced by
7.8% of patients on taking self-medication. The study group was aware of the
common dental procedures such as extraction and root canal treatment in which
antibiotics were commonly prescribed. Half of the patients (53.8%) do not know
the term antibiotic misuse, and 43.3% of the group opted antibiotic misuse to be
unacceptable.
CONCLUSION: The study revealed the knowledge, attitude, and practice of the
patients about self-medication in the Indian scenario. There is need for
health-care professionals and government bodies to enlighten the public about the
harmful effects of self-medication with antibiotics to overcome the antibiotic
resistance.
DOI: 10.4103/jehp.jehp_143_17
PMCID: PMC5963215
PMID: 29922695
145. Schizophr Res. 2018 Apr;194:62-69. doi: 10.1016/j.schres.2017.03.047. Epub

2017
Apr 6.
Minimal effects of prolonged smoking abstinence or resumption on cognitive

performance challenge the "self-medication" hypothesis in schizophrenia.
Boggs DL(1), Surti TS(1), Esterlis I(2), Pittman B(3), Cosgrove K(2), Sewell
RA(2), Ranganathan M(2), D'Souza DC(4).
Author information:
(1)Psychiatry Service, VA Connecticut Healthcare System, 950 Campbell Avenue,
West Haven, CT 06516, USA; Department of Psychiatry, Yale University School of
Medicine, New Haven, CT, USA.
Medicine, New Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut
Mental Health Center, 34 Park Street, New Haven, CT 06519, USA.
(3)Department of Psychiatry, Yale University School of Medicine, New Haven, CT,
USA; Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, 34
Park Street, New Haven, CT 06519, USA.
Medicine, New Haven, CT, USA; Abraham Ribicoff Research Facilities, Connecticut
Mental Health Center, 34 Park Street, New Haven, CT 06519, USA. Electronic
address: deepak.dsouza@yale.edu.
One prominent, long-standing view is that individuals with schizophrenia smoke

cigarettes more than the general population to "self-medicate" cognitive deficits
and other symptoms. This study tested the self-medication hypothesis by examining
the effects of smoking abstinence and resumption on cognition in patients with
schizophrenia. Nicotine-dependent smokers with schizophrenia (n=26) were trained
on a cognitive battery and then hospitalized to achieve and maintain confirmed
abstinence from smoking for ~1 week. Cognition was tested while smoking as usual
(baseline), one day after smoking cessation (early abstinence), ~1 week later
(extended abstinence), and within ~3 weeks of resuming smoking (resumption). The
test battery included measures of processing speed, attention, conflict
resolution, verbal memory, working memory, verbal fluency, and executive function
to evaluate multiple cognitive domains affected by schizophrenia. Positive and
negative symptoms of schizophrenia, depressive symptoms, and dyskinesia were also
measured at baseline and after prolonged abstinence. There were no significant
changes in global cognitive test performance with smoking cessation, abstinence,
or resumption. There were small decreases in a measure of processing speed and
delayed verbal recall with abstinence, but these findings failed to survive
adjustments for multiple comparisons. Surprisingly, in this within subject
"On-Off-Off-On" design, there were no significant effects of early or prolonged
abstinence from smoking on cognitive and behavioral measures in smokers with
schizophrenia. The results of this study challenge the widely held
"self-medication" hypothesis of smoking and schizophrenia, question the extent of
pro-cognitive effects of smoking and nicotine in schizophrenia, and support
encouraging smoking cessation in schizophrenia.
Published by Elsevier B.V.
DOI: 10.1016/j.schres.2017.03.047
PMCID: PMC5630481
146. Aust Fam Physician. 2015 Jul;44(7):497-501.
Self-medication for cough and the common cold: information needs of consumers.
Kloosterboer SM(1), McGuire T, Deckx L, Moses G, Verheij T, van Driel ML.

Author information:
(1)MD, Faculty of Medicine, Utrecht University, Utrecht, the Netherlands, Faculty
of Medicine.
BACKGROUND: Despite the high use of over-the-counter (OTC) cough and cold
medicines, little is known about Australia's cough and cold medicines information
needs. The aim of this study was to identify gaps in consumers' perceived
knowledge and concerns, to better target consumer medicines information and
improve quality use of medicines.
METHODS: We analysed cough-and-cold related enquiries from consumers who
contacted an Australian national medicine call centre between September 2002 and
June 2010.
RESULTS: Of 5503 cough and cold calls, female callers made up 86% of the calls
and 33% were related to children. Questions most frequently related to drug-drug
interactions (29%). An analysis of narratives over an 18-month period (248 calls)
revealed 20% of the calls concerned potentially clinically relevant interactions,
particularly those involving psychotropic agents.
DISCUSSION: The potential for interactions with cough and cold medicines
purchased OTC is recognised by consumers. Patient information should address
their concerns. Doctors should be aware of the common cough and cold interactions
and communicate likely clinical symptoms to patients when prescribing medication
to prevent potential harm.
147. BMC Public Health. 2019 Jun 10;19(1):726. doi: 10.1186/s12889-019-7020-x.
Prevalence of self-medication with antibiotics and associated factors in the

community of Asmara, Eritrea: a descriptive cross sectional survey.
Ateshim Y(1), Bereket B(2), Major F(2), Emun Y(2), Woldai B(2), Pasha I(2), Habte
E(3), Russom M(4).
Author information:
(1)School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea.
yonatesh23@gmail.com.
(3)Biostatistics and Epidemiology Unit, School of Public Health, Asmara College
of Health Sciences, Asmara, Eritrea.
(4)Eritrean Pharmacovigilance Centre, National Medicine and Food Administration,
Ministry of Health, Asmara, Eritrea.
BACKGROUND: Development of drug resistance caused by self-medication with

antibiotics, can be seen as one of the growing global threats. Self-medication is
defined as the selection and use of medicines by individuals to treat
self-recognized illnesses or symptoms. The purpose of this study is to assess the
practice of self-medication with antibiotics and associated factors among the
community of Asmara, Eritrea.
METHODS: This was a community based descriptive cross-sectional study conducted
in 16 selected sub-districts of Asmara from September to November 2017. A
Two-stage cluster sampling was employed to select study sites and participants.
Data was collected in a face to face interview with a structured questionnaire
and entered to CSPro version 6.2. Descriptive statistics, cross-tabulation and
logistic regression were executed using SPSS version 22.
RESULTS: A total of 580 study participants were recruited with a response rate of
99.5% (N = 577). The prevalence of Self-medication with antibiotics (SMA) in this
study was found to be 45.1% [95% CI (40.5, 49.6)] and majority of them practiced
once or twice in a period of 12 months. The main reasons for SMA were previous
successful experience (34.4%) and the illness being 'not serious enough to seek
medical care' (25.7%). Of those who self-medicated, 84.1% of used amoxicillin at
least once. Wound infection (17.9%) and sore throat (13.9%) were the most
self-recognized complaints that required self-medication. Antibiotics were
supplied and recommended mostly by the community drug outlets. Only Sex
(p = 0.046), knowledge (p = 0.019) and attitude (p < 0.001) of the participants
were found significantly associated with the practice of SMA in the multivariate
logistic regression.
CONCLUSIONS: Though majority of the respondents considered self-medication with
antibiotics as inappropriate practice, about half of them were practicing it
anyway. Therefore immediate attention from relevant bodies is required.
DOI: 10.1186/s12889-019-7020-x
PMCID: PMC6558833
148. PLoS One. 2017 Jul 10;12(7):e0180431. doi: 10.1371/journal.pone.0180431.

eCollection 2017.
Gastrointestinal parasite infections and self-medication in wild chimpanzees

surviving in degraded forest fragments within an agricultural landscape mosaic in
Uganda.
McLennan MR(1)(2), Hasegawa H(3)(4), Bardi M(5), Huffman MA(6).
Author information:
(1)Anthropology Centre for Conservation, Environment and Development, Oxford
Brookes University, Oxford, United Kingdom.
(2)Bulindi Chimpanzee and Community Project, Hoima, Uganda.
(3)Department of Infectious Disease Control, Faculty of Medicine, Oita
University, Hasama, Yufu, Oita, Japan.
(4)Department of Biology, Faculty of Medicine, Oita University, Hasama, Yufu,
Oita, Japan.
(5)Department of Psychology and Behavioral Neuroscience, Randolph-Macon College,
Ashland, Virginia, United States of America.
(6)Primate Research Institute, Kyoto University, Inuyama, Japan.
Monitoring health in wild great apes is integral to their conservation and is

especially important where they share habitats with humans, given the potential
for zoonotic pathogen exchange. We studied the intestinal parasites of wild
chimpanzees (Pan troglodytes schweinfurthii) inhabiting degraded forest fragments
amid farmland and villages in Bulindi, Uganda. We first identified protozoan and
helminth parasites infecting this population. Sixteen taxa were demonstrated
microscopically (9 protozoa, 5 nematodes, 1 cestode, and 1 trematode). DNA
sequence analysis enabled more precise identification of larval nematodes (e.g.
Oesophagostomum stephanostomum, O. bifurcum, Strongyloides fuelleborni, Necator
sp. Type II) and tapeworm proglottids (genus Bertiella). To better understand the
ecology of infections, we used multidimensional scaling analysis to reveal
general patterns of association among parasites, climate, and whole leaf
swallowing-a prevalent self-medicative behaviour at Bulindi linked to control of
nodular worms (Oesophagostomum spp.). Prevalence of parasites varied with climate
in diverse ways. For example, Oesophagostomum sp. was detected in faeces at
higher frequencies with increasing rainfall but was most clearly associated with
periods of low temperature. Certain parasites occurred together within chimpanzee
hosts more or less frequently than expected by chance. For example, the commensal
ciliate Troglodytella abrassarti was negatively associated with Balantidium coli
and Oesophagostomum sp., possibly because the latter taxa make the large
intestine less suitable for T. abrassarti. Whole leaves in faeces showed
independent associations with the prevalence of Oesophagostomum sp.,
Strongyloides sp., and hookworm by microscopic examination, and with egestion of
adult O. stephanostomum by macroscopic inspection. All parasites identified to
species or genus have been reported in wild chimpanzees inhabiting less-disturbed
environments than Bulindi. Nevertheless, several disease-causing taxa infecting
these chimpanzees are potentially transmissible between apes and humans (e.g.
rhabditoid and strongyle nematodes), underscoring the importance of identifying
and reducing risks of pathogen exchange in shared landscapes.
PMCID: PMC5503243
149. East Mediterr Health J. 2014 Oct 12;20(9):547-53.
Household storage of medicines and self-medication practices in south-east

Islamic Republic of Iran.
Foroutan B(1), Foroutan R(2).
Author information:
(1)Department of Pharmacology, School of Medicine, Shahroud University of Medical
Sciences, Shahroud, Islamic Republic of Iran.
(2)School of Medicine, Shiraz University of Medical Sciences, Shiraz, Islamic
Republic of Iran.
Self-medication and inappropriate storage of medicines at home are potential

health risks. This crosssectional study in south-east Islamic Republic of Iran in
2010 aimed to determine where householders kept their medicines and to assess the
frequency and determinants of self-medication. Householders from different parts
of Birjand city (n = 500) were visited and completed a semi-structured
questionnaire. Analgesics were the most common medicines stored at home, followed
by adult cold remedies and antibiotics. The refrigerator was the most common
place for storing medicines (50.6%). Most householders did not consult the
package inserts. Many householders (53.6%) reported that they practised
self-medication, and the frequency of reuse of physicianprescribed antibiotics
was high. There was a significant association between self-medication and
educational level but not with age, sex, martial status, occupation and type of
insurance. Better public knowledge and information about storage and risks of
reuse of prescription medications is needed.
Publisher: ‫التخزين المنزلي للدوية وممارسات التطبيب الذاتي في جنوب شرق جمهورية‬
‫ رضا فوروتانإن التطبيب الذاتي والتخزين غير الملئم‬،‫إيران السلميةبهزاد فوروتان‬
‫ وقد هدفت دراسة أجريت في جنوب شرق‬.‫للدوية في المنزل يشكلن مخاطر صحية محتملة‬
‫ وإلى تقييم‬،‫جمهورية إيران السلمية إلى تحديد الماكن التي تحفظ بها السر أدويتها‬
‫ تمت زيارة أسر من‬2010 ‫ ففي مسح مستعرض أجري عام‬.‫وتيرة التطبيب الذاتي ومحدددداته‬
‫ فكانت‬.‫( وتم ملء استبيان شبه منظم‬500 = ‫مناطق مختلفة من مدينة بيرجند )العدد‬
‫ تلتها أدوية علج نزلت البرد‬،‫المسكنات أكثر الدوية التي تخزن في المنزل شيوعاا‬
‫ وكانت الثلجة المكان الكثر شيوعا ا لتخزين الدوية‬.‫لدى البالغين والمضادات الحيوية‬
(50.6%). ‫ وذكرت أسر‬.‫وتب د رين أن معظم السر لم تطلع على النشرات المدرجة في العبوات‬
‫ وكانت وتيرة إعادة استخدام المضادات‬،‫( أنها تمارس التطبيب الذاتي‬%53.6) ‫كثيرة‬
‫ وكان هناك تراببط كبير بين التطبيب الذاتي‬.‫الحيوية الموصوفة من قبل الطباء عالية‬
‫ لم يكن هناك ترابط مع السن والجنس والمهنة ونوع التأمين وكذلك‬.‫والمستوى التعليمي‬
‫ وخلصت الدراسة إلى أن هناك حاجة إلى تحسين معرفة الجمهور ومعلوماتهم‬.‫الوضع العائلي‬
‫بشأن تخزين الدوية ومخاطر إعادة استخدام أدوية الوصفات الطبية‬.Publisher:
Conservation de médicaments à domicile et pratiques d'automédication dans le
sud-est de la République islamique d'Iran.L'automédication et la conservation
inappropriée de médicaments à domicile représentent des risques potentiels pour
la santé. La présente enquête transversale réalisée en 2010 dans le sud-est de la
République islamique d'Iran visait à déterminer où les ménages conservaient leurs
médicaments et à évaluer la fréquence de l'automédication et ses déterminants.
Des ménages dans différents quartiers de la ville de Birjand (n = 500) ont fait
l'objet d'une visite et ont rempli un questionnaire semi-structuré. Les
analgésiques étaient les médicaments les plus couramment conservés à domicile,
suivis par les médicaments contre le rhume chez l'adulte et les antibiotiques. Le
réfrigérateur était l'endroit le plus fréquent pour la conservation des
médicaments (50,6 %). La plupart des ménages ne consultaient pas les notices des
médicaments. De nombreux ménages (53,6 %) ont affirmé qu'ils pratiquaient
l'automédication, et la fréquence de réutilisation des antibiotiques prescrits
par un médecin était élevée. Il existait une forte association entre
l'automédication et le niveau d'études, contrairement à l'âge, au sexe, à la
situation matrimoniale, au métier et au type d'assurance. La population a besoin
d'accroître ses connaissances et son niveau d'information sur la conservation des
médicaments et sur les risques liés à la réutilisation des médicaments prescrits.
150. J Family Community Med. 2018 May-Aug;25(2):95-101. doi:

10.4103/jfcm.JFCM_124_17.
Self-medication with Antibiotics in a primary care setting in King Khalid

University Hospital, Riyadh, Saudi Arabia.
Al-Qahtani MA(1), Amin HS(1), Al-Qahtani AA(1), Alshahrani AM(1), Alghamdi HA(1),
Althwayee MS(2), Alzahrani AA(2).
Author information:
(1)Department of Family and Community Medicine, King Khalid University Hospital,
College of Medicine, King Saud University, Riyadh, Saudi Arabia.
(2)Department of Family and Community Medicine, Prince Sultan Military Medical
Center, Riyadh, Saudi Arabia.
OBJECTIVES: The objectives of this study are to estimate the prevalence of

self-medication with antibiotics in King Khalid University Hospital population
and evaluate the factors affecting this behavior.
MATERIALS AND METHODS: This was a cross-sectional study conducted at King Khalid
university hospital from April to May 2016. A pretested self-administered
questionnaire was handed to a random selection of 519 patients attending the
primary care clinics . Data were entered into Microsoft Office Excel 2007 and
sent to SPSS version 20 for analysis. Descriptive statistics and logistic
regression were applied.
RESULTS: The prevalence rate of self-medication with antibiotics was 40.8%. Older
patients and males were most likely to use antibiotics without a prescription.
The most common illnesses that made patients use antibiotics was upper
respiratory tract infections (73.2%). Commercial pharmacies were the major source
82.8%. Only 27.8% patients consulted their physicians for the correct dosage .
The previous experience with a similar illness (67.2%) and difficulty in
obtaining medical help (29.3%) were the most common reasons for
self-administration of antibiotics. Improved health condition (57.8%) was the
main reason for stopping the use of antibiotics while lack of improvement in
health status led to a shift to another antibiotic in 62.5% of the respondents.
CONCLUSION: The prevalence of using antibiotics without a prescription is
relatively high. Proper education of the public on the dangers of the misuse of
antibiotics through the media might help to reduce this practice.
DOI: 10.4103/jfcm.JFCM_124_17
PMCID: PMC5958530
PMID: 29922109
151. Front Public Health. 2016 Apr 18;4:69. doi: 10.3389/fpubh.2016.00069.

eCollection
2016.
Observations on the Prevalence, Characteristics, and Effects of Self-Treatment.
Zhao Y(1), Ma S(1).
Author information:
(1)Department of Biostatistics, Yale University , New Haven, CT , USA.
AIMS: When facing illness, a person may choose self-treatment as an alternative

to hospital (and primary care)-based treatment. Despite its important role in
health care, the study on self-treatment remains limited. The goal is to
collectively report the observations in the literature on the prevalence,
characteristics, and effects of self-treatment.
METHODS: Databases (Medline/PubMed and Google Scholar) were searched. Articles
were scrutinized for country of origin, sample size, recall period, prevalence,
associated factors, etc.
RESULTS: Published studies have reported that in some regions, the prevalence of
self-treatment is high and varies across illness conditions and treatment
approaches. Self-medication is the most popular self-treatment approach. Multiple
regional, demographic, personal, cultural, and religious factors have been
implicated in the pursuit of self-treatment. In addition, accessibility of health
care also plays a role. In general, self-treatment has a positive clinical and
financial effect. However, there have been concerns on abuse and possible
negative effects.
CONCLUSION: This article reviews observations made in recent studies on several
important aspects of self-treatment. Comprehensive and systematic study is still
lacking. Interventions are needed to solve several problems associated with
self-treatment.
DOI: 10.3389/fpubh.2016.00069
PMCID: PMC4834428
PMID: 27148515
152. Curr Obes Rep. 2018 Jun;7(2):204-209. doi: 10.1007/s13679-018-0310-2.
Early Childhood Obesity Risk Factors: Socioeconomic Adversity, Family

Dysfunction, Offspring Distress, and Junk Food Self-Medication.
Hemmingsson E(1)(2).
Author information:
(1)The Swedish School of Sport and Health Sciences, Box 5626, 114 86, Stockholm,
Sweden. erik.hemmingsson@gih.se.
(2)Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
erik.hemmingsson@gih.se.
PURPOSE OF REVIEW: To explore the sequence and interaction of infancy and early
childhood risk factors, particularly relating to disturbances in the social
environment, and how the consequences of such exposures can promote weight gain
and obesity.
RECENT FINDINGS: This review will argue that socioeconomic adversity is a key
upstream catalyst that sets the stage for critical midstream risk factors such as
family strain and dysfunction, offspring insecurity, stress, emotional turmoil,
low self-esteem, and poor mental health. These midstream risk factors,
particularly stress and emotional turmoil, create a more or less perfect foil for
calorie-dense junk food self-medication and subtle addiction, to alleviate
uncomfortable psychological and emotional states. Disturbances in the social
environment during infancy and early childhood appear to play a critical role in
weight gain and obesity, through such mechanisms as insecurity, stress, and
emotional turmoil, eventually leading to junk food self-medication and subtle
addiction.
DOI: 10.1007/s13679-018-0310-2
PMCID: PMC5958160
153. J Pharm Bioallied Sci. 2017 Oct-Dec;9(4):251-258. doi:

10.4103/jpbs.JPBS_189_17.
Academic Stress and Prevalence of Stress-Related Self-Medication among

Undergraduate Female Students of Health and Non-Health Cluster Colleges of a
Public Sector University in Dammam, Saudi Arabia.
Al Rasheed F(1), Naqvi AA(2), Ahmad R(3), Ahmad N(4).
Author information:
(1)Pharm.D 5th Year student, College of Clinical Pharmacy, Imam Abdulrahman Bin
Faisal University, Dammam 31441, Saudi Arabia.
Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia.
(3)Department of Natural Products and Alternative Medicines, College of Clinical
Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia.
(4)Department of Pharmaceutics, College of Clinical Pharmacy, Imam Abdulrahman
Bin Faisal University, Dammam 31441, Saudi Arabia.
Objective: The objective was to report academic stress and prevalence of

stress-related self-medication among undergraduate female students of health and
nonhealth cluster colleges at a public sector university in Dammam, Saudi Arabia.
Materials and Methods: A 5-month cross-sectional survey was conducted in the
university. The survey included the English version of 10-item Perceived Stress
Scale (PSS) to report self-perceived stress. Student responses were analyzed by
SPSS version 22 software.
Results: The majority of students (85%) perceived examinations as a stressor.
Most of the students (64%) had perceived moderate stress that increased as
students progressed from preparatory year to 4th year. It declined in students of
5th and 6th year. The prevalence of stress related was reported at 39.58%.
Highest prevalence of stress-induced self-medication was reported from College of
Nursing (59.09%) and lowest (29.69%) from clinical pharmacy. Most common drug
used to self-medicate during stress was caffeine (49.5%). The PSS score was
significantly associated with colleges and study levels.
Conclusion: Students studying in health cluster colleges reported high academic
stress and self-medication practice. The major stressors identified were
examination and course load. Student counseling sessions and counseling by
pharmacists regarding self-care may help in the reduction of such stressors and
may promote responsible self-medication. Self-evaluation and quality assurance
process of curriculum may highlight areas for improvement in the courses. This
may help in lowering academic stress among students.
DOI: 10.4103/jpbs.JPBS_189_17
PMCID: PMC5810075
PMID: 29456376
154. J Trop Med. 2016;2016:6438639. doi: 10.1155/2016/6438639. Epub 2016 Jun 2.
High School Students Are a Target Group for Fight against Self-Medication with
Antimalarial Drugs: A Pilot Study in University of Kinshasa, Democratic Republic
of Congo.
Kabongo Kamitalu R(1), Aloni MN(2).
Author information:
(1)Centre Hospitalier du Mont Amba, University of Kinshasa, Kinshasa, Democratic
Republic of the Congo; Centre de Santé Universitaire, University of Kinshasa,
Kinshasa, Democratic Republic of the Congo.
(2)Division of Hemato-Oncology and Nephrology, Department of Pediatrics,
University Hospital of Kinshasa, School of Medicine, University of Kinshasa,
Kinshasa, Democratic Republic of the Congo.
Aim. To assess the self-medication against malaria infection in population of

Congolese students in Kinshasa, Democratic Republic of Congo (DRC). Methods. A
cross-sectional study was carried out in University of Kinshasa, Kinshasa,
Democratic Republic of Congo. Medical records of all students with malaria
admitted to Centre de Santé Universitaire of University of Kinshasa from January
1, 2008, to April 30, 2008, were reviewed retrospectively. Results. The median
age of the patients was 25.4 years (range: from 18 to 36 years). The majority of
them were male (67.9%). Artemisinin-based combination treatments (ACTs) was the
most used self-prescribed antimalarial drugs. However, self-medication was
associated with the ingestion of quinine in 19.9% of cases. No case of ingestion
of artesunate/artemether in monotherapy was found. All the medicines taken were
registered in DRC. In this series, self-prescribed antimalarial was very
irrational in terms of dose and duration of treatment. Conclusion. This paper
highlights self-medication by a group who should be aware of malaria treatment
protocols. The level of self-prescribing quinine is relatively high among
students and is disturbing for a molecule reserved for severe disease in
Congolese health care policy in management of malaria.
DOI: 10.1155/2016/6438639
PMCID: PMC4909922
PMID: 27340411
155. Learn Mem. 2016 Sep 15;23(10):515-33. doi: 10.1101/lm.042192.116. Print 2016
Oct.
Effects of drugs of abuse on hippocampal plasticity and hippocampus-dependent

learning and memory: contributions to development and maintenance of addiction.
Kutlu MG(1), Gould TJ(2).
Author information:
(1)Department of Biobehavioral Health, Penn State University, University Park,
Pennsylvania 16802, USA.
(2)Department of Biobehavioral Health, Penn State University, University Park,
Pennsylvania 16802, USA thomas.gould@psu.edu.
It has long been hypothesized that conditioning mechanisms play major roles in
addiction. Specifically, the associations between rewarding properties of drugs
of abuse and the drug context can contribute to future use and facilitate the
transition from initial drug use into drug dependency. On the other hand, the
self-medication hypothesis of drug abuse suggests that negative consequences of
drug withdrawal result in relapse to drug use as an attempt to alleviate the
negative symptoms. In this review, we explored these hypotheses and the
involvement of the hippocampus in the development and maintenance of addiction to
widely abused drugs such as cocaine, amphetamine, nicotine, alcohol, opiates, and
cannabis. Studies suggest that initial exposure to stimulants (i.e., cocaine,
nicotine, and amphetamine) and alcohol may enhance hippocampal function and,
therefore, the formation of augmented drug-context associations that contribute
to the development of addiction. In line with the self-medication hypothesis,
withdrawal from stimulants, ethanol, and cannabis results in
hippocampus-dependent learning and memory deficits, which suggest that an attempt
to alleviate these deficits may contribute to relapse to drug use and maintenance
of addiction. Interestingly, opiate withdrawal leads to enhancement of
hippocampus-dependent learning and memory. Given that a conditioned aversion to
drug context develops during opiate withdrawal, the cognitive enhancement in this
case may result in the formation of an augmented association between
withdrawal-induced aversion and withdrawal context. Therefore, individuals with
opiate addiction may return to opiate use to avoid aversive symptoms triggered by
the withdrawal context. Overall, the systematic examination of the role of the
hippocampus in drug addiction may help to formulate a better understanding of
addiction and underlying neural substrates.
© 2016 Kutlu and Gould; Published by Cold Spring Harbor Laboratory Press.
DOI: 10.1101/lm.042192.116
PMCID: PMC5026208
156. J Clin Diagn Res. 2017 Aug;11(8):FC06-FC09. doi:

10.7860/JCDR/2017/25368.10495.
Epub 2017 Aug 1.
Iranians' Self-Report Knowledge and Practice about Arbitrary Use of Antibiotics.
Hosseinzadeh K(1), Azimian J(2).
Author information:
(1)Assistant Professor, Social Determinants of Health Research Centre, Qazvin
University of Medical Sciences, Qazvin, Iran.
(2)Associate Professor, Department of Nursing, Faculty of Nursing and Midwifery,
Qazvin University of Medical Sciences, Qazvin, Iran.
INTRODUCTION: Scientific studies revealed a high prevalence rate of

self-medication among Iranians, nevertheless there are few studies exploring the
factors affecting on.
AIM: This study was conducted to detect the knowledge and behaviour of
individuals who take antibiotics arbitrarily.
MATERIALS AND METHODS: The research population included all Iranian men and women
between 20 and 60 years. The sample size based on previous studies and after
applying the correction factor 1.6. Total of 950 subjects were involved in this
cross-sectional study. Face and content validity (qualitative) tool was confirmed
by expert faculty members. It was estimated based on Cronbach's alpha reliability
0.73. After coding, all data were entered into SPSS and analyzed.
RESULTS: The mean and SD of knowledge was 4.58±0.65. Sore throat (80%) and runny
nose (70%) were the most common causes of antibiotic consumption in the
participants. The most common reason for antibiotic use was its availability.
More than 68% of participants said they never read the brochure of antibiotics.
More than 51% of them were unable to understand the content of the brochure.
There was a positive relation between participants' knowledge and performance.
More than 60% of them had a history of dosage change.
CONCLUSION: Results of present study revealed that the study population did not
possess the requisite knowledge about the appropriate behaviour in the use of
antibiotics. It is recommended to do some educational program in order to improve
their knowledge and behaviour. Further studies with larger sample in this regard
are recommended.
DOI: 10.7860/JCDR/2017/25368.10495
PMCID: PMC5620792
PMID: 28969151
157. Adv Ther. 2017 Jan;33(12):2257-2268. Epub 2016 Oct 31.
Self-Administration of Medicines and Dietary Supplements Among Female Amateur

Runners: A Cross-Sectional Analysis.
Locquet M(1), Beaudart C(2), Larbuisson R(3), Leclercq V(2), Buckinx F(2), Kaux
JF(4)(5), Reginster JY(2), Bruyère O(2)(4).
Author information:
Liège, Liège, Belgium. medea.locquet@ulg.ac.be.
Liège, Liège, Belgium.
(3)Department of Anesthesiology-Reanimation, University of Liège, Liège, Belgium.
(4)Department of Sports and Rehabilitation Sciences, University of Liège, Liège,
Belgium.
(5)Department of Physical Medicine, Rehabilitation and Sport Traumatology,
SPORTS2, FIFA Medical Centre of Excellence, University and University Hospital of
Liège, Liège, Belgium.
INTRODUCTION: Self-administration of medicines or dietary supplements without any

physician's advice is a widespread behavior and appears to be more frequently
practiced by women. Moreover, reasons to self-administer products are often pains
and injuries especially among athletes who might also use remedies to improve
physical performance. The objective of this study was thus to assess the
prevalence of self-administration of medicines and dietary supplements as well as
its determinants among female amateur runners.
METHODS: Our sample was comprised of women who took part in amateur running
events. Data regarding self-administration of substances, exclusively aiming at
being physically prepared for the running event (i.e., intake the week before),
were collected through an anonymous self-administered questionnaire including
four specific themes (i.e., general information, self-administered medicines and
dietary supplements, context of self-administration of substances and knowledge
of the anti-doping regulations).
RESULTS: A total of 136 women, with a median age of 39 years (interquartile
range: 27-47), volunteered. Among them, 34.6% reported self-administration of
medicines during the period immediately preceding the running event, with the aim
to be physically prepared. More than one third (33.8%) also declared
self-administration of dietary supplements. Furthermore, we observed that about
8.1% of the sample had consumed a potentially doping substance. After adjustments
for confounding variables, the probability of self-administration of products
(medicines or supplements) increased significantly with the intensity of the
activity and the membership in a sports club.
CONCLUSIONS: Our study showed that self-administration of products among female
runners seems to be a widespread behavior, where the intensity of the sports
practice and the network of runners seem to influence the decision to resort to
this behavior.
DOI: 10.1007/s12325-016-0426-2
PMCID: PMC5126181
158. Int J Environ Res Public Health. 2015 Jun 17;12(6):7002-16. doi:
10.3390/ijerph120607002.
Public Knowledge, Beliefs and Behavior on Antibiotic Use and Self-Medication in

Lithuania.
Pavydė E(1), Veikutis V(2), Mačiulienė A(3), Mačiulis V(4), Petrikonis K(5),
Stankevičius E(6).
Author information:
(1)Institute of Physiology and Pharmacology, Lithuanian University of Health
Sciences, A. Mickeviciaus Str. 9, Kaunas 44307, Lithuania.
egle.svitojute@lsmuni.lt.
(2)Institute of Microbiology and Virology, Lithuanian University of Health
Sciences, Kaunas 49264, Lithuania. vincentas.veikutis@med.kmu.lt.
(3)Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas
50161, Lithuania. asta.svitojute@gmail.com.
(4)Department of Anesthesiology, Lithuanian University of Health Sciences, Kaunas
50161, Lithuania. vt.maciulis@gmail.com.
(5)Department of Neurology, Lithuanian University of Health Sciences, Kaunas
50161, Lithuania. kestutispetrikonis@yahoo.com.
(6)Institute of Physiology and Pharmacology, Lithuanian University of Health
Sciences, A. Mickeviciaus Str. 9, Kaunas 44307, Lithuania.
edgaras.stankevicius@lsmuni.lt.
Irrational antibiotic use has led society to antibiotic resistance-a serious

health problem worldwide. This study aimed to assess public knowledge, beliefs,
and behavior concerning antibiotic use and self-medication in Lithuania. The
cross-sectional survey method was processed using a validated questionnaire in
different regions of Lithuania. In total, 1005 adults completed the questionnaire
and were included in the study. More than half of the respondents (61.1%) had
poor knowledge of antibiotics. Almost half of the respondents incorrectly
identified antibiotics as being effective either against viral (26.0%) or mixed
(bacterial and viral) infections (21.7%). The respondents with lower educational
qualifications (OR = 2.515; 95% CI 1.464-4.319; p = 0.001) and those from rural
areas (OR = 1.765; 95% CI 1.041-2.991; p = 0.035) were significantly less
knowledgeable of antibiotics. There was no significant difference between
genders, different age groups, or different parenthood status. The determined
level of self-medication with antibiotics was 31.0%. The men (OR = 1.650; 95% CI
1.120-2.430; p = 0.011), the respondents from rural areas (OR = 2.002; 95% CI
1.343-2.985; p = 0.001), and those without children (OR = 2.428; 95% CI
1.477-3.991; p < 0.001) were more likely to use antibiotics in self-medication.
Lithuanian residents' knowledge of antibiotics is insufficient. More information
about antibiotic use should be provided by physicians and pharmacists.
Self-medication with antibiotics is a serious problem in Lithuania and requires
considerable attention.
DOI: 10.3390/ijerph120607002
PMCID: PMC4483745
159. Adv Ther. 2016 Oct;33(10):1691-1703. Epub 2016 Aug 17.
Self-Care in the Twenty First Century: A Vital Role for the Pharmacist.
Bell J(1), Dziekan G(2), Pollack C(3), Mahachai V(4).
Author information:
(1)University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
john.bell@nexonline.com.au.
(2)World Self-Medication Industry (WSMI), Nyon, Switzerland.
(3)Global R&D, Pfizer Consumer Healthcare, Madison, NJ, USA.
(4)GI & Liver Center, Bangkok Medical Center, Chulalongkorn University, Bangkok,
Thailand.
In order for the global healthcare system to remain sustainable, healthcare

spending needs to be reduced, and self-treating certain conditions under the
guidance of a pharmacist provides a means of accomplishing this goal. This
article was developed to describe global healthcare trends affecting self-care
with a specific focus on the role of the pharmacist in facilitating
over-the-counter (OTC) medication management. Potential healthcare-related
economic benefits associated with the self-care model are outlined. The
importance of the collaboration between healthcare providers (HCPs), including
specialists, primary care providers, and pharmacists, is also discussed. The
evolving role of the pharmacist is examined and recommendations are provided for
ways to successfully engage with other HCPs and consumers to optimize the
pharmacist's unique qualifications and accessibility in the community. Using the
management of frequent heartburn with an OTC proton-pump inhibitor as a model,
the critical role of the pharmacist in patient self-treatment of certain symptoms
will be discussed based on the World Gastroenterology Organization's recently
published guidelines for the community-based management of common
gastrointestinal symptoms. As the global healthcare system continues to evolve,
self-care is expected to have an increasing role in treating certain minor
ailments, and pharmacists are at the forefront of these changes. Pharmacists can
guide individuals in making healthy lifestyle choices, recommend appropriate OTC
medications, and educate consumers about when they should consult a
physician.FUNDING: Pfizer Inc.
DOI: 10.1007/s12325-016-0395-5
PMCID: PMC5055554
160. JAMA Oncol. 2017 Oct 1;3(10):1403-1406. doi: 10.1001/jamaoncol.2017.0243.
Characterizing 18 Years of the Death With Dignity Act in Oregon.
Blanke C(1)(2), LeBlanc M(2), Hershman D(2), Ellis L(2), Meyskens F(2).
Author information:
(1)SWOG Group Chair's Office, Portland, Oregon.
(2)SWOG Executive Advisory Committee, Portland, Oregon.
Erratum in
JAMA Oncol. 2017 Oct 1;3(10):1431.
JAMA Oncol. 2017 Oct 1;3(10):1431.
Importance: Numerous states have pending physician-aided dying (PAD) legislation.

Little research has been done regarding use of PAD, or ways to improve the
process and/or results.
Objectives: To evaluate results of Oregon PAD, the longest running US program; to
disseminate results; and to determine promising PAD research areas.
Design, Setting, and Participants: A retrospective observational cohort study of
991 Oregon residents who had prescriptions written as part of the state's Death
with Dignity Act. We reviewed publicly available data from Oregon Health
Authority reports from 1998 to 2015, and made a supplemental information request
to the Oregon Health Authority.
Main Outcomes and Measures: Number of deaths from self-administration of lethal
medication versus number of prescriptions written.
Results: A total of 1545 prescriptions were written, and 991 patients died by
using legally prescribed lethal medication. Of the 991 patients, 509 (51.4%) were
men and 482 (48.6%) were women. The median age was 71 years (range, 25-102
years). The number of prescriptions written increased annually (from 24 in 1998
to 218 in 2015), and the percentage of prescription recipients dying by this
method per year averaged 64%. Of the 991 patients using lethal self-medication,
762 (77%) recipients had cancer, 79 (8%) had amyotrophic lateral sclerosis, 44
(4.5%) had lung disease, 26 (2.6%) had heart disease, and 9 (0.9%) had HIV. Of
991 patients, 52 (5.3%) were sent for psychiatric evaluation to assess
competence. Most (953; 96.6%) patients were white and 865 (90.5%) were in hospice
care. Most (118, 92.2%) patients had insurance and 708 (71.9%) had at least some
college education. Most (94%) died at home. The estimated median time between
medication intake and coma was 5 minutes (range, 1-38 minutes); to death it was
25 minutes (range, 1-6240 minutes). Thirty-three (3.3%) patients had known
complications. The most common reasons cited for desiring PAD were activities of
daily living were not enjoyable (89.7%) and losses of autonomy (91.6%) and
dignity (78.7%); inadequate pain control contributed in 25.2% of cases.
Conclusions and Relevance: The number of PAD prescriptions written in Oregon has
increased annually since legislation enactment. Patients use PAD for reasons
related to quality of life, autonomy, and dignity, and rarely for uncontrolled
pain. Many questions remain regarding usage and results, making this area
suitable for cancer care delivery research.
DOI: 10.1001/jamaoncol.2017.0243
PMCID: PMC5824315
161. Basic Clin Pharmacol Toxicol. 2016 Oct;119(4):412-7. doi: 10.1111/bcpt.12603.

Epub 2016 May 4.
Iron Supplements and Magnesium Peroxide: An Example of a Hazardous Combination in

Self-Medication.
Vrolijk MF(1), Opperhuizen A(2)(3), Jansen EH(4), Bast A(2), Haenen GR(2).
Author information:
(1)Department of Pharmacology and Toxicology, Maastricht University, Maastricht,
The Netherlands. m.vrolijk@maastrichtuniversity.nl.
(2)Department of Pharmacology and Toxicology, Maastricht University, Maastricht,
The Netherlands.
(3)Netherlands Food and Consumer Product Safety Authority (NVWA), Utrecht, The
Netherlands.
(4)National Institute for Public Health and the Environment (RIVM), Bilthoven,
The Netherlands.
The use of self-medication, which includes dietary supplements and

over-the-counter drugs, is still on the rise, while safety issues are not well
addressed yet. This especially holds for combinations. For example, iron
supplements and magnesium peroxide both produce adverse effects via the formation
of reactive oxygen species (ROS). This prompted us to investigate the effect of
the combination of three different iron supplements with magnesium peroxide on
ROS formation. Hydroxyl radical formation by the three iron supplements either
combined with magnesium peroxide or alone was determined by performing a
deoxyribose assay. Free iron content of iron supplements was determined using
ferrozine assay. To determine hydrogen peroxide formation by magnesium peroxide,
a ferrous thiocyanate assay was performed. Finally, electron spin resonance
spectroscopy (ESR) was performed to confirm the formation of hydroxyl radicals.
Our results show that magnesium peroxide induces the formation of hydrogen
peroxide. All three iron supplements induced the formation of the extremely
reactive hydroxyl radical, although the amount of radicals formed by the
different supplements differed. It was shown that combining iron supplements with
magnesium peroxide increases radical formation. The formation of hydroxyl
radicals after the combination was confirmed with ESR. All three iron supplements
contained labile iron and induced the formation of hydroxyl radicals.
Additionally, magnesium peroxide in water yields hydrogen peroxide, which is
converted into hydroxyl radicals by iron. Hence, iron supplements and magnesium
peroxide is a hazardous combination and exemplifies that more attention should be
given to combinations of products used in self-medication.
© 2016 Nordic Association for the Publication of BCPT (former Nordic

Pharmacological Society).
DOI: 10.1111/bcpt.12603
162. Drug Alcohol Depend. 2017 Aug 1;177:1-13. doi:

10.1016/j.drugalcdep.2017.03.009.
Epub 2017 May 16.
Prevalence, reasons, perceived effects, and correlates of medical marijuana use:

A review.
Park JY(1), Wu LT(2).
Author information:
(1)Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke
University, BOX 3903, Durham, NC, USA. Electronic address: ji.yeun.park@duke.edu.
University, BOX 3903, Durham, NC, USA; Department of Medicine, School of
Medicine, Duke University, Durham, NC, USA; Duke Clinical Research Institute,
Duke University Medical Center, Durham, NC, USA; Center for Child and Family
Policy, Sanford School of Public Policy, Duke University, Durham NC, USA.
Electronic address: litzy.wu@duke.edu.
BACKGROUND: The use of marijuana for medical purposes is now legal in some U.S.
states and other jurisdictions, such as Canada, and Israel. Despite the
widespread legalization of medical marijuana globally, there is limited
information on patterns and correlates of medical marijuana use (MMU). We
conducted a literature review to assess prevalence, reasons, perceived effects,
and correlates of MMU among adolescents and adults.
METHODS: We searched peer-reviewed articles in English between January 1996 and
August 2016 from several databases (PubMed, Google Scholar, Embase, CINAHL, and
PsycINFO) using different combinations of keywords.
RESULTS: A total of 25 articles met the inclusion criteria. In the U.S., national
survey estimates of prescribed MMU was 1.1% among 12th graders and 17% among
adults who reported past-year marijuana use. The reported prevalence of
prescribed MMU ranged from <1.7% in Israeli cancer patients to 17.4% in American
health care patients. The reported prevalence of self-medication with marijuana
ranged from 15% in Canadian patients with chronic pain to 30% in British patients
with multiple sclerosis. Pain was the most frequently endorsed reason for use.
MMU appeared to provide symptom relief for a range of pain conditions, sleep
disturbance, and anxiety symptoms, but it did not appear to provide sufficient
relief of cluster headache symptoms. Non-medical marijuana use was a common
factor associated with MMU across studies.
CONCLUSION: Either MMU or self-medication with marijuana was common, mainly due
to pain management. Additional research is needed to evaluate temporal and causal
associations of non-medical marijuana use with MMU.
DOI: 10.1016/j.drugalcdep.2017.03.009
PMCID: PMC5542049
163. Trans R Soc Trop Med Hyg. 2019 Apr 1;113(4):183-188. doi:
10.1093/trstmh/try138.
Self-medication with non-prescribed pharmaceutical agents in an area of low

malaria transmission in northern Tanzania: a community-based survey.
Hertz JT(1), Madut DB(2), Tesha RA(3), William G(4), Simmons RA(5), Galson SW(1),
Maro VP(4), Crump JA(6), Rubach MP(2).
Author information:
(1)Department of Surgery, Division of Emergency Medicine, Duke University Medical
Center, 2301 Erwin Rd, Durham, NC, USA.
(2)Department of Medicine, Division of Infectious Disease, Duke University
Medical Center, 2301 Erwin Rd, Durham, NC, USA.
(3)Department of Statistical Science, Duke University, Durham, NC, USA.
(4)Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
(5)Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, USA.
(6)Otago Global Health Institute, University of Otago, Dunedin, New Zealand.
BACKGROUND: Self-treatment with antimicrobials is common in sub-Saharan Africa.

Little is known about the prevalence of this practice where malaria transmission
intensity is low, and little is known about the prevalence of self-treatment with
other medications such as antihypertensives and antihyperglycemics.
METHODS: A two-stage randomized population-based cluster survey with selection
proportional to population size was performed in northern Tanzania.
Self-identified healthcare decision-makers from randomly selected households were
asked to report instances of self-medication without a prescription in the
preceding year. Associations between self-treatment and sociodemographic
characteristics were assessed with Pearson's chi-squared and the Student's
t-test.
RESULTS: A total of 718 participants completed the survey, and 344 (47.9%)
reported any household member obtaining medication without a prescription. Of
these, 85 (11.8%) obtained an antimicrobial and four (0.6%) obtained an
antihypertensive or antihyperglycemic. Of respondents reporting self-treatment,
306 (89.0%) selected the medication themselves. Self-treatment with
antimicrobials was associated with post-primary education (OR 1.95, 95% CI
1.22-3.16, p=0.005), younger age (43.1 vs 48.7 years, p=0.007) and higher
socioeconomic status score (0.42 vs 0.34, p=0.023).
CONCLUSIONS: Self-treatment with antimicrobials in an area of low malaria
transmission intensity was uncommon and self-treatment with antihypertensives and
antihyperglycemics was rare.
© The Author(s) 2018. Published by Oxford University Press on behalf of Royal

Society of Tropical Medicine and Hygiene.
DOI: 10.1093/trstmh/try138
PMCID: PMC6432801
PMID: 30597114
164. Acta Odontol Latinoam. 2018 Aug;31(2):117-121.
Self-medication in patients seeking care in a dental emergency service.
Stolbizer F(1)(2), Roscher DF(3), Andrada MM(3), Faes L(2), Arias C(2), Siragusa
C(3)(2), Prada S(2), Saiegh J(2), Rodríguez D(2), Gualtieri A(4), Mendez
CF(5)(6).
Author information:
(1)Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Cirugía y
Traumatología Bucomaxilofacial II, Buenos Aires, Argentina. fstolbizer@gmail.com.
(2)Universidad de Buenos Aires, Facultad de Odontología, Servicio de Emergencias,
Buenos Aires, Argentina.
(3)Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Cirugía y
Traumatología Bucomaxilofacial II, Buenos Aires, Argentina.
(4)Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Biofísica y
Bioestadística, Buenos Aires, Argentina.
(5)Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Farmacología,
Buenos Aires, Argentina.
(6)CONICET-Universidad de Buenos Aires, Instituto de investigaciones Biomédicas
(INBIOMED), Buenos Aires, Argentina.
The aims of this work were: To determine what percentage of firsttime patients to
the Dental Emergency Department at the School of Dentistry of Buenos Aires
University had taken medications to relieve or treat their condition. To
determine what percentage of these had used selfmedication, and which were the
most frequently taken medicines. To determine whether there is an association
between selfmedication and educational level, and between selfmedication and
whether the patient has health coverage. This was an observational,
crosssectional study which reviewed 567 clinical histories of patients who
visited the Dental Emergency Department from March 2015 to September 2016. The
following parameters were assessed: sex, age, reason for consultation,
medication, dose, interval, duration and indication. Patients' educational level
and whether they had health coverage were ascertained. Confidence intervals of
95% were calculated for percentages using the Wilson score method. Inferential
analyses were performed using the Chisquare test (ᵪ2). Significance level was set
at 5%. Eighty five percent (85%,.n=481) of the patients had taken at least one
medication; 77% (n=372) had used selfmedication. The most frequently used
medicines were nonsteroid antiinflammatory drugs (61%), antibiotics (34%) and
glucocorticoids (2%). No association was found between selfmedication and
patients' having health coverage (ᵪ2=13; p=0.08). No significant association was
found between educational level and selfmedication (ᵪ2=10; p=0.22). Nevertheless,
the lowest percentages of selfmedication were found in subjects with complete
university studies (77%; CI95: 60% to 89%), while the highest percentages were
found in subjects with incomplete primary education (89%; CI95: 69% to 97%),
complete primary education (92%; CI95: 82% to 96%) and incomplete secondary
educations (90%; CI95: 84% to 94%).High levels of selfmedication were found in
the study population. Although no association was found between educational level
and selfmedication behavior, the percentage of selfmedication was higher among
patients with lower educational levels. The high level of selfmedication
highlights the importance of conducting campaigns to raise awareness about the
adequate use of medicines.
Publisher: Los objetivos del presente trabajo fueron: Determinar qué porcentaje
de pacientes que concurrió por primera vez al Servicio de Urgencias de la
Facultad de Odontología de la Universidad de Buenos Aires consumió medicamentos
para aliviar o tratar su dolencia. Determinar qué porcentaje de pacientes fueron
automedicados, y cuáles fueron los medica mentos más utilizados. Determinar si
existe relación entre la automedicación y el nivel de estudio y entre la
automedicación y la presencia de cobertura médica. Se realizó un estudio
observacional y transversal. Se relevaron 567 historias clínicas de pacientes que
concurrieron entre marzo 2015 y septiembre 2016 y se valoraron los siguientes
parámetros: sexo, edad, origen de la consulta, medicación, dosis, intervalo,
duración, e indicación. Se indagó el nivel educacional alcanzado y la existencia
de cobertura médica. Se calcularon intervalos de confianza al 95% para
porcentajes mediante el método score de Wilson. Se realizaron análisis
inferenciales mediante la prueba Chicuadrado (ᵪ2). Se fijó un nivel de
significación del 5%. El 85% (n=481) de los pacientes había consumido al menos un
medicamento. El 77% (n=372) de los pacientes estaba autome dicado. Los
medicamentos más utilizados fueron antiinflamatorios no esteoroideos (61%),
antibióticos (34%) y glucocorticoides (2%). No se encontró asociación entre la
automedicación y la presencia de cobertura médica (ᵪ2=13; p=0,08). No se encontró
asociación significativa entre el nivel de estudios y la automedicación (ᵪ2=10;
p=0,22). Sin embargo, los sujetos con estudio universitario completo presentaron
el menor porcentaje de automedicación (77%; IC95: 60% a 89%), mientras que los
mayores porcentajes se encontraron en sujetos con primario incompleto (89%; IC95:
69% a 97%), primario completo (92%; IC95: 82% a 96%) y secundario incompleto
(90%; IC95: 84% a 94%). Se encontraron niveles elevados de automedicación en la
población estudiada. Si bien no se observó asociación entre nivel educativo y la
conducta de automedicación, fue mayor el porcentaje de automedicación en
pacientes con menor nivel educativo. La alta presencia de automedicación refuerza
la importancia de realizar campañas de concientización sobre el consumo adecuado
de medicamentos.
Sociedad Argentina de Investigación Odontológica.
165. Saudi Pharm J. 2019 Feb;27(2):235-239. doi: 10.1016/j.jsps.2018.11.004. Epub

2018
Nov 10.
Practices, awareness and attitudes toward self-medication of analgesics among

health sciences students in Riyadh, Saudi Arabia.
Al Essa M(1)(2)(3), Alshehri A(1), Alzahrani M(1), Bustami R(1), Adnan S(1),
Alkeraidees A(1), Mudshil A(1), Gramish J(1)(2).
Author information:
(1)College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences,
P.O. BOX 3660, Riyadh 11426, Saudi Arabia.
(2)Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, MC 1445,
Saudi Arabia.
(3)King Abdullah International Medical Research Center (KAIMRC), Riyadh 14611,
Saudi Arabia.
Background: Self-medication is a common practice among health sciences students

in Saudi Arabia. It is known that inappropriate selfmedication may harm
individuals due to increasing the risk of drug misuse or delaying a hospital
visit by masking some symptoms. Thus, the aim of our study is to investigate and
assess practices, awareness and attitudes toward analgesics self-medication among
health science students in Riyadh, Saudi Arabia.
Methods: This is a cross-sectional study in a form of electronic survey that was
conducted among health sciences students from different universities in Riyadh,
Saudi Arabia in 2016. Two hundred and seventy-two students responded to the
questionnaire. The electronic questionnaire survey covered demographics,
self-medication practice and the analgesics consumption, attitude and awareness
about the safety of self-medication practice of analgesics.
Results: Factors associated with high prevalence of self-medication were not
significant except for age (P = 0.04). Health sciences students had adequate
knowledge about the safety of analgesics consumption itself and simultaneous use
of analgesics with other drugs, significantly different by college; 80% for
Pharmacy, 71% for Medicine, 61% for Nursing and Dentistry, and 25% for Applied
Medical Sciences and pre-professional students (p = 0.037).
Conclusion: The occurrence of self-medication practices is distressingly high
among health sciences students. It is necessary to educate the students about the
side effects and drawbacks of irresponsible selfmedication.
DOI: 10.1016/j.jsps.2018.11.004
PMCID: PMC6362167
PMID: 30766435
166. Medicines (Basel). 2018 Jan 6;5(1). pii: E3. doi: 10.3390/medicines5010003.
European Ethnopharmaceuticals for Self-Medication in Japan: Review Experience of

Vitis vinifera L., Folium Extract and Vitex agnus-castus L., Fructus Extract as
OTC Drugs.
Hoshino T(1), Muto N(2), Tsukada S(3), Nakamura T(4)(5), Maegawa H(6).
Author information:
(1)Office of Planning and Coordination, Pharmaceuticals and Medical Devices
Agency, Tokyo 100-0013, Japan. hoshino-tatsuro@pmda.go.jp.
(2)Office of OTC/Quasi-drugs, Pharmaceuticals and Medical Devices Agency, Tokyo
100-0013, Japan. muto-nanami@pmda.go.jp.
(3)Office of New drugs IV, Pharmaceuticals and Medical Devices Agency, Tokyo
100-0013, Japan. tsukada-shinsuke@pmda.go.jp.
(4)Office of OTC/Quasi-drugs, Pharmaceuticals and Medical Devices Agency, Tokyo
100-0013, Japan. cba07499@nifty.com.
(5)Division of Pharmacognosy, Phytochemistry and Narcotics, National Institute of
Health Sciences, Kanagawa 210-9501, Japan. cba07499@nifty.com.
(6)Office of Vaccines and Blood Products, Pharmaceuticals and Medical Devices
Agency, Tokyo 100-0013, Japan. maegawa-hikoichiro@pmda.go.jp.
Since the publication of "Application Guideline for Western Traditional Herbal

Medicines as OTC Drugs" in 2007, only two European ethnopharmaceuticals, Vitis
vinifera L., folium extract (Antistax) and Vitex agnus-castus L., fructus extract
(Prefemin), have been approved as OTC drugs in Japan. In this review, we describe
the current regulation of Western ethnopharmaceuticals in Japan, summarize our
regulatory experiences and discuss the scientific and regulatory issues involved.
DOI: 10.3390/medicines5010003
PMCID: PMC5874568
PMID: 29316611
167. Int J Clin Pharm. 2017 Feb;39(1):70-77. doi: 10.1007/s11096-016-0397-z. Epub

2016
Nov 30.
Improving the provision of OTC medication information in community pharmacies in

Poland.
Piecuch A(1), Makarewicz-Wujec M(2), Kozłowska-Wojciechowska M(2).
Author information:
(1)Department of Clinical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy,
Medical University of Warsaw, ul. Banacha 1, 02-097, Warsaw, Poland.
anna.piecuch@wum.edu.pl.
(2)Department of Clinical Pharmacy and Pharmaceutical Care, Faculty of Pharmacy,
Medical University of Warsaw, ul. Banacha 1, 02-097, Warsaw, Poland.
Background An informed or shared decision-making model is desirable to support

the choice of over-the-counter (OTC) medications in pharmacies: it respects
patient empowerment in self-medication. Such a model is achievable provided that
pharmacists are a credible, competent information source open to patient needs.
Objective To study the dependencies among selected factors that may influence the
provision of OTC medication information. The study was conducted from the
perspective of a community pharmacist. Method The study consisted of an
auditorium survey with a self-administered questionnaire. We attempted to
determine the relationships among three selected constructs: patient centredness
(four items), competence (four items), and provision of OTC medication
information (six items) as latent variables. We analysed hypothetical
relationships among the observable variables and latent variables using
structural equation modelling. Main outcome measure Selected factors that may
influence the provision of OTC medication information. Results In all, 1496
pharmacists took part in the study. The model demonstrated adequate fit (χ2 =
198.39, df = 64). The patient-centredness construct was demonstrated to have a
strong direct positive impact on the provision of OTC medication information
construct (β = 0.77, P < 0.05). Provision of OTC medication information was also
shown to have a strong direct effect on the competence variable (β = 0.90,
P < 0.05). Conclusion If a pharmacist is patient centred, there is a greater
possibility that they will provide information about OTC medicines; that may
influence the pharmacist's feelings about their ability to cope with patient
initiatives and enhance the pharmacist's selfperceived competence.
DOI: 10.1007/s11096-016-0397-z
PMCID: PMC5306170
Conflict of interest statement: The authors declare no conflicts of interest.
168. J Gen Fam Med. 2017 Jul 24;18(6):336-340. doi: 10.1002/jgf2.81. eCollection
2017
Dec.
Reasons for the preference of clinic visits to self-medication by common cold
patients in Japan.
Tsutsumi M(1)(2), Shaku F(3)(4), Ozone S(2)(5), Sakamoto N(2)(5), Maeno T(2)(5).
Author information:
(1)Himawari Home Clinic Sumino-kai Healthcare Corporation Chiba Japan.
(2)Primary Care and Medical Education Faculty of Medicine University of Tsukuba
Tsukuba Japan.
(3)Division of Respiratory Medicine Department of Internal Medicine Nihon
University School of Medicine Tokyo Japan.
(4)Department of Psychosomatic Internal Medicine Nihon University Itabashi
Hospital Tokyo Japan.
(5)General Medicine and Primary Care University of Tsukuba Hospital Tsukuba
Japan.
Background: Many Japanese visit medical institutions for common cold treatment,
which can cause congestion in these institutions and an increase in medical
expenses, although the common cold can be treated sufficiently through
self-medication. Therefore, to elucidate the reasons individuals with common
colds do not use over-the-counter (OTC) medication, we conducted an investigation
using a self-administered inquiry sheet to determine reasons for clinic visits
and for the avoidance of OTC medication.
Methods: The study was of patients with self-diagnosed common cold symptoms using
an anonymous self-report questionnaire.
Results: Of the 471 patients administered the questionnaire, 442 responded. The
analysis was focused on the 37 patients who responded that they had considered
using OTC medication before coming to the clinic but decided against it and came
to the clinic instead. The majority responded positively saying that they felt
reassured when seen by a physician (91.9%) and that their common cold was cured
more rapidly (89.2%).
Conclusions: It can be presumed that many patients with common colds visit
medical institutions because they feel reassured and feel that their symptoms
improve at a quicker rate. The findings of this study indicated that there is a
need for accurate information and relief from anxiety for patients regarding the
common cold.
DOI: 10.1002/jgf2.81
PMCID: PMC5729384
PMID: 29264062
169. J Soc Pers Relat. 2014 Dec;31(8):997-1018.
Friendship Intimacy, Close Friend Drug Use, and Self-Medication in Adolescence.
Shadur J(1), Hussong A(2).
Author information:
(1)The University of Maryland at College Park, Center for Addictions,
Personality, and Emotion Research, Cole Activities Building Suite 2103-D, College
Park, MD 20742, United States.
(2)The University of North Carolina at Chapel Hill, CB#3270 Davie Hall, Chapel
Hill, NC 27599, United States.
The current study examined between- and within-person processes related to

friendship intimacy, close-friend substance use, negative affect, and
self-medication. We tested between-person hypotheses that global negative affect,
friendship intimacy, and close-friend drug use predict increased substance use,
and the within-person hypothesis that friendship intimacy and close-friend
substance use moderate the temporal relationship between daily negative affect
and subsequent substance use (i.e., self-medication). Experience sampling
methodology (ESM) was employed to capture daily variations in mood and substance
use, and multilevel modeling techniques were used to parse between- versus
within-person differences in risk for use. Findings supported between-person
hypotheses that higher levels of negative affect and lower levels of friendship
intimacy predicted greater substance use, and a consistent trend indicated that
friendship intimacy and close-friend drug use interact to predict substance use
more generally (though not for self-medication). Risk and protective mechanisms
emerged from this interaction such that the effect of friendship intimacy on
adolescent use depends on the degree of close-friend drug use. More specific
reformulations of the risk processes involving friendships and self-medication
among younger youth are indicated.
DOI: 10.1177/0265407513516889
PMCID: PMC4245029
PMID: 25473144
170. Diseases. 2018 Apr 27;6(2). pii: E32. doi: 10.3390/diseases6020032.
Self-Medication with Antibiotics, Attitude and Knowledge of Antibiotic Resistance

among Community Residents and Undergraduate Students in Northwest Nigeria.
Ajibola O(1), Omisakin OA(2), Eze AA(3), Omoleke SA(4).
Author information:
(1)Department of Microbiology, Faculty of Science, Federal University, Birnin
Kebbi, Kalgo Road P.M.B. 1157, Birnin Kebbi 860222, Kebbi State, Nigeria.
olumide.ajibola@fubk.edu.ng.
(2)Department of Demography and Social Statistics, Faculty of Art, Social and
Management Sciences, Federal University Birnin Kebbi, Kalgo Road P.M.B. 1157,
Birnin Kebbi 860222, Kebbi State, Nigeria. omisakinolusola@yahoo.com.
(3)Department of Medical Biochemistry, University of Nigeria, Enugu Campus, Enugu
400241, Nigeria. anthonius.eze@unn.edu.ng.
(4)Immunization, Vaccines and Emergencies, World Health Organization, Kebbi State
Field Office, Birnin Kebbi 860222, Nigeria. omolekes@who.int.
This study set out to evaluate self-medicated antibiotics and knowledge of

antibiotic resistance among undergraduate students and community members in
northern Nigeria. Antibiotic consumption pattern, source of prescription,
illnesses commonly treated, attitude towards antibiotics, and knowledge of
antibiotic resistance were explored using a structured questionnaire. Responses
were analyzed and summarized using descriptive statistics. Of the 1230
respondents from undergraduate students and community members, prescription of
antibiotics by a physician was 33% and 57%, respectively, amongst undergraduate
students and community members. We tested the respondents’ knowledge of
antibiotic resistance (ABR) and found that undergraduate students displayed less
knowledge that self-medication could lead to ABR (32.6% and 42.2% respectively).
Self-medication with antibiotics is highly prevalent in Northwest Nigeria, with
most medicines being purchased from un-licensed stores without prescription from
a physician. We also observed a significant gap in respondents’ knowledge
of ABR. There is an urgent need for public health authorities in Nigeria to
enforce existing laws on antibiotics sales and enlighten the people on the
dangers of ABR.
DOI: 10.3390/diseases6020032
PMCID: PMC6023284
PMID: 29702565
171. World J Gastroenterol. 2015 May 28;21(20):6381-3. doi:

10.3748/wjg.v21.i20.6381.
Self-medication of achalasia with cannabis, complicated by a cannabis use

disorder.
Luquiens A(1), Lourenco N(1), Benyamina A(1), Aubin HJ(1).
Author information:
(1)Amandine Luquiens, Amine Benyamina, Henri-Jean Aubin, Hôpital Paul
Brousse-Addictologie, 94804 Villejuif cedex, France.
Achalasia is a rare esophagus motility disorder. Medical, endoscopic and surgical

treatments are available, but all endorse high relapse rates. No data has been
published to date reporting a therapeutic effect of cannabis use neither in
achalasia nor on its influence on manometric measurements. We report the case of
a patient diagnosed with achalasia. He could benefit from a large panel of
therapeutic interventions, but none of them was effective over the time. He first
used cannabis at age 20 and identified benefits regarding achalasia symptoms. He
maintained regular moderate cannabis use for 9 years, with minimal digestive
inconvenience. A manometry performed without cannabis premedication was realized
at age 26 and still found a cardiospasm. Cannabis use could explain the gap
between functional symptoms assessment and manometry measurement. Further
investigations are warranted to explore a therapeutic effect of cannabis in
achalasia and possible influence on outcome measurements.
DOI: 10.3748/wjg.v21.i20.6381
PMCID: PMC4445116
172. PLoS One. 2019 Jan 23;14(1):e0211191. doi: 10.1371/journal.pone.0211191.

eCollection 2019.
Self-medication for migraine: A nationwide cross-sectional study in Italy.
Brusa P(1)(2), Allais G(3)(4), Scarinzi C(5), Baratta F(1), Parente M(1), Rolando
S(3), Gnavi R(5), Spadea T(5), Costa G(5), Benedetto C(3), Mana M(6), Giaccone
M(2)(7), Mandelli A(7), Manzoni GC(4), Bussone G(4).
Author information:
(1)Department of Science and Technology of Drugs, University of Turin, Turin,
Italy.
(2)Order of Pharmacists of Turin, Turin, Italy.
(3)Department of Surgical Sciences, Women's Headache Center, University of Turin,
Turin, Italy.
(4)FI.CEF Onlus, Italian Headache Foundation, Milan, Italy.
(5)Epidemiology Unit, ASL TO3, Grugliasco (Turin), Italy.
(6)ATF Informatics, Cuneo, Italy.
(7)FOFI, Federation of the Orders of Italian Pharmacists, Rome, Italy.
Headache disorders are considered the second leading cause of years lived with
disability worldwide, and 90% of people have a headache episode at least once a
year, thus representing a relevant public health priority. As the pharmacist is
often the first and only point of reference for people complaining of headache,
we carried out a survey in a nationwide sample of Italian pharmacies, in order to
describe the distribution of migraine or non-migraine type headaches and
medicines overuse among people entering pharmacies seeking for self-medication;
and to evaluate the association, in particular of migraine, with
socio-demographic and clinical characteristics, and with the pathway of care
followed by the patients. A 14-item questionnaire, including socio-demographic
and clinical factors, was administered by trained pharmacists to subjects who
entered a pharmacy requesting self-medication for a headache attack. The ID
Migraine™ Screener was used to classify headache sufferers in four classes. From
June 2016 to January 2017, 4424 people have been interviewed. The prevalence of
definite migraines was 40%, significantly higher among women and less educated
people. About half of all headache sufferers and a third of migraineurs do not
consider their condition as a disease and are not cared by any doctor. Among
people seeking self-medication in pharmacies for acute headache attacks, the rate
of definite or probable migraine is high, and a large percentage of them is not
correctly diagnosed and treated. The pharmacy can be a valuable observatory for
the study of headaches, and the first important step to improve the quality of
care delivered to these patients.
PMCID: PMC6343913
PMID: 30673780

interests exist.
173. Value Health. 2014 Nov;17(7):A423-4. doi: 10.1016/j.jval.2014.08.1051. Epub

2014
Oct 26.
Home Pharmacies: An Insight In Self-Medication Practice.
Paut KM(1), Tomic Z(1), Bukumiric Z(2), Trivic B(1), Sabo A(1).
Author information:
(1)Faculty of Medicine, Novi Sad, Serbia and Montenegro.
(2)Faculty of Medicine, Belgrade, Serbia and Montenegro.
DOI: 10.1016/j.jval.2014.08.1051
PMID: 27201082
174. Ostomy Wound Manage. 2017 Sep;63(9):24-31.
A Cross-sectional, Descriptive Study of Medication Use Among Persons With a

Gastrointestinal Stoma.
Pereira de Paula BA(1), da Silva Alves GC(1), PercÍnio Á(1), Pereira ML(1),
Moraes JT(1), Sanches C(1).
Author information:
(1)Federal University of São João Del Rei, Bairro Chanadour, Divinópolis, Brazil.
Research on the use of medications in people with intestinal stomas is lacking,

creating gaps in knowledge of pharmacoepidemiology in these patients. A
cross-sectional, descriptive study was conducted over a period of 4 months in
Divinópolis, Brazil to describe the profile of medication use among people
enrolled in the Health Support Service for People with Stoma - Level II (SSPS II)
of a municipality in the state of Minas Gerais, Brazil. All patients from SSPS II
with a colostomy or ileostomy were invited by phone to participate; those with
incomplete registration data and/or who were <18 years old, hospitalized for any
reason, or had their stoma reversed were excluded from participation. During home
interviews, researchers obtained sociodemographic profiles (age, gender,
education, occupation, and family income) and information on comorbidities,
medication use, adherence to medication protocols (per the Morisky Green Levine
test), polypharmacy, and adult/pharmaceutical care (medication description and
indication, expiration date, self-medication). Drug storage was assessed by
visual evaluation. The information was entered onto individual data sheets,
numbered to ensure patient anonymity. The data then were entered into and
analyzed using SSPS II statistical software using frequency measurements,
measures of central tendency, and dispersion of demographic variables, health
conditions, and medicine use. The study population included 59 persons (average
age 66.9 ± 13.27 years), 36 (61.0%) women, 38 (64.4%) with an incomplete/primary
level education, and 44 (74.5%) retired. Forty-nine (49) patients had a colostomy
and 10 had an ileostomy; cancer was the main reason for stoma creation (61.1%).
Half of the survey participants reported having 1 or 2 comorbidities (average
2.3); the most prevalent (52) was circulatory system disease among which
hypertension (38, 64.4%) was most common. Analysis of the pharmacotherapeutic
profile (prescribed and used) showed 89.8% of the study population used
medication, and 52.8% were prescribed >5 medications (polypharmacy). Low and
medium level adherence with prescriptions was noted (37.7%); 39.6% reported
receiving no guidance on the use of the medication associated with their
condition. Improper storage was observed in 33.9% of participants. In this
population, persons with a stoma had complex pharmacotherapy, a high rate of
polypharmacy, and deficiency in guidance on the use of medication. Further
research into determining whether investments in both inclusion of a pharmacist
on the team and more pharmacoepidemiological studies would improve patient care
and medication safety in patients with a stoma is warranted.
175. BMC Pharmacol Toxicol. 2017 Feb 14;18(1):11. doi: 10.1186/s40360-017-0116-y.
Antibiotic use practices of pharmacy staff: a cross-sectional study in Saint

Petersburg, the Russian Federation.
Belkina T(1), Duvanova N(2), Karbovskaja J(3), Tebbens JD(4), Vlcek J(2).
Author information:
(1)Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec
Kralove, Charles University, Heyrovskeho 1203, Hradec Kralove, 50005, Czech
Republic. belkinat@faf.cuni.cz.
Republic.
(3)Department of Technology of Dosage Forms, Saint Petersburg State Chemical -
Pharmaceutical Academy, Prof. Popova Str. 14, Saint Petersburg, 197376, Russian
Federation.
(4)Department of Biophysics and Physical Chemistry, Faculty of Pharmacy in Hradec
Republic.
BACKGROUND: Non-prescription access to antimicrobials is common, and

self-prescribing is increasingly popular in Russian society. The aim of this
study was to assess the attitudes of community pharmacists regarding antibiotic
use and self-medication.
METHODS: We conducted a cross-sectional study from September-December 2015 of
community pharmacists in the Saint-Petersburg and Leningrad region, Russia. A
self-administered questionnaire was used to assess antibiotic use and
self-medication practices. The data were analysed using logistic regression and
Pearson chi-squared tests.
RESULTS: Of the 316 pharmacists (77.07%) who completed the questionnaire, 230
(72.8%) self-medicated with antibiotics. Antibiotics were mostly used to
self-treat upper (53.3%) and lower respiratory tract infections (19.3%), relying
on their own knowledge (81.5%), previous treatment experience (49%) and patients'
prescriptions (17%). The most commonly used antibiotics were macrolides (33.2%).
Characteristics such as age, education and experience were related to antibiotic
use and self-medication.
CONCLUSIONS: The study confirmed that self-prescription of antibiotics is a
common practice amongst pharmacists in Saint Petersburg and also identified
personal and professional characteristics of pharmacists strongly associated with
self-medication.
DOI: 10.1186/s40360-017-0116-y
PMCID: PMC5307805
176. Syst Rev. 2018 Jul 21;7(1):102. doi: 10.1186/s13643-018-0758-x.
Evidence of factors influencing self-medication with antibiotics in LMICs: a

systematic scoping review protocol.
Torres NF(1)(2), Chibi B(3), Middleton LE(4), Solomon VP(4), Mashamba-Thompson

T(3).
Author information:
(1)Instituto Superior de Ciências de Saúde - ISCISA (High Institute for Health
Sciences), Maputo, Mozambique. torresneusa@gmail.com.
(2)Discipline of Public Health Medicine, School of Nursing and Public Health,
University of KwaZulu Natal, Durban, South Africa. torresneusa@gmail.com.
(3)Discipline of Public Health Medicine, School of Nursing and Public Health,
University of KwaZulu Natal, Durban, South Africa.
(4)School of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
BACKGROUND: The Sustainable Development Goals (SDGs) emphasize the need for
strengthening the capacity of all developing countries in the early warning, risk
reduction and management of national as well as global health risks. Despite
there being a considerable amount of effort in controlling and promoting the
rational use of antibiotics, studies show that the practice of self-medication
with antibiotics (SMA) systematically exposes individuals to the risk of
antibiotic resistance and other antibiotic side effects. The proposed scoping
review aims to map literature on the factors influencing self-medication with
antibiotics in low- and middle-income countries (LMICs).
METHODS AND ANALYSIS: The adopted search strategy for this scoping review study
will involve electronic databases including PubMed, Web of Knowledge, Science
Direct, EBSCOhost (PubMed, CINAHL, MEDLINE), Google Scholar, BioMed Central and
World Health Organization library. A two-stage mapping strategy will be
conducted. Stage 1 will screen studies through examining their titles and
screening abstracts descriptively by focus and method as stipulated by the
inclusion and exclusion criteria. In stage 2, the researchers will extract data
from the included studies. A parallel screening and data extraction will be
undertaken by two reviewers. In accessing the quality of the included studies,
the researchers will utilize the mixed methods appraisal tool (MMAT, version 11).
The NVivo computer software (version 11) shall be used to classify, sort, arrange
and examine relationships in the data, and to extract the relevant outcomes and
for the thematic analysis of the studies.
DISCUSSION: The study anticipates finding relevant studies reporting evidence on
the factors influencing self-medication with antibiotics in LMICs. The evidence
obtained from the included studies will help guide future research. The study
findings will be disseminated electronically and in print with presentations
being done at relevant platforms, i.e. conferences related to antibiotic use,
antimicrobial resistance, health seeking behaviour and the use of medicines.
SYSTEMATIC REVIEW REGISTRATION: Prospero Registration Number: CRD42017072954.
DOI: 10.1186/s13643-018-0758-x
PMCID: PMC6054840

eCollection 2018.
Knowledge, attitudes, and practice regarding medication use in pregnant women in

Southern Italy.
Navaro M(1), Vezzosi L(1), Santagati G(1), Angelillo IF(1); Collaborative Working
Group.
Author information:
(1)Department of Experimental Medicine of the University of Campania "Luigi
Vanvitelli", Naples, Italy.
The study assessed knowledge, attitudes, and medication use of a random sample of
pregnant women attending outpatient Gynecology and Obstetrics clinics at randomly
selected public General and Teaching hospitals in Naples, Italy. A total of 503
women participated. Those more likely to know that a pregnant woman with chronic
condition must discuss whether or not to take a medication with the physician
were Italian, aged 31-40 years, employed, with no history of abortion, having had
a medical problem within the previous year, with a better self-perceived health
status, who knew how to use medications during pregnancy, and who needed
information on medications. The knowledge of the potential risk of using
non-prescribed medications during pregnancy was significantly higher in employed
women, who received information from physicians, who knew how to use medications
during pregnancy, and who knew the possible damages related to medications use.
More than half had used at least one medication. Those aged 26-35 years, Italian,
non-graduated, in the third trimester, having had a medical problem within the
previous year, with a risky pregnancy, and with a knowledge that women with
chronic condition must discuss whether or not to take a medication with the
physician were more likely to use medication. Less than half had used medication
without a physician's advice. Those who were more likely to self-medicate were
older, Italian, multiparous, with no history of abortion, who knew that women
with chronic condition must discuss whether or not to take a medication with the
physician, who did not know the potential risk of using non-prescribed medication
during pregnancy, who had used prescribed medication during pregnancy, and who
needed information about medications. Educational programs for women about
medication use are important to increase their knowledge of the potential risks
to the pregnant women and the unborn child in order to reduce self-medication.
PMCID: PMC6007931
interests exist.
178. J Pak Med Assoc. 2019 Apr;69(4):523-526.
Self-Medication Phenomenon; A Population Based Study from Lahore.
Akram A(1), Maqsood U(1), Latif MZ(2), Arshad HS(1), Riaz H(2), Qureshi MA(2).
Author information:
(1)Department of Physical Therapy, Azra Naheed Medical College, The Superior
University, Lahore.
(2)Azra Naheed Medical College, The Superior University Lahore, Pakistan.
OBJECTIVE: To study the reasons of self-medication in rural and urban

population..
METHODS: The cross-sectional descriptive study was conducted in Lahore, Pakistan,
from March to August 2017, and comprised inhabitants of rural and urban areas of
the city regardless of gender and aged 18-50 years. The subjects were enrolled
using non probability convenience sampling technique. Data was collected using a
semi-structured questionnaire, which was validated through content validity
index. Data was analysed using SPSS 21.
RESULTS: Of the 786 participants, 551(70%) were from the urban areas and 235(30%)
were from the rural areas. The mean age of the sample was 30.54±8.50. Overall,
746(95%) were taking medicines without a prescription. Among them, 528(96%) were
urban and 218(93%) were rural inhabitants (p<0.07). Besides, 352(47.2%) were
males and 394(52.8%) were females (p>0.05). The most frequent reason cited for
self-medication was quick relief by 478(64.1%) subjects.
CONCLUSIONS: Self-medication prevalence was very high in both urban and rural
populations.
PMID: 31000857
179. Work Stress. 2016;30(4):374-394. doi: 10.1080/02678373.2016.1252971. Epub 2016

Nov 3.
Work Stress and Alcohol Use: Developing and Testing a Biphasic Self-Medication
Model.
Frone MR(1).
Author information:
(1)State University of New York at Buffalo.
This study developed and tested a moderated-mediation model of work stress and
alcohol use, based on the biphasic (stimulant and sedative) effects of alcohol
and the self-medication and stress-vulnerability models of alcohol use. The model
proposes that exposure to work stressors can increase both negative affect and
work fatigue, and that these two sources of strain can subsequently motivate the
use of alcohol. However, the relations of negative affect and work fatigue to
alcohol use are conditional on the joint moderating effects of alcohol outcome
expectancies and gender. Data were collected from a national probability sample
of 2,808 U.S. workers. Supporting the model, the results indicated that work
stressor exposure was conditionally related via negative affect to heavy alcohol
use among both men and women holding strong tension reduction alcohol
expectancies and to after work alcohol use among men holding strong tension
reduction alcohol expectancies. Also, work stressor exposure was conditionally
related via work fatigue to both heavy alcohol use and workday alcohol use among
men holding strong fatigue reduction alcohol expectancies. The results have
application in the identification of individuals at higher risk of problematic
alcohol use and are relevant to workplace safety and to the design of appropriate
interventions.
DOI: 10.1080/02678373.2016.1252971
PMCID: PMC5228600
PMID: 28090129
180. Indian J Med Res. 2016 Jun;143(6):809-820. doi: 10.4103/0971-5916.192075.
Impact of community-based health insurance in rural India on self-medication &

financial protection of the insured.
Dror DM(1), Chakraborty A(2), Majumdar A(1), Panda P(1), Koren R(3).
Author information:
(1)Micro Insurance Academy, New Delhi, India and Institute of Health Policy &
Management, Erasmus University, Rotterdam, The Netherlands.
(2)Micro Insurance Academy, New Delhi, India and Institute of Health Policy &
Management, Erasmus University, Rotterdam, The Netherlands; Public Health
Foundation of India, Gurgaon, India, .
(3)Tel Aviv University, Rabin Medical Center, Petah Tikva, Israel.
BACKGROUND & OBJECTIVES: The evidence-base of the impact of community-based

health insurance (CBHI) on access to healthcare and financial protection in India
is weak. We investigated the impact of CBHI in rural Uttar Pradesh and Bihar s0
tates of India on insured households' self-medication and financial position.
METHODS: Data originated from (i) household surveys, and (ii) the Management
Information System of each CBHI. Study design was "staggered implementation"
cluster randomized controlled trial with enrollment of one-third of the treatment
group in each of the years 2011, 2012 and 2013. Around 40-50 per cent of the
households that were offered to enroll joined. The benefits-packages covered
outpatient care in all three locations and in-patient care in two locations. To
overcome self-selection enrollment bias, we constructed comparable control and
treatment groups using Kernel Propensity Score Matching (K-PSM). To quantify
impact, both difference-in-difference (DiD), and conditional-DiD (combined K-PSM
with DiD) were used to assess robustness of results.
RESULTS: Post-intervention (2013), self-medication was less practiced by insured
HHs. Fewer insured households than uninsured households reported borrowing to
finance care for non-hospitalization events. Being insured for two years also
improved the HH's location along the income distribution, namely insured HHs were
more likely to experience income quintile-upgrade in one location, and less
likely to experience a quintile-downgrade in two locations.
INTERPRETATION & CONCLUSIONS: The realized benefits of insurance included better
access to healthcare, reduced financial risks and improved economic mobility,
suggesting that in our context health insurance creates welfare gains. These
findings have implications for theoretical, ethical, policy and practice
considerations.
DOI: 10.4103/0971-5916.192075
PMCID: PMC5094122
Conflict of interest statement: None.

181. J Family Med Prim Care. 2018 Jan-Feb;7(1):124-129. doi:
10.4103/jfmpc.jfmpc_227_17.
A comparison of the frequency, risk factors, and type of self-medication in

pregnant and nonpregnant women presenting to Shahid Akbar Abadi Teaching Hospital
in Tehran.
Botyar M(1), Kashanian M(1), Abadi ZRH(1), Noor MH(1), Khoramroudi R(1),
Monfaredi M(2), Nasehe G(1).
Author information:
(1)Department of Midwifery, University of Medical Sciences, Tehran, Iran.
(2)Department of Biology, Islamic Azad University, Karaj Branch, Karaj, Iran.
Background: Self-medication is a serious health problem that leads to an

increased per capita consumption of medications, drug resistance, lack of optimal
treatment, drug poisoning, and other unwanted complications. This study was
conducted to compare self-medication in pregnant and nonpregnant women presenting
to Shahid Akbar Abadi Teaching Hospital in Tehran, Iran.
Materials and Methods: To conduct this cross-sectional study, 210 pregnant women
and 210 nonpregnant women aged 15-45 years presenting to Shahid Akbar Abadi
Teaching Hospital, Tehran, Iran, were selected through random sampling. Data were
collected through interviews using a semi-structured questionnaire. The
Chi-square test, t-test, and logistic regression model were used to analyze the
data.
Results: The prevalence of self-medication was 34.8% in the pregnant and 77.1% in
the nonpregnant women. The age group in which the most frequent instances of
self-medication were observed (53.4%) was the 21-30 age group in the pregnant
women and the 31-40 age group (44.4%) in the nonpregnant women, suggesting a
statistically significant intergroup difference in terms of age (P = 0.0001).
Medicinal plants were the most common medications used by the pregnant women
(19.6%) and synthetic medications were the most common used by the nonpregnant
women (38.1%). The reasons for using medications without a prescription included
believing in the illness being mild (22.8%), not having health insurance (9%),
easy access in the pregnant women, a previous history of the illness, and easy
access in the nonpregnant women.
Conclusions: As medicinal plants are the most common medications used by pregnant
women and since assessing the risk of herbal substances is difficult, pregnant
women should be advised against the arbitrary use of these substances.
DOI: 10.4103/jfmpc.jfmpc_227_17
PMCID: PMC5958553
PMID: 29915745
182. J Neurosci Rural Pract. 2014 Oct;5(4):384-6. doi: 10.4103/0976-3147.139991.
Over-the-counter self-medication leading to intracranial hypertension in a young

lady.
Ramana Reddy AM(1), Prashanth LK(1), Sharat Kumar GG(1), Chandana G(1), Jadav
R(1).
Author information:
(1)Advanced Neurosciences Institute, BGS Global Hospital, Bangalore, Karnataka,
India.
Intracranial hypertension (idiopathic-IIH and secondary) is a potentially
treatable condition. Although various factors such as female gender and obesity,
certain drugs have been implicated as risk factors for IIH, there remains a lack
of clarity in the exact causal-effect relationship. In India, self-medication by
obtaining drugs over the counter due to lack of adequate drug regulation and
ignorance of the public is a very common practice with a potential for severe
adverse effects. We present a case of a young lady who has developed intracranial
hypertension possibly due to self-medication with steroids and cyproheptadine,
obtained over the counter.
DOI: 10.4103/0976-3147.139991
PMCID: PMC4173236
PMID: 25288841
183. Med J Islam Repub Iran. 2017 Dec 22;31:119. doi: 10.14196/mjiri.31.119.
eCollection 2017.
Application of media literacy education for changing attitudes about

self-medication of slimming supplements.
Solhi M(1), Jormand H(2), Gohari MR(3).
Author information:
(1)Health Promotion Research Center, Iran University of Medical Sciences, Tehran,
Iran.
(2)School of Health, Iran University of Medical Sciences, Tehran, Iran.
(3)Department of Biostatistics, School of Health, Iran University of Medical
Background: Self-medication of slimming supplements has increased, and media

advertising has a role in this. The present study aimed at determining the effect
of media literacy educational intervention on attitudes about self-medication of
slimming supplements among the female students at dormitories of Iran University
of Medical Sciences. Methods: In this quasi-experimental study with a control
group, 98 students were selected by multistage cluster sampling method and were
randomly divided into 2 equal groups of test and control. The data collecting
instrument was a researcher-made questionnaire about media literacy and attitude
on self-medication of slimming pills. Based on the results obtained from the
early completion of the questionnaires, an appropriate educational intervention
was designed and implemented. Data were analyzed 1 and 3 months after the
intervention using the following statistical methods: repeated measurements,
Friedman test, Chi square, independent T-test and MannWhitney test. Results:
Before the intervention, the mean scores of attitude and dimensions of media
literacy were moderate in both groups, and there was no significant difference
between them. However, positive correlations were observed among attitude and
knowledge (r=0.99, p= 0.001), critical thinking (r= 0.61, p= 0.001), and analysis
(r= 0.37, p= 0.009) in the experimental group. The mean scores of attitudes and
dimensions of media literacy were found to be significant in both groups 1 and 3
months after the intervention (p<0.05). Conclusion: Media literacy education was
effective in promoting a positive attitude about slimming supplements.
DOI: 10.14196/mjiri.31.119
PMCID: PMC6014786
PMID: 29951420
184. Int J Environ Res Public Health. 2018 Apr 5;15(4). pii: E687. doi:
10.3390/ijerph15040687.
Keeping Antibiotics at Home Promotes Self-Medication with Antibiotics among

Chinese University Students.
Wang X(1), Lin L(2)(3)(4), Xuan Z(5), Li L(6), Zhou X(7).
Author information:
(1)Zhejiang University Institute of Social Medicine, 866 Yuhangtang Road,
Hangzhou 310058, Zhejiang, China. ellen_wang@zju.edu.cn.
(2)Department of Social and Behavioral Sciences, Harvard T.H. Chan School of
Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
llin@hsph.harvard.edu.
(3)Center for Community-Based Research, Dana-Farber Cancer Institute, 450
Brookline Avenue, Boston, MA 02215, USA. llin@hsph.harvard.edu.
(4)Division of Policy Translation and Leadership Development, Harvard T.H. Chan
School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
llin@hsph.harvard.edu.
(5)Department of Community Health Sciences, Boston University School of Public
Health, 801 Massachusetts Ave, Boston, MA 02118, USA. zxuan@bu.edu.
Hangzhou 310058, Zhejiang, China. lilu@zju.edu.cn.
Hangzhou 310058, Zhejiang, China. zhouxudong@zju.edu.cn.
BACKGROUND: Inappropriate use of antibiotics has caused antimicrobial resistance,

presenting a major health challenge to the world population. Self-medication with
antibiotics (SMA) is currently at an alarming level in China.
OBJECTIVES: To determine the sources of antibiotics leftover at home, the risk
factors of keeping antibiotics at home, and the associations between keeping
antibiotics at home and SMA among Chinese university students.
METHODS: Six provinces were purposely selected from six regions of China, and one
multi-disciplinary university was selected from each chosen province. A total of
11,192 university students were selected using cluster random sampling from the
selected universities. Logistic regression was conducted to examine the
relationship between keeping antibiotics at home and SMA.
RESULTS: Out of the 11,192 students surveyed, 7057 (63.1%) reported keeping
antibiotics at home at the time they were surveyed. Of those who kept antibiotics
in their home, 1965 (27.8%) reported that these antibiotics were left over from a
previous prescription by a doctor and 4893 (69.3%), purchased antibiotics over
the counter. Additionally, 29.6% (507/1711) of students self-medicated with
antibiotics when ill during the month before the survey. Students keeping
antibiotics at home were five times (95% CI 3.53, 7.05) more likely to engage in
SMA when ill and 2.6 times (95% CI 2.34, 2.89) more likely to self-medicating
with antibiotics for prophylaxis than the other students. Female students, those
with a family background of higher education, and those who had a parent working
in the medical field had a significantly higher chance of keeping antibiotics at
home.
CONCLUSIONS: The high prevalence of keeping antibiotics at home and SMA among
young adults is a serious concern. Professional regulations and
population-tailored health education are needed.
DOI: 10.3390/ijerph15040687
PMCID: PMC5923729

185. Schizophr Res. 2018 Apr;194:78-85. doi: 10.1016/j.schres.2017.04.016. Epub
2017
Apr 14.
The link between schizophrenia and substance use disorder: A unifying hypothesis.
Khokhar JY(1), Dwiel LL(1), Henricks AM(1), Doucette WT(1), Green AI(2).
Author information:
(1)Department of Psychiatry, Geisel School of Medicine at Dartmouth, United
States.
(2)Department of Psychiatry, Geisel School of Medicine at Dartmouth, United
States; Department of Molecular and Systems Biology, Geisel School of Medicine at
Dartmouth, United States; Dartmouth Clinical and Translational Science Institute,
Dartmouth College, United States. Electronic address: Alan.I.Green@dartmouth.edu.
Substance use disorders occur commonly in patients with schizophrenia and

dramatically worsen their overall clinical course. While the exact mechanisms
contributing to substance use in schizophrenia are not known, a number of
theories have been put forward to explain the basis of the co-occurrence of these
disorders. We propose here a unifying hypothesis that combines recent evidence
from epidemiological and genetic association studies with brain imaging and
pre-clinical studies to provide an updated formulation regarding the basis of
substance use in patients with schizophrenia. We suggest that the genetic
determinants of risk for schizophrenia (especially within neural systems that
contribute to the risk for both psychosis and addiction) make patients vulnerable
to substance use. Since this vulnerability may arise prior to the appearance of
psychotic symptoms, an increased use of substances in adolescence may both
enhance the risk for developing a later substance use disorder, and also serve as
an additional risk factor for the appearance of psychotic symptoms. Future
studies that assess brain circuitry in a prospective longitudinal manner during
adolescence prior to the appearance of psychotic symptoms could shed further
light on the mechanistic underpinnings of these co-occurring disorders while
identifying potential points of intervention for these difficult-to-treat
co-occurring disorders.
DOI: 10.1016/j.schres.2017.04.016
PMCID: PMC6094954
186. Int J Health Sci (Qassim). 2018 Sep-Oct;12(5):3-9.
Frequency of use of non-prescribed medication among population sample from Al

Madina City and its impact on quality of care in Saudi Arabia.
Mahrous MS(1).
Author information:
(1)Department of Medical Education, College of Dentistry, Taibah University,
Madinah, Saudi Arabia.
Objective: Self-medication can be defined as the practice of using drugs that

have not been prescribed, recommended, or controlled by a certified health-care
professional. This term can be used when discussing patients who use
non-prescription medications to treat self-diagnosed disorders or symptoms,
without consulting a medical practitioner and without any medical supervision.
The objectives of this study are to identify patterns of self-medication in Saudi
Arabia, to measure the association between gender and the use of non-prescribed
medication, and to identify the type of medications involved, the dosages used,
and patient's sources of knowledge regarding the types, and doses of medications.
Method: Cross-section analytical observational study, conducted in Al Medina
city, Saudi Arabia, over 6 months using a pretested self-administered
questionnaire using a convenience sampling technique.
Results: With a response rate of 68.8%, it was found that 72.5% reported the use
of non-prescribed medication and 24.3% reported a history of experiencing side
effects from using non-prescribed medication with no significant difference
between male and female. 81% were keen to read the medication instruction with
higher response among females.Analgesics were the most common type of medication
used with an 86.5% agreement with no statistical significant differences between
male and females.
Conclusion: The study found heavy use of non-prescribed medication among the Al
Medina residents sampled. This suggests a need for specialist training programs
that could be directed at pharmacists, to help them disseminate information on
the safe use of OTC or non-prescribed medications.
PMCID: PMC6124833
PMID: 30202401
187. Soc Sci Med. 2016 Mar;152:1-8. doi: 10.1016/j.socscimed.2016.01.022. Epub 2016
Jan 18.
"I'm running my depression:" Self-management of depression in neoliberal

Australia.
Brijnath B(1), Antoniades J(2).
Author information:
(1)Department of General Practice, School of Primary Care, Faculty of Medicine
Nursing and Health Sciences, Monash University, Australia. Electronic address:
bianca.brijnath@monash.edu.
(2)Department of General Practice, School of Primary Care, Faculty of Medicine
Nursing and Health Sciences, Monash University, Australia.
The current study examines how the neoliberal imperative to self-manage has been
taken up by patients, focusing specifically on Indian-Australians and
Anglo-Australians living with depression in Australia. We use Nikolas Rose's work
on governmentality and neoliberalism to theorise our study and begin by
explicating the links between self-management, neoliberalism and the Australian
mental health system. Using qualitative methods, comprising 58 in-depth
interviews, conducted between May 2012 and May 2013, we argue that participants
practices of self-management included reduced use of healthcare services,
self-medication and self-labour. Such practices occurred over time, informed by
unsatisfactory interactions with the health system, participants confidence in
their own agency, and capacity to craft therapeutic strategies. We argue that as
patients absorbed and enacted neoliberal norms, a disconnect was created between
the policy rhetoric of self-management, its operationalisation in the health
system and patient understandings and practices of self-management. Such a
disconnect, in turn, fosters conditions for risky health practices and poor
health outcomes.
DOI: 10.1016/j.socscimed.2016.01.022
188. J Can Dent Assoc. 2015;81:f10.
OUTPATIENT MEDICATION USE AND IMPLICATIONS FOR DENTAL CARE: GUIDANCE FOR
CONTEMPORARY DENTAL PRACTICE.
Fitzgerald J, Epstein JB, Donaldson M, Schwartz G, Jones C, Fung K(1).
Author information:
(1)Catherine St, Ottawa ON K2P 2G8.
BACKGROUND: Adverse effects of medication used in dental care are likely to

increase as North Americans live longer, experience more and greater severity of
chronic conditions and take more medications. Thus, documentation of medication
use and the implications for contemporary dental practice is of increasing
importance.
METHODS: We recorded medication use in patients referred to a large private
periodontal practice in Ottawa, Ontario. Patients self-reported medication use
and medication allergies in their health history forms on admission.
RESULTS: Of 322 sequential patients enrolled, 164 were female and the overall
median age was 52 (range 6-94 years). Participants reported taking 249 unique
medications in 28 categories. Two-thirds of patients (63.7%) were taking
prescription or over-the-counter (OTC) medications or both. The average number of
medications per patient was 1.9 (range 0-14). The average number of OTC
medications per patient was 0.5 for those not taking prescription medications and
0.4 for patients taking prescription medications concurrently. The number of OTC
products per patient was 0-7.
CONCLUSIONS: Given the prevalence of the use of both prescription and OTC
products, accurate recording of the medication profile is necessary in
contemporary dental practice. Medication use and medication allergies provide
information on patients' medical history and diagnoses that may have implications
for their oral condition and delivery of dental care. Additional concerns include
potential interactions between frequently used medications reported by patients
and medications that are commonly used in dentistry.
CLINICAL IMPLICATIONS: The increase in the use of multiple medications and OTC
products by the outpatient community has an impact on dental care and prescribed
medications in dental care. Thus, it is important to have a complete and accurate
medication history to ensure a high standard of care in dental practice.
189. Fam Med. 2014 Nov-Dec;46(10):797-801.
Self-treatment and informal treatment for depression among resident physicians.
Stoesser K(1), Cobb NM.
Author information:
(1)Department of Family and Preventive Medicine, University of Utah.
Comment in
Fam Med. 2015 Jun;47(6):487-8.
Fam Med. 2015 Jun;47(6):488-9.
BACKGROUND AND OBJECTIVES: There is awareness of depression in resident

physicians, yet limited information on self-treatment or informal treatment
behaviors for depression. This study sought to identify the prevalence of
moderate to severe depression, self-treatment, and informal treatment for
depression in resident physicians.
METHODS: A total of 704 residents at the University of Utah were sent a survey on
depression in the fall of 2009, with a response rate of 36.9% (260).
RESULTS: Moderate to severe depression was present in 17.7% (46/260) of
residents. Only 1.2% (3/254) of all residents had prescribed their own
antidepressant medication, and just 0.8% (2/257) of residents had self-treated
for depression with samples from their clinic. Regarding informal prescribing,
5.9% (15/256) of residents had received prescription antidepressants from another
provider without a formal clinical consultation or appointment, and 3.1% (8/254)
of residents had informally prescribed antidepressant medications to another
resident colleague. Merely 26.7% (12/45) of residents with moderate to severe
depression scores were currently receiving treatment for depression.
CONCLUSIONS: Moderate to severe depression in resident physicians is common and
undertreated. Self-treatment behaviors of self-prescribing and use of clinical
samples have a low prevalence but are present. Similarly, informally obtaining
prescription antidepressants and informally prescribing antidepressants to other
residents exist at a low rate.
190. BMC Public Health. 2019 Feb 6;19(1):159. doi: 10.1186/s12889-019-6470-5.
Self-medication with over the counter drugs, prevalence of risky practice and its
associated factors in pharmacy outlets of Asmara, Eritrea.
Tesfamariam S(1), Anand IS(2), Kaleab G(3), Berhane S(3), Woldai B(2), Habte
E(4), Russom M(5).
Author information:
sirakino2015@gmail.com.
(2)Pharmacology and Clinical Pharmacy Unit, School of Pharmacy, Asmara College of
Health Sciences, Asmara, Eritrea.
(4)Biostatistics and Epidemiology Unit, School of Public Health, Asmara College
of Health Sciences, Asmara, Eritrea.
(5)Eritrean Pharmacovigilance Centre, National Medicine and Food Administration,
Ministry of Health, Asmara, Eritrea.
BACKGROUND: Although over the counter (OTC) drugs are believed to be relatively
safe, their inappropriate use could have serious implications. The aim of the
study was to assess the practice of self-medication, prevalence of risky practice
and its associated factors in pharmacy outlets of Asmara, Eritrea.
METHODS: A descriptive cross-sectional study was conducted among 609 customers in
20 pharmacy outlets in Asmara between August and September, 2017. Two-stage
cluster sampling was employed and data were collected using a structured
questionnaire through face to face exit interviews. Descriptive statistics and
multivariate logistic regression were performed using SPSS (version 22).
RESULTS: Of the 609 customers, 93.7% had practiced self-medication with OTC
drugs; of which 81.8% were at risky practice. On average, each participant was
using OTC drugs at least once a month (Median = 1, IQR = 3.67). Educational level
(p < 0.0001), religion (p = 0.047), occupation (p = 0.027) and knowledge
regarding OTC drugs (p = 0.019) were significantly associated with risky
practice. Respondents with elementary and below educational level were fifteen
times (AOR = 15.49, CI: 1.97, 121.80) at higher risk compared to those with
higher education, and students were almost three times (AOR = 2.96, CI: 1.13,
7.73) at higher risk than governmental employees. Furthermore, respondents with
below average score in knowledge were more likely to be engaged in risky practice
(AOR = 1.83, CI: 1.11, 3.04) compared to those with above average score. The most
frequently preferred OTC drug group was analgesics (34.3%) followed by
antipyretics (15.7%) and cough and cold preparations (14.2%). About 14% of the
respondents admitted that they had taken more than the recommended dose and 6.9%
had experienced drug related problems following the consumption of OTC drugs.
Always, 35% of the respondents read package insert(s) and 73.9% check expiry
dates while purchasing OTC drugs. Refrigerating OTC drugs, where it is not
recommended, was also one of the prominent risky practices.
CONCLUSIONS: This study revealed that inappropriate self-medication practice with
OTC drugs was prevalent requiring early intervention to minimize the risks.
DOI: 10.1186/s12889-019-6470-5
PMCID: PMC6364400
191. Fam Med. 2015 Jun;47(6):487-8.
Self-treatment and informal treatment for depression among resident physicians.
Mata DA(1), Ramos MA.
Author information:
(1)Department of Pathology, Brigham and Women's Hospital, Harvard Medical School,
Boston, MA.
Comment in
Fam Med. 2015 Jun;47(6):488-9.
Comment on
Fam Med. 2014 Nov-Dec;46(10):797-801.

eCollection 2017.
Socio-demographic, health-related, and individual correlates of diagnostic

self-testing by lay people: Results from a representative survey in Germany.
Kuecuekbalaban P(1), Schmidt S(1), Beutel M(2), Weidner K(3), de Zwaan M(4),
Braehler E(2), Muehlan H(1).
Author information:
(1)Department Health and Prevention, Ernst-Moritz-Arndt-University Greifswald,
Greifswald, Germany.
(2)Department of Psychosomatic Medicine and Psychotherapy, University Medical
Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
(3)Clinic and Polyclinic for Psychiatry and Psychosomatics of the University of
Medical Centre Carl Gustav Carus of the Technical University of Dresden, Dresden,
Germany.
(4)Department of Psychosomatic and Psychotherapy of the Medical University of
Hannover, Hannover, Germany.
INTRODUCTION: A broad range of self-tests (testing for e.g. HIV, cancer,
hepatitis B/C) have become available and can be conducted by lay consumers
without the help of a health professional. The aims of this study were to (a)
investigate the prevalence of self-testing, (b) identify the most frequently used
self-tests, and (c) explore the associations between socio-demographic,
health-related and individual factors with self-testing.
METHODS: A face-to-face plus paper-pencil cross-sectional survey was conducted.
The sample consisted of 2.527 respondents who were representative of the German
population in terms of the age, sex, and residence. Basic descriptive statistics
and univariate logistic regression analyses were performed.
RESULTS: 8.5% of the participants reported having used one or more self-tests in
the past, totalling 363 self-tests, with a mean of 1.7 (min. = 1, max. = 6). The
three self-tests most frequently indicated were for detecting diabetes, bowel
cancer, and allergies. Self-testers were older (Nagelkerke R2 = .006, p < .01),
had a higher BMI (Nagelkerke R2 = .013, p < .001) and displayed more physical and
mental fatigue (Nagelkerke R2 = .031, p < .001) than non-testers. Self-testers
also reported higher global life satisfaction values (Nagelkerke R2 = .008, p <
.01) and a higher educational level (Nagelkerke R2 = .015, p < .01).
CONCLUSIONS: Self-testing is fairly prevalent in Germany Given the current
shortage of physicians in Germany, especially in rural areas, and recent studies
on the use of self-medication, the topic of self-testing has a great practical
and socio-political relevance. Future studies should investigate further
predictors of self-testing (e.g. contextual, situational and individual factors)
as well as the emotional consequences of testing as a layperson without the
attendance of a health professional.
PMCID: PMC5708746
193. Infect Drug Resist. 2019 May 17;12:1333-1351. doi: 10.2147/IDR.S203364.

eCollection 2019.
Self-medication of antibiotics: investigating practice among university students

at the Malaysian National Defence University.
Haque M(1), Rahman NAA(2), McKimm J(3), Kibria GM(1), Azim Majumder MA(4), Haque
SZ(5), Islam MZ(6), Binti Abdullah SL(1), Daher AM(1), Zulkifli Z(7), Rahman
S(8), Kabir R(9), Lutfi SNNB(1), Aishah Binti Othman NS(1).
Author information:
(1)Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional
Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000,
Malaysia.
(2)Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health
Sciences, International Islamic University Malaysia, Kuantan, 25200, Malaysia.
(3)Swansea University School of Medicine, Grove Building, Swansea University,
Swansea, Wales, SA2 8PP, UK.
(4)Department of Medical Education, Faculty of Medical Sciences, The University
of the West Indies, Bridgetown, Barbados, West Indies.
(5)Department of Orthopedic Surgery, Ninewells Hospital & Medical School, Dundee,
DD1 9SY, Scotland, UK.
(6)Department of Pharmacology, Eastern Medical College, Burichang 3520,
Bangladesh.
(7)Department of Surgery, Sultan Haji Ahmad Shah Hospital, Temerloh, Pahang,
28000, Malaysia.
(8)Department of Pharmacology and Public Health, School of Medicine, American
University of Integrative Sciences, Bridgetown, Barbados.
(9)School of Allied Health, Faculty of Health, Education, Medicine and Social
Care, Anglia Ruskin University, Chelmsford, Essex, UK.
Background: Self-medication of drugs to alleviate symptoms is a common global

behavior, helping relieve burdens on health services, but many drugs eg,
antibiotics are prescription-only. Self-medication of antibiotics (SMA) is an
irrational use of drugs, contributing to microbial resistance increasing health
care costs and higher mortality and morbidity. This study aimed to assess SMA
among university students. Methods: This was a cross-sectional study conducted
among medical and non-medical students of the National Defence University of
Malaysia. A validated instrument was used to gather data. Ethics approval was
obtained. Random and universal sampling was adopted, and SPSS 21 was used for
data analysis. Results: A total of 649 students participated in the study: 48.5%
male and 51.5% female, 39.3% reported self-medicating with antibiotics.
Penicillin, doxycycline, clarithromycin were the antibiotics most used with the
majority reporting no adverse drug reactions. Cost savings and convenience were
the principal reasons for SMA which were mainly obtained from local retail
pharmacies. Despite medical students (particularly the more senior) having better
knowledge of antibiotic use than non-medical students, 89% of all research
participants responded that practicing SMA was a good/acceptable practice.
Conclusion: SMA is common amongst Malaysian students and, despite understanding
why SMA is unwise, even medical students self-medicate.
DOI: 10.2147/IDR.S203364
PMCID: PMC6529675
PMID: 31190922
Conflict of interest statement: Dr. Md Anwarul Azim Majumder is the current

Editor-in-Chief of the Advances in Medical Education and Practice journal for
Dove Medical Press. The authors report no other conflicts of interest in this
work.
194. Psychol Addict Behav. 2015 Mar;29(1):184-91. doi: 10.1037/adb0000026. Epub

2014
Nov 24.
A prospective study of adolescents' nonmedical use of anxiolytic and sleep

medication.
Boyd CJ(1), Austic E(2), Epstein-Ngo Q(3), Veliz PT(2), McCabe SE(2).
Author information:
(1)School of Nursing, Addiction Research Center, University of Michigan.
(2)Addiction Research Center, University of Michigan.
(3)School of Nursing, Addiction Research Center, and Institute for Research on
Women and Gender, University of Michigan.
The purpose of this longitudinal study (N = 2,745) was to determine whether

adolescents' recent medical use of anxiolytic or sleep medication was associated
with increased incidence of using someone else's prescription for these classes
of medication (nonmedical use). Data were collected from adolescents attending 5
Detroit area secondary schools between December and April in 3 consecutive
academic years between 2009 and 2012. Respondents were assigned to the following
3 mutually exclusive groups for the analyses: (1) never prescribed anxiolytic or
sleep medication (in their lifetime); (2) prescribed anxiolytic or sleep
medication in their lifetime, but not during the study period; or (3) prescribed
anxiolytic or sleep medication during the study period. Almost 9% of the sample
had received a prescription for anxiolytic or sleep medication during their
lifetime, and 3.4% had received at least 1 prescription during the 3-year study
period. Compared with adolescents never prescribed anxiolytic or sleep
medication, adolescents prescribed these medicines during the study period were
10 times more likely to engage in nonmedical use for reasons such as "to get
high" or "to experiment" (adjusted odds ratio [ORadj.] = 10.15; 95% CI
[3.97-25.91]), and 3 times more likely to engage in nonmedical use to self-treat
anxiety or to sleep (ORadj. = 3.24; 95% CI [1.67-6.29]). Adolescents prescribed
anxiolytics during their lifetime but not during the 3-year study were 12 times
more likely to use another's anxiolytic medication, compared with adolescents
never prescribed anxiolytics (ORadj. = 12.17; 95% CI [3.98-37.18]). These risk
factors have significant implications for later substance use problems.
DOI: 10.1037/adb0000026
PMCID: PMC4388758

Oct
26.
Perception Pattern Analysis of Self-Medication Practices Among People in Southern

District of Karnataka, India.
Udupa N(1), Jain P(2), Lokhande AK(3).
Author information:
(1)Manipal College of Pharmaceutical Sciences, Manipal, India.
(2)MCOPS, Manipal University, Udupi, India.
(3)Manipal College of Pharmaceutical Sciences, Manipal University, Manipal,
India.
DOI: 10.1016/j.jval.2014.08.371
PMID: 27202890
196. Br J Sports Med. 2015 May;49(9):580-2. doi: 10.1136/bjsports-2015-094784.
High prevalence of medication use in professional football tournaments including

the World Cups between 2002 and 2014: a narrative review with a focus on NSAIDs.
Tscholl PM(1), Vaso M(2), Weber A(2), Dvorak J(3).
Author information:
(1)FIFA-Medical Assessment and Research Center (F-MARC), Schulthess Clinic,
Zürich, Switzerland Division of Orthopedics and Trauma Surgery, Geneva University
Hospital, Switzerland.
(2)Fédération Internationale de Football Association, Zürich, Switzerland.
(3)FIFA-Medical Assessment and Research Center (F-MARC), Schulthess Clinic,
Zürich, Switzerland Fédération Internationale de Football Association, Zürich,
Switzerland.
The use of medication in international football has been monitored since the 2002
FIFA World Cup. Team physicians were asked to provide information on prescribed
medication 72 h prior to each match for every player. 69% of adult male players
reported using medication, with more than half the players using non-steroidal
anti-inflammatory drugs (NSAIDs). Up to one-third of all players used NSAIDs
prior to every match, regardless of whether they took the field or not. The mean
intake of medication was significantly higher during the FIFA Women's World Cup
(0.85 vs 0.77 substances per player and per match in men, p<0.001), whereas the
use of NSAIDs was similar to that for men. In the Under-20 and Under-17 male
competitions, the use of medication was lower as 60% of players used some kind of
medication and 43% of the players used NSAIDs during the tournaments. Despite the
potential side effects of medication, especially of NSAIDs in the recovery
process after a sports activity, there is no evidence of decreasing intake. The
reported incidence is alarming, and moreover is most probably underestimated,
since self-medication by the players or treatment already prescribed by club
physicians is not included in the published reports. Future studies should focus
on the daily dosage, time of treatment and especially the medical indication for
painkilling agents to better understand the underlying factors.
Published by the BMJ Publishing Group Limited. For permission to use (where not
already granted under a licence) please go to
http://group.bmj.com/group/rights-licensing/permissions.
DOI: 10.1136/bjsports-2015-094784
PMCID: PMC4413681
197. J Ayub Med Coll Abbottabad. 2017 Jan-Mar;29(1):87-89.
Trend Of Irrational Medication Among The Students Of Department Of Pharmacy

Abbottabad University Of Science And Technology In Common Cold And Flu.
Rehman MU(1), Mehsud SU(2), Ali S(3), Ishaq M(4), Khan MA(5).
Author information:
(1)Department of Pharmacology, IBMS-Khyber Medical University Peshawar, Pakistan.
(2)2Department of Pharmacy, Abbottabad University of Science and Technology
Abbottabad, Pakistan.
(3)Comsats Institute of Information and Technology, Abbottabad, Pakistan.
(4)Department of Community Medicine, Saidu Medical College, Saidu Sharif Swat,
Pakistan.
(5)Epidemeologic Cell, NIH, Islamabad, Pakistan.
BACKGROUND: Common cold and flu are mostly of viral pathogenesis with symptoms in
upper respiratory tract. It is highly contagious and close inter-individual
contact in winter season increase the spread spectrum. Mis-interpretation with
bacterial cause leads to irrationality in its medication.
METHODS: A cross-sectional study was conducted among pharmacy department students
in February-March 2016. Data were collected through self-administered
questionnaire and expressed as percentage frequency.
RESULTS: Total 180 students were provided with questionnaire to fill the desired
data. 66 out of them were reported as patients of common cold and flu. Trend of
medication after compilation and analyzing data reveal that: 60.60% (n=40/66)
students got irrational medication, 4.54% (n=3/66) students presents with other
disease, so were declared of complex nature and 9.1% (n=6/66) patients, presented
only with symptoms were counseled accordingly to the standard therapy by Health
Protection Agency-UK (Management of infection guidance for primary care for
consultation and local adaptation, 2013), and Columbia University Medical Center
(Guidelines for the empiric use of antibiotics in adult patients - Feb, 2005) and
all of them were followed for their entire therapy time. All of the counseled
patients recovered successfully. Total 25.76% (n=17/66) other than that of
counseled group students also got rational medication.
CONCLUSIONS: Use of medicine by students in study was found irrational. National
and international awareness programs about such viral disease should be designed
and arranged to promote information in the community and limit the irrational
medication. It also need an active health regulatory authority in undeveloped and
less developed countries specially to limit the availability of prescription
drugs without physician advise through availability of qualified person in
pharmacies.
198. J Pediatr (Rio J). 2014 Nov-Dec;90(6):608-15. doi: 10.1016/j.jped.2014.03.004.

Epub 2014 Jun 20.
Medication use among children 0-14 years old: population baseline study.
Cruz MJ(1), Dourado LF(2), Bodevan EC(3), Andrade RA(2), Santos DF(2).
Author information:
(1)Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do
Jequitinhonha e Mucuri (UFVJM), Diamantina, MG, Brazil. Electronic address:
maria_enfermagem@yahoo.com.br.
(2)Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do
Jequitinhonha e Mucuri (UFVJM), Diamantina, MG, Brazil.
(3)Faculdade de Ciências Exatas e Tecnológicas, Universidade Federal dos Vales do
Jequitinhonha e Mucuri (UFVJM), Diamantina, MG, Brazil.
OBJECTIVE: Determine the prevalence of medication use in children and adolescents

in 20 municipalities of Vale do Jequitinhonha, Minas Gerais-Brazil, showing the
main groups and variables that may have influenced use.
METHODS: Descriptive population-based survey sample of 555 interviews, selected
by simple random cluster sampling of 137 census tracts. Inclusion criteria were
age ≤ 14 years, mandatory interview with the legal guardians, and regardless of
having received medications. Regarding the usage pattern, participants were
divided into two groups: consumption and non-consumption of drugs. A descriptive
analysis of the variables and tests of association were performed.
RESULTS: The prevalence of drug consumption was 56.57%, and 42.43% showed no
consumption. The use of medicinal plants was 72.9% for drug users and 74.3% for
non-users. The health conditions for consumption were cough, common cold, flu,
nasal congestion or bronchospasm (49.7%), fever (5.4%), headache (5.4%),
diarrhea, indigestion, and abdominal colic (6.7%). In cases of self-medication,
30.57% of the drugs were given by the mother, and 69.42% were prescription drugs.
Self-medication was prevalent using paracetamol (30.2%), dipyrone (20.8%), and
cold medicine (18.8%). There was increased use of analgesics/antipyretics,
followed by respiratory medications, systemic antibiotics, histamine H1
antagonists, and vitamins/antianemics.
CONCLUSIONS: The prevalence of drugs use in children was high, indicating the
need for formulating educational programs aiming at the awareness of caregivers
regarding rational use.
Copyright © 2014 Sociedade Brasileira de Pediatria. Published by Elsevier Editora

Ltda. All rights reserved.
DOI: 10.1016/j.jped.2014.03.004
199. Arch Public Health. 2016 Jan 22;74:1. doi: 10.1186/s13690-015-0113-9.

eCollection
2016.
Prevalence of using non prescribed medications in economically deprived rural

population of Pakistan.
Haseeb A(1), Bilal M(1).
Author information:
(1)Dow University of Health Sciences, Karachi, Pakistan.
BACKGROUND: Self medication is described as an act of procurement and consumption

of medical drugs without the advice of medical physician for diagnosis,
prescription and surveillance of treatment. There is a paucity of literature with
regards to self medication among rural dwellers of Pakistan and no initiatives
have been taken to resolve this issue. Therefore, the study aimed to evaluate
frequency, practice and prevalence of self medication among economically deprived
rural population of Karachi (South Pakistan).
METHODS: This was the descriptive, epidemiological cross sectional survey which
was conducted at the two largest tertiary care government based teaching
hospitals of Karachi, Civil hospital and Jinnah Postgraduate Medical Centre, from
January 2015 until March 2015. Seven hundred rural dwellers were recruited; who
were the residents of outskirts of Karachi city were enrolled in the above
mentioned period through the outpatient department (OPD) of the respective
hospitals.
RESULTS: According to the survey, 595 (85 %) subjects practiced self medication.
The most common reasons evaluated for self medication were cost of consultation
(90.3 %) and availability of transport (81.0 %) from rural area to health care
facility. The paracetamol as a painkiller (93.0 %), acetylsalicylic acid as an
anti pyretic (69.0 %), anti biotic (52.0 %) and anti allergic (51.0 %) were the
commonest drug used without prescription of a health care physician. A
significant difference was obtained in carrying out self medication between
participants earning less than 50,000 PKR and greater than this amount
(p = 0.029; 61 % vs. 24 %) and for the self medicated patients having education
less than graduation with the participants having education of graduation or
above it (p = 0.03; 63 % vs. 22 %).
CONCLUSION: The self medication among rural dwellers of Karachi is high . As a
result, urgent steps must be taken to initiate the awareness and educational
programs regarding potential risks of self medication. Secondly, strict measures
must be introduced to stop supply of prescription drugs from pharmacies without
prescription. Thirdly, provision of cost effective treatment from public sector
hospitals to rural population can help to reduce self medication among rural
population of Pakistan.
DOI: 10.1186/s13690-015-0113-9
PMCID: PMC4722669
PMID: 26807216
200. J Pain Res. 2017 Feb 10;10:365-374. doi: 10.2147/JPR.S123554. eCollection

2017.
Risk perception about medication sharing among patients: a focus group

qualitative study on borrowing and lending of prescription analgesics.
Markotic F(1), Vrdoljak D(2), Puljiz M(3), Puljak L(4).
Author information:
(1)Centre for Clinical Pharmacology, University Clinical Hospital Mostar, Mostar,
Bosnia and Herzegovina.
(2)Department of Family Medicine, University of Split School of Medicine, Split.
(3)Family Medicine Clinic, Health Centre Imotski, Kamenmost.
(4)Laboratory for Pain Research, University of Split School of Medicine, Split,
Croatia.
BACKGROUND: One form of self-medication is sharing of medications, defined as

borrowing or lending medications in situations where the receiver of these drugs
is not the individual to whom the medications were allocated.
OBJECTIVE: To explore experiences and opinions of patients about sharing
prescription analgesics, reasons for sharing prescription analgesics, the way in
which patients choose to share those medications, their awareness of risk
regarding sharing prescription analgesics, and how they estimated the potential
risk.
METHODS: This qualitative study was conducted by focus group discussions with 40
participants led by a moderator trained in focus group methodology using a
semi-structured moderator guide. Adults aged ≥18 years who had received a
prescription for an analgesic at least once in a lifetime were included. Six
separate focus groups were conducted to discuss participants' perception of risks
associated with sharing of prescription analgesics among patients. Additionally,
participants filled out two questionnaires on demographic data, their own
behavior regarding sharing analgesics, and their attitudes about risks associated
with sharing prescription analgesics.
RESULTS: In a questionnaire, 55% of the participants indicated that they
personally shared prescription analgesics, while subsequently in the focus group
discussions, 76% confessed to such behavior. Participants recognized certain
risks related to sharing of prescription analgesics, mentioned a number of
reasons for engaging in such behavior, and indicated certain positive aspects of
such behavior. Forty-five percent of the participants indicated that sharing
prescription analgesics is riskier than sharing nonprescription analgesics.
CONCLUSION: There is a prevalent attitude among participants that sharing
prescription analgesics is a positive behavior, where potential benefits outweigh
risks.
DOI: 10.2147/JPR.S123554
PMCID: PMC5315341
PMID: 28243140

201. Life Sci. 2014 Oct 2;114(2):86-92. doi: 10.1016/j.lfs.2014.08.005. Epub 2014
Aug
14.
Exercise decreases speedball self-administration.
Lacy RT(1), Strickland JC(1), Brophy MK(1), Witte MA(1), Smith MA(2).
Author information:
(1)Department of Psychology, Davidson College, USA.
(2)Department of Psychology, Davidson College, USA; Program in Neuroscience,
Davidson College, USA. Electronic address: masmith@davidson.edu.
AIMS: Epidemiological studies report that individuals who exercise are less
likely to abuse drugs. Preclinical studies report that exercise, in the form of
treadmill or wheel running, reliably decreases the self-administration of
psychomotor stimulants and opioids. To date, preclinical studies have only
examined the effects of exercise on responding maintained by individual drugs and
not by combinations of multiple drugs. This limits the translational appeal of
these studies because polydrug abuse is common among substance abusing
populations. The purpose of this study was to examine the effects of exercise on
the self-administration of speedball, a combination of cocaine and heroin that is
frequently encountered in intravenous drug abusing populations.
MAIN METHODS: Female rats were obtained at weaning and assigned to sedentary or
exercising conditions. Sedentary rats were housed in standard cages that
permitted no exercise beyond normal cage ambulation; exercising rats were housed
in similar cages with an activity wheel. After 6weeks, rats were implanted with
intravenous catheters and trained to self-administer cocaine, heroin, and dose
combinations of cocaine and heroin (i.e., speedball) on a progressive ratio
schedule of reinforcement.
KEY FINDINGS: Doses of speedball maintained greater levels of responding than
corresponding doses of cocaine and heroin alone. Importantly, responding
maintained by cocaine, heroin, and speedball was lower in exercising rats than
sedentary rats.
SIGNIFICANCE: These data indicate that exercise decreases the self-administration
of speedball and suggest that exercise may reduce the abuse of drug combinations
that have traditionally been resistant to treatment.
Copyright © 2014 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.lfs.2014.08.005
PMCID: PMC4175302
202. Saudi Pharm J. 2018 Mar;26(3):335-341. doi: 10.1016/j.jsps.2018.01.009. Epub

2018
Feb 1.
An epidemiological study on herbal product self-medication practice among

psychotic outpatients from Serbia: A cross-sectional study.
Nikolić G(1)(2), Stojanović NM(1), Randjelović PJ(3), Manojlović S(4), Radulović

NS(5).
Author information:
(1)Faculty of Medicine, University of Niš, Zorana Đinđića 81, 18000 Niš, Serbia.
(2)Clinic for Mental Health, Clinical Center Niš, 18000 Niš, Serbia.
(3)Department of Physiology, Faculty of Medicine, University of Niš, Zorana
Đinđića 81, 18000 Niš, Serbia.
(4)Clinic for Psychiatry ''Gornja Toponica'', Clinical Center Niš, 18000 Niš,
Serbia.
(5)Department of Chemistry, Faculty of Sciences and Mathematics, University of
Niš, Višegradska 33, 18000 Niš, Serbia.
Utilization of herbal products (HPs) is a common practice in the traditional

medicine of people from southeastern Serbia. In this study, we focused on the
usage of HPs as a self-medication practice among patients diagnosed with a mental
illness, by aiming to ascertain the usage prevalence, the identity of the main
plant taxa utilized, their formulations and target symptoms. This was
accomplished through a cross-sectional study of psychiatric outpatients,
conducted in the Clinic for Mental Health Protection in Niš, and which included a
questionnaire on HP utilization and a non-structured psychiatric interview.
Typically, single, middle-aged males, with a secondary education degree, utilized
Matricaria chamomilla and/or Melissa officinalis in a form of an infusion (tea)
for relieving anxiety and psychotic symptoms. In some cases, adverse effects were
noted when HPs were used in combination with prescribed psychotropic medications.
Our and previous results urge a thorough evaluation of possible benefits and/or
harmful interactions of HP with standard medication in the treatment of
psychiatric patients.
DOI: 10.1016/j.jsps.2018.01.009
PMCID: PMC5856938
PMID: 29556124
203. Acta Med Litu. 2016;23(2):135-141. doi: 10.6001/actamedica.v23i2.3330.
Inappropriate habits of antibiotic use among medical specialists and students in

Vilnius.
Barkus A(1), Lisauskienė I(1)(2)(3).
Author information:
(1)Medical Faculty, Vilnius University, Vilnius, Lithuania.
(2)Department of Pathology, Forensic Medicine and Pharmacology, Medical Faculty,
Vilnius University, Lithuania.
(3)Centre of Anaesthesiology, Intensive Care and Pain Management, Vilnius
University Hospital Santariškių Klinikos, Vilnius, Lithuania.
INTRODUCTION: The resistance to antibacterial drugs is an emerging worldwide

problem. Numbers of inappropriate ways to use antibiotics contribute to this
issue. Self-medication is one of them. This study seeks to find out how prevalent
the self-medication with antibiotics, their storage at home and the inappropriate
acquisition of antibacterial drugs are among medical specialists in Vilnius,
Lithuania.
METHODS: A cross-sectional survey was conducted. To better identify the potential
target groups, the respondents were classified according to their relation to
medical care: physicians, other medical personnel, medical students and people,
directly not related to medical care.
RESULTS: The overall actual self-medication with antibiotics rate was 4.0%. And,
although the actual self-medication rate might seem rather low, the intended
self-medication rate was 51.4%. Also, a prevalent antibacterial drugs storage at
home (45.8%) with a wide variety of preparations was reported. Only 61.9%
respondents received prescriptions for antibiotics from their treating physician.
7.6% used the non-prescribed medicines and 22.0% received a prescription from a
physician, who was either their colleague or a familiar person.
CONCLUSIONS: Inappropriate habits of antibiotic use are prevalent. While there
were some differences between the research groups, most of them were not
statistically significant. It means that measures should be taken targeting
health care givers as well as the general population. Educational programs about
the rational use of antibiotics may help reducing the improper habits of
antibacterial drugs usage, including self-medication. Encouraging the electronic
drug prescription may be beneficial while reducing the prevalent inappropriate
acquisition of antibiotics.
Publisher: Santrauka Įžanga. Atsparumas antibakteriniams vaistams – ryškėjanti

problema visame pasaulyje. Ją lemia įvairūs netinkami antibiotikų vartojimo
įpročiai, vienas jų – savigyda. Šiuo tyrimu siekiama išsiaiškinti, kaip tarp
medicinos specialistų ir studentų Vilniuje paplitę savigyda antibiotikais, jų
laikymas namuose bei netinkami įsigijimo būdai. Metodika. Atlikta pjūvio tipo
apklausa. Siekiant geriau identifikuoti rizikos grupes, respondentai buvo
suskirstyti pagal jų santykį su medicina: gydytojai, kitas medicinos personalas,
medicinos studentai ir asmenys, tiesiogiai nesusiję su medicina. Rezultatai.
Bendras savigydos antibiotikais paplitimo dažnis – 4,0 %. Nors jis atrodo ir
mažas, polinkis vartoti antibiotikus nesikreipus į gydytoją – didelis – net 51,4
%. Taip pat nustatytas paplitęs antibiotikų laikymas namuose (45,8 %) ir stebėta
didelė namuose laikomų preparatų įvairovė. Tik 61,9 % respondentų teigė receptą
antibiotikams gavę iš savo gydančio gydytojo, 7,6 % vartojo be recepto, 22,0 %
receptą gavo iš kolegos ar draugo. Išvados. Netinkami antibiotikų vartojimo
įpročiai yra paplitę. Nors pastebėta šiokių tokių skirtumų tarp tiriamųjų grupių,
dauguma jų statistiškai nebuvo reikšmingi. Siekiant mažinti netinkamus
antibiotikų vartojimo įpročius reikėtų kreiptis tiek į sveikatos priežiūros
specialistus, tiek į visuomenę. Šių įpročių, taip pat ir savigydos, paplitimą
galėtų sumažinti edukacinės programos apie racionalų antibiotikų vartojimą.
Skatinimas išrašyti elektroninius receptus galėtų padėti mažinti netinkamą
antibiotikų įsigijimą. Raktažodžiai: savigyda, antibiotikai, antibakteriniai
vaistai, atsparumas antibiotikams, netinkami antibiotikų vartojimo
įpročiai.Publisher: Santrauka Įžanga. Atsparumas antibakteriniams vaistams –
ryškėjanti problema visame pasaulyje. Ją lemia įvairūs netinkami antibiotikų
vartojimo įpročiai, vienas jų – savigyda. Šiuo tyrimu siekiama išsiaiškinti, kaip
tarp medicinos specialistų ir studentų Vilniuje paplitę savigyda antibiotikais,
jų laikymas namuose bei netinkami įsigijimo būdai. Metodika. Atlikta pjūvio tipo
apklausa. Siekiant geriau identifikuoti rizikos grupes, respondentai buvo
suskirstyti pagal jų santykį su medicina: gydytojai, kitas medicinos personalas,
medicinos studentai ir asmenys, tiesiogiai nesusiję su medicina. Rezultatai.
Bendras savigydos antibiotikais paplitimo dažnis – 4,0 %. Nors jis atrodo ir
mažas, polinkis vartoti antibiotikus nesikreipus į gydytoją – didelis – net 51,4
%. Taip pat nustatytas paplitęs antibiotikų laikymas namuose (45,8 %) ir stebėta
didelė namuose laikomų preparatų įvairovė. Tik 61,9 % respondentų teigė receptą
antibiotikams gavę iš savo gydančio gydytojo, 7,6 % vartojo be recepto, 22,0 %
receptą gavo iš kolegos ar draugo. Išvados. Netinkami antibiotikų vartojimo
įpročiai yra paplitę. Nors pastebėta šiokių tokių skirtumų tarp tiriamųjų grupių,
dauguma jų statistiškai nebuvo reikšmingi. Siekiant mažinti netinkamus
antibiotikų vartojimo įpročius reikėtų kreiptis tiek į sveikatos priežiūros
specialistus, tiek į visuomenę. Šių įpročių, taip pat ir savigydos, paplitimą
galėtų sumažinti edukacinės programos apie racionalų antibiotikų vartojimą.
Skatinimas išrašyti elektroninius receptus galėtų padėti mažinti netinkamą
antibiotikų įsigijimą. Raktažodžiai: savigyda, antibiotikai, antibakteriniai
vaistai, atsparumas antibiotikams, netinkami antibiotikų vartojimo įpročiai.
DOI: 10.6001/actamedica.v23i2.3330
PMCID: PMC5088746
PMID: 28356800
204. Integr Pharm Res Pract. 2016 Dec 19;6:1-6. doi: 10.2147/IPRP.S103494.
eCollection
2017.
Abuse of over-the-counter medicines: a pharmacist's perspective.
Sansgiry SS(1), Bhansali AH(1), Bapat SS(1), Xu Q(1).
Author information:
(1)Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of
Houston, Houston, TX, USA.
Self-care and self-medication practices are essential components of any health

care systems. The use of over-the-counter (OTC) medications is a part of the
self-medication process. The popularity of OTC medication use among patients may
increase the abuse potential of OTC medications. With pharmacists being as
accessible as they are, they are often the first line of contact for patients,
and have the opportunity to educate and counsel patients on appropriate OTC
medication use. The presence of a pharmacist ensures safe and effective use of
OTC medications. Pharmacists can liaise with other health care providers in the
management of self-care practices by patients. However, a pharmacist has
traditionally been underutilized in this role. This article provides a brief
review on OTC medications with abuse potential and the effect of self-medication
on OTC medication abuse. This review further describes the barriers faced by
pharmacists in OTC medication abuse management, given the increased potential of
prescription-to-OTC switch in recent years. In addition, the potential for a
behind-the-counter drug category to boost patient-pharmacist interaction was
discussed. The current review supports the positive role played by pharmacists in
the management of OTC medication abuse. This review adds to the knowledge base of
the barriers faced by pharmacists to prevent OTC medication abuse while
developing appropriate intervention strategies. By expanding the role of
pharmacists, OTC medication abuse may be controlled more effectively, thereby
providing better patient medication therapy management and outcomes.
DOI: 10.2147/IPRP.S103494
PMCID: PMC5774309
PMID: 29354545

205. Fam Med. 2015 Jun;47(6):488-9.
Reply to "self-treatment and informal treatment for depression among resident

physicians".
Stoesser K(1), Cobb NM.
Author information:
(1)Department of Family and Preventive Medicine, University of Utah.
Comment on
Fam Med. 2014 Nov-Dec;46(10):797-801.
Fam Med. 2015 Jun;47(6):487-8.
206. Harm Reduct J. 2017 Oct 6;14(1):68. doi: 10.1186/s12954-017-0194-6.
Mitigating risks of students use of study drugs through understanding motivations

for use and applying harm reduction theory: a literature review.
Abelman DD(1).
Author information:
(1)School of Health Studies, Faculty of Health Sciences, Western University,
London, ON, N6A 5B9, Canada. dabelman@uwo.ca.
As postsecondary students' use of "study drugs" becomes more popular with

increasingly reported negative effects on health and academic performance,
failing prohibitionist policies to reduce consumption, and ambiguity in
literature towards best practices to address this population, we present a
literature review that seeks effective solutions educational institutions can
apply to improve outcomes for students who use drugs. Motivations for use,
effects of the substances, an analysis of efforts to control use from educational
institutions, and suggestions on promoting most effective outcomes based on harm
reduction, are described. Theory, quantitative, and qualitative works from
systematic reviews, cohort studies, and epidemiological assessments are examined
on the "study drugs" methylphenidate, dextroamphetamine, and amphetamine, also
known as Adderall, Ritalin, Focalin, and Concerta. There is a focus on
postsecondary students ages 18-25 in North America. Results show important risk
factors for drug use including low perceived self-efficacy or enjoyment in
courses, poor accommodation of special needs, reliance on external validation,
having a low GPA, and experiencing a mental health issue. There is much
misconception on the health and academic effects of these drugs in literature,
among students, and on online knowledge sources. We suggest these drugs do not
improve GPA and learning, while they might temporarily increase memory, but with
detrimental negative health effects. Campaigns that address underlying factors of
use can be most successful in mitigating harms.
DOI: 10.1186/s12954-017-0194-6
PMCID: PMC5639593
207. J Clin Diagn Res. 2015 Jan;9(1):QC01-4. doi: 10.7860/JCDR/2015/11626.5388.

Epub
2015 Jan 1.
Is It Safe to Provide Abortion Pills over the Counter? A Study on Outcome

Following Self-Medication with Abortion Pills.
Nivedita K(1), Shanthini F(2).
Author information:
(1)Associate Professor, Department of Obstetrics and Gynecology, Sri
Manakulavinayagar Medical College Hospital , Kalitheerthalkuppam, Puducherry,
India .
(2)Professor, Department of Obstetrics and Gynecology, Sri Manakulavinayagar
Medical College Hospital , Kalitheerthalkuppam, Puducherry, India .
BACKGROUND: Medical abortion is a safe method of termination of pregnancy when

performed as per guidelines with a success rate of 92-97 %. But
self-administration of abortion pills is rampant throughout the country due to
over the counter availability of these drugs and complications are not uncommon
due to this practice. The society perceives unsupervised medical abortion as a
very safe method of termination and women use this as a method of spacing.
AIM OF THE STUDY: The aim of this study was to study the implications of
self-administration of abortion pills by pregnant women.
MATERIALS AND METHODS: Retrospective observational study done in Sri Manakula
Vinayagar Medical College & Hospital between the period of July 2013 to June2014.
Case sheets were analysed to obtain data regarding self-administration of
abortion pills and complications secondary to its administration. The following
data were collected. Age, marital status, parity, duration of pregnancy as
perceived by the women, confirmation of pregnancy, duration between pill intake
and visit to hospital, whether any intervention done elsewhere, any known medical
or surgical complications, Hb level on admission, whether patient was in shock,
USG findings, evidence of sepsis, blood transfusion, treatment given and duration
of hospital stay. Descriptive analysis of the collected data was done.
RESULTS: Among the 128 cases of abortion in the study period, 40 (31.25%)
patients had self-administered abortion pills. Among these 40 patients 27.5% had
consumed abortion pills after the approved time period of 63 days of which 17.5%
had consumed pills after 12 weeks of gestation. The most common presentation was
excessive bleeding (77.5%) Severe anaemia was found in 12.5% of the patients and
5% of patients presented with shock. The outcome was as follows : 62.5% of the
patients were found to have incomplete abortion, 22.5% had failed abortion and
7.5% of patients had incomplete abortion with sepsis. Surgical evacuation was
performed in 67.5% of the patients whereas 12.5% of the patients required
surgical evacuation with blood transfusion. Medical methods were used in 15% of
the patients whereas 2.5% required transfusion along with medical methods.
CONCLUSION: Unsupervised medical abortion can lead to increased maternal
morbidity and mortality. To curtail this harmful practice, strict legislations
are required to monitor and also to restrict the sales of abortion pills over the
counter and access to abortion pills for the public should be only through
centers approved for MTP. Large scale prospective studies are required to assess
the actual magnitude of this problem.
DOI: 10.7860/JCDR/2015/11626.5388
PMCID: PMC4347129
PMID: 25738038
208. J Family Med Prim Care. 2017 Oct-Dec;6(4):867-869. doi:

10.4103/jfmpc.jfmpc_206_17.
A case report of over-the-counter codeine dependence as consequence of

self-medication for premature ejaculation.
Anil SS(1), Ratnakaran B(2), Suresh N(3).
Author information:
(1)Department of Psychiatry, Government Medical College, Thiruvananthapuram,
Kerala, India.
(2)Department of Psychiatry, Dr. Kunhalu's Nursing Home, Ernakulam, Kerala,
India.
(3)Department of Psychiatry, General Hospital, Ernakulam, Kerala, India.
Over-the-counter (OTC) opioid abuse, including codeine, has been a growing

problem around the world. Although the majority of the abusers use it for
recreational purposes, many become dependent on it after having used it a
medication for pain or cough. We present a case of codeine dependence where the
initial prescribed use had been as a cough medication, but the subsequent abuse
of it occurred the following self-medication for premature ejaculation. There is
growing need for awareness among doctors and pharmacists of OTC abuse of opioids
and for preventive interventions such as restricting supply, audit of pharmacies,
training pharmacists, and counter staff and dispensing knowledge about proper use
of opioid-containing medications to patients.
PMCID: PMC5848416
PMID: 29564281
209. Proc Natl Acad Sci U S A. 2014 Dec 9;111(49):17339-41. doi:

10.1073/pnas.1419966111.
News feature: Animals that self-medicate.
Shurkin J.
DOI: 10.1073/pnas.1419966111
PMCID: PMC4267359
210. J Clin Diagn Res. 2015 Aug;9(8):QL01-2. doi: 10.7860/JCDR/2015/14291.6380.

Epub
2015 Aug 1.
Comment on "Is It Safe to Provide Abortion Pills Over The Counter? A Study on
Outcome Following Self-Medication with Abortion Pills".
Frye LJ(1), Winikoff B(2).
Author information:
(1)Program Associate, Gynuity Health Projects , New York, NY 10010 US .
(2)President, Gynuity Health Projects , New York, NY 10010 US .
DOI: 10.7860/JCDR/2015/14291.6380
PMCID: PMC4576599
PMID: 26436006
211. J Gerontol A Biol Sci Med Sci. 2016 Jul;71(7):954-60. doi:

10.1093/gerona/glv227.
Epub 2016 Jan 11.
Predictors of New Onset Sleep Medication and Treatment Utilization Among Older
Adults in the United States.
Leggett A(1), Pepin R(2), Sonnega A(3), Assari S(4).
Author information:
(1)Department of Psychiatry, University of Michigan, Ann Arbor.
leggetta@med.umich.edu.
(2)Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
(3)Institute for Social Research, University of Michigan, Ann Arbor.
(4)Department of Psychiatry and Center for Ethnicity, Culture, and Health, School
of Public Health, University of Michigan, Ann Arbor.
BACKGROUND: Sleep disturbances are common among older adults resulting in

frequent sleep medication utilization, though these drugs are associated with a
number of risks. We examine rates and predictors of new prescription sleep
medications and sleep treatments, as well as sleep treatments without a doctor's
recommendation.
METHODS: Participants were 8,417 adults aged 50 and older from two waves of the
nationally representative Health and Retirement Study (HRS) who were not using a
sleep medication or treatment at baseline (2006). Logistic regression analyses
are run with sociodemographic, health, and mental health factors as predictors of
three outcomes: new prescription medication use, sleep treatment use, and sleep
treatment out of a doctor's recommendation in 2010.
RESULTS: New sleep medication prescriptions were started by 7.68%, 12.62% started
using a new sleep treatment, and 31.93% were using the treatment outside of their
doctor's recommendation. Common predictors included greater severity of insomnia,
worsening insomnia, older age, and use of psychiatric medications. New
prescription medication use was also associated with poorer mental and physical
health, whereas new sleep treatment was associated with being White, higher
educated, and drinking less alcohol.
CONCLUSIONS: Starting a new prescription sleep medication may reflect poorer
health and higher health care utilization, whereas beginning a sleep treatment
may reflect an individual's awareness of treatments and determination to treat
their problem. Clinicians should be aware of predictors of new sleep medication
and treatment users and discuss various forms of treatment or behavioral changes
to help patients best manage sleep disturbance.
© The Author 2016. Published by Oxford University Press on behalf of The

Gerontological Society of America. All rights reserved. For permissions, please
e-mail: journals.permissions@oup.com.
DOI: 10.1093/gerona/glv227
PMCID: PMC4906325
212. Infect Drug Resist. 2019 Jun 11;12:1617. doi: 10.2147/IDR.S218283. eCollection
2019.
Self-medication of antibiotics: investigating practice among university students

at the Malaysian National Defence University [Corrigendum].
[No authors listed]
DOI: 10.2147/IDR.S218283
PMCID: PMC6576122
PMID: 31354310

eCollection 2018.
'I take my tablets with the whiskey': A qualitative study of alcohol and
medication use in mid to later life.
Haighton C(1)(2), Kidd J(2), O'Donnell A(2), Wilson G(2)(3), McCabe K(4), Ling
J(4).
Author information:
(1)Department of Social Work, Education and Community Wellbeing, Northumbria
University, Newcastle upon Tyne, United Kingdom.
(2)Institute of Health and Society, Newcastle University, Newcastle upon Tyne,
United Kingdom.
(3)Reid School of Music, University of Edinburgh, Edinburgh, United Kingdom.
(4)School of Nursing and Health Sciences, University of Sunderland, Sunderland,
United Kingdom.
BACKGROUND: Concurrent alcohol and medication use can result in significant

problems especially in mid to later life. Alcohol is often used instead of
medication for a number of health-related conditions. This novel qualitative
study explored concurrent alcohol and medication use, as well as the use of
alcohol for medicinal purposes, in a sample of individuals in mid to later life.
METHODS: Twenty-four interviews (12 men/12 women, ages 51-90 years) and three
focus groups (n = 27, 6 men/21 women, ages 50-95 years) from three branches of
Age UK and two services for alcohol problems in North East England.
RESULTS: Older people in this study often combined alcohol and medication,
frequently without discussing this with their family doctor. However, being
prescribed medication could act as a motivating factor to stop or reduce alcohol
consumption. Participants also used alcohol to self-medicate, to numb pain, aid
sleep or cope with stress and anxiety. Some participants used alcohol to deal
with depression although alcohol was also reported as a cause of depression.
Women in this study reported using alcohol to cope with mental health problems
while men were more likely to describe reducing their alcohol consumption as a
consequence of being prescribed medication.
CONCLUSIONS: As older people often combine alcohol and medication, health
professionals such as family doctors, community nurses, and pharmacists should
consider older patients' alcohol consumption prior to prescribing or dispensing
medication and should monitor subsequent drinking. In particular, older people
should be informed of the dangers of concurrent alcohol and medication use.
PMCID: PMC6193697
Conflict of interest statement: CH serves on the PLOS ONE Editorial Board. This
does not alter our adherence to all the PLOS ONE policies on sharing data and
materials.
214. PLoS One. 2019 Feb 28;14(2):e0212875. doi: 10.1371/journal.pone.0212875.

eCollection 2019.
Knowledge, practices and attitudes on antibiotics use in Cameroon:

Self-medication and prescription survey among children, adolescents and adults in
private pharmacies.
Elong Ekambi GA(1), Okalla Ebongue C(2), Penda IC(3), Nnanga Nga E(1), Mpondo
Mpondo E(1), Eboumbou Moukoko CE(2)(4).
Author information:
(1)Pharmaceutical Sciences Department, Faculty of Medicine and Pharmaceutical
Sciences, University of Douala, Douala, Cameroon.
(2)Biological Sciences Department, Faculty of Medicine and Pharmaceutical
(3)Clinical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences,
University of Douala, Douala, Cameroon.
(4)Centre Pasteur Cameroon, Yaoundé, Cameroon.
Benefits of antibiotics are threatened by the self-medication, people's lack of

knowledge and inappropriate use of antibiotics, especially in developing
countries. This study was designed to determine knowledge; attitudes and
practices toward antibiotics use in an urban community, and evaluate the factors
that are associated with antibiotic use. Between January and March 2015, a cross
sectional and prospective study was conducted in all pharmacies within the Douala
IV health district, Cameroon. Anonymous interviews including both open and closed
ended questions were conducted in participants selected by convenience sampling
Descriptive and logistic regression analysis were performed using StataSE11
software (version 11 SE) and R software (version 3.1.1) in data analysis. Overall
402 (33.7%) of 1,192 customers purchased antibiotics and of these, 47% bought
antibiotics without a prescription. 60.7% of purchased antibiotics was for adult
'patients and around 60% of parents carried out self-medication on their
children. The vast majority reported that all microbes can be treated with
antibiotics (88.3%). The belief that antibiotics are appropriate for bacterial
infections was more common among those with a higher level education (OR = 4.03,
95%CI:1.89-8.57, p<0.0001) and among public/private servants (OR = 2.47,
95%CI:1.21-5.08, p = 0.013). Physicians provide less explanations about
antibiotics are and their potential side effects than the pharmacy auxiliaries
(OR = 0.205, 95%CI = 0.09-0.46, p<0.0001), but more than pharmacists (OR = 3.692,
95%CI:1.44-9.25, p = 0.005). Indications on antibiotics use were 7 times more
given to customers with a prescription compared to those without a prescription
(OR = 7.37, 95% CI = 2.13-25.43, p = 0.002). Adult male (OR = 2.32,
95%CI:1.24-4.34, p = 0.009) and higher education (OR = 2.05, 95%CI:1.08-3.89, p =
0.027) were significantly associated with self-medication. Misuse, little
"practical knowledge" and high self-medication confirm the unsatisfactory
prescription and dispensing practices of the antibiotics in our country. These
results highlight the important of the development and implementation appropriate
guidelines for the responsible use of antibiotics for health care providers and
health education targeting community members themselves.
PMCID: PMC6394986
PMID: 30818373

interests exist.
215. J Pak Med Assoc. 2016 Jan;66(1):68-71.
Utilization of over the counter medication among pregnant women; a

cross-sectional study conducted at Isra University Hospital, Hyderabad.
Bohio R(1), Brohi ZP(2), Bohio F(1).
Author information:
(1)House Officer, Obstetrics & Gynaecology, Isra University Hospital, Hyderabad
Sindh, Pakistan.
(2)Department of Obstetrics & Gynaecology, Isra University Hospital, Hyderabad
Sindh, Pakistan.
OBJECTIVE: To determine the frequency of use of over-the-counter medication among

pregnant women, types of medicines, source of information and reason to opts for
self-medication.
METHODS: The descriptive cross-sectional study was conducted at Isra University
Hospital, Hyderabad, Pakistan, from April 14 to October 14, 2014, and comprised
pregnant women who were interviewed face to face. Data was collected on a
proforma comprising demographic data, practice of using over-the-counter
medications before and during pregnancy, type of medicines, illnesses, knowledge
about the medicines, source of recommendation and reason for practicing it. Data
was analysed on SPSS 16.
RESULTS: The mean age of 351 patients in the study was 26.19±4.82 years (range:
18-45 years).The mean gestational age was 26.28±10.42. Overall, 223(63.5%)
patients were using over-the-counter drugs before pregnancy; 128(36.5%) had used
them in previous pregnancy; and 133(37.9%) were using them during the current
pregnancy. Most common medication used was acetaminophen 58(43.6%), headache was
the most common illness 80(60.2%). A total of 103(77.4%) had no knowledge about
the medicines.
CONCLUSIONS: A significant number of pregnant women indulged in the practice of
using over-the-counter medication.
216. Curr Neuropharmacol. 2018;16(4):426-437. doi:

10.2174/1570159X15666170915142122.
Why are Antidepressant Drugs Effective Smoking Cessation Aids?

Shoaib M(1), Buhidma Y(1).
Author information:
(1)Institute of Neuroscience, Medical School, Newcastle University, Newcastle,
United Kingdom.
BACKGROUND: Before the advent of varenicline, antidepressant drugs were reported

to exhibit better clinical efficacy than nicotine replacement therapy as smoking
cessation aids. The most studied is bupropion, a clinically-effective
antidepressant, the first to be marketed throughout Europe for smoking cessation.
Since depression and tobacco smoking have a high incidence of cooccurrence, this
would implicate an underlying link between these two conditions. If this
correlation can be confirmed, then by treating one condition the related state
would also be treated.
OBJECTIVES: This review article will evaluate the various theories relating to
the use of antidepressant drugs as smoking cessation aids and the underlying
mechanisms link tobacco smoking and depression to explain the action of
antidepressants in smoking cessation. One plausible theory of self-medication
which proposes that people take nicotine to treat their own depressive symptoms
and the affective withdrawal symptoms seen with abstinence from the drug. If the
depression can instead be treated with antidepressants, then they may stop
smoking altogether. Another theory is that the neurobiological pathways
underlying smoking and depression may be similar. By targeting the pathways of
depression in the brain, antidepressants would also treat the pathways affected
by smoking and ease nicotine cravings and withdrawal. The role of genetic
variation predisposing an individual to depression and initiation of tobacco
smoking has also been discussed as a potential link between the two conditions.
Such variation could either occur within the neurobiological pathways involved in
both disorders or it could lead to an individual being depressed and
selfmedicating with nicotine.
Copyright© Bentham Science Publishers; For any queries, please email at

epub@benthamscience.org.
DOI: 10.2174/1570159X15666170915142122
PMCID: PMC6018185
217. J Psychopharmacol. 2017 Jul;31(7):801-811. doi: 10.1177/0269881117705071. Epub

2017 Apr 26.
Targeting neuronal dysfunction in schizophrenia with nicotine: Evidence from

neurophysiology to neuroimaging.
Smucny J(1), Tregellas JR(1)(2).
Author information:
(1)1 Department of Psychiatry, University of Colorado Anschutz Medical Campus,
Aurora, CO, USA.
(2)2 Research Service, Denver VA Medical Center, Denver, CO, USA.
Patients with schizophrenia self-administer nicotine at rates higher than is

self-administered for any other psychiatric illness. Although the reasons are
unclear, one hypothesis suggests that nicotine is a form of 'self-medication' in
order to restore normal levels of nicotinic signaling and target abnormalities in
neuronal function associated with cognitive processes. This brief review
discusses evidence from neurophysiological and neuroimaging studies in
schizophrenia patients that nicotinic agonists may effectively target
dysfunctional neuronal circuits in the illness. Evidence suggests that nicotine
significantly modulates a number of these circuits, although relatively few
studies have used modern neuroimaging techniques (e.g. functional magnetic
resonance imaging (fMRI)) to examine the effects of nicotinic drugs on
disease-related neurobiology. The neuronal effects of nicotine and other
nicotinic agonists in schizophrenia remain a priority for psychiatry research.
DOI: 10.1177/0269881117705071
PMCID: PMC5963521
218. J Pak Med Assoc. 2015 Aug;65(8):825-8.
Frequency of using non-prescribed medication in Majmaah city, Saudi Arabia -- A

cross sectional study.
Alzahrani M(1), Alhindi T(2), Almutairi A(2), Aldajani M(2), Sami W(3).
Author information:
(1)Department of Family Medicine, College of Medicine, Majmaah University,
Kingdom of Saudi Arabia.
(2)Medical Student, College of Medicine, Majmaah University, Kingdom of Saudi
Arabia.
(3)Department of Public Health & Community Medicine, College of Medicine, Majmaah
University, Kingdom of Saudi Arabia.
OBJECTIVE: To determine the frequency of using non-prescribed medication in a

Saudi Arabian city.
METHODS: The cross-sectional study was conducted in Majmaah city, Saudi Arabia,
from January to May 2014, and comprised adults of either gender. For data
collection, a questionnaire was designed and its reliability was checked by
Cronbach Alpha. SPSS 20 was used for statistical analysis.
RESULTS: Of the 390 respondents 276(70.8%) were males, while 114(29.2%) were
females. The overall mean age was 29.90±11.56 years (range: 18-83 years). Of the
total, 363(93.1%) were using non-prescribed medication; and 148(37.9%) said they
were using the drugs as they had experienced similar symptoms before and they
knew the treatment. Public pharmacies were the main source for obtaining
non-prescribed medication for 163(41.8%) subjects. Gender and use of
non-prescribed medication was significantly associated (p<0.05).
CONCLUSIONS: The frequency of using non-prescribed medication in Majmaah city was
high. Pain-killers, antibiotics and antipyretics were the most used
non-prescribed medications. Male respondents used non-prescribed medication more
than the females.
219. Med Sci Monit. 2017 Jun 13;23:2890-2896.
Reciprocal Evolution of Opiate Science from Medical and Cultural Perspectives.
Stefano GB(1), Pilonis N(2), Ptacek R(1), Kream RM(1).
Author information:
(1)Department of Psychiatry, Charles University First Faculty of Medicine and
General Teaching Hospital, Center for Cognitive Molecular Neuroscience, Prague,
Czech Republic.
(2)Warsaw Medical University, Public Central Teaching Hospital, Warsaw, Poland.
Over the course of human history, it has been common to use plants for medicinal
purposes, such as for providing relief from particular maladies and
self-medication. Opium represents one longstanding remedy that has been used to
address a range of medical conditions, alleviating discomfort often in ways that
have proven pleasurable. Opium is a combination of compounds obtained from the
mature fruit of opium poppy, papaver somniferum. Morphine and its biosynthetic
precursors thebaine and codeine constitute the main bioactive opiate alkaloids
contained in opium. Opium usage in ancient cultures is well documented, as is its
major extract morphine. The presence of endogenous opiate alkaloids and opioid
peptides in animals owe their discovery to their consistent actions at particular
concentrations via stereo select receptors. In vitro expression of morphine
within a microbiological industrial setting underscores the role it plays as a
multi-purpose pharmacological agent, as well as reinforcing why it can also lead
to long-term social dependence. Furthermore, it clearly establishes a reciprocal
effect of human intelligence on modifying evolutionary processes in papaver
somniferum and related plant species.
DOI: 10.12659/msm.905167
PMCID: PMC5478244
220. Pan Afr Med J. 2018 Aug 31;30:302. doi: 10.11604/pamj.2018.30.302.16321.

eCollection 2018.
Characterization of pharmaceutical medication without a medical prescription in

children before hospitalization in a resource-limited setting, Cameroon.
Penda CI(1)(2), Moukoko ECE(3)(4), Youmba JFN(5), Mpondo EM(5).
Author information:
(1)Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical
(2)Department of Pediatrics, Laquintinie Hospital of Douala, Cameroon.
(3)Department of Biological Sciences, Faculty of Medicine and Pharmaceutical
Sciences, University of Douala, Cameroon.
(4)Malaria Research Service, Centre Pasteur Cameroon, Yaoundé, Cameroon.
(5)Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmaceutical
Sciences, University of Douala, Cameroon.
Introduction: The use of different therapeutic approaches is common among sick

children in Cameroon. The main objective of this study was to characterize the
use of non-prescription drugs and describe the therapeutic itineraries of sick
children before admission to the hospital.
Methods: A cross-sectional and prospective study was conducted from January to
May 2017. A closed-ended questionnaire (CEQ) consisting of one or several
response options was administered to the parents/guardians of the children on
admission to the hospital in the pediatric ward of the Laquintinie Hospital in
Douala (LHD) and the Cité des Palmiers District Hospital (CPDH) of the city of
Douala. Inclusion of participants was made consecutively for adolescents who gave
their consent and parents or guardians who signed the informed consent for all
children. The confidentiality of the data was ensured by the replacement of the
names by codes.
Results: Overall, 295 hospitalized children were included with an average age of
3.1 (SD: 3.3) years in the study. More than half of these children (58.6%) came
from LHD. More than 90% of parents had at least one therapeutic recourse (TR).
The ratio of boys to girls 3/1. Self-medication (74.1%) and medical consultation
(16.9%) were the main therapeutic paths in 1st recourse. The medical consultation
(80.2%) and the pharmaceutical advice (16.9%) were used frequently in 2nd
recourse. The mean lapse time to see a medical professional was 2.7 days
(min-max: 0-14 days). The main symptoms associated with TR were fever (76.6%),
vomiting (24.7%) and diarrhea (22.7%). The most frequently used drugs were
Analgesics/antipyretics (47.6%), antimalarials (15.0%) and antibiotics (10.2%)
and the family medicine box was the highest source of drugs.
Conclusion: Self medication remains the first therapeutic path, followed by
medical consultation as second therapeutic path taken when the disease is
perceived as serious.
DOI: 10.11604/pamj.2018.30.302.16321
PMCID: PMC6320450
221. Diabetes Metab J. 2017 Dec;41(6):449-456. doi: 10.4093/dmj.2017.41.6.449.
Association of Self-Care Behaviors and Quality of Life among Patients with Type 2
Diabetes Mellitus: Chaldoran County, Iran.
Babazadeh T(1), Dianatinasab M(2), Daemi A(3), Nikbakht HA(4), Moradi F(5),
Ghaffari-Fam S(6).
Author information:
(1)PhD Candidate in Health Education and Promotion, Student Research Committee,
Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
(2)Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of
Medical Sciences, Shiraz, Iran. dianatinasab@sums.ac.ir.
(4)Social Determinants of Health Research Center, Babol University of Medical
Sciences, Babol, Iran.
(5)Department of Municipal Health in Tehran, Tehran Municipality, Tehran, Iran.
(6)School of Nursing of Miyandoab, Urmia University of Medical Sciences, Urmia,
Iran. ghaffari.sa@tak.iums.ac.ir.
BACKGROUND: Self-care of diabetes is an essential part for controlling the

disease and improvement of quality of life in type 2 diabetes mellitus (T2DM)
patients. This study aimed to analyze the associated factors of quality of life
in patients with T2DM in order to design effective interventions.
METHODS: This cross-sectional study was conducted on 120 T2DM patients referred
to health centers of Chaldoran, West Azerbaijan Province, Iran. The quality of
life's questionnaires from World Health Organization and the self-care behaviors'
questionnaires were used for data collection.
RESULTS: The mean age of patients was 46.30% and 53.30% of them were male. Among
demographic variables, gender (P=0.002), age groups (P=0.007), and household
monthly income (P=0.009) were significantly associated with total quality of
life. Also, self-care nutrition (odds ratio [OR], 1.47; P=0.001), self-management
of blood glucose control (OR, 1.29; P=0.002), and self-medication behavior (OR,
1.18; P=0.030) were identified as factors significantly associated with quality
of life.
CONCLUSION: Self-care behaviors were significantly associated with quality of
life; among them, the greatest influence was observed in self-care nutrition
behavior. According to the findings of this study, appropriate interventions on
self-care behaviors about nutrition can improve the quality of life for T2DM
patients.
Copyright © 2017 Korean Diabetes Association

DOI: 10.4093/dmj.2017.41.6.449
PMCID: PMC5741554
PMID: 29272083
Conflict of interest statement: No potential conflict of interest relevant to

this article was reported.
222. Trop Med Int Health. 2017 May;22(5):638-654. doi: 10.1111/tmi.12865. Epub 2017
Apr 11.
Health care-seeking behaviours and health expenditures in adults aged 45 years

and older in China, 2011-2013.
Li J(1), Feng XL(1).
Author information:
(1)School of Public Health, Peking University, Beijing, China.
OBJECTIVES: To provide an assessment of China's progress to universal health

coverage (UHC) from the perspective of people-centred care.
METHODS: We obtained data on 28 103 participants from the China Health and
Retirement Longitudinal Study (CHALRS) during 2011-2013. We used logistic
regressions and generalised linear models to analyse care-seeking behaviours and
medical expenditures.
RESULTS: We found that 95.5% of the subjects were covered by social health
insurance in 2013, and nearly 60% subjects in need of medical care were
self-medicated. Health insurance was a strong predictor for the access to
outpatient care. Use of pure and mixed self-medication increased by 15% and 32%
respectively, while use of pure outpatient care fell by 10% between 2011 and
2013, after adjusting for predisposing, service needs and enabling factors. Such
trends were particularly evident for the Urban Resident Basic Medical Insurance
and the New Cooperative Medical Scheme, which covered more than 80%. The monthly
out-of-pocket medical expenditures and the probability of encountering
catastrophic health expenditures for outpatient care were four times larger than
that for self-medication. Between 2011 and 2013, outpatient care medical costs
rose by nearly 50%, whereas there was no such obvious trend for self-medication.
People with insurance schemes offering lower cost sharing incurred consistently
higher out-of-pocket outpatient payments.
CONCLUSIONS: The monitoring of global progress to UHC should incorporate
self-medication. In China, it seems that the current reform and the huge
government investment have not resulted in access to affordable quality care. To
achieve UHC, not only universal insurance, but system-level efforts are needed.
© 2017 John Wiley & Sons Ltd.
DOI: 10.1111/tmi.12865
223. BMC Health Serv Res. 2018 May 10;18(1):346. doi: 10.1186/s12913-018-3146-2.
Patient-directed self-management of pain (PaDSMaP) compared to treatment as usual

following total knee replacement; a randomised controlled trial.
Deane KHO(1), Gray R(1)(2), Balls P(3), Darrah C(3), Swift L(4), Clark AB(4),
Barton GR(4), Morris S(4), Butters S(3), Bullough A(3), Flaherty H(1)(5), Talbot
B(6), Sanders M(3), Donell ST(7)(8).
Author information:
(1)School of Health Sciences, University of East Anglia, Norwich Research Park,
Norwich, UK.
(2)Present address: School of Nursing and Midwifery, Latrobe University,
Melbourne, Australia.
(3)Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
(4)Norwich Medical School, Norwich Clinical Trials Unit, University of East
Anglia, Norwich, UK.
(5)Present address: School of Clinical & Applied Sciences, Leeds Beckett
University, Leeds, UK.
(6)Public & Patient Involvement in Research (PPIRes), South Norfolk Clinical
Commissioning Group, Norwich, UK.
(7)Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
s.donell@uea.ac.uk.
(8)Norwich Medical School, University of East Anglia, Norwich, UK.
s.donell@uea.ac.uk.
BACKGROUND: Self-administration of medicines by patients whilst in hospital is

being increasingly promoted despite little evidence to show the risks and
benefits. Pain control after total knee replacement (TKR) is known to be poor.
The aim of the study was to determine if patients operated on with a TKR who
self-medicate their oral analgesics in the immediate post-operative period have
better pain control than those who receive their pain control by nurse-led drug
rounds (Treatment as Usual (TAU)).
METHODS: A prospective, parallel design, open-label, randomised controlled trial
comparing pain control in patient-directed self-management of pain (PaDSMaP) with
nurse control of oral analgesia (TAU) after a TKR. Between July 2011 and March
2013, 144 self-medicating adults were recruited at a secondary care teaching
hospital in the UK. TAU patients (n = 71) were given medications by a nurse after
their TKR. PaDSMaP patients (n = 73) took oral medications for analgesia and
co-morbidities after two 20 min training sessions reinforced with four booklets.
Primary outcome was pain (100 mm visual analogue scale (VAS)) at 3 days following
TKR surgery or at discharge (whichever came soonest). Seven patients did not
undergo surgery for reasons unrelated to the study and were excluded from the
intention-to-treat (ITT) analysis.
RESULTS: ITT analysis did not detect any significant differences between the two
groups' pain scores. A per protocol (but underpowered) analysis of the 60% of
patients able to self-medicate found reduced pain compared to the TAU group at
day 3/discharge, (VAS -9.9 mm, 95% CI -18.7, - 1.1). One patient in the
self-medicating group over-medicated but suffered no harm.
CONCLUSION: Self-medicating patients did not have better (lower) pain scores
compared to the nurse-managed patients following TKR. This cohort of patients
were elderly with multiple co-morbidities and may not be the ideal target group
for self-medication.
TRIAL REGISTRATION: ISRCTN10868989 . Registered 22 March 2012, retrospectively
registered.
DOI: 10.1186/s12913-018-3146-2
PMCID: PMC5944138
224. Risk Manag Healthc Policy. 2019 Jan 15;12:1-3. doi: 10.2147/RMHP.S190514.
eCollection 2019.
Patterns of self-medication among university students - a medical students'

analysis.
Waqar S(1), Al-Khayat MS(1), Khan MA(1).
Author information:
(1)Faculty of Medicine, St George's, University of London, London, UK,
waqarsyed458@gmail.com.
Comment on
Risk Manag Healthc Policy. 2018 Sep 12;11:169-176.
DOI: 10.2147/RMHP.S190514
PMCID: PMC6339650
PMID: 30697091

interest in this communication.
225. Med Sante Trop. 2017 Jun 1;27(2):147-154. doi: 10.1684/mst.2017.0678.
Emergence and spread of antibiotic resistance in West Africa : contributing

factors and threat assessment.
Ouedraogo AS(1), Jean Pierre H(2), Bañuls AL(3), Ouédraogo R(1), Godreuil S(4).
Author information:
(1)Service de bactériologie-virologie, CHU de Souro Sanou, Bobo Dioulasso,
Burkina Faso.
(2)Laboratoire de bactériologie-virologie, CHU de Montpellier, 34295 Montpellier
cedex 5, France.
(3)Mivegec, UMR IRD 224, CNRS 5290, Université de Montpellier, Montpellier,
France.
(4)Laboratoire de bactériologie-virologie, CHU de Montpellier, 34295 Montpellier
cedex 5, France, Mivegec, UMR IRD 224, CNRS 5290, Université de Montpellier,
Montpellier, France.
The emergence and spread of antibiotic resistance present a major public health
issue in both developed (DC) and less developed countries (LDC). Worldwide, its
main cause is the uncontrolled and unjustified use of antibiotics. In countries
with limited resources, such as West African nations, other features, more
specifically socioeconomic and behavioral factors, contribute to exacerbate this
problem. The objective of this review is to give an update of the common and
specific factors involved in the amplification of antibiotic resistance phenomena
in LCD, particularly in West African countries. In particular, some frequent
societal behaviors (such as self-medication), inadequate healthcare
infrastructure (insufficiently trained prescribers and inadequate diagnostic
tools), and an uncontrolled drug sector (antibiotics sold over-the-counter,
improperly stored, counterfeit, and/or expired) all strongly promote the
emergence of antibiotic resistance. This risk is particularly worrisome for
enterobacteriaceae producing extended spectrum beta-lactamases (10 to 100 % of
colonizations and 30 to 50 % of infections). A similar trend has been observed
for carbapenem resistance in enterobacteriaceae with rates ranging from 10 to
30 % and for methicillin resistance in Staphylococcus aureus, which now exceeds
30 %. These troubling observations call for effective health policies in these
regions. These intervention strategies must be integrated and simultaneously
target policy makers, prescribers, and users.
DOI: 10.1684/mst.2017.0678
226. Patient Prefer Adherence. 2016 Jun 27;10:1161-7. doi: 10.2147/PPA.S105600.
eCollection 2016.
Association between patients' beliefs and oral antidiabetic medication adherence

in a Chinese type 2 diabetic population.
Wu P(1), Liu N(2).
Author information:
(1)Department of Clinical Pharmacy, School of Basic Medical Sciences and Clinical
Pharmacy, China Pharmaceutical University.
(2)Institute of Cardiovascular Disease, Southeast University Medical School,
Nanjing, People's Republic of China.
Erratum in
Patient Prefer Adherence. 2016;10:1697.
PURPOSE: The objective of this study was to identify, using the theory of planned
behavior (TPB), patients' beliefs about taking oral antidiabetic drugs (OADs) as
prescribed, and to measure the correlations between beliefs and medication
adherence.
PATIENTS AND METHODS: We performed a cross-sectional study of type 2 diabetic
patients using structured questionnaires in a Chinese tertiary hospital. A total
of 130 patients were enrolled to be interviewed about TPB variables (behavioral,
normative, and control beliefs) relevant to medication adherence. Medication
adherence was assessed using the eight-item Morisky Medication Adherence Scale
(MMAS-8). Spearman's rank correlation was used to assess the association between
TPB and MMAS-8. Logistic regression analysis was performed to examine the
relationship between different variables and MMAS-8, with statistical
significance determined at P<0.05.
RESULTS: From 130 eligible Chinese patients with an average age of 60.6 years and
a male proportion of 50.8%, a nonsignificant relationship between behavioral,
normative, and the most facilitating control beliefs and OAD adherence was found
in our study. Having the OADs on hand (P=0.037) was the only facilitating control
belief associated with adherence behavior. Being away from home or eating out
(P=0.000), not accepting the disease (P=0.000), ignorance of life-long drug
adherence (P=0.038), being busy (P=0.001), or poor memory (P=0.008) were control
belief barriers found to be correlated with poor adherence. TPB is the only
important determinant influencing OAD adherence among all the factors (P=0.011).
CONCLUSION: The results indicate that the TPB model could be used to examine
adherence to OADs. One facilitating control belief, and most of the barrier
control beliefs of TPB were related to medication adherence among Chinese type 2
diabetes inpatients. It will be helpful to understand patients' self-medication
and provide methods to develop instruments for identifying factors that influence
OAD adherence.
DOI: 10.2147/PPA.S105600
PMCID: PMC4930230
PMID: 27390519
227. Am J Drug Alcohol Abuse. 2016 Sep;42(5):500-506. Epub 2016 Jul 11.
Increased self-reported impulsivity in methamphetamine users maintaining drug

abstinence.
Jones HW(1), Dean AC(2)(3), Price KA(2), London ED(2)(4)(3).

Author information:
(1)a Department of Clinical Psychology, Fuller Graduate School of Psychology,
Fuller Theological Seminary , Pasadena , CA , USA.
(2)b Department of Psychiatry and Biobehavioral Sciences , UCLA Semel Institute
for Neuroscience , Los Angeles , CA , USA.
(3)d Brain Research Institute, David Geffen School of Medicine , Los Angeles , CA
, USA.
(4)c Department of Molecular and Medical Pharmacology , UCLA Semel Institute for
Neuroscience , Los Angeles , CA , USA.
BACKGROUND: Impulsivity has been proposed as an important factor in the

initiation and maintenance of addiction. Indirect evidence suggests that some
methamphetamine users report less impulsivity when they are using methamphetamine
compared to when abstaining from drug use, but this hypothesis has not been
directly tested.
OBJECTIVES/METHODS: In this study, self-reports of impulsivity were obtained from
32 methamphetamine-dependent (DSM-IV) research participants and 41 healthy
control subjects, using the Barratt Impulsiveness Scale-11. The methamphetamine
users were assessed during an active period of methamphetamine use, as determined
through urinalysis, and again after approximately 1 week of confirmed abstinence.
Control subjects likewise completed two assessments. A subset of participants
also completed serial assessments of the Beck Depression Inventory
(Methamphetamine Group, N = 17, Control Group, N = 38) and the Methamphetamine
Withdrawal Questionnaire (Methamphetamine Group, N = 12).
RESULTS: There was a significant interaction of group with time on impulsivity (p
= 0.044), reflecting a significant increase from the first to the second
assessment in the methamphetamine users (p = 0.013), but no change among healthy
control subjects. In contrast, depressive and withdrawal symptoms significantly
decreased between the first and second assessments in the methamphetamine users
(ps ≤0.01). Change in impulsivity in methamphetamine users was not significantly
correlated with change in withdrawal or depression (ps >0.05).
CONCLUSIONS: These findings suggest that methamphetamine users report more
impulsivity when abstaining from drug use, an effect that is not significantly
related to methamphetamine withdrawal. Attenuation of impulsivity may reinforce
continued methamphetamine use in these individuals.
DOI: 10.1080/00952990.2016.1192639
PMCID: PMC5055455
Conflict of interest statement: Declaration of Interest The investigators have no

conflicts of interest or financial disclosures to report.
228. Harm Reduct J. 2015 Feb 18;12:1. doi: 10.1186/s12954-015-0037-2.
Long-term self-treatment with methadone or buprenorphine as a response to

barriers to opioid substitution treatment: the case of Sweden.
Richert T(1), Johnson B(2).
Author information:
(1)Department of Social Work, Malmö University, Malmo, Sweden.
torkel.richert@mah.se.
(2)Department of Social Work, Malmö University, Malmo, Sweden.
bjorn.johnson@mah.se.
BACKGROUND: It is well known that illicit use of methadone and buprenorphine is

common among people with an opioid dependence. Less notice has been taken of the
fact that these substances are also used for extended periods of self-treatment,
as a way of handling barriers to OST. In this study, motives for self-treatment
are investigated, as well as attitudes and perceived barriers to OST among drug
users with an opioid dependence in Sweden.
METHOD: The study is based on qualitative research interviews with 27 opioid
users who have treated themselves with methadone or buprenorphine for a period of
at least three months.
RESULTS: The duration of self-treatment among the interviewees varied from
5 months to 7 years. Self-treatment often began as a result of a wish to change
their life situation or to cut back on heroin, in conjunction with perceived
barriers to OST. These barriers consisted of (1) difficulties in gaining access
to OST due to strict inclusion criteria, limited access to treatment or a
bureaucratic and arduous assessment process, (2) difficulties remaining in
treatment, and (3) ambivalence toward or reluctance to seek OST, primarily due to
a fear of stigmatization or disciplinary action. Self-treatment was described as
an attractive alternative to OST, as a stepping stone to OST, and as a way of
handling waiting lists, or as a saving resource in case of involuntary discharge.
CONCLUSION: Illicit use of methadone and buprenorphine involve risks but may also
have important roles to play for users who are unwilling or not given the
opportunity to enter OST. A restrictive and strict rehabilitation-oriented
treatment model may force many to manage their own treatment. More generous
inclusion criteria, a less complex admission process, fewer involuntary
discharges, and less paternalistic treatment may lead to increasing numbers
seeking OST. Control measures are necessary to prevent diversion and harmful drug
use but must be designed in such a way that they impose as few restrictions as
possible on the daily life of patients.
DOI: 10.1186/s12954-015-0037-2
PMCID: PMC4337060
229. J Pharm (Cairo). 2017;2017:8516741. doi: 10.1155/2017/8516741. Epub 2017 Oct

10.
Patients' Knowledge and Attitude toward the Disposal of Medications.
AlAzmi A(1), AlHamdan H(1), Abualezz R(2), Bahadig F(1), Abonofal N(1), Osman
M(1).
Author information:
(1)Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City
(KAMC 6255), Pharmaceutical Care Services Department, P.O. Box 9515, Jeddah
21423, Saudi Arabia.
(2)Ministry of National Guard Health Affairs (MNGHA), Prince Mohamed Bin
Abdulaziz Hospital, Pharmaceutical Care Services Department, P.O. Box 40740,
Madinah 41511, Saudi Arabia.
Background: Safe disposal of medications is of high concern as malpractice may

lead to harmful consequences such as undesirable effects, prescription drug
abuse, overstocking, self-medication, accidental overdose, and even death. There
is a lack of uniform and nationwide guidance on how patients should safely
dispose their leftover medications. This study aims to assess patients' knowledge
and attitude regarding the disposal of medications.
Method: This research is a cross-sectional study. A self-administered
questionnaire was used to collect data from various outpatient pharmaceutical
services in King Abdulaziz Medical City (KAMC), Jeddah.
Results: The study revealed that 73% of the respondents throw the medications in
the trash, 14% return the medications to a pharmacy, 5% never dispose them, and
3% donate the medications to a friend or charity centers. More than 80% of the
respondents never received any information or advice from healthcare providers
about safe and proper disposal of medications.
Conclusion: Our findings suggest that there is an immediate requirement for the
establishment of collaborative and uniform guidelines for the safe disposal of
leftover medications. A policy for drug donation needs to be included in routine
patient education as well as educational and collective programs for the public.
DOI: 10.1155/2017/8516741
PMCID: PMC5654249
PMID: 29130019
230. J Evid Based Complementary Altern Med. 2017 Jul;22(3):494-501. doi:

10.1177/2156587216671392. Epub 2016 Oct 5.
The Significance of Ayurvedic Medicinal Plants.
Kumar S(1), Dobos GJ(1), Rampp T(1).
Author information:
(1)1 University of Duisburg-Essen, Essen, Germany.
Traditional Indian medicine (ayurveda) is becoming increasingly popular, with

many chronic conditions responding to it well. Most patients begin to take
conventional medications as soon as their diagnoses are made, so ayurvedic
treatments are usually undergone alongside and/or after conventional medical
approaches. A detailed knowledge of the action of food, spices, and medicinal
plants is needed in order to understand their potential influence fully. While
societal use of ayurvedic plants and Indian spices is commonplace, without ill
effect, the use of more concentrated products made from single plants, often in
the form of teas or tablets, is of more concern. The mechanisms by which
polyherbal drugs and their extracts act differ in many respects from the actions
of single substances or synthetic drugs. Despite the fact that ayurvedic
medicines are based on natural herbal materials, their safety depends on their
method of administration, taking into account individuals' needs and their
specific disease conditions.
DOI: 10.1177/2156587216671392
PMCID: PMC5871155
231. Pharmacol Biochem Behav. 2018 May;168:17-24. doi: 10.1016/j.pbb.2018.03.005.

Epub
2018 Mar 13.
Self-administration of methamphetamine aerosol by male and female baboons.
Foltin RW(1).
Author information:
(1)Division on Substance Use Disorders, New York State Psychiatric Institute and
Department of Psychiatry, Columbia University Medical Center, 1051 Riverside
Drive, Unit 120, New York, NY 10032, USA. Electronic address:
rwf2@cumc.columbia.edu.
The reinforcing efficacy of vaporized methamphetamine HCl (0.3 mg/kg) was

determined in baboons with minimal previous drug exposure. A group of 8 adult
male baboons was tested prior to a group of 7 adult female baboons. Baboons were
initially trained to suck on a brass stem activating a pressure-sensitive relay
(i.e., puff), to receive one M&M® candy. Five of the 8 males and 6 of the 7
females learned to activate the relay. 0.05 ml of 95% ethyl alcohol containing
0.3 mg/kg methamphetamine was vaporized and delivered to the mouth of the baboon
after he/she completed 2 puffs; a single candy was given after an additional 5
puffs to ensure that baboons continued puffing after the aerosol entered their
mouths. Puffing was recorded but not reinforced by candy or drug for 2 min after
each aerosol delivery for males and 1 min for females. Males could earn 10 and
females could earn 20 aerosol deliveries. Males made between 225 and 650 puffs
each session. Females made between 200 and 400 puffs each session. When only
candy and placebo aerosol were delivered the number of puffs decreased in all 6
females but increased in all 5 males. When candy was delivered without aerosol,
puffing decreased in 4 of 5 males, but this manipulation was not tested in
females. Methamphetamine aerosol delivery maintained lower rates of puffing
behavior in females than males, but procedural differences weaken interpretation
of this sex comparison. Although training non-human primates to inhale drug
vapors is time consuming, if successful, their long lifespan could provide years
of valuable data justifying further work with non-human primates using models of
vaporized drug self-administration.
Copyright © 2017. Published by Elsevier Inc.
DOI: 10.1016/j.pbb.2018.03.005
PMCID: PMC5892839
232. Eur J Hosp Pharm. 2017 Nov;24(6):349-354. doi: 10.1136/ejhpharm-2016-001032.

Epub
2016 Oct 28.
Studying the knowledge, attitude and practice of antibiotic misuse among

Alexandria population.
El-Hawy RM(1), Ashmawy MI(1), Kamal MM(1), Khamis HA(2), Abo El-Hamed NM(3),
Eladely GI(4), Abdo MH(4), Hashem Y(1), Ramadan M(4), Hamdy DA(1).
Author information:
(1)Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
(2)Faculty of Science, Alexandria University, Alexandria, Egypt.
(3)Faculty of Agriculture, Alexandria University, Alexandria, Egypt.
(4)Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Aim: To assess knowledge, attitude and practice (KAP) of antimicrobial

self-medication among a convenience sample of population in Alexandria, Egypt.
Methodology: A descriptive cross-sectional study using a self-administrated
semi-constructed questionnaire. A convenience sample of 359 participants was
studied using appropriate consent. The questionnaire had four sections:
demographics, KAP, professional medical knowledge and attitude of children
caregivers toward antimicrobial self-medication. The questionnaire was initially
constructed in English and then translated into its final Arabic version. The
Arabic version was pilot-tested and face-validated. Descriptive and quantitative
analysis were performed using SPSS (V.20.0).
Results: Approximately 64% (231) of the studied population used antibiotics
without prescription in the past 12 months. This was significantly correlated
with female gender and lack of knowledge. The main reason for self-medication was
due to saving time and effort (109, 47%) followed by not preferring doctor visits
(89, 39%). More than 60% of cases used amoxicillin-clavulanic acid. The main
sources of antibiotics were leftovers from previously prescribed pharmaceuticals
and those purchased from community pharmacies. 85 participants were young
children caregivers of which 18 (21%) reported administering antibiotics to their
children without consulting a physician. Out of 115 who claimed attaining medical
background, only 30 (26%) managed to answer section 3 correctly with 23 of them
reporting antibiotic self-medication.
Conclusion: This study showed an increased tendency towards antibiotic
self-medication among Alexandrian adults and children that was not significantly
decreased in population with medical background. The reasons discussed within the
study should be further addressed to decrease such practice.
DOI: 10.1136/ejhpharm-2016-001032
PMCID: PMC6451550
PMID: 31156970
233. Ther Adv Psychopharmacol. 2019 Jul 1;9:2045125319859969. doi:

10.1177/2045125319859969. eCollection 2019.
The relationship between nicotine and psychosis.
Quigley H(1), MacCabe JH(2).
Author information:
(1)Department of Psychosis Studies, Institute of Psychiatry, Psychology and
Neuroscience, Kings College London, SE5 8AF, Denmark Hill, London, UK.
(2)Department of Psychosis Studies, Institute of Psychiatry, Psychology and
Neuroscience, Kings College London, London, UK.
Cigarette smoking is strongly associated with psychotic disorders such as

schizophrenia. For several decades it was assumed that the relationship could be
explained by reverse causation; that smoking was secondary to the illness itself,
either through self-medication or a process of institutionalization, or was
entirely explained by confounding by cannabis use or social factors. However,
studies have exposed that such hypotheses cannot fully explain the association,
and more recently a bidirectional relationship has been proposed wherein
cigarette smoking may be causally related to risk of psychosis, possibly via a
shared genetic liability to smoking and psychosis. We review the evidence for
these candidate explanations, using findings from the latest epidemiological,
neuroimaging, genetic and preclinical work.
DOI: 10.1177/2045125319859969
PMCID: PMC6604123
PMID: 31308936
Conflict of interest statement: Conflict of interest statement: The authors

declare that there is no conflict of interest.
234. Soc Sci Med. 2015 Dec;146:147-54. doi: 10.1016/j.socscimed.2015.10.033. Epub

2015
Oct 19.
"Just Advil": Harm reduction and identity construction in the consumption of

over-the-counter medication for chronic pain.
Eaves ER(1).
Author information:
(1)Department of Family and Community Medicine, University of Arizona College of
Medicine, USA. Electronic address: emerye@email.arizona.edu.
Direct-to-consumer marketing has sparked ongoing debate concerning whether ads

empower consumers to be agents of their own care or shift greater control to the
pharmaceutical industry. Ads for over-the-counter (OTC) medications in particular
portend to offer simple, harmless solutions for meeting the demands of social
life. Rather than join the longstanding debate between consumer agency and social
control in pharmaceutical advertising, I approach self-medication with
over-the-counter (OTC) analgesics using Harm Reduction as a framework. From this
perspective, consumption of OTC analgesics by chronic pain sufferers is a means
of seeking some level of relief while also avoiding the stigma associated with
prescription pain medication. Qualitative methods are used to analyze data from
two sources: (1) semi-structured qualitative interviews with 95 participants in a
trial examining the effectiveness of Traditional Chinese Medicine for
Temporomandibular Disorders (TMD) from 2006 to 2011 in Tucson, AZ and Portland,
OR; and (2) print, online, and television advertisements for three major brands
of OTC pain medication. Participants described their use of OTC medications as
minimal, responsible, and justified by the severity of their pain. OTC medication
advertising, while ostensibly ambiguous and targeting all forms of pain,
effectively lends support to the consumption of these medications as part of the
self-projects of chronic pain sufferers, allowing them to reconcile conflicting
demands for pain relief while being stoic and maintaining a positive moral
identity. Describing OTC medication as "just over-the-counter" or "not real pain
medication," sufferers engage in ideological harm reduction, distinguishing
themselves from "those people who like taking pain medication" while still
seeking relief. Justifying one's use of OTC medication as minimal and "normal,"
regardless of intake, avoids association with the addictive potential of
prescription pain medications and aligns the identity of the chronic pain
sufferer with a culturally sanctioned identity as stoic bearer of pain.
Copyright © 2015 Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.socscimed.2015.10.033
PMCID: PMC4643358
235. J Cyst Fibros. 2016 Sep;15(5):630-3. doi: 10.1016/j.jcf.2016.04.009. Epub 2016

May 5.
Episodic oral antibiotic use in CF: Discordance between the electronic medical
record and self-report.
Caverly LJ(1), Caverly TJ(2), Kalikin LM(3), Foster BK(3), Simon RH(4), LiPuma
JJ(3).
Author information:
(1)Department of Pediatrics and Communicable Diseases, University of Michigan
Medical School, Ann Arbor, MI 48109, United States. Electronic address:
caverlyl@med.umich.edu.
(2)Department of Internal Medicine, University of Michigan Medical School, Ann
Arbor, MI 48109, United States; Center for Clinical Management Research, Veterans
Affairs, Ann Arbor, MI 48105, United States.
(3)Department of Pediatrics and Communicable Diseases, University of Michigan
Medical School, Ann Arbor, MI 48109, United States.
(4)Department of Internal Medicine, University of Michigan Medical School, Ann
Arbor, MI 48109, United States.
BACKGROUND: Accurate accounting of antibiotic use is necessary for studies

comparing the CF airway microbiota across clinically relevant disease states.
While poor adherence to chronic therapies is well described for individuals with
CF, use patterns of episodic oral antibiotics are less clear.
METHODS: Eleven individuals with CF completed daily questionnaires regarding
antibiotic use for a mean of 458days. Self-report of episodic oral antibiotic use
was compared to antibiotic prescription data in the electronic medical record
(EMR).
RESULTS: Self-reported use of episodic oral antibiotics differed from EMR data an
average of 8.3% of days per subject. The majority of these discrepancies were due
to self-reported use of oral antibiotics outside of the EMR-documented dates of
antibiotic prescription.
CONCLUSIONS: Discrepancies exist between self-reported use of episodic oral
antibiotics and EMR data that have implications for studies of the CF airway
microbiota.
Copyright © 2016 European Cystic Fibrosis Society. Published by Elsevier B.V. All
rights reserved.
DOI: 10.1016/j.jcf.2016.04.009
PMCID: PMC5014681
236. Psychiatr Danub. 2018 Jun;30(Suppl 4):216-223.
Smoking in Schizophrenia: an Updated Review.
Šagud M(1), Vuksan-Ćusa B, Jakšić N, Mihaljević-Peleš A, Rojnić Kuzman M, Pivac

N.
Author information:
(1)Department of Psychiatry, University Hospital Centre Zagreb, Kispaticeva 12,
10 000 Zagreb, Croatia, marinasagud@mail.com.
Patients with schizophrenia continue to have the highest rate of both smoking and
heavy nicotine dependence. The interaction between smoking and schizophrenia is
complex. There is evidence of the shared genetic background. Recent preclinical
and clinical research has further investigated self-medication hypothesis, given
that nicotine might alleviate cortical dysfunction. While prior research
indicated some favorable effects of smoking on cognitive performance,
particulatly on attention/vigilance, recent studies did not confirm those
findings. Lower severity of negative symptoms in smokers was not confirmed across
studies. Cigarette smoking decreases clozapine and olanzapine concentrations.
There is no consistent evidence of favorable effects of nicotine on symptoms in
schizophrenia, but the evidence of detrimental effects of smoking on general
health is highly consistent. Smoking cessation should be a priority in patients
with schizophrenia.
237. Clin J Am Soc Nephrol. 2015 Mar 6;10(3):435-42. doi: 10.2215/CJN.06520714.

Epub
2015 Feb 20.
Chronic pain and analgesic use in CKD: implications for patient safety.
Wu J(1), Ginsberg JS(1), Zhan M(2), Diamantidis CJ(1), Chen J(1), Woods C(3),
Fink JC(4).
Author information:
(1)Departments of Medicine and.
(2)Epidemiology and Public Health, School of Medicine, University of Maryland,
Baltimore, Maryland; and.
(3)Department of Pharmaceutical Health Services Research, School of Pharmacy,
University of Maryland, Baltimore.
(4)Departments of Medicine and jfink@medicine.umaryland.edu.
Comment in
Clin J Am Soc Nephrol. 2015 Mar 6;10(3):350-2.
BACKGROUND AND OBJECTIVES: Chronic pain in predialysis CKD is not fully

understood. This study examined chronic pain in CKD and its relationship with
analgesic usage.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data include baseline visits from
308 patients with CKD enrolled between 2011 and 2013 in the Safe Kidney Care
cohort study in Baltimore, Maryland. The Wong-Baker FACES Pain Rating Scale
measured chronic pain severity. Analgesic prescriptions and over-the-counter
purchases were recorded up to 30 days before visits, and were classified as a
drug-related problem (DRP) based on an analgesic's nephrotoxicity and dose
appropriateness at participants' eGFR. Participants were sorted by pain frequency
and severity and categorized into ordinal groups. Analgesic use and the rate of
analgesics with a DRP were reported across pain groups. Multivariate regression
determined the factors associated with chronic pain and assessed the relationship
between chronic pain and analgesic usage.
RESULTS: There were 187 (60.7%) participants who reported chronic pain. Factors
associated with pain severity included arthritis, taking ≥12 medications, and
lower physical function. Use of nonsteroidal anti-inflammatory drugs was reported
by seven participants (5.8%) with no chronic pain. Mild and severe chronic pain
were associated with analgesics with a DRP, with odds ratios of 3.04 (95%
confidence interval [95% CI], 1.12 to 8.29) and 5.46 (95% CI, 1.85 to 16.10),
respectively. The adjusted rate of analgesics with a DRP per participant
increased from the group with none to severe chronic pain, with rates of 0.07
(95% CI, 0.04 to 0.13), 0.12 (95% CI, 0.07 to 0.20) and 0.16 (95% CI, 0.09 to
0.27), respectively.
CONCLUSIONS: Chronic pain is common in CKD with a significant relationship
between the severity of pain and both proper and improper analgesic usage.
Screening for chronic pain may help in understanding the role of DRPs in the
delivery of safe CKD care.
Copyright © 2015 by the American Society of Nephrology.
DOI: 10.2215/CJN.06520714
PMCID: PMC4348685
238. Rev Saude Publica. 2017 Jun 22;51:52. doi: 10.1590/S1518-8787.2017051006556.
Potentially inappropriate medications among older adults in Pelotas, Southern

Brazil.

Lutz BH(1)(2), Miranda VIA(1), Bertoldi AD(1)(2).
Author information:
(1)Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas.
Pelotas, RS, Brasil.
(2)Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal
de Pelotas. Pelotas, RS, Brasil.
OBJECTIVE: To assess the use of potentially inappropriate medications among older

adults.
METHODS: This is a population-based cross-sectional study with 1,451 older
individuals aged 60 years or more in the city of Pelotas, State of Rio Grande do
Sul, Brazil, in 2014. We have investigated the use of medications in the last 15
days. Using the Beers criteria (2012), we have verified the use of potentially
inappropriate medications and their relationship with socioeconomic and
demographic variables, polypharmacy, self-medication, and burden of disease.
RESULTS: Among the 5,700 medications used, 5,651 could be assessed as to being
inappropriate. Of these, 937 were potentially inappropriate for the older adults
according to the 2012 Beers criteria (16.6%). Approximately 42.4% of the older
adults studied used at least one medication considered as potentially
inappropriate. The group of medications for the nervous system accounted for
48.9% of the total of the potentially inappropriate medications. In the adjusted
analysis, the variables female, advanced age, white race, low educational level,
polypharmacy, self-medication, and burden of disease were associated with the use
of potentially inappropriate medications.
CONCLUSIONS: It is important to known the possible consequences of the use of
medication among older adults. Special attention should be given to the older
adults who use polypharmacy. Specific lists should be created with more
appropriate medications for the older population in the National Essential
Medicine List.
OBJETIVO: Avaliar o uso de medicamentos potencialmente inadequados entre idosos.
MÉTODOS: Estudo transversal de base populacional com 1.451 idosos com 60 anos ou
mais em Pelotas, RS, em 2014. Investigou-se o uso de medicamentos nos últimos 15
dias. Utilizando os critérios de Beers (2012), verificou-se a potencial
inadequação dos medicamentos e sua relação com variáveis socioeconômicas e
demográficas, polifarmácia, automedicação e carga de doença.
RESULTADOS: Dentre os 5.700 medicamentos utilizados, 5.651 puderam ser avaliados
quanto à inadequação. Destes, 937 eram potencialmente inadequados para idosos
segundo os critérios de Beers de 2012 (16,6%). Cerca de 42,4% dos idosos usaram
no mínimo um medicamento considerado potencialmente inapropriado. O grupo de
medicamentos para o sistema nervoso correspondeu a 48,9% do total de medicamentos
potencialmente inadequados. Na análise ajustada, as variáveis sexo feminino,
idade avançada, cor da pele branca, baixa escolaridade, polifarmácia,
automedicação e carga de doença mostraram-se associadas ao uso de medicamentos
potencialmente inadequados.
CONCLUSÕES: É importante que sejam bem conhecidas as possíveis consequências do
uso de medicamentos entre idosos. Atenção especial deve ser dada aos idosos que
fazem uso de polifarmácia. É necessário existir listas específicas com
medicamentos mais adequados para uso em idosos na Relação Nacional de
Medicamentos Essenciais.
DOI: 10.1590/S1518-8787.2017051006556
PMCID: PMC5493363
239. Ann N Y Acad Sci. 2017 Apr;1394(1):92-105. doi: 10.1111/nyas.13276. Epub 2016
Dec
9.
Utility of preclinical drug versus food choice procedures to evaluate candidate
medications for methamphetamine use disorder.
Banks ML(1).
Author information:
(1)Department of Pharmacology and Toxicology, Virginia Commonwealth University,
Richmond, Virginia.
Substance use disorders are diagnosed as a manifestation of inappropriate

behavioral allocation toward abused drugs and away from other behaviors
maintained by more adaptive nondrug reinforcers (e.g., money and social
relationships). Substance use disorder treatment goals include not only
decreasing drug-maintained behavior but also promoting behavioral reallocation
toward these socially adaptive alternative reinforcers. Preclinical drug
self-administration procedures that offer concurrent access to both drug and
nondrug reinforcers provide a translationally relevant dependent measure of
behavioral allocation that may be useful for candidate medication evaluation. In
contrast to other abused drugs, such as heroin or cocaine, preclinical
methamphetamine versus food choice procedures have been a more recent
development. We hypothesize that preclinical to clinical translatability would be
improved by the evaluation of repeated pharmacological treatment effects on
methamphetamine self-administration under a methamphetamine versus food choice
procedure. In support of this hypothesis, a literature review suggests strong
concordance between preclinical pharmacological treatment effects on
methamphetamine versus food choice in nonhuman primates and clinical medication
treatment effects on methamphetamine self-administration in human laboratory
studies or methamphetamine abuse metrics in clinical trials. In conclusion, this
literature suggests preclinical methamphetamine versus food choice procedures may
be useful in developing innovative pharmacotherapies for methamphetamine use
disorder.
© 2016 New York Academy of Sciences.
DOI: 10.1111/nyas.13276
PMCID: PMC5423852
240. Yale J Biol Med. 2015 Sep 3;88(3):247-56. eCollection 2015 Sep.
Prescription Sedative Misuse and Abuse.
Weaver MF(1).
Author information:
(1)Department of Psychiatry and Behavioral Sciences, University of Texas Medical
School at Houston, Houston, Texas.
Sedatives are widely prescribed for anxiety or insomnia and include

benzodiazepines, selective benzodiazepine receptor subtype agonists (z-drugs),
and barbiturates. These sedatives are controlled substances due to their
potential for misuse and abuse. Misuse is often self-medication (chemical coping)
of psychological symptoms in ways unauthorized by the prescriber, usually as dose
escalation leading to requests for early refills. Sedatives are abused for
euphoric effects, which may have dangerous consequences. Some sedative overdoses
can be treated with flumazenil, a reversal agent, along with supportive care.
Sedative withdrawal syndrome is treated by tapering the sedative and may require
hospitalization. Long-term treatment of sedative addiction requires counseling,
often with the help of an addiction-treatment professional.
PMCID: PMC4553644
241. J Neurosci. 2016 Jan 6;36(1):235-50. doi: 10.1523/JNEUROSCI.3468-15.2016.
Cocaine Self-Administration Experience Induces Pathological Phasic Accumbens

Dopamine Signals and Abnormal Incentive Behaviors in Drug-Abstinent Rats.
Saddoris MP(1), Wang X(2), Sugam JA(2), Carelli RM(2).
Author information:
(1)Department of Psychology and Neuroscience, University of Colorado, Boulder,
Colorado 80309, and Department of Psychology and Neuroscience, University of
North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599
michael.saddoris@colorado.edu.
(2)Department of Psychology and Neuroscience, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina 27599.
Chronic exposure to drugs of abuse is linked to long-lasting alterations in the

function of limbic system structures, including the nucleus accumbens (NAc).
Although cocaine acts via dopaminergic mechanisms within the NAc, less is known
about whether phasic dopamine (DA) signaling in the NAc is altered in animals
with cocaine self-administration experience or if these animals learn and
interact normally with stimuli in their environment. Here, separate groups of
rats self-administered either intravenous cocaine or water to a receptacle
(controls), followed by 30 d of enforced abstinence. Next, all rats learned an
appetitive Pavlovian discrimination and voltammetric recordings of real-time DA
release were taken in either the NAc core or shell of cocaine and control
subjects. Cocaine experience differentially impaired DA signaling in the core and
shell relative to controls. Although phasic DA signals in the shell were
essentially abolished for all stimuli, in the core, DA did not distinguish
between cues and was abnormally biased toward reward delivery. Further, cocaine
rats were unable to learn higher-order associations and even altered simple
conditioned approach behaviors, displaying enhanced preoccupation with
cue-associated stimuli (sign-tracking; ST) but diminished time at the food cup
awaiting reward delivery (goal-tracking). Critically, whereas control DA
signaling correlated with ST behaviors, cocaine experience abolished this
relationship. These findings show that cocaine has persistent, differential, and
pathological effects on both DA signaling and DA-dependent behaviors and suggest
that psychostimulant experience may remodel the very circuits that bias organisms
toward repeated relapse.SIGNIFICANCE STATEMENT: Relapsing to drug abuse despite
periods of abstinence and sincere attempts to quit is one of the most pernicious
facets of addiction. Unfortunately, little is known about how the dopamine (DA)
system functions after periods of drug abstinence, particularly its role in
behavior in nondrug situations. Here, rats learned about food-paired stimuli
after prolonged abstinence from cocaine self-administration. Using voltammetry,
we found that real-time DA signals in cocaine-experienced rats were strikingly
altered relative to controls. Further, cocaine-experienced animals found
reward-predictive stimuli abnormally salient and spent more time interacting with
cues. Therefore, cocaine induces neuroplastic changes in the DA system that
biases animals toward salient stimuli (including reward-associated cues), putting
addicts at increasing risk to relapse as addiction increases in severity.
Copyright © 2016 the authors 0270-6474/16/360235-16$15.00/0.

DOI: 10.1523/JNEUROSCI.3468-15.2016
PMCID: PMC4701963
242. J Cutan Pathol. 2016 Jun;43(6):492-7. doi: 10.1111/cup.12705. Epub 2016 Apr 7.
The self-reported use of immunostains and cytogenetic testing in the diagnosis of

melanoma by practicing U.S. pathologists of 10 selected states.
Zhao G(1), Lee KC(2), Kwon G(1), Frederick PD(3), Onega TL(4)(5)(6), Piepkorn
MW(1)(7), Knezevich S(8), Barnhill RL(9)(10), Elder DE(11), Elmore JG(3).
Author information:
(1)Division of Dermatology, Department of Medicine, University of Washington
School of Medicine, Seattle, WA, USA.
(2)Department of Dermatology, Massachusetts General Hospital, Harvard University,
Boston, MA, USA.
(3)Department of Medicine, University of Washington School of Medicine, Seattle,
WA, USA.
(4)Department of Biomedical Data Science, Norris Cotton Cancer Center, Lebanon,
NH, USA.
(5)Department of Epidemiology, Norris Cotton Cancer Center, Lebanon, NH, USA.
(6)Department of Community and Family Medicine, Geisel School of Medicine at
Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice,
Lebanon, NH, USA.
(7)Dermatopathology Northwest, Bellevue, WA, USA.
(8)Pathology Associates, Clovis, CA, USA.
(9)Department of Pathology, Faculty of Medicine, University of Paris Descartes,
Paris, France.
(10)Institut Curie, Paris, France.
(11)Department of Pathology, University of Pennsylvania, Philadelphia, PA, USA.
Comment in
J Cutan Pathol. 2017 Jun;44(6):599-600.
BACKGROUNDS: The diagnosis of melanoma can be challenging, especially in lesions

for which the histopathologic criteria bridge two or more taxonomic categories.
Newer genomic analytical methods of fluorescence in situ hybridization (FISH) and
comparative genomic hybridization (CGH) have been introduced as ancillary
techniques to differentiate benign and malignant melanocytic proliferations.
METHODS: We evaluated how pathologists perceive and are incorporating these new
cytogenetic testing technologies into their practices. We conducted a study of
207 U.S. pathologists who interpret melanocytic lesions in clinical practice in
10 SEER states. Pathologists were surveyed regarding perceptions and utilization
of FISH and/or CGH in their clinical practices.
RESULTS: Results showed that 38% of pathologists use FISH and/or CGH in
interpreting melanocytic lesions. Pathologists reporting FISH and/or CGH use were
significantly younger (p < 0.05), were fellowship trained or board certified in
dermatopathology (p < 0.001) and were affiliated with an academic institute (p <
0.001). Pathologists reporting that their colleagues consider them an expert in
the assessment of melanocytic lesions were more likely to employ FISH and/or CGH
in their practices than non-experts.
CONCLUSIONS: Early users of cytogenetic testing technologies in cutaneous
pathology are more likely to be younger, affiliated with an academic institution
and fellowship trained or board certified in dermatopathology.
© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
DOI: 10.1111/cup.12705
PMCID: PMC5592970
243. Int J Neuropsychopharmacol. 2018 Apr 1;21(4):361-370. doi:

10.1093/ijnp/pyx117.
Antagonism of Neurotensin Receptors in the Ventral Tegmental Area Decreases

Methamphetamine Self-Administration and Methamphetamine Seeking in Mice.
Dominguez-Lopez S(1)(2), Piccart E(2), Lynch WB(1)(2), Wollet MB(2), Sharpe

AL(3)(4), Beckstead MJ(1)(2).
Author information:
(1)Aging & Metabolism Research Program, Oklahoma Medical Research Foundation,
Oklahoma City, OK.
(2)Department of Cellular and Integrative Physiology, University of Texas Health,
San Antonio, Texas.
(3)Department of Pharmaceutical Sciences, Feik School of Pharmacy, University of
the Incarnate Word, San Antonio, Texas.
(4)College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma
City, OK.
Background: Neurotensin is a peptide that modulates central dopamine

neurotransmission and dopamine-related behaviors. Methamphetamine
self-administration increases neurotensin levels in the ventral tegmental area,
but the consequences for self-administration behavior have not been described.
Here we test the hypothesis that antagonizing neurotensin receptors in the
ventral tegmental area attenuates the acquisition of methamphetamine
self-administration and methamphetamine intake.
Methods: We implanted mice with an indwelling catheter in the right jugular vein
and bilateral cannulae directed at the ventral tegmental area. Mice were then
trained to nose-poke for i.v. infusions of methamphetamine (0.1 mg/kg/infusion)
on a fixed ratio 3 schedule.
Results: Mice receiving microinfusions of the neurotensin NTS1/NTS2 receptor
antagonist SR142948A in the ventral tegmental area (10 ng/side) prior to the
first 5 days of methamphetamine self-administration required more sessions to
reach acquisition criteria. Methamphetamine intake was decreased in
SR142948A-treated mice both during training and later during maintenance of
self-administration. Drug seeking during extinction, cue-induced reinstatement,
and progressive ratio schedules was also reduced in the SR142948A group. The
effects of SR142948A were not related to changes in basal locomotor activity or
methamphetamine psychomotor properties. In both SR142948A- and saline-treated
mice, a strong positive correlation between methamphetamine intake and enhanced
locomotor activity was observed.
Conclusion: Our results suggest that neurotensin input in the ventral tegmental
area during initial methamphetamine exposure contributes to the acquisition of
methamphetamine self-administration and modulates later intake and
methamphetamine-seeking behavior in mice. Furthermore, our results highlight the
role of endogenous neurotensin in the ventral tegmental area in the reinforcing
efficacy of methamphetamine, independent of its psychomotor effects.
DOI: 10.1093/ijnp/pyx117
PMCID: PMC5888879
244. Front Pharmacol. 2017 Nov 21;8:841. doi: 10.3389/fphar.2017.00841. eCollection
2017.
Traditional and Current Food Use of Wild Plants Listed in the Russian
Pharmacopoeia.
Shikov AN(1), Tsitsilin AN(2), Pozharitskaya ON(1), Makarov VG(1), Heinrich M(3).
Author information:
(1)Saint-Petersburg Institute of Pharmacy, Kuzmolovsky, Russia.
(2)All Russian Research Institute Medicinal and Aromatic Plants (VILAR), Moscow,
Russia.
(3)Research Cluster Biodiversity and Medicines, Centre for Pharmacognosy and
Phytotherapy, UCL School of Pharmacy, University of London, London, United
Kingdom.
Historically Russia can be regarded as a "herbophilious" society. For centuries

the multinational population of Russia has used plants in daily diet and for
self-medication. The specificity of dietary uptake of medicinal plants
(especially those in the unique and highly developed Russian herbal medical
tradition) has remained mostly unknown in other regions. Based on 11th edition of
the State Pharmacopoeia of the USSR, we selected 70 wild plant species which have
been used in food by local Russian populations. Empirical searches were conducted
via the Russian-wide applied online database E-library.ru, library catalogs of
public libraries in St-Petersburg, the databases Scopus, Web of Science, PubMed,
and search engine Google Scholar. The large majority of species included in
Russian Pharmacopoeia are used as food by local population, however, aerial parts
are more widely used for food. In this review, we summarize data on medicinal
species published in Russia and other countries that are included in the Russian
Pharmacopoeia and have being used in food for a long time. Consequently, the
Russian Pharmacopoeia is an important source of information on plant species used
traditionally at the interface of food and medicine. At the same time, there are
the so-called "functional foods", which denotes foods that not only serves to
provide nutrition but also can be a source for prevention and cure of various
diseases. This review highlights the potential of wild species of Russia
monographed in its pharmacopeia for further developing new functional foods
and-through the lens of their incorporation into the pharmacopeia-showcases the
species' importance in Russia.
DOI: 10.3389/fphar.2017.00841
PMCID: PMC5702350
PMID: 29209213
245. J Ment Health. 2016;25(1):23-7. doi: 10.3109/09638237.2015.1078883. Epub 2015

Oct
20.
Coping with mental health issues: subjective experiences of self-help and helpful
contextual factors at the start of mental health treatment.
Biringer E(1)(2), Davidson L(3), Sundfør B(2), Lier HØ(1), Borg M(2)(4).
Author information:
(1)a Helse Fonna Local Health Authority , Haugesund , Norway .
(2)b Regional Research Network on Mood Disorders (MoodNet) , Bergen , Norway .
(3)c Department of Psychiatry , Yale University School of Medicine , New Haven ,
CT , USA , and.
(4)d Faculty of Health Sciences , Buskerud and Vestfold University College ,
Drammen , Norway.
BACKGROUND: Self-help strategies and various contextual factors support recovery.

However, more in-depth knowledge is needed about how self-help strategies and
supportive environments facilitate the recovery process.
AIMS: To explore what individuals who have recently been referred to a specialist
Community Mental Health Center experience as helpful and what they do to help
themselves.
METHOD: Ten service users participated in in-depth interviews within a
collaborative-reflexive framework. A hermeneutic-phenomenological approach was
used.
RESULTS: Participants described a variety of helpful strategies and environmental
supports. Four relevant main themes were identified: helpful activities, helpful
people and places, self-instruction and learning about mental problems and
medication and self-medication.
CONCLUSIONS: The process of recovery is initiated before people become users of
mental health services. This study confirms that recovery takes place within the
person's daily life context and involves the interplay of contextual factors,
such as family, friends, good places, work and other meaningful activities. The
coping strategies reported may represent an important focus for attention and
clinical intervention.
DOI: 10.3109/09638237.2015.1078883
PMCID: PMC4776697
246. Schweiz Arch Tierheilkd. 2015 Nov;157(11):619-23.
Phytotherapy in zoo animals.
Hoby S, Wenker C, Walkenhorst M.
DOI: 10.17236/sat00042
247. Evol Appl. 2017 May 20;10(7):651-657. doi: 10.1111/eva.12465. eCollection 2017
Aug.
Changes in diet associated with cancer: An evolutionary perspective.
Thomas F(1), Rome S(2), Mery F(3), Dawson E(3), Montagne J(4), Biro PA(5),
Beckmann C(5), Renaud F(1), Poulin R(6), Raymond M(7), Ujvari B(5).
Author information:
(1)CREEC/MIVEGEC UMR IRD/CNRS/UM 5290 Montpellier Cedex 5 France.
(2)CarMen (UMR INSERM 1060, INRA 1397, INSA) Faculté de Médecine Lyon-Sud
Université de Lyon Oullins France.
(3)Evolution, Génomes, Comportement and Ecologie CNRS, IRD Université Paris-Sud,
Université Paris-Saclay Gif-sur-Yvette France.
(4)Institute for Integrative Biology of the Cell (I2BC) CNRS Université
Paris-Sud, CEA, UMR 9198 Gif-sur-Yvette France.
(5)Centre for Integrative Ecology School of Life and Environmental Sciences
Deakin University Waurn Ponds VIC Australia.
(6)Department of Zoology University of Otago Dunedin New Zealand.
(7)Institute of Evolutionary Sciences University of Montpellier Montpellier
France.
Changes in diet are frequently correlated with the occurrence and progression of
malignant tumors (i.e., cancer) in both humans and other animals, but an
integrated conceptual framework to interpret these changes still needs to be
developed. Our aim is to provide a new perspective on dietary changes in
tumor-bearing individuals by adapting concepts from parasitology. Dietary changes
may occur alongside tumor progression for several reasons: (i) as a pathological
side effect with no adaptive value, (ii) as the result of self-medication by the
host to eradicate the tumor and/or to slow down its progression, (iii) as a
result of host manipulation by the tumor that benefits its progression, and
finally (iv) as a host tolerance strategy, to alleviate and repair damages caused
by tumor progression. Surprisingly, this tolerance strategy can be beneficial for
the host even if diet changes are beneficial to tumor progression, provided that
cancer-induced death occurs sufficiently late (i.e., when natural selection is
weak). We argue that more data and a unifying evolutionary framework, especially
during the early stages of tumorigenesis, are needed to understand the links
between changes in diet and tumor progression. We argue that a focus on dietary
changes accompanying tumor progression can offer novel preventive and therapeutic
strategies against cancer.
DOI: 10.1111/eva.12465
PMCID: PMC5511355
PMID: 28717385
248. J Med Toxicol. 2015 Jun;11(2):165-6. doi: 10.1007/s13181-015-0473-0.
Introduction to Special Issue: At the Precipice of Quality Health Care: The Role
of the Toxicologist in Enhancing Patient and Medication Safety : At the Precipice
of Quality Health Care: The Role of the Toxicologist in Enhancing Patient and
Medication Safety. Venue: 2014 North American Congress of Clinical Toxicology.
ACMT Pre-Meeting Symposium, New Orleans, LA.
Farmer B(1), Smith SW.
Author information:
(1)Division of Emergency Medicine, Weill-Cornell Medical Center, 525 E 68th St.,
M-130, New York, NY, 10065, USA, bmf9001@med.cornell.edu.
DOI: 10.1007/s13181-015-0473-0
PMCID: PMC4469724
249. PLoS One. 2017 Sep 19;12(9):e0184420. doi: 10.1371/journal.pone.0184420.

eCollection 2017.
The expected and unexpected benefits of dispensing the exact number of pills.
Treibich C(1), Lescher S(2), Sagaon-Teyssier L(2)(3), Ventelou B(1)(3).
Author information:
(1)Département AMSE, Aix-Marseille Université, CNRS, EHESS and Centrale,
Marseille, France.
(2)SESSTIM, Sciences Economiques & Sociales de la Santé et Traitement de
l'Information Médicale, Aix Marseille Université, INSERM, IRD, Marseille, France.
(3)ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur,
Marseille, France.
BACKGROUND: From November 2014 to November 2015, an experiment in French

community pharmacies replaced traditional pre-packed boxes by per-unit dispensing
of pills in the exact numbers prescribed, for 14 antibiotics.
METHODS: A cluster randomised control trial was carried out in 100 pharmacies. 75
pharmacies counted out the medication by units (experimental group), the other 25
providing the treatment in the existing pharmaceutical company boxes (control
group). Data on patients under the two arms were compared to assess the
environmental, economic and health effects of this change in drug dispensing. In
particular, adherence was measured indirectly by comparing the number of pills
left at the end of the prescribed treatment.
RESULTS: Out of the 1185 patients included during 3 sessions of 4 consecutive
weeks each, 907 patients experimented the personalized delivery and 278 were
assigned to the control group, consistent with a 1/3 randomization-rate at the
pharmacy level. 80% of eligible patients approved of the per-unit dispensing of
their treatment. The initial packaging of the drugs did not match with the
prescription in 60% of cases and per-unit dispensing reduced by 10% the number of
pills supplied. 13.1% of patients declared that they threw away pills residuals
instead of recycling-no differences between groups. Finally, per-unit dispensing
appeared to improve adherence to antibiotic treatment (marginal effect 0.21, IC
95, 0.14-0.28).
CONCLUSIONS: Supplying antibiotics per unit is not only beneficial in terms of a
reduced number of pills to reimburse or for the environment (less pills wasted
and non-recycled), but also has a positive and unexpected impact on adherence to
treatment, and thus on both individual and public health.
PMCID: PMC5604959
250. Am J Hematol. 2017 Sep;92(9):940-945. doi: 10.1002/ajh.24811. Epub 2017 Jul

19.
Safety and efficacy of recombinant activated coagulation factor VII in congenital

hemophilia with inhibitors in the home treatment setting: A review of clinical
studies and registries.
Young G(1), Escobar MA(2), Pipe SW(3), Cooper DL(4).
Author information:
(1)Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, University
of Southern California Keck School of Medicine, Los Angeles, California.
(2)University of Texas Health Science Center and the Gulf States Hemophilia and
Thrombophilia Center, Houston, Texas.
(3)Hemophilia and Coagulation Disorders Program, University of Michigan, Ann
Arbor, Michigan.
(4)Clinical, Medical and Regulatory Affairs, Novo Nordisk Inc, Plainsboro, New
Jersey.
Self-administration of factor and bypassing agents by persons with hemophilia in

the home setting is recommended to facilitate earlier intervention after bleeding
episodes. The objective of this review was to summarize recombinant activated
coagulation factor VII (rFVIIa) safety and efficacy data from clinical trials and
patient registries documenting use in the home treatment setting in people with
congenital hemophilia with inhibitors (CHwI). A total of 16 studies and
registries were identified for inclusion; 14 evaluated on-demand treatment of
acute bleeding episodes (865 patients, 9024 bleeding episodes) and 2 evaluated
use for secondary prophylaxis (108 patients, 42,861 prophylaxis days). In the
on-demand studies, efficacy was consistently high (81%-96%), and thrombotic
events were uncommon (n = 3). In the secondary prophylaxis studies, rFVIIa was
associated with a 45% to 59% reduction in bleeding episodes and no thrombotic
events. These data support the clinical practice of administering rFVIIa in
patients in the home treatment setting after initiation under a physician's care.
© 2017 Wiley Periodicals, Inc.
DOI: 10.1002/ajh.24811
251. Expert Rev Anti Infect Ther. 2016 Sep;14(9):863-72. doi:

10.1080/14787210.2016.1206468. Epub 2016 Jul 11.
Antibiotic use in acute respiratory infections in under-fives in Uganda: findings

and implications.
Kibuule D(1), Kagoya HR(2), Godman B(3)(4).
Author information:
(1)a School of Pharmacy, Faculty of Health Sciences , University of Namibia ,
Windhoek , Namibia.
(2)b School of Public Health , Makerere University Kampala-Uganda , Kampala ,
Uganda.
(3)c Department of Pharmacoepidemiology , Strathclyde Institute of Pharmacy and
Biomedical Sciences, Pharmacy , Glasgow , UK.
(4)d Division of Clinical Pharmacology, Karolinska Institutet , Karolinska
University Hospital Huddinge , Stockholm , Sweden.
BACKGROUND: Self-medication with antibiotics among households is common in

Uganda. However, there are limited studies evaluating self-purchasing of
antibiotics for acute respiratory infections (ARI) in the under-fives.
Consequently, the objective of this study was to evaluate patterns of household
self-medication with antibiotics in ARI among under-fives in Kampala.
METHODS: Descriptive cross-sectional observational design. Care takers at
households were selected from five divisions of Kampala using the WHO 30-cluster
method and interviewed using a standardized questionnaire in June - July 2011.
RESULTS: Out of the 200 households, most ARI cases 107 (53.5%; p = 0.322) were
inappropriately managed. The prevalence of antibiotic use in ARI was 43% (p <
0.001). Amoxicillin (31.4%) and cotrimoxazole (30%) were the most self-medicated
antibiotics. Antibiotics use was associated with pneumonia symptoms and access to
antibiotics.
CONCLUSIONS: Household use of antibiotics in ARIs among under-fives is
suboptimal. There is an urgent need for guidelines on awareness to reduce
self-medication of ARIs in Uganda.
DOI: 10.1080/14787210.2016.1206468
252. Schizophr Bull. 2018 Apr 6;44(3):535-541. doi: 10.1093/schbul/sbx092.
Additive Effect of Cigarette Smoking on Gray Matter Abnormalities in

Schizophrenia.
Yokoyama N(1), Sasaki H(1), Mori Y(1), Ono M(1), Tsurumi K(1), Kawada R(1),
Matsumoto Y(1), Yoshihara Y(1), Sugihara G(1), Miyata J(1), Murai T(1), Takahashi
H(1).
Author information:
(1)Department of Psychiatry, Graduate School of Medicine, Kyoto University,
Kyoto, Japan.
It is widely known that there is a high prevalence of cigarette smoking in

schizophrenia. One of the explanations is the self-medication hypothesis. Based
on this hypothesis, it has been suggested that nicotine has procognitive effect
or even neuroprotective effect in schizophrenia. However, cigarettes contain
numerous neurotoxic substances, making the net effect of cigarette smoking on
brain function and structure complex. Indeed, recent studies have called into
question the self-medication hypothesis. We aimed to test whether there is an
interaction between diagnosis and smoking status in gray matter volume, ie,
whether smoking has specific effects on gray matter or whether main effects of
these 2 variables additively affect common brain regions. Magnetic resonance
imaging (MRI) images were obtained from 4 groups: (1) normal controls with no
smoking history, (2) normal controls currently smoking and/or with a past history
of smoking, (3) schizophrenia patients with no smoking history, and (4)
schizophrenia patients currently smoking and/or with a past history of smoking.
We used voxel-based morphometry to compare gray matter volumes among the 4
groups. We did not find any interaction between diagnosis and smoking, but we did
find negative additive effects of schizophrenia diagnosis and smoking status in
the left prefrontal cortex. The decrease in left prefrontal volume was associated
with greater numbers of cigarette pack years and severe positive and negative
symptoms. The current findings do not support the neuroprotective effect of
smoking on gross brain structure in schizophrenia, emphasizing the necessity of
longitudinal studies to test causal relationships among these variables.
DOI: 10.1093/schbul/sbx092
PMCID: PMC5890451
253. Alcohol. 2017 Sep;63:33-42. doi: 10.1016/j.alcohol.2017.03.004. Epub 2017 Jul

18.
P3b amplitude is not reduced in abstinent alcoholics with a current MDD.
Fein G(1), Cardenas VA(2).
Author information:
(1)Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, HI
96732, USA; Department of Medicine and Psychology, University of Hawaii,
Honolulu, HI 96822, USA. Electronic address: george@nbresearch.com.
(2)Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, HI
96732, USA.
BACKGROUND AND AIMS: In two studies of long-term abstinent alcoholics (LTAAs), we

found that about 17% had a current major depressive disorder (MDD). We tested the
hypothesis that LTAAs with a current MDD diagnosis do not exhibit the reduced P3b
event-related potential amplitude endophenotype for alcoholism. This is
consistent with the majority of LTAAs with a current MDD having developed alcohol
dependence via self-medication of their MDD rather than their alcohol dependence
arising from the alcoholism endophenotype. We revisited the P3b data from the two
LTAAs studies, comparing LTAAs with a current MDD vs. LTAAs without a current MDD
to each other and to non-substance abusing controls (NSACs). In northern
California, 48 LTAAs and 48 non-substance abusing controls were studied, while in
Honolulu, 105 LTAAs and 77 NSACs were studied. A total of 26 LTAAs had a current
MDD (10 in California and 16 in Honolulu). The difference in P3b amplitude and
latency (measured in targets-standards) in a 3-condition visual oddball paradigm
was compared to MDD diagnoses gathered using the computerized Diagnostic
Interview Schedule. Across both study sites, LTAAs without a current MDD (either
with no lifetime MDD or a lifetime, but not current MDD) had lower P3b amplitudes
than NSACs. In contrast, P3b amplitudes in LTAAs with a current MDD did not
differ from controls. We conclude that alcohol dependence in LTAAs with a current
MDD did not derive from the alcoholism endophenotype. This group may not exhibit
the externalizing diathesis characterized by impulsive, disinhibited behavior and
may have developed alcohol dependence via excessive drinking in an attempt to
self-medicate their MDD. These results have major implications for targeted
treatments of alcoholism and comorbid MDD.
DOI: 10.1016/j.alcohol.2017.03.004
PMCID: PMC5600327
254. Clin J Am Soc Nephrol. 2017 Nov 7;12(11):1778-1786. doi: 10.2215/CJN.12311216.

Epub 2017 Aug 15.
Patterns of NSAIDs Use and Their Association with Other Analgesic Use in CKD.
Zhan M(1), St Peter WL(1), Doerfler RM(1), Woods CM(1), Blumenthal JB(1),
Diamantidis CJ(1), Hsu CY(1), Lash JP(1), Lustigova E(1), Mahone EB(1), Ojo
AO(1), Slaven A(1), Strauss L(1), Taliercio JJ(1), Winkelmayer WC(1), Xie D(1),
Fink JC(2); Chronic Renal Insufficiency Cohort (CRIC) Study Investigators.
Author information:
(1)Due to the number of contributing authors, the affiliations are provided in
the Supplemental Material.
(2)Due to the number of contributing authors, the affiliations are provided in
the Supplemental Material. jfink@som.umaryland.edu.
BACKGROUND AND OBJECTIVES: Avoiding nonsteroidal anti-inflammatory drugs is

important for safe CKD care. This study examined nonsteroidal anti-inflammatory
drug use patterns and their association with other analgesic use in CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Chronic Renal Insufficiency
Cohort Study is an observational cohort study that enrolled 3939 adults ages
21-74 years old with CKD between 2003 and 2008 using age-based eGFR inclusion
criteria. Annual visits between June of 2003 and December of 2011 were organized
into 15,917 visit-pairs (with an antecedent and subsequent visit) for 3872
participants with medication information. Demographics, kidney function, and
clinical factors were ascertained along with report of nonsteroidal
anti-inflammatory drug or other analgesic use in the prior 30 days.
RESULTS: In our study, 24% of participants reported nonsteroidal
anti-inflammatory drug use at baseline or at least one follow-up study visit.
Having a 10 ml/min per 1.73 m2 higher eGFR level at an antecedent visit was
associated with higher odds of starting nonsteroidal anti-inflammatory drugs at a
subsequent visit (odds ratio, 1.44; 95% confidence interval, 1.34 to 1.56).
Seeing a nephrologist at the antecedent visit was associated with lower odds of
starting or staying on nonsteroidal anti-inflammatory drugs at a subsequent visit
(odds ratio, 0.70; 95% confidence interval, 0.56 to 0.87 and odds ratio, 0.61;
95% confidence interval, 0.46 to 0.81, respectively). Starting and stopping
nonsteroidal anti-inflammatory drugs were both associated with higher odds of
increasing the number of other analgesics (odds ratio, 1.52; 95% confidence
interval, 1.25 to 1.85 and odds ratio, 1.78; 95% confidence interval, 1.39 to
2.28, respectively) and higher odds of increasing the number of opioid analgesics
specifically (odds ratio, 1.92; 95% confidence interval, 1.48 to 2.48 and odds
ratio, 1.46; 95% confidence interval, 1.04 to 2.03, respectively).
CONCLUSIONS: Nonsteroidal anti-inflammatory drug use is common among patients
with CKD but less so among those with worse kidney function or those who see a
nephrologist. Initiation or discontinuation of nonsteroidal anti-inflammatory
drugs is often associated with supplementation with or replacement by,
respectively, other analgesics, including opioids, which introduces possible
drug-related problems when taking these alternative analgesics.
DOI: 10.2215/CJN.12311216
PMCID: PMC5672983
255. Subst Abuse Treat Prev Policy. 2017 May 30;12(1):29. doi:
10.1186/s13011-017-0112-7.
Physical pain is common and associated with nonmedical prescription opioid use
among people who inject drugs.
Dahlman D(1)(2), Kral AH(3), Wenger L(3), Hakansson A(4)(5), Novak SP(6).
Author information:
(1)Department of Clinical Sciences Lund, Division of Psychiatry, Lund University,
Lund, Sweden. disa.dahlman@med.lu.se.
(2)Malmo Addiction Centre, Clinical Research Unit, Sodra Forstadsg. 35, plan 4,
SE-205 02, Malmo, Sweden. disa.dahlman@med.lu.se.
(3)Behavioral and Urban Health Program, RTI International, San Francisco, USA.
(4)Department of Clinical Sciences Lund, Division of Psychiatry, Lund University,
Lund, Sweden.
(5)Malmo Addiction Centre, Clinical Research Unit, Sodra Forstadsg. 35, plan 4,
SE-205 02, Malmo, Sweden.
(6)Battelle Memorial Institute, Baltimore, MD, USA.
BACKGROUND: People who inject drugs (PWID) often have poor health and lack access
to health care. The aim of this study was to examine whether PWID engage in
self-treatment through nonmedical prescription opioid use (NMPOU). We describe
the prevalence and features of self-reported physical pain and its association
with NMPOU.
METHODS: PWID (N = 702) in San Francisco, California (age 18+) were recruited to
complete interviewer administered surveys between 2011 and 2013. Multivariate
logistic regression analysis was conducted to examine the associations among
self-reported pain dimensions (past 24-h average pain, pain interference with
functional domains) and NMPOU, controlling for age, sex, psychiatric illness,
opioid substitution treatment, homelessness, street heroin use and unmet
healthcare needs.
RESULTS: Almost half of the sample reported pain, based on self-reported measures
in the 24 h before their interview. The most common pain locations were to their
back and lower extremities. Past 24-h NMPOU was common (14.7%) and associated
with past 24 h average pain intensity on a 10 point self-rating scale (adjusted
odds ratio [AOR] = 2.15, 95% confidence interval [CI] 1.21-3.80), and past 24 h
pain interference with general activity (AOR 1.82 [95% CI 1.04-3.21]), walking
ability (AOR 2.52 [95% CI 1.37-4.63]), physical ability (AOR 2.01 [95% CI
1.16-3.45]), sleep (AOR 1.98 [95% CI 1.13-3.48]) and enjoyment of life (AOR 1.79
[95% CI 1.02-3.15]).
CONCLUSION: Both pain and NMPOU are common among PWID, and highly correlated in
this study. These findings suggest that greater efforts are needed to direct
preventive health and services toward this population.
DOI: 10.1186/s13011-017-0112-7
PMCID: PMC5450090
256. J Am Board Fam Med. 2017 Nov-Dec;30(6):832-834. doi:

10.3122/jabfm.2017.06.170066.
Dysrhythmias with Loperamide Used for Opioid Withdrawal.
Vithalani ND(1), Heron C(2), Rao RE(2), Cardell AF(2), Stephens MB(2).
Author information:
(1)From the Penn State Health, State College, PA (NDV, CH, RER, MBS); Mount
Nittany Physician Group, State College (AFC). nvithalanimd@gmail.com.
(2)From the Penn State Health, State College, PA (NDV, CH, RER, MBS); Mount
Nittany Physician Group, State College (AFC).
Comment in
J Am Board Fam Med. 2018 May-Jun;31(3):488-489.
The antidiarrheal loperamide has had a recent, drastic increase in off-label use
as an alternative treatment for symptoms of opioid withdrawal. The concept of
this is easily discovered on the Internet and social media, where there are
multiple blogs and forums promoting loperamide use at doses of 70 to 200 mg per
day. Unfortunately, the serious side effects are not well recognized. Multiple
cases of cardiac dysrhythmias contributing to death have been highlighted in
recent literature. In November 2016, the US Food & Drug Administration released a
statement highlighting the potential heart effects and risk of death with high
doses of loperamide.1 This case regards a 22-year-old who took 200 mg of
loperamide per day for 2 years as an alternative to methadone in her attempts to
wean off heroin. Her subsequent spontaneous collapse, dysrhythmias, and acute
hospital treatment are reviewed in detail as they were contradictory to standard
therapy and required a multidisciplinary approach. Her outpatient management
addressed the complex biological, psychological, and social aspects of her
addiction.
© Copyright 2017 by the American Board of Family Medicine.
DOI: 10.3122/jabfm.2017.06.170066
Conflict of interest statement: Conflict of interest: none declared.
257. J Res Pharm Pract. 2017 Apr-Jun;6(2):120-125. doi: 10.4103/jrpp.JRPP_17_12.
Initiatives to Reduce Nonprescription Sales and Dispensing of Antibiotics:

Findings and Implications.
Marković-Peković V(1)(2), Grubiša N(3), Burger J(4), Bojanić L(5), Godman

B(6)(7).
Author information:
(1)Ministry of Health and Social Welfare, Republic of Srpska, Bosnia and
Herzegovina.
(2)Department of Social Pharmacy, University of Banja Luka, Republic of Srpska,
(3)Health Insurance Fund of Republika Srpska, Republic of Srpska, Bosnia and
Herzegovina.
(4)Medicine Usage in South Africa (MUSA), North-West University, Potchefstroom,
South Africa.
(5)Public Health Institute, Republic of Srpska, Bosnia and Herzegovina.
(6)Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and
Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.
(7)Division of Clinical Pharmacology, Karolinska Institute, Karolinska University
Hospital Huddinge, Stockholm, Sweden.
OBJECTIVE: Irrational use of antimicrobials is a major driver of antimicrobial

resistance, exacerbated by dispensing antibiotics without a prescription. Our
previous study suggested this was a problem in the Republic of Srpska despite
legislation. Since then, a number of activities have been initiated.
Consequently, the study aimed to ascertain whether these multiple initiatives had
reduced this.
METHODS: Patients visiting all community pharmacies in the Republic from October
2014 to July 2015 presenting with symptoms typical of an acute, viral, and mostly
uncomplicated upper respiratory tract infection, with results compared to the
previous study. If an antibiotic was suggested, the maximum allowance was
€3/pack.
FINDINGS: Self-medication with antibiotics significantly decreased from 58% to
18.5% of pharmacies. In both studies, most patients were offered over-the-counter
medication. The most common reason for not dispensing an antibiotic was
"antibiotics can be dispensed with a prescription only." The penicillins were the
most dispensed antibiotic. Fewer patients than the previous study were given
instructions about antibiotic use and no discussion on their side effects.
CONCLUSION: While encouraging that self-medication decreased significantly, 18.5%
were disappointing given recent initiatives. Fewer instructions about antibiotics
if an antibiotic was dispensed were also disappointing. This suggests the need
for even stronger enforcement of the laws as well as further training of pharmacy
personnel to ensure the future appropriate use of medicines.
DOI: 10.4103/jrpp.JRPP_17_12
PMCID: PMC5463547
PMID: 28616436
258. J Exp Biol. 2017 Aug 15;220(Pt 16):2848-2857. doi: 10.1242/jeb.143800.
Parasite-altered feeding behavior in insects: integrating functional and

mechanistic research frontiers.
Bernardo MA(1), Singer MS(2).
Author information:
(1)Department of Biology, Wesleyan University, Middletown, CT 06105, USA.
(2)Department of Biology, Wesleyan University, Middletown, CT 06105, USA
msinger@wesleyan.edu.
Research on parasite-altered feeding behavior in insects is contributing to an

emerging literature that considers possible adaptive consequences of altered
feeding behavior for the host or the parasite. Several recent ecoimmunological
studies show that insects can adaptively alter their foraging behavior in
response to parasitism. Another body of recent work shows that infection by
parasites can change the behavior of insect hosts to benefit the parasite;
manipulations of host feeding behavior may be part of this phenomenon. Here, we
address both the functional and the underlying physiological frontiers of
parasite-altered feeding behavior in order to spur research that better
integrates the two. Functional categories of parasite-altered behavior that are
adaptive for the host include prophylaxis, therapy and compensation, while host
manipulation is adaptive for the parasite. To better understand and distinguish
prophylaxis, therapy and compensation, further study of physiological feedbacks
affecting host sensory systems is especially needed. For host manipulation in
particular, research on mechanisms by which parasites control host feedbacks will
be important to integrate with functional approaches. We see this integration as
critical to advancing the field of parasite-altered feeding behavior, which may
be common in insects and consequential for human and environmental health.
© 2017. Published by The Company of Biologists Ltd.
DOI: 10.1242/jeb.143800
Conflict of interest statement: Competing interestsThe authors declare no

competing or financial interests.
259. BMC Health Serv Res. 2017 Feb 13;17(1):136. doi: 10.1186/s12913-017-2072-z.
Evaluation of medicines dispensing pattern of private pharmacies in Rajshahi,

Bangladesh.
Saha S(1), Hossain MT(2).
Author information:
(1)Rajshahi Medical College, University of Rajshahi, 6002, Rajshahi, Bangladesh.
shuvormc53@gmail.com.
(2)Rajshahi Medical College Hospital, Rajshahi, Bangladesh.
BACKGROUND: In developing country like BANGLADESH, people depend more on

pharmacies due to expediency, shorter waiting time, cost reduction, availability
of credit and flexible opening hours. The aim of this study was to investigate
medicines dispensing patterns of the pharmacies in RAJSHAHI, BANGLADESH and to
identify and analyze contribution of drugsellers and quacks in irrational drug
use.
METHODS: This cross-sectional study was conducted during January 2016 - April,
2016 in 75 randomly selected private pharmacies including both licensed and
unlicensed pharmacies of covering LAKSHMIPUR area.
RESULT: During the whole study process, total 7944 clients visited the pharmacies
under observation and 24,717 medicines were dispensed. 22.70% of all these drugs
were sold without a prescription. Out of the 5610 items dispensed without
prescription, 66.2% were dispensed on the request of clients themselves and 33.8%
on the recommendation of a drug seller. Number of medicine in a prescription was
highly variable ranging from 2 to 5 medicines per prescriptions (mean = 3.03).
The average number of medicines dispensed from each of the pharmacies during the
observation period was 392, varied pharmacy to pharmacy - ranging from 194 to
588. Lowest selling medicines were sedative and hypnotics and highest selling
medicines were antimicrobials. The recommendation rate for antibiotics was
highest for the quacks (26.48%) though the major amount of the antimicrobials
(n = 3039, 65.83%) were dispensed on prescription. Macrolides, quinolones,
metronidazoles and cephalosporins are most favourite drug of quacks, clients and
pharmacists.
CONCLUSION: Majority of medicines were dispensed irrationally without any
prescription and over the counter dispensing of many low safety profile drugs was
common. The results and discussion presented in this paper will be helpful to
provide a baseline to redirect further studies in this area.
DOI: 10.1186/s12913-017-2072-z
PMCID: PMC5307842

eCollection 2015.
Where Failure Is Not an Option -Personalized Medicine in Astronauts.
Stingl JC(1), Welker S(2), Hartmann G(3), Damann V(4), Gerzer R(5).
Author information:
(1)Research Division, Federal Institute for Drugs and Medical Devices, Bonn,
Germany; Centre for Translational Medicine, University Bonn Medical Faculty,
Bonn, Germany.
(2)Research Division, Federal Institute for Drugs and Medical Devices, Bonn,
Germany.
(3)Institute for clinical chemistry and clinical pharmacology, University of
Bonn, Bonn, Germany.
(4)Space Medicine Office, European Space Agency, Cologne, Germany.
(5)Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany.
Drug safety and efficacy are highly variable among patients. Most patients will
experience the desired drug effect, but some may suffer from adverse drug
reactions or gain no benefit. Pharmacogenetic testing serves as a pre-treatment
diagnostic option in situations where failure or adverse events should be avoided
at all costs. One such situation is human space flight. On the international
space station (ISS), a list of drugs is available to cover typical emergency
settings, as well as the long-term treatment of common conditions for the use in
self-medicating common ailments developing over a definite period. Here, we
scrutinized the list of the 78 drugs permanently available at the ISS (year 2014)
to determine the extent to which their metabolism may be affected by genetic
polymorphisms, potentially requiring genotype-specific dosing or choice of an
alternative drug. The purpose of this analysis was to estimate the potential
benefit of pharmacogenetic diagnostics in astronauts to prevent therapy failure
or side effects.
PMCID: PMC4619198
261. J Optom. 2017 Apr - Jun;10(2):104-110. doi: 10.1016/j.optom.2016.06.001. Epub

2016 Jul 14.
Parents' awareness and perception of children's eye diseases in Nigeria.
Ebeigbe JA(1), Emedike CM(2).
Author information:
(1)Department of Optometry, Faculty of Life Sciences, University of Benin,
Nigeria. Electronic address: jennifer.ebeigbe@uniben.edu.
(2)Department of Optometry, Faculty of Life Sciences, University of Benin,
Nigeria.
PURPOSE: Most causes of childhood blindness are treatable or preventable.

Knowledge of parents' awareness and perception of eye problems is important in
helping to understand parents' eye care seeking behavior. This understanding
becomes necessary as early detection and intervention can be effective when done
at an early age.
METHOD: Study was carried out in Benin City, Nigeria. Thirty-five parents aged
38-54 years with a mean age of 43(±2) years were recruited. Twenty six were
females and nine males. Ten eye care practitioners aged 30-45 years with a mean
age of 40 (±2) were included. Seven were males and three were females. Data was
analyzed qualitatively and in percentages.
RESULTS: Majority of parents were aware of common eye problems: Blurry vision
(85.7%), measles in eye (48.5%), cataract (74.3%), conjunctivitis (48.5%),
itching and redness (74.3%), crossed eyes (34.3%), strabismus (57.1%), short
sightedness (48.5%) and stye or hordeolum (57.1%). Too much carbohydrate, night
reading and too much TV were some of the reasons given for bad eyesight. Self
medication and use of local remedies for treatment of conjunctivitis was common
practice (94.3%). Chloramphenicol eyedrop was the most common drug used for any
eye problem before visiting a doctor (80.0%).
CONCLUSION: Parents are aware of common eye diseases in children but have wrong
perception of their causes. Programs to increase public awareness of causes of
eye problems and harmful effects of self medication are advocated for to expose
inherent dangers.
Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier

España, S.L.U. All rights reserved.
DOI: 10.1016/j.optom.2016.06.001
PMCID: PMC5383457
262. Int J Pharm Pract. 2018 Aug;26(4):310-317. doi: 10.1111/ijpp.12405. Epub 2017
Sep
19.
Assessment of counselling for acute diarrhoea in German pharmacies: a simulated

patient study.
Langer B(1), Bull E(1), Burgsthaler T(1), Glawe J(1), Schwobeda M(1), Simon K(1).
Author information:
(1)Faculty of Health, Nursing, Administration, University of Applied Sciences
Neubrandenburg, Neubrandenburg, Germany.
OBJECTIVES: The aim of this study was to assess the quality of counselling
provided for acute diarrhoea and to evaluate the role of the patient's approach
and different user groups in determining the outcome of counselling.
METHODS: The simulated patient methodology was used in all 21 community
pharmacies in a north-eastern German city. Four different scenarios related to
self-medication of acute diarrhoea were developed and used in all the pharmacies
(a total of 84 visits). The assessment form, completed immediately postvisit by
the simulated patient, included 9 objective items scored using dichotomous scales
to produce a scale from 0 to 9. After evaluating the data, every pharmacy
received individual performance feedback to encourage behavioural changes and
improve the quality of the counselling provided.
KEY FINDINGS: Overall, the quality of counselling was poor (mean score of 3.3/9
(37%)). The most common information provided was about dosage (87% of
interactions), while the least common information given was about side effects
(4% of interactions). The main effect was seen when comparing the product and
symptom requests (F(1,60) = 24.748, P < 0.001, ωp2 = 0.277). There was no effect
resulting from different user groups (F(1,28) = 0.237, P = 0.630, ωp2 = -0.026)
and no interaction between the type of request and different user groups (F(1,28)
= 3.395, P = 0.076, ωp2 = 0.073).
CONCLUSIONS: This study highlighted the current deficits in appropriate
counselling provided by community pharmacies in Germany.
© 2017 The Authors. International Journal of Pharmacy Practice published by John

Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society.
DOI: 10.1111/ijpp.12405
PMCID: PMC6055702
263. Folia Med Cracov. 2015;55(2):49-59.
Non-steroidal anti-inflammatory drugs and paracetamol in self-therapy of various

disorders in students of different fields of study.
Wiliński J(1), Lechowicz M, Kameczura T, Głowacki M, Kameczura A, Chrapusta A,

Wiliński B.
Author information:
(1)Non-Public Health Care Center Heart-to-Heart Mogilany, Rynek 4, Mogilany,
Poland. putamen@interia.pl.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol

are most commonly the first-line pharmacotherapy in combating different pain and
inflammatory disorders and fever. Unfortunately, those drugs might have serious
side effects, especially when they are used in an inappropriate way. The aim of
the study was to explore various aspects of NSAIDs and paracetamol use in the
self-therapy of miscellaneous disorders in young adults. The questionnaire-based
survey comprised 250 consecutive students aged 22.1 ± 1.9 years (189 women) of
diverse fields of study. The drugs were applied in clinical conditions in which
they should be avoided including asthma attack (1.2%), vomiting (2.4%), malaise
and depression (3.6%), in autumn and winter as a preventive measure against
infections (14.0%), heart-burn (2.0%) and during food poisoning (16.0%). As many
as 6.0% of the students claimed that studied medications are ultimately free of
adverse reactions. Men more frequently than women used NSAIDs and paracetamol
during alcohol consumption (49.2% vs 30.7%, p = 0.009, respectively) but less
often were aware that there are maximum doses of medications which should not be
exceeded (57.4% vs 76.7%, p = 0.003, respectively). The students of
medical-related degree courses (n = 82) compared with individuals of other
subjects (n = 168) declared they more often have the custom of always reading
medications' leaflets (46.3% vs 31.0%, p = 0.017, respectively). Side effects of
medicines were reported by 65 participants - 26.0%. In conclusion, students'
knowledge about NSAIDs and paracetamol is low. Participants do not search for
information on drug related endangerments, the medication group choice for the
given disorder is often inappropriate and the drugs are applied in conditions in
which they are contraindicated.
264. BMC Med. 2018 Jul 26;16(1):115. doi: 10.1186/s12916-018-1104-9.
Medications that reduce emergency hospital admissions: an overview of systematic

reviews and prioritisation of treatments.
Bobrovitz N(1)(2), Heneghan C(3)(4), Onakpoya I(3)(4), Fletcher B(3), Collins
D(3)(5), Tompson A(3)(6), Lee J(3), Nunan D(3)(4), Fisher R(3)(7), Scott B(8)(9),
O'Sullivan J(3)(4), Van Hecke O(3), Nicholson BD(3), Stevens S(3), Roberts N(10),
Mahtani KR(3)(4).
Author information:
(1)Nuffield Department of Primary Care Health Sciences, University of Oxford,
Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom.
niklas.bobrovitz@phc.ox.ac.uk.
(2)Centre for Evidence-Based Medicine, University of Oxford, Oxford, United
Kingdom. niklas.bobrovitz@phc.ox.ac.uk.
Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom.
(4)Centre for Evidence-Based Medicine, University of Oxford, Oxford, United
Kingdom.
(5)Faculty of Medicine, University of British Columbia, Vancouver, Canada.
(6)Faculty of Public Health and Policy, London School of Hygiene and Tropical
Medicine, London, United Kingdom.
(7)The Health Foundation, London, United Kingdom.
(8)Department of Critical Care Medicine, University of Calgary, Calgary, Canada.
(9)Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada.
(10)Bodelian Libraries, University of Oxford, Oxford, UK.
Comment in
BMC Med. 2018 Oct 5;16(1):169.
BACKGROUND: Rates of emergency hospitalisations are increasing in many countries,

leading to disruption in the quality of care and increases in cost. Therefore,
identifying strategies to reduce emergency admission rates is a key priority.
There have been large-scale evidence reviews to address this issue; however,
there have been no reviews of medication therapies, which have the potential to
reduce the use of emergency health-care services. The objectives of this study
were to review systematically the evidence to identify medications that affect
emergency hospital admissions and prioritise therapies for quality measurement
and improvement.
METHODS: This was a systematic review of systematic reviews. We searched MEDLINE,
PubMed, the Cochrane Database of Systematic Reviews & Database of Abstracts of
Reviews of Effects, Google Scholar and the websites of ten major funding agencies
and health charities, using broad search criteria. We included systematic reviews
of randomised controlled trials that examined the effect of any medication on
emergency hospital admissions among adults. We assessed the quality of reviews
using AMSTAR. To prioritise therapies, we assessed the quality of trial evidence
underpinning meta-analysed effect estimates and cross-referenced the evidence
with clinical guidelines.
RESULTS: We identified 140 systematic reviews, which included 1968 unique
randomised controlled trials and 925,364 patients. Reviews contained 100
medications tested in 47 populations. We identified high-to moderate-quality
evidence for 28 medications that reduced admissions. Of these medications, 11
were supported by clinical guidelines in the United States, the United Kingdom
and Europe. These 11 therapies were for patients with heart failure
(angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers,
aldosterone receptor antagonists and digoxin), stable coronary artery disease
(intensive statin therapy), asthma exacerbations (early inhaled corticosteroids
in the emergency department and anticholinergics), chronic obstructive pulmonary
disease (long-acting muscarinic antagonists and long-acting beta-2 adrenoceptor
agonists) and schizophrenia (second-generation antipsychotics and
depot/maintenance antipsychotics).
CONCLUSIONS: We identified 11 medications supported by strong evidence and
clinical guidelines that could be considered in quality monitoring and
improvement strategies to help reduce emergency hospital admission rates. The
findings are relevant to health systems with a large burden of chronic disease
and those managing increasing pressures on acute health-care services.
DOI: 10.1186/s12916-018-1104-9
PMCID: PMC6060538
265. Int J Environ Res Public Health. 2018 Jun 4;15(6). pii: E1165. doi:
10.3390/ijerph15061165.
Knowledge, Attitude, and Practice with Respect to Antibiotic Use among Chinese
Medical Students: A Multicentre Cross-Sectional Study.
Hu Y(1), Wang X(2), Tucker JD(3), Little P(4), Moore M(5), Fukuda K(6), Zhou
X(7).
Author information:
(1)School of Public Health, The University of Hong Kong, Hong Kong, China.
huhubest@gmail.com.
(2)School of Public Health, Zhejiang University, Hangzhou 310058, China.
xiaominzjuhvd@gmail.com.
(3)UNC-China Project, University of North Carolina at Chapel Hill, Chapel Hill,
NC 27599, USA. jdtucker@med.unc.edu.
(4)Primary Care and Population Science, University of Southampton, Southampton
SO16 5ST, UK. p.little@soton.ac.uk.
(5)Primary Care and Population Science, University of Southampton, Southampton
SO16 5ST, UK. mvm198@soton.ac.uk.
(6)School of Public Health, The University of Hong Kong, Hong Kong, China.
kfukuda@hku.hk.
(7)School of Public Health, Zhejiang University, Hangzhou 310058, China.
zhouxudong@zju.edu.cn.
OBJECTIVE: Inappropriate antibiotic use leads to antibiotic resistance. This has

become a serious global crisis, with more multi-drug resistant infections and
fewer effective antibiotics available. This study aims to understand knowledge,
attitude, and practice (KAP) with respect to antibiotic use for self-limiting
illnesses among medical students in China.
METHODS: An online cross-sectional survey instrument questionnaire was
distributed in six regional universities in China from September to November
2015. Overall, 1819 medical students were enrolled. A pre-tested questionnaire
was delivered by the researchers. KAP scores were calculated to determine the
appropriation. Chi-squared and multivariable logistic regression and adjusted odd
ratios (aORs) with 95% confidence interval (CI) were used to assess the
relationship between the demographic characteristics and antibiotic use knowledge
and behaviour.
RESULTS: In total, 11,192 students completed the questionnaires, with a response
rate of 95%. In total, 529 (29%) medical students reported at least one
self-limiting illness in the prior month. Of those with a self-limiting illness,
285 (54%) self-medicated, with 77 (27%) using antibiotics; 111 (21%) went to see
a doctor, of which 64 (58%) were prescribed antibiotics, and 133 did nothing
(25%). In the past year, 279 (15%) of medical students had used antibiotics as
prophylaxis, and 273 (15%) of medical students had demanded an antibiotic from a
doctor. Meanwhile, 1166 (64%) of them kept a personal stock of antibiotics, and
1034 (57%) of them had bought antibiotics at a pharmacy, of which 97% were
purchased without a prescription. Students with high KAP scores with respect to
antibiotics were significantly less likely to self-medicate with antibiotics (aOR
0.37, 95% CI 0.15⁻0.91, p = 0.031), use antibiotics for prophylaxis (aOR 0.35,
95% CI 0.21⁻0.60, p < 0.0001), or demand an antibiotic (aOR 0.46, 95% CI
0.26⁻0.81, p = 0.007) from the doctor. Logistical regression showed that students
whose fathers had a higher education level, whose mothers had medical background,
who were from urban areas were more likely to stock antibiotics and self-medicate
with antibiotics.
CONCLUSION: High rates of antibiotic self-medication for self-limiting illness
and stocking of antibiotics among medical students were observed. Along with the
high rates of medical students receiving unnecessary antibiotics from their
doctors were observed. The students' knowledge and attitude towards to
antibiotics, which drive prescribing, highlight the urgent need for effective
antibiotic stewardship and training programs in Chinese healthcare institutes and
medical schools.
DOI: 10.3390/ijerph15061165
PMCID: PMC6025109
266. Subst Use Misuse. 2017 Nov 10;52(13):1701-1711. doi:

10.1080/10826084.2017.1306563. Epub 2017 Jun 16.
Opioid-Involved Overdose Among Male Afghanistan/Iraq-Era U.S. Military Veterans:

A Multidimensional Perspective.
Bennett AS(1)(2), Elliott L(1)(2), Golub A(1), Wolfson-Stofko B(1)(2), Guarino

H(1)(2)(3).
Author information:
(1)a Center for Community and Health Disparities Research , National Development
and Research Institutes, Inc. , New York , NY , USA.
(2)b Center for Drug Use and HIV/HCV Research , New York University , New York ,
NY , USA.
(3)c Institute for Infectious Disease Research , National Development and
Research Institutes, Inc. , New York , NY , USA.
BACKGROUND: Mirroring nationwide trends in a broad range of U.S. populations, an

alarming number of Afghanistan/Iraq-era U.S. Military veterans have experienced
opioid-related overdoses. A growing body of research has examined the proximal
behaviors that can precipitate an overdose; considerably less is known about more
distal physiological, psychosocial and structural influences on these risk
behaviors.
OBJECTIVES: This study adopts a multidimensional approach to better understand
opioid-related overdose among U.S. Military veterans, and seeks to explore not
only the proximal behavioral precipitants of overdose events, but also the
complex nexus of physiological, psychological, and sociological influences that
undergird overdose events.
METHODS: This qualitative examination is based on interview data from 36 male
veterans who were discharged from the military after September 2001 and
experienced at least one opioid-related overdose during or after military
service. Participants were recruited in New York City during 2014 to share
narrative accounts of their overdoses.
RESULTS: Veterans' accounts indicate that background experiences, such as
self-medication for social and psychological pain, trauma, social alienation and
isolation, and histories of illicit drug use, precondition the more immediate
factors and behaviors that precipitate overdose (including bingeing on drugs,
mixing drugs, naiveté about dosage, and ambivalence about life/death).
CONCLUSIONS: Findings suggest the need for comprehensive drug safety and overdose
education that is sensitive to veterans' physiological, psychological, and
sociological conditions. A multidimensional understanding of the distal and
proximal overdose risks faced by veterans and other vulnerable groups may help
lay a foundation for more inclusive/holistic approaches to overdose prevention
and education.
DOI: 10.1080/10826084.2017.1306563
PMCID: PMC5628147
267. Sao Paulo Med J. 2018 Sep-Oct;136(5):407-413. doi:

10.1590/1516-3180.2018.0168060818.
Use of antibiotics by adults: a population-based cross-sectional study.
Pereira JQ(1), Silva MT(2), Galvão TF(3).
Author information:
(1)BPharm. Pharmacist and Assistant Scientist at Johnson & Johnson Brasil, São
José dos Campos (SP), Brazil.
(2)MSc, PhD. Pharmacist and Professor, School of Medicine, Universidade Federal
do Amazonas (UFAM), Manaus (AM), Brazil, and Postgraduate Program on
Pharmaceutical Sciences, Universidade de Sorocaba (UNISO), Sorocaba (SP), Brazil.
(3)MSc, PhD. Pharmacist and Professor, School of Pharmaceutical Sciences,
Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
BACKGROUND: The consumption of antibiotics has been widely discussed, mainly

because of antibacterial resistance, which has become a worldwide concern. In
Brazil, sale of antibiotics is currently ruled by Agência Nacional de Vigilância
Sanitária (ANVISA) regulation RDC 20/2011, which restricts sales to those made
under medical prescription. The aims of this study were to evaluate antibiotic
use and associated factors among adults in the Metropolitan Region of Manaus,
Amazonas, Brazil, and to assess the proportion of self-medication from this use.
DESIGN AND SETTING: Population-based cross-sectional study conducted in the
Metropolitan Region of Manaus between May and August 2015.
METHODS: Adults aged ≥ 18 years were selected through probabilistic sampling in
three stages. Trained interviewers collected data from the participants in their
homes. Antibiotic consumption over the last 15 days was reported. Bivariate
analysis was used to calculate the prevalence ratio (PR) of antibiotic usage,
with 95% confidence interval (95% CI). A multivariate model adjusted according to
significant variables at P ≤ 0.20 using Poisson regression with robust variance
was constructed.
RESULTS: The prevalence of antibiotic use was 3.4% (95% CI 2.8-4.0%). Adjusted
analysis showed that consumption was higher among women than among men (PR 1.58;
95% CI 1.11-2.24) and among people with fair health status than among those with
good health (PR 1.52; 95% CI 1.08-2.15). The prevalence of self-medication was
19.0%; amoxicillin was the most self-medicated antibiotic (10/26).
CONCLUSION: Antibiotic use was associated with women and individuals with fair
health status. One fifth of the antibiotics were consumed through
self-medication, contrary to the current Brazilian legislation.
DOI: 10.1590/1516-3180.2018.0168060818
268. J Infect Public Health. 2017 Sep - Oct;10(5):522-526. doi:

10.1016/j.jiph.2016.09.016. Epub 2017 Feb 3.
Over-the-counter antibiotics in Saudi Arabia, an urgent call for policy makers.

Bin Nafisah S(1), Bin Nafesa S(2), Alamery AH(3), Alhumaid MA(4), AlMuhaidib
HM(5), Al-Eidan FA(6).
Author information:
(1)King Fahd Medical City, Emergency Department, 395529 Riyadh 11375, Saudi
Arabia. Electronic address: dr.sharafaldeen@yahoo.com.
(2)King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.
Electronic address: S.nafesa@hotmail.com.
Electronic address: Aliyah80@live.com.
Electronic address: Mazen.humaid@gmail.com.
Electronic address: Haitham.almuhaidib@gmail.com.
Electronic address: Faleidan@gmail.com.
Antibiotics over-consumption is a pandemic that has a tremendous cost on the

overwhelmed healthcare system. The accessibility of antibiotics coupled with the
misconception of public toward those drugs both of which implicated in the use
and misuse of antibiotics. The aim of this study was to investigate the
perception of the community toward antibiotics, its purpose and harmfulness, in
addition to the accessibility of those drugs as over the counter and without
prescriptions. We also investigated the behavior toward antibiotic prescriptions
when perceived unnecessary. This is a cross-sectional study in Riyadh-Saudi
Arabia based upon a structured self-administered questionnaire. The study
included 473 individuals with a mean age of 27 years old. Forty eight percent
(n=227) of the participants obtain antibiotics without prescriptions. Ninety two
percent (n=208) of those noted pharmacist counseling as their method of
acquisition. Self-prescription noted in 8.4% (n=19). Viral illnesses accounted
for the highest percentage for seeking antibiotics in 35.5% (n=166) more commonly
among females. Thirty one point eight percent (n=149) used antibiotics for
analgesia while 13.7% (n=64) believed in their prophylactic use. We also noted
that the prevalence of sharing antibiotics is 19.7%. The perceived unnecessary
prescriptions uncovered 122 of the participants who reported throwing the
prescribed antibiotics away after acquisition. Dispensing antibiotics without
prescription is an issue that mandates a political intervention and
implementation of the existing laws that prohibit dispensing without proper
prescription. We advocate public health measures targeting both healthcare
providers and the public on the use and misuse of antibiotics.
Copyright © 2017 King Saud Bin Abdulaziz University for Health Sciences.
Published by Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.jiph.2016.09.016
269. Brain Sci. 2018 May 14;8(5). pii: E88. doi: 10.3390/brainsci8050088.
Transitioning Bodies. The Case of Self-Prescribing Sexual Hormones in Gender

Affirmation in Individuals Attending Psychiatric Services.
Metastasio A(1)(2), Negri A(3), Martinotti G(4)(5), Corazza O(6).
Author information:
(1)Camden and Islington NHS Foundation Trust, London NW1 0PE, UK.
antonio.metastasio@candi.nhs.uk.
(2)Centre for Clinical & Health Research Services, School of Life and Medical
Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK.
antonio.metastasio@candi.nhs.uk.
Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK. ngrttl@gmail.com.
giovanni.martinotti@gmail.com.
(5)Department of Neuroscience, Imaging, and Clinical Science, "G. d'Annunzio"
University of Chieti-Pescara, 66100 Chieti, Italy. giovanni.martinotti@gmail.com.
o.corazza@herts.ac.uk.
Self-prescribing of sexual hormones for gender affirmation is a potentially

widespread and poorly studied phenomenon that many clinicians are unaware of. The
uncontrolled use of hormones poses significant health hazards, which have not
been previously reported in the literature. We have collected seven clinical
cases in general adult psychiatry settings (both inpatient and outpatients),
describing transgender and gender non-conforming individuals' (TGNC)
self-prescribing and self-administering hormones bought from the Internet without
any medical consultation. Among these cases, two were taking androgens, and the
rest were taking oestrogens. The main reason for self-administration of hormones
seems to be the lack of access to specialised care due to discrimination and long
waiting lists. We advocate for clinicians to be aware of the phenomenon and
proactively help TGNC individuals by enquiring about self-prescribing of
hormones, providing information and referring to the most appropriate treatment
centre as well as encourage a public debate on the discrimination and the stigma
that TGNC population suffer from. Overall, there is an urgent need for the
implementation of different and innovative health care services for TGNC
individuals as well as more targeted prevention strategies on such underreported
and highly risky behaviours. Furthermore, it is necessary for every clinician
involved in the care for TGNC people to be aware of their special needs and be
able to be an allied and an advocate to help in reducing stigma and
discrimination that affect the access to care for this often underserved
population.
DOI: 10.3390/brainsci8050088
PMCID: PMC5977079
PMID: 29757929
270. Rev Saude Publica. 2017 Nov 13;51(suppl 2):18s. doi:

10.11606/S1518-8787.2017051007144.
Use of medicines by patients of the primary health care of the Brazilian Unified
Health System.
Costa CMFN(1), Silveira MR(2), Acurcio FA(2), Guerra AA Junior(2), Guibu IA(3),
Costa KS(4)(5)(6), Karnikowski MGO(7), Soeiro OM(8), Leite SN(9), Costa EA(10),
Nascimento RCRMD(1), Araújo VE(11), Álvares J(2).
Author information:
(1)Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica.
Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG,
Brasil.
(2)Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal
de Minas Gerais. Belo Horizonte, MG, Brasil.
(3)Faculdade de Ciências Médicas. Santa Casa de São Paulo. São Paulo, SP, Brasil.
(4)Núcleo de Estudos de Políticas Públicas. Universidade Estadual de Campinas.
Campinas, SP, Brasil.
(5)Programa de Pós-Graduação em Saúde Coletiva. Departamento de Saúde Coletiva.
Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Campinas, SP,
Brasil.
(6)Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina.
Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil.
(7)Faculdade de Ceilândia. Universidade de Brasília. Brasília, DF, Brasil.
(8)Faculdade de Ciências Farmacêuticas. Pontifícia Universidade Católica de
Campinas. Campinas, SP, Brasil.
(9)Departamento de Ciências Farmacêuticas. Universidade Federal de Santa
Catarina, Florianópolis, SC, Brasil.
(10)Instituto de Saúde Coletiva. Universidade Federal da Bahia. Salvador, BA,
Brasil.
(11)Instituto de Ciências Biológicas da Saúde. Pontifícia Universidade Católica
de Minas Gerais. Belo Horizonte, MG, Brasil.
OBJECTIVE: To characterize the use of medicines by patients of the primary health

care of the Brazilian Unified Health System (SUS).
METHODS: This is a cross-sectional, exploratory, and descriptive study, part of
the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de
Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and
Promotion of Rational Use of Medicines - Services, 2015). Interviews were carried
out with patients present in the services by semi-structured questionnaires.
Sociodemographic, clinical, and use of medicines variables were assessed and the
use of medicines in the 30 days prior to the interview was also verified. The
population was stratified into three age groups: 18 to 44, 45 to 64, and 65 years
or more. The differences between the age groups were verified using the Student's
t-test for continuous variables and chi-square test for the categorical ones. The
complex samples analysis plan was employed. The medicines were classified
according to the Anatomical Therapeutic Chemical Classification System.
RESULTS: Of the 8,803 patients interviewed, 6,511 (76.2%) reported to have used
medicines in the 30 days prior to the interview. On average, each patient used
2.32 medicines, without difference between the sexes. Among medicine users, 18.2%
were aged 65 years or more. Compared to the other age groups, older adults
presented more comorbidities, used more medicines, and self-reported worse health
conditions. They were also less educated, reported worse economic situation, and
lived alone. The medicines that were mostly used were "other analgesics and
antipyretics" (3rd ATC level) and Losartan (5th ATC level).
CONCLUSIONS: Most medicine users had lower education level and presented
comorbidities. The most used medicines were the antihypertensive ones.
Self-medication was higher among young people. Most patients reported to use
generic medicines. The average number of medicines and the prevalence of use
increased with age. Due to the characteristics observed and the difficulties in
the use of medicines, older adults are in a situation of greater vulnerability.
DOI: 10.11606/S1518-8787.2017051007144
PMCID: PMC5676385
271. BMJ Open. 2017 Nov 14;7(11):e014998. doi: 10.1136/bmjopen-2016-014998.
Prospective daily diary study reporting of any and all symptoms in healthy adults
in Pakistan: prevalence and response.
Anwar M(1), Green JA(1), Norris P(1), Bukhari NI(2).

Author information:
(1)School of Pharmacy, University of Otago, Dunedin, New Zealand.
(2)University College of Pharmacy, University of the Punjab, Lahore, Pakistan.
Erratum in
BMJ Open. 2018 Jun 30;8(6):.
OBJECTIVES: Prevalence of symptoms in everyday life and how people respond to

these symptoms is little studied outside Western culture and developed countries.
We sought to use modified diary methods to explore the prevalence of and
responses to symptoms in Pakistan.
DESIGN: Prospective daily survey of symptoms and response.
SETTING: 8 cities across four provinces in Pakistan.
PARTICIPANTS: Stratified intercept in each city to recruit 153 participants of
which 151 completed.
PRIMARY AND SECONDARY OUTCOME MEASURES: Each day for 30 days, participants were
prompted by text message (short message service (SMS)) to complete a symptom
diary. On days where symptoms were experienced, participants also reported how
they responded. Prevalence was adjusted to population age and gender
distributions.
RESULTS: 92% of participants experienced symptoms (adjusted prevalence 94%,
95% CI 91% to 97%), with musculoskeletal pain (83%, adj. 84%, 95% CI 84% to 90%)
and respiratory symptoms (75%, adj. 77%, 95% CI 71% to 84%) the most prevalent
types of symptoms. Self-medication and use of home remedies and traditional
medicines were the most common responses. Seeking professional help or using
conventional medicine were less common, and self-medication responses included
the use of antibiotics without prescription. The range of home remedies and
traditional medicines was very diverse.
CONCLUSIONS: While symptom experience in Pakistan was similar to Western
countries, home remedies were much more frequently used to respond to symptoms.
Understanding how people respond and manage their experience of symptoms outside
formal healthcare is important for designing effective policy and interventions,
and this needs to be understood within the broader context including the cultural
and economic setting, the health system and other structural determinants of
health.
DOI: 10.1136/bmjopen-2016-014998
PMCID: PMC5695404
272. Int J Pharm Pract. 2017 Dec;25(6):438-446. doi: 10.1111/ijpp.12334. Epub 2017
Mar
6.
Managing sleep problems using non-prescription medications and the role of

community pharmacists: older adults' perspectives.
Abraham O(1), Schleiden LJ(1), Brothers AL(1), Albert SM(2).
Author information:
(1)Department of Pharmacy and Therapeutics, School of Pharmacy, University of
Pittsburgh, Pittsburgh, PA, USA.
(2)Department of Behavioral and Community Health Sciences, Graduate School of
Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
OBJECTIVES: To examine older adults' perspectives regarding managing sleep

problems through selection and use of non-prescription sleep aids, and the role
of pharmacists.
METHODS: Telephone interviews were conducted from May to June 2015 with 116
individuals aged ≥60 years in Pittsburgh, Pennsylvania. Participants reported in
a previous survey to have used at least one non-prescription sleep aid in the
past 30 days and were willing to participate in a follow-up interview. Interview
guides were designed to elicit perspectives of sleep problems, selection and use
of non-prescription sleep aids, and consultation with healthcare professionals.
Interview transcripts underwent content analysis.
KEY FINDINGS: Four themes emerged as follows: experiences with sleep problems,
selection of non-prescription sleep aids, non-prescription sleep aid use and
interactions with healthcare professionals. Over half of participants reported
using a non-prescription sleep aid for >1 year, were satisfied with its use and
perceived it improved sleep quality. Participants commonly used an
antihistamine-only sleep aid; 36% of participants self-recommended their sleep
aid; and 16% of participants consulted healthcare professionals. Few participants
read medication dosage labels (22%), side effects or warnings (19%), and many
reported they disregarded directions. Participants did not typically consult
pharmacists about sleep problems (65%) but perceived that they could assist with
medication concerns.
CONCLUSIONS: Although most participants had favourable perceptions of
non-prescription sleep aids, older adults may be inappropriately using
non-prescription sleep aids to self-manage sleep problems by frequently
disregarding medication labels and directions for safe use. Also, few older
adults are discussing their sleep aid selection and use with pharmacists.
© 2017 The Authors. International Journal of Pharmacy Practice published by John

Wiley & Sons Ltd on behalf of Royal Pharmaceutical Society.
DOI: 10.1111/ijpp.12334
PMCID: PMC5724494
273. J Gen Intern Med. 2016 May;31(5):486-91. doi: 10.1007/s11606-016-3586-5. Epub

2016 Jan 25.
Primary Care Patients with Drug Use Report Chronic Pain and Self-Medicate with
Alcohol and Other Drugs.
Alford DP(1), German JS(2), Samet JH(2)(3), Cheng DM(2)(4), Lloyd-Travaglini

CA(5), Saitz R(2)(3).
Author information:
(1)Clinical Addiction Research and Education (CARE) Unit, Section of General
Internal Medicine, Department of Medicine, Boston Medical Center and Boston
University School of Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA,
02118, USA. Dan.Alford@bmc.org.
(2)Clinical Addiction Research and Education (CARE) Unit, Section of General
Internal Medicine, Department of Medicine, Boston Medical Center and Boston
University School of Medicine, 801 Massachusetts Avenue, 2nd floor, Boston, MA,
02118, USA.
(3)Department of Community Health Sciences, Boston University School of Public
Health, Boston, MA, USA.
(4)Department of Biostatistics, Boston University School of Public Health,
Boston, MA, USA.
(5)Data Coordinating Center, Boston University School of Public Health, Boston,
MA, USA.
Comment in
J Gen Intern Med. 2016 May;31(5):451-2.
J Gen Intern Med. 2016 May;31(5):533.
BACKGROUND: Chronic pain is common among patients with drug use disorders. The
prevalence of chronic pain and its consequences in primary care patients who use
drugs is unknown.
OBJECTIVES: To examine: 1) the prevalence of chronic pain and pain-related
dysfunction among primary care patients who screen positive for drug use, and 2)
the prevalence of substance use to self-medicate chronic pain in this population.
DESIGN: This was a cross-sectional analysis.
PARTICIPANTS: This study included 589 adult patients who screened positive for
any illicit drug use or prescription drug misuse, recruited from an urban,
hospital-based primary care practice.
MAIN MEASURES: Both pain and pain-related dysfunction were assessed by numeric
rating scales, and grouped as: (0) none, (1-3) mild, (4-6) moderate, (7-10)
severe. Questions were asked about the use of substances to treat pain.
KEY RESULTS: Among 589 participants, chronic pain was reported by 87% (95% CI:
84-90%), with 13% mild, 24% moderate and 50% severe. Pain-related dysfunction was
reported by 74% (95% CI: 70-78%), with 15% mild, 23% moderate, and 36% severe. Of
the 576 that used illicit drugs (i.e., marijuana, cocaine, and/or heroin), 51%
reported using to treat pain (95% CI: 47-55% ). Of the 121 with prescription drug
misuse, 81% (95% CI: 74-88%) used to treat pain. Of the 265 participants who
reported any heavy drinking in the past 3 months, 38% (95% CI: 32-44%) did so to
treat pain compared to 79% (95% CI: 68-90%) of the 57 high-risk alcohol users.
CONCLUSIONS: Chronic pain and pain-related dysfunction were the norm for primary
care patients who screened positive for drug use, with nearly one-third reporting
both severe pain and severe pain-related dysfunction. Many patients using illicit
drugs, misusing prescription drugs and using alcohol reported doing so in order
to self-medicate their pain. Pain needs to be addressed when patients are
counseled about their substance use.
DOI: 10.1007/s11606-016-3586-5
PMCID: PMC4835374
Conflict of interest statement: Compliance with Ethical Standards Conflicts of

Interest The authors declare that they do not have a conflict of interest.
274. J Med Case Rep. 2017 May 15;11(1):137. doi: 10.1186/s13256-017-1302-7.
St John's wort (Hypericum perforatum)-induced psychosis: a case report.
Ferrara M(1), Mungai F(2)(3), Starace F(1).
Author information:
(1)Dipartimento di Salute Mentale e Dipendenze Patologiche, Modena, Italy.
(2)Dipartimento di Salute Mentale e Dipendenze Patologiche, Modena, Italy.
f.mungai@ausl.mo.it.
(3)Department of Mental Health & Drug Abuse, AUSL Modena, Viale Muratori 201,
41124, Modena, Italy. f.mungai@ausl.mo.it.
BACKGROUND: St John's wort (Hypericum perforatum) has been known for centuries
for its therapeutic properties and its efficacy as an antidepressant has been
confirmed by a growing body of evidence. During the last two decades it has also
come to prominence with a wider public, due to advertising efforts across Europe
and United States of America. However, its availability without prescription, as
an over-the-counter medication, raises some concern regarding its clinical
management and unsupervised administration to individuals with psychopathological
risks. To date, the evidence available regarding the administration of Hypericum
in people with severe mental health problems is still meager and refers mainly to
affective disorder spectrum or psychotic relapse in people with established
diagnoses. To the best of our knowledge, this is the first report regarding the
onset of psychotic features in a patient presenting with psychotic diathesis.
CASE PRESENTATION: The case discussed in this report is a 25-year-old white man,
not known to the psychiatric services, with a history of brief and self-remitting
drug-induced psychosis and a positive family history of psychotic depression. He
was admitted to hospital due to the onset of florid psychotic symptoms
concomitant with self-administration of Hypericum perforatum.
CONCLUSIONS: The aim of this report is to promote further systematic research,
draw the attention of clinicians to the potential risks of Hypericum
precipitating psychosis, and raise awareness among health professionals to
investigate and caution their patients on the haphazard use of phytotherapeutics
such as Hypericum.
DOI: 10.1186/s13256-017-1302-7
PMCID: PMC5430601
275. Saudi Pharm J. 2016 Jul;24(4):452-7. doi: 10.1016/j.jsps.2014.08.002. Epub

2014
Aug 9.
Microemulgel: an overwhelming approach to improve therapeutic action of drug

moiety.
Ashara KC(1), Paun JS(1), Soniwala MM(1), Chavda JR(1), Mendapara VP(2), Mori
NM(3).
Author information:
(1)Department of Pharmaceutics, B.K. Mody Govt. Pharmacy College, Rajkot 360003,
Gujarat, India.
(2)Department of Pharmaceutical Sciences, Saurashtra University, Rajkot-360005,
Gujarat, India.
(3)Department of Pharmaceutical Sciences, Saurashtra University, Rajkot-360005,
Gujarat, India; Torrel (Hospital Division) a Member of Torrent Group, Ahmedabad,
Gujarat, India.
As compared to gel and other topical preparations microemulgel has been prepared
by screening of oils, emulsifier, and co-emulsifier on bases of solubility of an
API in it. An API has high solubility and oil may also have more or less
pharmacological property, so it may assist the therapeutic action of API. Due to
presence of oil portion, it leads to more penetration of API in the skin. Oil
Micelle Size was less than 500 nm which provides more area for absorption of API
in the skin so more penetration and more effective than macro-emulsion.
Microemulgel has an advantage of emulgel that has dual benefits of micro-emulsion
and gel and several other desirable properties like good consistency,
thyrotrophic, greaseless, easily spreadable as well as removable, emollient,
non-staining, water soluble, longer shelf-life, bio-friendly, transparent,
pleasant appearance, ability of patients for self-medication, termination of
medications will be easy, etc.
DOI: 10.1016/j.jsps.2014.08.002
PMCID: PMC4908067
PMID: 27330376
276. BMJ Health Care Inform. 2019 Aug;26(1). pii: e100050. doi:
10.1136/bmjhci-2019-100050.
Combined effect of pill refilling and self-medication reminder system on

patients' adherence to tuberculosis treatment during continuation phase in
Northwest Ethiopia: a study protocol for randomised controlled trial.
Gashu KD(1), Gelaye KA(2), Lester R(3), Tilahun B(2).
Author information:
(1)University of Gondar, College of Medicine and Health Sciences, Institute of
Public Health, Gondar, Ethiopia kassahundessie@gmail.com.
(2)University of Gondar, College of Medicine and Health Sciences, Institute of
Public Health, Gondar, Ethiopia.
(3)University of British Columbia, Research Pavilion, Rm 566, 828 W 10th,
Vancouver, BC, V5Z 1 M9, Canada.
INTRODUCTION: Patients' failure to adhere on tuberculosis (TB) treatment leads to

drug resistance, relapse and death. Non-adherence to TB treatment is higher
during continuation treatment phase. The study aimed to evaluate effectiveness of
combined pill refilling and medication reminders on adherence to TB treatment.
METHODS AND ANALYSIS: A two-arm randomised controlled trial on adult patients
with TB was used during continuation treatment phase. In the first arm, in
addition to usual care, participants will receive cellphone-based daily
medication and weekly pill refilling reminders. In the control arm, participants
will receive only usual care. The study will use a covariate adaptive
randomisation technique to balance covariates during allocation. The primary
outcome is patients' adherence to TB treatment and secondary outcomes are
attendance to clinic and treatment outcomes. We apply intention to treat with
generalised linear mixed model.
ETHICS AND DISSEMINATION: Ethical approval was obtained from Institutional Review
Board of University of Gondar. Written informed consent was applied during
enrolment. We will publish findings in peer-reviewed, scientific journals and
conferences.
TRIAL REGISTRATION NUMBER: PACTR201901552202539.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No

commercial re-use. See rights and permissions. Published by BMJ.
DOI: 10.1136/bmjhci-2019-100050
PMID: 31484661
277. Psychiatr Pol. 2018 Apr 30;52(2):261-273. doi: 10.12740/PP/68472. Epub 2018
Apr
30.
The reasons for use of cannabinoids and stimulants in patients with

schizophrenia.
[Article in English, Polish]

Simonienko K(1), Wygnał N(1), Cwalina U(2), Kwiatkowski M(1), Szulc A(3),
Waszkiewicz N(1).
Author information:
(1)Klinika Psychiatrii Uniwersytetu Medycznego w Białymstoku.
(2)Zakład Statystyki i Informatyki Medycznej Uniwersytetu Medycznego w
Białymstoku.
(3)Klinika Psychiatryczna, Wydział Nauki o Zdrowiu, Warszawski Uniwersytet
Medyczny.
OBJECTIVES: Both cannabinoids and psychoactive substances from the group of

stimulants can have a significant effect on the induction, course and treatment
of severe mental illness. They also can be treated as self-medication. Many
patients feel subjective benefits of using psychoactive substances in the areas
of social competence, to cope with side effects of neuroleptics, stress
accompanying mental illness or to control its symptoms. Our research tries to
explain the causes of taking psychoactive substances by patients with
schizophrenia.
METHODS: A total of 50 schizophrenia patients using cannabinoids, including 25 of
them using also stimulants, took part in our research. They filled out
questionnaires about the causes of drug use and subjectively perceived mental
complaints. We analyzed medical documentation.
RESULTS: It was found that subjects using both cannabinoids and stimulants
pointed to spirituality as a cause significantly more often than subjects taking
only cannabinoids. Marijuana and hashish were significantly more often taken to
improve social relations. In both groups, the most common reasons were:
curiosity, the need to relax, problem solving, improving relationships, and
remedy for 'shyness'. In the group using only cannabinoids, it was observed that
people who felt misunderstood often smoked marijuana to solve problems.
Individuals using stimulants often complained of poor concentration.
CONCLUSIONS: Ignorance of the consequences of using psychoactive substances in
people at risk of schizophrenia or in those already ill is an additional risk
factor. The results may indicate an increased demand for psychoeducation and
social support regarding many areas of life of patients suffering from
schizophrenia.
DOI: 10.12740/PP/68472
278. Croat Med J. 2019 Feb 28;60(1):42-45.
Hypercalcemia secondary to excessive self-medication with antacids causing acute

pancreatitis: a case report.
Vassallo P(1), Green N, Courtney E.
Author information:
(1)Pietro Vassallo, Department of Surgery, Royal United Hospitals Bath NHS
Foundation Trust, Combe Park, Bath, BA1 3NG, United Kingdom, p.vassallo@nhs.net.
Excessive self-medication with over-the-counter drugs is an issue commonly

encountered by health care professionals. It can result in uncommon presentations
of life-threatening illnesses. These medications are frequently overlooked by
clinicians when taking histories from patients, and their risks are often
downplayed. We present the case of a 35-year-old woman with acute pancreatitis
secondary to hypercalcemia. This condition occurred due to long-term excessive
self-administration of calcium-rich antacid tablets. Her clinical course involved
multifactorial rebound hypocalcemia after treatment and multiple complications
from the abuse of other non-prescription medications. Acute pancreatitis
secondary to antacid-induced milk-alkali syndrome has been minimally reported in
the literature. There are no reports describing rebound hypocalcemia as a
complication of its treatment or presenting this pathology in the context of
multiple over-the-counter drug abuse. This case highlights the importance of
taking thorough drug histories, including non-prescription medications, in acute
clinical assessments.
PMCID: PMC6406064
279. J Anim Ecol. 2016 Sep;85(5):1246-54. doi: 10.1111/1365-2656.12558. Epub 2016

Jul
21.
Fitness costs of animal medication: antiparasitic plant chemicals reduce fitness

of monarch butterfly hosts.
Tao L(1), Hoang KM(1), Hunter MD(2), de Roode JC(1).
Author information:
(1)Department of Biology, Emory University, 1510 Clifton Road, Atlanta, GA,
30322, USA.
(2)Department of Ecology and Evolutionary Biology, University of Michigan, 830 N
University Avenue, Ann Arbor, MI, 48109, USA.
The emerging field of ecological immunology demonstrates that allocation by hosts

to immune defence against parasites is constrained by the costs of those
defences. However, the costs of non-immunological defences, which are important
alternatives to canonical immune systems, are less well characterized. Estimating
such costs is essential for our understanding of the ecology and evolution of
alternative host defence strategies. Many animals have evolved medication
behaviours, whereby they use antiparasitic compounds from their environment to
protect themselves or their kin from parasitism. Documenting the costs of
medication behaviours is complicated by natural variation in the medicinal
components of diets and their covariance with other dietary components, such as
macronutrients. In the current study, we explore the costs of the usage of
antiparasitic compounds in monarch butterflies (Danaus plexippus), using natural
variation in concentrations of antiparasitic compounds among plants. Upon
infection by their specialist protozoan parasite Ophryocystis elektroscirrha,
monarch butterflies can selectively oviposit on milkweed with high foliar
concentrations of cardenolides, secondary chemicals that reduce parasite growth.
Here, we show that these antiparasitic cardenolides can also impose significant
costs on both uninfected and infected butterflies. Among eight milkweed species
that vary substantially in their foliar cardenolide concentration and
composition, we observed the opposing effects of cardenolides on monarch fitness
traits. While high foliar cardenolide concentrations increased the tolerance of
monarch butterflies to infection, they reduced the survival rate of caterpillars
to adulthood. Additionally, although non-polar cardenolide compounds decreased
the spore load of infected butterflies, they also reduced the life span of
uninfected butterflies, resulting in a hump-shaped curve between cardenolide
non-polarity and the life span of infected butterflies. Overall, our results
suggest that the use of antiparasitic compounds carries substantial costs, which
could constrain host investment in medication behaviours.
© 2016 The Authors. Journal of Animal Ecology © 2016 British Ecological Society.
DOI: 10.1111/1365-2656.12558
280. Subst Abuse Treat Prev Policy. 2015 Mar 15;10:12. doi: 10.1186/s13011-015-
0006-5.
Polypharmacy among anabolic-androgenic steroid users: a descriptive

metasynthesis.
Sagoe D(1), McVeigh J(2), Bjørnebekk A(3), Essilfie MS(4), Andreassen CS(5)(6),
Pallesen S(7).
Author information:
(1)Department of Psychosocial Science, University of Bergen, Christiesgate 12,
5015, Bergen, Norway. dominic.sagoe@psysp.uib.no.
(2)Centre for Public Health, Liverpool John Moores University, 15-21 Webster
Street, Liverpool, L3 2ET, UK. j.mcveigh@ljmu.ac.uk.
(3)Department of Physical Medicine and Rehabilitation, Unit of Neuropsychology,
Oslo University Hospital, Kirkeveien 166, Ullevål, Norway.
astrid.bjornebekk@psykologi.uio.no.
(4)Departments of Surgery and Paediatrics, La General Hospital, PMB, Accra,
Ghana. Essilfie@gmail.com.
5015, Bergen, Norway. cecilie.andreassen@psych.uib.no.
(6)The Competence Centre, Bergen Clinics Foundation, Vestre Torggate 11, 5015,
Bergen, Norway. cecilie.andreassen@psych.uib.no.
5015, Bergen, Norway. staale.pallesen@psysp.uib.no.
BACKGROUND: As far as we are aware, no previous systematic review and synthesis

of the qualitative/descriptive literature on polypharmacy in anabolic-androgenic
steroid(s) (AAS) users has been published.
METHOD: We systematically reviewed and synthesized qualitative/descriptive
literature gathered from searches in electronic databases and by inspecting
reference lists of relevant literature to investigate AAS users' polypharmacy. We
adhered to the recommendations of the UK Economic and Social Research Council's
qualitative research synthesis manual and the PRISMA guidelines.
RESULTS: A total of 50 studies published between 1985 and 2014 were included in
the analysis. Studies originated from 10 countries although most originated from
United States (n=22), followed by Sweden (n=7), England only (n=5), and the
United Kingdom (n=4). It was evident that prior to their debut, AAS users often
used other licit and illicit substances. The main ancillary/supplementary
substances used were alcohol, and cannabis/cannabinoids followed by cocaine,
growth hormone, and human chorionic gonadotropin (hCG), amphetamine/meth,
clenbuterol, ephedra/ephedrine, insulin, and thyroxine. Other popular substance
classes were analgesics/opioids, dietary/nutritional supplements, and diuretics.
Our classification of the various substances used by AAS users resulted in 13
main groups. These non-AAS substances were used mainly to enhance the effects of
AAS, combat the side effects of AAS, and for recreational or relaxation purposes,
as well as sexual enhancement.
CONCLUSIONS: Our findings corroborate previous suggestions of associations
between AAS use and the use of other licit and illicit substances. Efforts must
be intensified to combat the debilitating effects of AAS-associated polypharmacy.
DOI: 10.1186/s13011-015-0006-5
PMCID: PMC4377045
281. Eye (Lond). 2016 Jan;30(1):64-7. doi: 10.1038/eye.2015.185. Epub 2015 Oct 2.
Chloroquine retinopathy: pattern of presentation in Ibadan, Sub-Sahara Africa.
Oluleye TS(1), Babalola Y(1), Ijaduola M(1).
Author information:
(1)Retina and Vitreous Unit, Department of Ophthalmology, University College
Hospital, Ibadan, Nigeria.
BackgroundSelf-medication with chloroquine is common in Ibadan, Sub-Sahara

Africa. Retinopathy from chloroquine is not uncommon. The aim was to determine
the pattern of presentation.MethodologyCases of Chloroquine retinopathy seen at
the Retina and Vitreous Unit of the University College Hospital, Ibadan between
2008 and 2014 were reviewed. Information on age, sex, duration of chloroquine
use, and visual loss were retrieved. Visual acuity at presentation, anterior, and
posterior segment findings were documented. The results were analyzed using
proportions and percentages.ResultsFourteen cases were seen during the study
period. Mean age was 50.7 years. Male to female ratio was 3.5 : 1. Average
duration of visual loss before presentation was 2.7 years. Average duration of
self-medication with chloroquine was 5.3 years. Presenting visual acuity showed
2(14%) cases of bilateral blindness(VA<3/60 in both eyes); 5(35.7%) cases of
uniocular blindness; three cases of bilateral low vision(VA worse than 6/18 but
better than 3/60). Anterior segment examination showed abnormal sluggish
pupillary reaction in those with severe affectation. Dilated fundoscopy showed
features ranging from mild macular pigmentary changes and bulls eye maculopathy
to overt extensive retinal degeneration involving the posterior pole, attenuation
of retinal vessels, optic atrophy, and beaten bronze appearance of atrophic
maculopathy.ConclusionChloroquine retinopathy is not uncommon in Ibadan,
Sub-Sahara Africa. Bulls eye maculopathy, extensive retinal, and macular
degeneration with optic atrophy are the main presentations. Public health
education is imperative.
DOI: 10.1038/eye.2015.185
PMCID: PMC4709532
282. Drug Alcohol Depend. 2017 Apr 1;173 Suppl 1:S4-S10. doi:
10.1016/j.drugalcdep.2016.03.014.
Understanding the demand side of the prescription opioid epidemic: Does the
initial source of opioids matter?
Cicero TJ(1), Ellis MS(2).
Author information:
(1)Washington University in St. Louis, Department of Psychiatry, Campus Box 8134,
660 S. Euclid Avenue, St. Louis, MO 63110, USA. Electronic address:
Cicerot@wustl.edu.
(2)Washington University in St. Louis, Department of Psychiatry, Campus Box 8134,
660 S. Euclid Avenue, St. Louis, MO 63110, USA.
BACKGROUND: These studies were carried out to examine whether the onset and
progression of an opioid substance use disorder (SUD) differed in those who first
used opioids to get "high" compared to those who received a prescription from a
doctor to relieve pain (Non-Rx vs. Rx groups, respectively).
METHODS: A subset of patients (N=214) from an ongoing larger study of patients
entering one of 125 drug treatment programs for opioid use disorder across the
country agreed to give up their anonymity and participate in structured and
open-ended online interviews examining drug abuse patterns.
RESULTS: With the exception that the Non-Rx group began their opioid abuse at a
younger age than the Rx group and more quickly evolved from initial exposure to
regular opioid abuse, there were relatively few differences in the
characteristics, patterns and trajectories of opioid abuse. The vast majority of
patients in both groups, most of whom had serious, antecedent psychiatric
disorders, indicated that they used opioids to self-medicate psychological
problems (67-73%) and/or stated that opioids provided a means to "escape" from
the stresses of everyday life (79-85%). As the SUD progressed, for many
individuals any "positive" attributes of opioids waned and avoidance of
withdrawal became the overriding concern, often serving as the impetus for
treatment.
CONCLUSIONS: Our results suggest that self-treatment of co-morbid psychiatric
disturbances is a powerful motivating force to initiate and sustain abuse of
opioids and that the initial source of drugs-a prescription or experimentation-is
largely irrelevant in the progression to a SUD.
Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.
DOI: 10.1016/j.drugalcdep.2016.03.014
283. Front Psychiatry. 2014 Nov 24;5:168. doi: 10.3389/fpsyt.2014.00168.

eCollection
2014.
Cannabis use and anxiety: is stress the missing piece of the puzzle?
Temple EC(1), Driver M(2), Brown RF(3).
Author information:
(1)Federation University Australia , Ballarat, VIC , Australia.
(2)University of New England , Armidale, NSW , Australia.
(3)The Australian National University , Canberra, ACT , Australia.
OBJECTIVE: Comorbidity between anxiety and cannabis use is common yet the nature
of the association between these conditions is not clear. Four theories were
assessed, and a fifth hypothesis tested to determine if the misattribution of
stress symptomology plays a role in the association between state-anxiety and
cannabis.
METHODS: Three-hundred-sixteen participants ranging in age from 18 to 71 years
completed a short online questionnaire asking about their history of cannabis use
and symptoms of stress and anxiety.
RESULTS: Past and current cannabis users reported higher incidence of lifetime
anxiety than participants who had never used cannabis; however, these groups did
not differ in state-anxiety, stress, or age of onset of anxiety. State-anxiety
and stress were not associated with frequency of cannabis use, but reported use
to self-medicate for anxiety was positively associated with all three. Path
analyses indicated two different associations between anxiety and cannabis use,
pre-existing and high state-anxiety was associated with (i) higher average levels
of intoxication and, in turn, acute anxiety responses to cannabis use; (ii)
frequency of cannabis use via the mediating effects of stress and
self-medication.
CONCLUSION: None of the theories was fully supported by the findings. However, as
cannabis users reporting self-medication for anxiety were found to be
self-medicating stress symptomology, there was some support for the
stress-misattribution hypothesis. With reported self-medication for anxiety being
the strongest predictor of frequency of use, it is suggested that researchers,
clinicians, and cannabis users pay greater attention to the overlap between
stress and anxiety symptomology and the possible misinterpretation of these
related but distinct conditions.
DOI: 10.3389/fpsyt.2014.00168
PMCID: PMC4241884
PMID: 25505428
284. Asian Pac J Cancer Prev. 2018 Oct 26;19(10):2935-2941.
Health-Seeking Behaviour and Delayed Presentation of Oral Cancer Patients in a

Developing Country: A Qualitative Study based on the Self-Regulatory Model
Azhar N(1), Doss JG.
Author information:
(1)Department of Community Oral Health and Clinical Prevention, Faculty of
Dentistry, University of Malaya, Kuala Lumpur, Malaysia. Email: jendoss@um.edu.my
Background: The aim of this study was to explore reasons for delayed
health-seeking for late stage oral cancer patients. Methods: Semi-structured
in-depth interviews were conducted with 35 oral cancer patients with TNM stage
III to IV disease, who were treated at six tertiary regional centres managing
oral cancer throughout Malaysia. Interviews were audio-recorded, transcribed
verbatim, coded using NVivo (version 10.0) qualitative software and analysed
using framework analysis. Results: Participants interpreted their early symptoms
as a minor condition and did not consider it as requiring immediate attention.
Four types of coping strategies causing delayed help-seeking emerged: 1)
self-remedy 2) self-medication 3) seeking traditional healers and 4) consulting
general medical practitioners (GPs) instead of dentists. Socio-economic factors,
cultural beliefs and religious practices have some influence on diagnostic delay.
Conclusion: Low levels of public knowledge and awareness regarding early signs
and symptoms of oral cancer as well as GPs’ misdiagnosis of early lesions results
in delayed diagnosis.
Creative Commons Attribution License
DOI: 10.22034/APJCP.2018.19.10.2935
PMCID: PMC6291039
285. Nat Sci Sleep. 2017 Mar 17;9:97-108. doi: 10.2147/NSS.S128095. eCollection
2017.
Alternative remedies for insomnia: a proposed method for personalized therapeutic

trials.
Romero K(1), Goparaju B(1), Russo K(1), Westover MB(2), Bianchi MT(1).
Author information:
(1)Neurology Department, Massachusetts General Hospital; Division of Sleep
Medicine, Harvard Medical School, Boston, MA, USA.
(2)Neurology Department, Massachusetts General Hospital.
Insomnia is a common symptom, with chronic insomnia being diagnosed in 5-10% of

adults. Although many insomnia patients use prescription therapy for insomnia,
the health benefits remain uncertain and adverse risks remain a concern. While
similar effectiveness and risk concerns exist for herbal remedies, many
individuals turn to such alternatives to prescriptions for insomnia. Like
prescription hypnotics, herbal remedies that have undergone clinical testing
often show subjective sleep improvements that exceed objective measures, which
may relate to interindividual heterogeneity and/or placebo effects. Response
heterogeneity can undermine traditional randomized trial approaches, which in
some fields has prompted a shift toward stratified trials based on genotype or
phenotype, or the so-called n-of-1 method of testing placebo versus active drug
in within-person alternating blocks. We reviewed six independent compendiums of
herbal agents to assemble a group of over 70 reported to benefit sleep. To bridge
the gap between the unfeasible expectation of formal evidence in this space and
the reality of common self-medication by those with insomnia, we propose a method
for guided self-testing that overcomes certain operational barriers related to
inter- and intraindividual sources of phenotypic variability. Patient-chosen
outcomes drive a general statistical model that allows personalized
self-assessment that can augment the open-label nature of routine practice. The
potential advantages of this method include flexibility to implement for other
(nonherbal) insomnia interventions.
DOI: 10.2147/NSS.S128095
PMCID: PMC5364017
PMID: 28360539
Conflict of interest statement: Disclosure Dr Bianchi has received funding from

the Department of Neurology, Massachusetts General Hospital, the Center for
Integration of Medicine and Innovative Technology, the Milton Family Foundation,
the MGH-MIT Grand Challenge, and the American Sleep Medicine Foundation. Dr
Bianchi has a patent pending on a home sleep monitoring device. Dr Bianchi has
research contracts with MC10 and Insomnisolv, a consulting agreement with
McKesson and International Flavors and Fragrances, received payment for
educational material from Oakstone Publishing, and has provided expert testimony
in sleep medicine. Dr Bianchi serves as a medical monitor for Pfizer. Dr Westover
has received funding from the NIH (NIH-NINDS 1K23NS090900). The other authors
report no conflicts of interest in this work.
286. J Pain Res. 2015 Apr 23;8:175-87. doi: 10.2147/JPR.S79618. eCollection 2015.
The effect of nonrecurring alcohol administration on pain perception in humans: a

systematic review.
Horn-Hofmann C(1), Büscher P(2), Lautenbacher S(3), Wolstein J(2).
Author information:
(1)Pathopsychology, University of Bamberg, Bamberg, Germany ; Physiological
Psychology, University of Bamberg, Bamberg, Germany.
(2)Pathopsychology, University of Bamberg, Bamberg, Germany.
(3)Physiological Psychology, University of Bamberg, Bamberg, Germany.
PURPOSE: Alcohol is believed to have pain-dampening effects and is often used as

self-medication by persons with pain problems; however, experimental evidence
confirming this effect is scarce. We conducted a systematic review of
experimental studies on the effects of nonrecurring alcohol administration on
pain perception in healthy human subjects and the underlying mechanisms.
METHOD: Three databases (PubMed, PsycINFO, and Web of Science) were searched for
relevant studies using a predefined algorithm. In a next step, irrelevant
articles were excluded by screening titles and abstracts. Finally, articles were
checked regarding a set of methodological criteria; only publications meeting
these criteria were selected for this review. A total of 14 experimental studies
were identified.
RESULTS: Overall, most of the studies were able to show a pain-dampening effect
of alcohol. However, many of them had methodological shortcomings (eg, lack of
placebo control, insufficient blinding, or very small sample sizes). In addition,
comparability is limited due to considerable variations in alcohol administration
and pain measurement. More importantly, potential mechanisms of action and
moderating variables have scarcely been investigated.
CONCLUSION: Despite the frequent use of alcohol as self-medication by persons
with pain problems, there are to date only a few experimental investigations of
alcohol effects on pain perceptions. The results of these studies suggest that
alcohol does in fact have pain-dampening effects. However, the mechanisms
implicated in these effects are still unknown, and experimental research has been
limited to pain-free subjects. Future research should provide more knowledge
about alcohol effects on pain, especially in chronic pain patients.
DOI: 10.2147/JPR.S79618
PMCID: PMC4412487
PMID: 25960674
287. Acta Pol Pharm. 2015 Mar-Apr;72(2):389-96.
USE OF MEDICINES AMONG STUDENTS OF HIGH SCHOOLS IN THE CZECH REPUBLIC.
Kopecna E, Mica M, Vlcek J, Svoboda D.
The aim of the study was to examine the prevalence and type of medicines used by
high school students in the Czech Republic and to analyze association between use
of medicines during last 6 months and self medication with different
socio-demographic and lifestyle aspects. A cross-sectional study was conducted in
high schools from two regions and three towns in the Czech Republic. The study
sample was a student population of nine selected high schools. The study was
approved by the local Ethics Committees and school board and was conducted in
compliance with the ethical principles of the Declaration of Helsinki.
Questionnaires respecting anonymity were distributed to the students during the
regular class period. Students answered closed and open questions divided into
six sections focussing on their experience with chronic and irregular use of
medicines, medicines use during last six months, conditions treated, type and
source of used medicines. A modified log-linear Poisson regression model with a
robust variance estimator (sandwich) was used for statistical analysis. In total,
979 students, aged 14-21 years (mean age 17 years) participated in the study: 32%
were male and 68% female; 19% of students reported regular use of medicines for
chronic disease. The use of medicines during the last 6 months was reported by
83% of students; 42% of them reported the use of both prescription and over the
counter (OTC) medicines; 22% the use only of OTC, and 31% only prescription
medicines. Allergy, asthma, disorders of the thyroid gland, atopic dermatitis,
and hypertensive diseases were among the most frequent long-term diseases. The
most frequent groups of medicines used for the treatment of long-term diseases
were systemic antihistamines, thyroid preparations, and respiratory drugs.
Nonsteroidal anti-inflammatory medicines, ibuprofen and paracetamol were the most
frequently used medicines during last six months. The study results showed quite
extensive use of both prescription and OTC medicines in students of high schools
between 14-21 years of age in the Czech Republic. Statistically significant
associations were found between use of medicines during last 6 months and type of
school, sex and chronic diseases, and between self-medication and sex.
288. Acta Pol Pharm. 2015 Jul-Aug;72(4):807-17.
KNOWLEDGE, ATTITUDE AND PERCEPTION REGARDING ANTIBIOTICS AMONG POLISH PATIENTS.
[No authors listed]
Antibiotics are drugs often used. This drugs used without legitimate indications
or incorrectly may cause not satisfactory clinical results. It is therefore
important for the society members to be aware of what is an antibiotic and which
benefits and risks its use may bring. The survey was conducted in 2010. Objective
of the study was to obtain information on the current knowledge and beliefs about
antibiotic therapy of Poles. The research material consisted of 609
questionnaires and interviews, conducted among the adult population residing in
the Lublin voivodeship. The study shows that rural inhabitants don't know the
term herbal medicine or antibiotic more often than inhabitants in the city.
Similarly, they more often don't know the action of antibiotics as well as use
them less frequently. Poles treat them as an emergency exit if they are not
helped by home treatments. There was a problem of overuse of antibiotics, related
to young people, which were busy and have no time for illness. Self-medication in
the antibiotic therapy also occurs and is caused, among others, by undisciplined
patients. The respondents admited that they have antibiotics from the previous
treatment, from pharmacy, or from family or friends. However, residents of rural
areas using an antibiotic most frequently, cited a pharmacy as the source of this
drug. Other issues dealt within this study generally doesn't differ for rural
inhabitants from the data obtained among the urban population.
289. BMJ Open. 2017 Jul 10;7(7):e016233. doi: 10.1136/bmjopen-2017-016233.
Sleeping pill use in Brazil: a population-based, cross-sectional study.
Kodaira K(1), Silva MT(2)(3).
Author information:
(1)Universidade de Sorocaba, Post-Graduate Program in Pharmaceutical Sciences,
Sorocaba, São Paulo, Brazil.
(2)Faculty of Medicine, Federal University of Amazonas, Manaus, Brazil.
(3)Post-Graduate Program in Pharmaceutical Sciences, Universidade de Sorocaba,
Sorocaba, Brazil.
OBJECTIVES: This study aimed to assess the prevalence of sleeping pill use in
Brazil.
DESIGN: A population-based cross-sectional study with a three-stage cluster
sampling design (census tracts, households and adult residents) was used.
SETTING: The Brazilian 2013 National Health Survey was used.
PARTICIPANTS: The study population consisted of household residents aged ≥18
years. A total of 60 202 individuals were interviewed, including 52.9% women, and
21% reported depressive symptoms.
OUTCOMES: The primary outcome was sleeping pill use, which was self-reported with
the question, 'Over the past two weeks, have you used any sleeping pills?' The
prevalence was calculated and stratified according to sociodemographic
characteristics. The associated factors were identified from prevalence ratios
(PRs) obtained through a Poisson regression with robust variance and adjusted for
sex and age.
RESULTS: The prevalence of sleeping pill use was 7.6% (95% CI 7.3% to 8.0%), and
the average treatment duration was 9.75 (95% CI 9.49 to 10.00) days.
Self-medication was found in 11.2% (95% CI 9.6% to 12.9%) of users. The following
factors were associated with sleeping pill use: female sex (PR=2.21; 95% CI 1.97
to 2.47), an age of ≥60 years (PR=5.43; 95% CI 4.14 to 7.11) and smoking
(PR=1.47; 95% CI 1.28 to 1.68). Sleeping pill use was also positively associated
with the severity of depressive symptoms (p<0.001), whereas alcohol intake was
inversely associated (PR=0.66; 95% CI 0.56 to 0.77).
CONCLUSIONS: One in every 13 Brazilians adults uses sleeping pills. There is a
lack of information about the reasons for this use. Actions are required to raise
awareness about the risks. The results could assist programmes in targeting
rational sleeping pill use and the identification of factors demanding
intervention.
DOI: 10.1136/bmjopen-2017-016233
PMCID: PMC5541607
290. Front Psychiatry. 2016 Sep 21;7:160. eCollection 2016.
Cognitive Dysfunction, Affective States, and Vulnerability to Nicotine Addiction:

A Multifactorial Perspective.
Besson M(1), Forget B(1).
Author information:
(1)Unité de Neurobiologie Intégrative des Systèmes Cholinergiques, Department of
Neuroscience, CNRS UMR 3571, Institut Pasteur , Paris , France.
Although smoking prevalence has declined in recent years, certain subpopulations

continue to smoke at disproportionately high rates and show resistance to
cessation treatments. Individuals showing cognitive and affective impairments,
including emotional distress and deficits in attention, memory, and inhibitory
control, particularly in the context of psychiatric conditions, such as
attention-deficit hyperactivity disorder, schizophrenia, and mood disorders, are
at higher risk for tobacco addiction. Nicotine has been shown to improve
cognitive and emotional processing in some conditions, including during tobacco
abstinence. Self-medication of cognitive deficits or negative affect has been
proposed to underlie high rates of tobacco smoking among people with psychiatric
disorders. However, pre-existing cognitive and mood disorders may also influence
the development and maintenance of nicotine dependence, by biasing
nicotine-induced alterations in information processing and associative learning,
decision-making, and inhibitory control. Here, we discuss the potential forms of
contribution of cognitive and affective deficits to nicotine addiction-related
processes, by reviewing major clinical and preclinical studies investigating
either the procognitive and therapeutic action of nicotine or the putative
primary role of cognitive and emotional impairments in addiction-like features.
DOI: 10.3389/fpsyt.2016.00160
PMCID: PMC5030478
PMID: 27708591
291. BMC Neurol. 2017 Sep 4;17(1):171. doi: 10.1186/s12883-017-0952-9.
Subjective patient-reported versus objective adherence to subcutaneous interferon

β-1a in multiple sclerosis using RebiSmart®: the CORE study.
Zecca C(1), Disanto G(1), Mühl S(2), Gobbi C(3)(4).
Author information:
(1)Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale
Regionale di Lugano, Lugano, Switzerland.
(2)Merck (Schweiz) AG, Zug, Switzerland.
Regionale di Lugano, Lugano, Switzerland. Claudio.Gobbi@eoc.ch.
Regionale di Lugano, Via Tesserete 46, 6903, Lugano, Switzerland.
Claudio.Gobbi@eoc.ch.
BACKGROUND: Patient adherence to treatment is key to preventing the worsening of

neurological disability in multiple sclerosis (MS). The RebiSmart® autoinjector
facilitates self-administration of subcutaneous interferon β-1a (sc IFN β-1a) and
records objective adherence data. The CORE study was undertaken to evaluate the
relationship between subjectively reported and objective adherence of MS patients
using RebiSmart® in Switzerland and explore variables associated with objective
adherence.
METHODS: Patients with relapsing-remitting MS who were treated with sc IFN β-1a
44 or 22 μg three times weekly using RebiSmart® for at least 9 months
participated in this phase IV non-interventional study. Neurologist
questionnaires were used at month 0 to collect patient demographics, medical
history and estimates of patients' adherence. Patient questionnaires were used to
record subjective patient-reported adherence at month 0 and estimates of
variables influencing adherence. Objective adherence data were obtained from the
RebiSmart® log-files at months 0 and 6.
RESULTS: Of 56 patients who completed the observation period, 53 had evaluable
data. Objective adherence differed significantly between self-reported compliant
(n = 33) and non-compliant groups (n = 20) (p = 0.00001). Older age, greater
disability, patient's perception of the importance of ease of use and storage,
being well informed about RebiSmart® features and neurologists' estimations of
adherence were all positively associated with treatment adherence.
CONCLUSIONS: We showed for the first time that subjective patient-reported
adherence in MS was well in line with objective adherence, suggesting that the
frequency of administration is reported accurately by patients to their
neurologist. This observation may have implications for future treatment
monitoring strategies and strategic medical decisions. Patients, particularly
those who are younger and with lower levels of disability, may benefit from being
better informed of the importance of being adherent to their treatments and
receiving information about their medication and the device they are using.
DOI: 10.1186/s12883-017-0952-9
PMCID: PMC5584024
292. Am J Med Sci. 2018 Feb;355(2):104-112. doi: 10.1016/j.amjms.2017.08.021. Epub

2017 Sep 21.
Research Ethics in Behavioral Interventions Among Special Populations: Lessons

From the Peer Approaches to Lupus Self-Management Study.
Faith TD(1), Egede L(2), Williams EM(3).
Author information:
(1)Department of Public Health Sciences, Medical University of South Carolina,
Charleston, South Carolina. Electronic address: wiled@musc.edu.
(2)Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Charleston, South Carolina; Department of Medicine, Medical College of Wisconsin,
Milwaukee, Wisconsin.
BACKGROUND: Research involving a homogenous cohort of participants belonging to a

special population must make considerations to recruit and protect the subjects.
This study analyses the ethical considerations made in the peer approaches to
lupus self-management project which pilot tested a peer mentoring intervention
for African American women with systemic lupus erythematosus.
METHODS: Considerations made at the outset of the project are described and their
justifications and reasoning are given. Through analysis of feedback from a
postintervention focus group and mentors' logs, implications on program outcomes
and participant satisfaction are discussed.
RESULTS: Feedback indicated the importance of recruiting and training capable
mentors, consistent contact from study staff to avert adverse events and avert
fear or mistrust and careful consideration that must go into the pairing of
mentors and mentees. Participant feedback also indicated that sensitive topics
must be addressed carefully to prevent distress and dissatisfaction.
CONCLUSIONS: Applying the lessons learned from this work as well as the
considerations that proved successful may improve the contextualization and
ethical conduct of behavioral interventions in special populations resulting in
improved tailoring and acceptability toward historically underserved individuals.
Published by Elsevier Inc.
DOI: 10.1016/j.amjms.2017.08.021
PMCID: PMC5896319
293. Pediatrics. 2017 Jan;139(1). pii: e20153779. doi: 10.1542/peds.2015-3779. Epub

2016 Dec 9.
A Previously Healthy Adolescent With Acute Encephalopathy and Decorticate

Posturing.
Kawai Y(1), DeMonbrun AG(2), Chambers RS(2), Nolan DA(3), Dolcourt BA(4), Malas
NM(5)(6), Quasney MW(2).
Author information:
(1)Divisions of Pediatric Critical Care Medicine and kawai.yu@mayo.edu.
(2)Divisions of Pediatric Critical Care Medicine and.
(3)Pediatric Neurology, Department of Pediatrics and Communicable Diseases.
(4)Division of Toxicology, Department of Emergency Medicine, Wayne State
University School of Medicine, Detroit, Michigan.
(5)Division of Child and Adolescent Psychiatry, Department of Psychiatry, and.
(6)Department of Pediatrics and Communicable Diseases, C.S. Mott Children's
Hospital, University of Michigan, Ann Arbor, Michigan; and.
A 14-year-old previously healthy female was transferred from a local emergency

department after being found unresponsive at home. Parental questioning revealed
she had fever and pharyngitis 2 weeks before presentation. Past mental health
history was negative, including concern for past or present suicidal
ideation/attempts, suspected substance use, or toxic ingestion. In the emergency
department, she was orotracheally intubated due to a Glasgow Coma Scale of 3. She
was hemodynamically stable and euglycemic. Electrocardiogram showed sinus
tachycardia. She underwent a noncontrast head computed tomography that was normal
and subsequently underwent a lumbar puncture. She had a seizure and was given a
loading dose of diazepam and fosphenytoin that led to cessation of extremity
movements. She was subsequently transferred to the PICU for additional
evaluation. Initial examination without sedation or analgesia demonstrated
dilated and minimally responsive pupils, intermittent decorticate posturing, and
bilateral lower extremity rigidity and clonus, consistent with a Glasgow Coma
Scale of 5. Serum studies were unremarkable with the exception of mild
leukocytosis. Chest radiograph only showed atelectasis. She was empirically
started on antibiotics to cover for meningitis pending final cerebral spinal
fluid test results. The pediatric neurology team was consulted for EEG
monitoring, and the patient was eventually sent for computed tomography angiogram
and magnetic resonance angiogram/venogram. We will review diagnostic evaluation
and management of an adolescent patient with acute encephalopathy with
decorticate posturing of unclear etiology.
Copyright © 2017 by the American Academy of Pediatrics.
DOI: 10.1542/peds.2015-3779
294. Am J Addict. 2015 Aug;24(5):403-9. doi: 10.1111/ajad.12213. Epub 2015 May 25.
"Sub is a weird drug:" A web-based study of lay attitudes about use of

buprenorphine to self-treat opioid withdrawal symptoms.
Daniulaityte R(1), Carlson R(1), Brigham G(2), Cameron D(3), Sheth A(3).
Author information:
(1)Department of Community Health, Center for Interventions, Treatment, and
Addictions Research (CITAR), Boonshoft School of Medicine, Wright State
University, Dayton, Ohio.
(2)Department of Psychiatry, University of Cincinnati, ADAPT, Roseburg, Oregon.
(3)Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), Wright
State University, Dayton, Ohio.
BACKGROUND: Illicit use of buprenorphine has increased in the U.S., but our
understanding of its use remains limited. This study aims to explore Web-forum
discussions about the use of buprenorphine to self-treat opioid withdrawal
symptoms.
METHODS: PREDOSE, a novel Semantic Web platform, was used to extract relevant
posts from a Web-forum that allows free discussions on illicit drugs. First, we
extract information about the total number of buprenorphine-related posts per
year between 2005 and 2013. Second, PREDOSE was used to identify all posts that
potentially contained discussions about buprenorphine and opioid withdrawal. A
total number of 1,217 posts that contained these terms were extracted and entered
into NVivo data base. A random sample of 404 (33%) posts was selected and content
analyzed.
RESULTS: Buprenorphine-related posts increased over time, peaking in 2011. The
posts were about equally divided between those that expressed positive and
negative views about the effectiveness of buprenorphine in relieving withdrawal
symptoms. Web-forum participants emphasized that buprenorphine's effectiveness
may become compromised because of the "size of a person habit," and/or when users
repeatedly switch back and forth between buprenorphine and other illicit opioids.
Most posts reported use of significantly lower amounts of buprenorphine (≤2 mg)
than doses used in standard treatment. Concomitant use of other psychoactive
substances was also commonly reported, which may present significant health
risks.
CONCLUSIONS: Our findings highlight the usefulness of Web-based data in drug
abuse research and add new information about lay beliefs about buprenorphine that
may help inform prevention and policy measures.
© American Academy of Addiction Psychiatry.
DOI: 10.1111/ajad.12213
PMCID: PMC4527156

eCollection 2017.
A cross-sectional analysis of traditional medicine use for malaria alongside free

antimalarial drugs treatment amongst adults in high-risk malaria endemic
provinces of Indonesia.
Suswardany DL(1)(2), Sibbritt DW(1), Supardi S(3), Pardosi JF(3)(4), Chang S(1),
Adams J(1).
Author information:
(1)Australian Research Centre in Complementary and Integrative Medicine (ARCCIM),
Faculty of Health, University of Technology Sydney, Sydney, New South Wales,
Australia.
(2)Universitas Muhammadiyah Surakarta, Central Java, Indonesia.
(3)National Institute of Health Research and Development, Ministry of Health,
Indonesia.
(4)School of Public Health and Community Medicine, University of New South Wales,
Australia.
BACKGROUND: The level of traditional medicine use, particularly Jamu use, in

Indonesia is substantial. Indonesians do not always seek timely treatment for
malaria and may seek self-medication via traditional medicine. This paper reports
findings from the first focused analyses of traditional medicine use for malaria
in Indonesia and the first such analyses worldwide to draw upon a large sample of
respondents across high-risk malaria endemic areas.
METHODS: A sub-study of the Indonesia Basic Health Research/Riskesdas Study 2010
focused on 12,226 adults aged 15 years and above residing in high-risk
malaria-endemic provinces. Logistic regression was undertaken to determine the
significant associations for traditional medicine use for malaria symptoms.
FINDINGS: Approximately one in five respondents use traditional medicine for
malaria symptoms and the vast majority experiencing multiple episodes of malaria
use traditional medicine alongside free antimalarial drug treatments. Respondents
consuming traditional medicine for general health/common illness purposes every
day (odds ratio: 3.75, 95% Confidence Interval: 2.93 4.79), those without a
hospital in local vicinity (odds ratio: 1.31, 95% Confidence Interval: 1.10
1.57), and those living in poorer quality housing, were more likely to use
traditional medicine for malaria symptoms.
CONCLUSION: A substantial percentage of those with malaria symptoms utilize
traditional medicine for treating their malaria symptoms. In order to promote
safe and effective malaria treatment, all providing malaria care in Indonesia
need to enquire with their patients about possible traditional medicine use.
PMCID: PMC5362041
296. Psychol Addict Behav. 2017 Aug;31(5):576-588. doi: 10.1037/adb0000285. Epub

2017
Jul 13.
Peer alcohol behavior moderates within-level associations between posttraumatic

stress disorder symptoms and alcohol use in college students.
Bachrach RL(1), Read JP(1).
Author information:
(1)Department of Psychology, University at Buffalo, State University of New York.
Self-medication theory (SMT) posits that individuals exposed to trauma and

resulting posttraumatic stress symptoms (PTSD) are at risk for heavy drinking and
associated negative consequences. Close peer alcohol use is also a powerful
predictor of alcohol involvement in college, particularly influencing those with
greater negative affect. As individuals with PTSD may rely on peers for support,
peer drinking behaviors are possibly putting them at further risk for greater
alcohol use and resulting consequences. To test self-medication processes, the
present study examined the relationship between weekday PTSD symptoms, weekend
alcohol behavior, and the influence of both emotionally supportive peer and other
friend drinking behavior by investigating: (a) whether weekday PTSD symptoms
predicted subsequent weekend alcohol use and consequences; and (b) whether the
relationship between weekday PTSD symptoms and weekend alcohol behavior was
moderated by various drinking behaviors of one's peers. Trauma-exposed
heavy-drinking college students (N = 128) completed a baseline assessment and 30
daily, Web-based assessments of alcohol use and related consequences, PTSD
symptoms, and peer alcohol behavior. Results directly testing SMT were not
supported. However, friend alcohol behavior moderated the relationship between
weekday PTSD and weekend alcohol behavior. Findings highlight the importance of
peer drinking as both a buffer and risk factor for problematic drinking and
provide useful information for interventions aimed at high-risk drinkers.
(PsycINFO Database Record
DOI: 10.1037/adb0000285
PMCID: PMC5605813
297. J Headache Pain. 2016;17:33. doi: 10.1186/s10194-016-0628-7. Epub 2016 Apr 14.
Headaches attributed to airplane travel: a Danish survey.
Bui SB(1), Petersen T(1), Poulsen JN(1), Gazerani P(2).
Author information:
(1)SMI®, Department of Health science and Technology, Faculty of Medicine,
Aalborg University, Aalborg, Denmark.
(2)SMI®, Department of Health science and Technology, Faculty of Medicine,
Aalborg University, Aalborg, Denmark. gazerani@hst.aau.dk.
Erratum in
J Headache Pain. 2016;17:50.
BACKGROUND: Airplane headache (AH) is a headache that occurs during take-off and
landing. The pain is described as severe, unilateral, and located in the
fronto-orbital region. This study aimed at investigating the incidence of AH
among Scandinavian air-travelers, and to elucidating potential risk factors.
METHODS: An online, Danish-survey was developed. The questionnaire consisted of
14 questions and was distributed through the Facebook-pages of
Scandinavian-airlines and interest organizations. Participants reached the
questionnaire through a web-link.
RESULTS: Out of 254 responses, 89 noted that they suffered from headaches
associated to airplane travel. Of the 89, 21 cases the headache was severe and
limited to 30 min duration, as described in the ICH's criteria of AH. The
remaining 68 cases indicated that the headache lasted longer than 30 min. Our
data demonstrated that High-Altitude Headache (HAH) is a risk factor for
developing AH (p < 0.05). Triptans (19 %) and paracetamol (5 %) were reported
effective to relieve AH.
CONCLUSION: This study indicates that up to 8.3 % of the studied population
suffered from AH, with a higher incidence in those with a history of HAH.
Self-medication by triptans and paracetamol were reported effective for relieving
AH.
DOI: 10.1186/s10194-016-0628-7
PMCID: PMC4831956
298. J Clin Psychiatry. 2016 Nov;77(11):e1495. doi: 10.4088/JCP.15cr10606.
A Call to Action: The Active Role Psychiatrists and the DEA Must Take to Decrease
Harm from Psychotropic Drugs Acquired via the Internet.
Goldenberg M(1), Hassamal S(1), IsHak WW(2)(1), Haglund M(1), Miotto K(1),
Danovitch I(1).
Author information:
(1)Department of Psychiatry, Cedars Sinai Medical Center, Los Angeles,
California, USA.
(2)waguih.ishak@cshs.org.
DOI: 10.4088/JCP.15cr10606
299. BMJ Open. 2017 Sep 3;7(9):e016453. doi: 10.1136/bmjopen-2017-016453.
Intermittent catheter users' symptom identification, description and management

of urinary tract infection: a qualitative study.
Okamoto I(1), Prieto J(1), Avery M(1), Moore K(2), Fader M(1), Sartain S(3),
Clancy B(3).
Author information:
(1)Faculty of Health Sciences, University of Southampton, University Road,
Southampton, SO17 1BJ, UK.
(2)Faculty of Nursing, University of Alberta, Edmonton, Canada.
(3)University of Southampton, University Road, Southampton SO17 1BJUK.
OBJECTIVES: To elucidate the views of intermittent catheter (IC) users regarding

urinary tract infection (UTI) symptom presentation, terminology for describing
signs and symptoms, the cause of UTI and management strategies.
DESIGN: Qualitative study with semi-structured interviews. The transcribed text
was analysed thematically.
SETTING: 12 general practitioner (GP) surgeries in Hampshire and Dorset, UK.
PARTICIPANTS: A convenience sample of 30 IC users, aged over 18, using IC for at
least 3 months who had at least one self-reported UTI since starting IC.
RESULTS: Participants reported a variety of signs and symptoms, such as urine
cloudiness and smell, as indicators of UTI. The terms used often differed from
those in the modified National Institute on Disability and Rehabilitation
Research (NIDRR) symptom set. IC users had difficulty distinguishing possible UTI
symptoms from those of their comorbidities. They expressed uncertainty about the
cause of UTI, often attributing it to poor hygiene and lifestyle behaviours.
Whereas some viewed UTI as an expected consequence of IC use that could be
self-managed, others felt more concerned and were more reliant on their GP for
support. A range of management strategies was described, including drinking more
fluids, increased attention to personal hygiene and self-medicating with
antibiotics.
CONCLUSIONS: There is uncertainty among IC users about UTI signs and symptoms and
when to seek help. Individual accounts of UTI fitted generally within the
modified NIDRR descriptors but adopted less technical and more 'lay' language. IC
users' descriptions of UTI signs and symptoms can lack precision, owing partly to
the presence of underlying health conditions. This, together with differing
levels of concern about the need to seek help and self-medication with
antibiotics, presents challenges for the GP. This study provides the basis for
developing a self-help tool which may aid identification of UTI and enhance
communication with healthcare professionals.
DOI: 10.1136/bmjopen-2017-016453
PMCID: PMC5588948
300. Risk Manag Healthc Policy. 2016 Jul 25;9:173-83. doi: 10.2147/RMHP.S98099.
eCollection 2016.
Medicine reclassification processes and regulations for proper use of

over-the-counter self-care medicines in Japan.
Nomura K(1), Kitagawa Y(2), Yuda Y(2), Takano-Ohmuro H(2).
Author information:
(1)Division of Molecular Epidemiology, Jikei University School of Medicine.
(2)Faculty of Pharmacy, Musashino University, Shinmachi, Tokyo, Japan.
OBJECTIVES: Japan has actively reclassified substances ranging from prescription

drugs to over-the-counter (OTC) drugs in recent years. The sale of most OTC drugs
was deregulated several times and pharmacists' supervision was deemed no longer
mandatory. Japan established a new OTC evaluation system in 2015 to hear opinions
from various stakeholders regarding medicine types to be reclassified. This study
aimed to examine the new framework to identify candidate substances for
reclassification. Moreover, we examined how to manage the safe, self-care use of
OTC drugs in Japan.
METHODS: The necessary regulatory information on OTC approvals as of January 2015
was collected using an Internet search and relevant databases. To highlight the
characteristics of OTC drugs in Japan, the UK was selected as a comparison
country because it too was actively promoting the reclassification of medicines
from prescription to nonprescription status, and because of economic similarity.
RESULTS: Japan and the UK have a risk-based classification for nonprescription
medicines. Japan has made OTC drugs available with mandatory pharmacists'
supervision, face-to-face with pharmacists, or online instruction, which is
similar to the "pharmacy medicine" practiced in the UK. Japan recently reformed
the reclassification process to involve physicians and the public in the process;
some interactions were back to "prescription-only medicine" in the UK.
CONCLUSION: It is expected that the opinion of marketers, medical professionals,
and the public will improve the discussion that will greatly contribute to the
safe use of drugs. Monitoring the new system will be noteworthy to ensure that
OTC drug users are managing their self-care properly and visiting a doctor only
when necessary. The supply methods are similar in Japan and the UK; however, the
expected growth in the Japanese OTC market by the Cabinet and the industry is
still uncertain.
DOI: 10.2147/RMHP.S98099
PMCID: PMC4968996
PMID: 27555801
301. Antimicrob Resist Infect Control. 2017 Mar 24;6:30. doi:

10.1186/s13756-017-0187-y. eCollection 2017.
Pervasive antibiotic misuse in the Cambodian community: antibiotic-seeking

behaviour with unrestricted access.
Om C(1), Daily F(2), Vlieghe E(3), McLaughlin JC(2), McLaws ML(1).
Author information:
(1)School of Public Health and Community Medicine, UNSW Medicine, UNSW, Level 3
Samuels Building, Sydney, 2052 NSW Australia.
(2)Diagnostic Microbiology Development Program, # 23 (First Floor), Street 310,
BKK 1, Khan Chamcar Morn, Phnom Penh, Cambodia.
(3)Department of Clinical Sciences, Institute of Tropical Medicine,
Nationalestraat 155, 2000 Antwerp, Belgium.
BACKGROUND: Antibiotic misuse is widespread in resource-limited countries such as

Cambodia where the burden of infectious diseases is high and access to
antibiotics is unrestricted. We explored healthcare seeking behaviour related to
obtaining antibiotics and drivers of antibiotic misuse in the Cambodian
community.
METHODS: In-depth interviews were held with family members of patients being
admitted in hospitals and private pharmacies termed pharmacy attendants in the
catchment areas of the hospitals. Nurses who run community primary healthcare
centres located within the hospital catchment areas were invited to attend focus
group discussions. Nvivo version 10 was used to code and manage thematic data
analysis.
RESULTS: We conducted individual interviews with 35 family members, 7 untrained
pharmacy attendants and 3 trained pharmacists and 6 focus group discussions with
30 nurses. Self-medication with a drug-cocktail was widespread and included
broad-spectrum antibiotics for mild illness. Unrestricted access to antibiotics
was facilitated by various community enablers including pharmacies or drug
outlets, nurse suppliers and unofficial village medical providers referred to as
"village Pett" whose healthcare training has historically been in the field and
not at university. These enablers supplied the community with various types of
antibiotics including broad spectrum fluoroquinolones and cephalosporins. When
treatment was perceived to be ineffective patients would prescriber-shop various
suppliers who would unfailingly provide them with antibiotics. The main driver of
the community's demand for antibiotics was a mistaken belief in the benefits of
antibiotics for a common cold, high temperature, pain, malaria and 'Roleak' which
includes a broad catch-all for perceived inflammatory conditions. For severe
illnesses, patients would attend a community healthcare centre, hospital, or when
their finances permitted, a private prescriber.
CONCLUSIONS: Pervasive antibiotic misuse was driven by a habitual
supplier-seeking behaviour that was enabled by unrestricted access and
misconceptions about antibiotics for mild illnesses. Unofficial suppliers must be
stopped by supporting existing regulations with tough new laws aimed at outlawing
supplies outside registered pharmacies and fining registered pharmacist/owners of
these pharmacies for supplying antibiotics without a prescription. Community
primary healthcare centres must be strengthened to become the frontline
antibiotic prescribers in the community thereby enabling the community's access
to inexpensive and appropriate healthcare. Community-based education program
should target appropriate health-seeking pathways and the serious consequences of
antibiotic misuse.
DOI: 10.1186/s13756-017-0187-y
PMCID: PMC5366159
PMID: 28352463
302. J Res Pharm Pract. 2018 Apr-Jun;7(2):77-82. doi: 10.4103/jrpp.JRPP_17_88.
Dispensing of Antimicrobials in Kenya: A Cross-sectional Pilot Study and Its

Implications.
Mukokinya MMA(1), Opanga S(2), Oluka M(1), Godman B(3)(4)(5).
Author information:
(1)Department of Pharmacology and Pharmacognosy, University of Nairobi, Nairobi,
Kenya.
(2)Department of Pharmaceutics and Pharmacy Practice, University of Nairobi,
Nairobi, Kenya.
(3)Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and
Biomedical Sciences, Strathclyde University, Glasgow, UK.
(4)Department of Laboratory Medicine, Division of Clinical Pharmacology,
Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm,
Sweden.
(5)Health Economics Centre, Liverpool University Management School, Liverpool
University, Liverpool, UK.
Objective: The objective of this study was to evaluate the extent of

self-medication of antibiotics and dispensing practices in Kenya.
Methods: A cross-sectional study was carried out at three selected pharmacies in
Nairobi (Kenya), between January and March 2017, targeting principally antibiotic
prescriptions for systemic use issued and dispensed as well as antibiotics sold
over-the-counter without a prescription. The quality of antibiotics prescribed
and dispensed was assessed against key WHO and other criteria. Benchmarking was
used to assess the quality of antibiotics prescribed as there are no
predetermined levels, just guidance and the rationale. Key indicators included:
utilization of penicillins, percentage utilization of third-and fourth-generation
of cephalosporins versus first and second generation, utilization of macrolides
including lincosamides and utilization of quinolones as a percent of total
systemic antibiotic use.
Findings: There was a low level of dispensing of antibiotics without a
prescription with over 90% (94.1%) of antibiotics dispensed with a valid
prescription. The most common antibiotics dispensed were the penicillins at just
over 50% of all antibiotics, the cephalosporins at over 12% (12.6%) and the
fluoroquinolones at just under 12% (11.7%). There were concerns with high use of
third and fourth generation cephalosporins versus first- and second-generation as
well as co-amoxiclav versus other penicillins.
Conclusion: Low levels of self-medication of antibiotics and high adherence to
quality standards for dispensing are encouraging and provide direction to other
countries. Educational initiatives are needed though to address high levels of
co-amoxiclav prescribing.
DOI: 10.4103/jrpp.JRPP_17_88
PMCID: PMC6036869
PMID: 30050960
303. J Clin Diagn Res. 2016 Aug;10(8):FC05-9. doi: 10.7860/JCDR/2016/20600.8298.

Epub
2016 Aug 1.
Utilization of Medicines Available at Home by General Population of Rural and

Urban Set Up of Western India.
Mirza N(1), Ganguly B(2).
Author information:
(1)Associate Professor, Department of Pharmacology, P.S. Medical College ,
Karamsad, Gujarat, India .
(2)Professor and Head, Department of Pharmacology, P.S. Medical College ,
Karamsad, Gujarat, India .
INTRODUCTION: In India, medicines are procured with prescription or without

prescription by patients, which are kept at home and often are utilized in
inappropriate manner. It may remain unused, get expired or may be repeated in the
way of self medication. So there remains an increase chance of self-medication
compared to prescribed drugs.
AIM: This study was aimed to explore the utilization pattern of medicines
available at home with special attention to the types of medicine (with or
without prescription) and their appropriate utilization (dosage compliance) and
intended self-medication.
MATERIALS AND METHODS: A cross-sectional study was conducted in Anand district of
Gujarat, India during the year 2012- 2014 after Human Research Ethics Committee
(HREC) approval. Data were collected from 800 houses, 400 each from urban and
rural areas and then analysed for the details of medicines available in the house
as: (i) number of homes having medicines; (ii) number of formulations with and
without prescriptions; (iii) number of formulations with package inserts &
expired formulations; (iv) Dosage forms of medicines; (v) pharmacological class
wise distribution of medicines; (vi) status of the medicine use whether for
current use, future use or leftover; and (vii) Appropriateness of medicines with
and without prescription in relation to dose and duration of treatment.
RESULTS: Medicines were available in 93.75% houses. More medicine formulations
(16.76%) were found without prescription in urban area than in rural (11.82%).
Highest number of dosage forms found, were that of tablets (62%). Among the
prescribed medicines, majority of medicines were from cardiovascular disease
(19.88%) and from without prescription medicines, Non-Steroidal Antiinflammatory
Drugs (NSAIDs) were the major group available at houses (35.13%). The leftover
medicines with prescription were 20.39% and without prescription medicines were
13.37%. Appropriate dose and duration of medicines were followed more
significantly by urban people than the rural. Only 2.91% medicines were found
along with package inserts and 2.94% crossed the expiry dates.
CONCLUSION: The evaluation of utilization of medicines, in urban and rural
population describes high drug storage, higher leftover medicines and
inappropriate use of medicines and many self medicated by patients which suggests
the need to educate the patients about proper and rational use of medicines.
DOI: 10.7860/JCDR/2016/20600.8298
PMCID: PMC5028514
PMID: 27656460
304. Trop Med Int Health. 2017 May;22(5):567-575. doi: 10.1111/tmi.12854. Epub 2017
Mar 9.
Prevalence and correlates of antibiotic sharing in the Philippines: antibiotic

misconceptions and community-level access to non-medical sources of antibiotics.
Barber DA(1), Casquejo E(2), Ybañez PL(2), Pinote MT(2), Casquejo L(2), Pinote
LS(2), Estorgio M(2), Young AM(1).
Author information:
(1)Department of Epidemiology, University of Kentucky, Lexington, KY, USA.
(2)Island Ventures, Inc., Lapu-Lapu City, Cebu, Philippines.
OBJECTIVE: To identify sociodemographic, knowledge and attitudinal correlates to

antibiotic sharing among a community-based sample of adults (age 18 and older) in
a low-income setting of the Philippines and to explore community-level data on
informal antibiotic distribution in roadside stands (i.e., sari-sari stands).
METHODS: Participants (n = 307) completed self-administered surveys. Correlates
to antibiotic sharing were assessed using logistic regression with Firth's
bias-adjusted estimates. Study staff also visited 106 roadside stands and
collected data on availability and characteristics of antibiotics in the stands.
RESULTS: 78% had shared antibiotics in their lifetime, most often with family
members. In multivariable analysis, agreement with the belief that it is safe to
prematurely stop an antibiotic course (OR: 2.8, CI: 1.3-5.8) and concerns about
antibiotic side effects (OR: 2.1, CI: 1.1-4.4) were significantly associated with
increased odds of reported antibiotic sharing. Antibiotic sharing was not
associated with sociodemographic characteristics or antibiotic knowledge.
Antibiotics were widely available in 60% of sampled sari-sari stands, in which
59% of antibiotics were missing expiration dates. Amoxicillin and cephalexin were
the most commonly available antibiotics for sale at the stands (60% and 21%,
respectively).
CONCLUSIONS: Antibiotic sharing was common and was associated with misconceptions
about proper antibiotic use. Antibiotics were widely available in sari-sari
stands, and usually without expiration information. This study suggests that
multipronged and locally tailored approaches to curbing informal antibiotic
access are needed in the Philippines and similar Southeast-Asian countries.
DOI: 10.1111/tmi.12854
305. Biol Pharm Bull. 2017 Oct 1;40(10):1730-1738. doi: 10.1248/bpb.b17-00340. Epub
2017 Aug 4.
Comparison of the Benefit Feeling Rate Based on the Sho of OTC Kakkonto, Cold
Remedy and Cold Remedy with Kakkonto Combination Product.
Okita M(1), Yayoshi Y(2), Ohara K(3), Negishi A(2), Akimoto H(2), Inoue N(1)(4),
Numajiri S(4), Ohshima S(1)(4), Honma S(5), Oshima S(2), Kobayashi D(1)(2).
Author information:
(1)Josai University Pharmacy.
(2)Department of Analytical Pharmaceutics and Informatics, Faculty of Pharmacy
and Pharmaceutical Sciences, Josai University.
(3)Laboratory of Drug Metabolism, Faculty of Pharmaceutical Sciences, Josai
International University.
(4)Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical
Sciences, Josai University.
(5)Onko-Do Kampo Akebono Yakkyoku Co., Ltd.
Kakkonto (KK), a traditional Japanese Kampo formulation for cold and flu, is
generally sold as an OTC pharmaceuticals used for self-medication. Kampo
formulations should be used according to the Sho-symptoms of Kampo medicine.
These symptoms refer to the subjective symptoms themselves. Although with OTC
pharmaceuticals, this is often not the case. We surveyed the relationship of
agreement of Sho with the benefit feeling rate (BFR) of patients who took KK
(n=555), cold remedies with KK (CK, n=315), and general cold remedies (GC, n=539)
using internet research. BFR of a faster recovery was greater in participants who
took the medication early and who had confidence in their physical strength in
all treatment groups. BFR was significantly higher in the GC group than in the KK
group for patients with headache, runny nose, blocked nose, sneezing, and cough.
BFR was also significantly higher in the GC group than in the CK group for
headache (males) and cough (females). BFR was the highest in the KK group for
stiff shoulders. All cold remedies were more effective when taken early, and the
larger the number of Sho that a patient had, the greater the BFR increased.
Therefore, a cold remedy is expected to be most effective when there are many
cold symptoms and when it is taken at an early stage of the common cold.
DOI: 10.1248/bpb.b17-00340
306. AIMS Public Health. 2017 Sep 29;4(5):430-445. doi:

10.3934/publichealth.2017.5.430. eCollection 2017.
Stocking up on Fish Mox: a Systematic Analysis of Cultural Narratives about

Self-medicating in Online Forums.
Howes-Mischel R(1).
Author information:
(1)Department of Sociology and Anthropology, James Madison University,
Harrisonburg, VA, USA.
This study is a systematic review of cultural narratives that drive American

belief in the value and efficacy of stocking up on fish antibiotics for human
consumption. Popularized by "doomsday prepper" forums and survivalist medical
professionals' online videos, this narrative suggests that in some scenarios
humans may benefit from such treatments-even as they note its contraindication to
mainstream public health advice. Discussions in crowd-sourcing forums however,
reveal that in practice Americans are using them as a form of home remedy to
treat routine infections without missing work or to make up for gaps in insurance
coverage. This article argues for greater attention to what makes it plausible
and reasonable to treat human conditions with animal medications. It suggests
that public health initiatives should address such decisions as emerging from a
rational analysis of social and economic conditions rather than dismissing such
practices as dangerous to population and individual health outcomes. As social
scientists of medicine have long argued, collective narratives about health and
medicine illustrate deeply the broader contexts in which communities understand
and experience bodily state and shape how communities interact with public health
institutions and respond to medical expertise. This study surveys online
discussions about "fish mox" to show how participants contest medical expertise
and promote a more distributed form of populist expertise. As such, consuming
fish mox is both panacea for health inequality and a critique of health
institutions for perpetrating such stratification.
DOI: 10.3934/publichealth.2017.5.430
PMCID: PMC6111272
PMID: 30155497
Conflict of interest statement: Conflict of Interest: The author declares no

conflicts of interest in this paper.
307. Indian Dermatol Online J. 2017 Mar-Apr;8(2):120-123. doi:

10.4103/2229-5178.202273.
Over-the-counter and Prescription Medications for Acne: A Cross-Sectional Survey

in a Sample of University Students in Saudi Arabia.
Alshehri MD(1), Almutairi AT(1), Alomran AM(1), Alrashed BA(1), Kaliyadan F(1).
Author information:
(1)Department of Dermatology, College of Medicine, King Faisal University, Saudi
Arabia.
INTRODUCTION AND BACKGROUND: Acne is a very common dermatological condition found

among the adolescent population in Saudi Arabia. Many patients with acne try
various forms of self-medication, over the counter medicines (OTC), and
prescription medicines for the same.
MATERIALS AND METHODS: This was a cross-sectional study among university students
in the Kingdom of Saudi Arabia (KSA). A validated questionnaire was distributed
to a convenience sample of university students to evaluate their knowledge and
attitudes towards OTC (mainly) as well as prescription medicine for acne.
Chi-square and multiple logistic regression tests were used for comparisons
between groups.
RESULTS: Four hundred and twenty valid, completed questionnaires were obtained. A
total of 220 (52.4%) used some type of OTC medications at least once, where as
108 (25.7%) used prescription medicines and 92 (21.9%) used both. The most common
OTC medications used were cleansers by 250 participants (41.9%). Among
prescription medicines, the most common were topical and oral antibiotics
(11.4%). Bivariate and multivariate analysis showed that females are
statistically more likely to use OTC medicines compared to males (Odds ratio:
1.7).
CONCLUSION: The use of self-medications and OTC medications is common among
university students in KSA. The most common OTC medicine used for acne was
cleanser.
DOI: 10.4103/2229-5178.202273
PMCID: PMC5372432
PMID: 28405552

308. Allergo J Int. 2015 Dec;24(8):303-311. doi: 10.1007/s40629-015-0085-x.
Acid suppression therapy and allergic reactions.
Untersmayr E(1).
Author information:
(1)Department of Pathophysiology and Allergy Research, Center of Pathophysiology,
Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
The development of pharmaceutical agents such as sucralfate, histamine 2 (H2)

receptor blockers and proton pump inhibitors (PPIs) reducing gastric acidity has
been a mile stone for treatment of dyspeptic disorders. However, due to current
prescription habits resulting in overuse of these potent drugs as well as
over-the-counter (OTC) availability associated with self-medication, substantial
health concern is related to the mechanisms of drug action as well as known side
effects influencing gastrointestinal physiology. More than a decade ago the first
study appeared reporting an association between anti-ulcer drug intake and food
allergy development. Ever since this first report several experimental as well as
human studies verified this correlation, demonstrating that acid suppressive
drugs not only influence the sensitization capacity of orally ingested proteins,
but also represent a risk factor for food allergy patients. Additionally, gastric
acid suppression was reported to increase the risk for development of drug
hypersensitivity reactions. These consequences of anti-ulcer drug intake might on
the one hand be associated with direct influence of these drugs on immune
responses. On the other hand reduction of gastric acidity leads to impaired
gastrointestinal protein degradation. Nevertheless, also disruption of the
gastrointestinal barrier function, changes in microbiome or lack of tolerogenic
peptic digests might contribute to the connection between anti-ulcer drug intake
and allergic reaction. Therefore, these drugs should only be prescribed based on
a precise gastroenterological diagnosis taking into consideration allergological
mechanisms to ensure patients' safety.
DOI: 10.1007/s40629-015-0085-x
PMCID: PMC5464390
PMID: 28603686
309. Pharmacy (Basel). 2018 Jun 7;6(2). pii: E52. doi: 10.3390/pharmacy6020052.
Over-The-Counter (OTC) Drug Consumption among Adults Living in Germany: Results

from the German Health Interview and Examination Survey for Adults 2008⁻2011
(DEGS1).
Barrenberg E(1), Knopf H(2), Garbe E(3)(4).
Author information:
(1)Department of Clinical Epidemiology, Leibniz Institute for Prevention Research
and Epidemiology-BIPS, Achterstraße 30, 28359 Bremen, Germany.
barrenberg@leibniz-bips.de.
(2)Department of Epidemiology and Health Monitoring, Robert Koch-Institute,
General-Pape-Straße 62-66, 12101 Berlin, Germany. knopfh@rki.de.
(3)Department of Clinical Epidemiology, Leibniz Institute for Prevention Research
and Epidemiology-BIPS, Achterstraße 30, 28359 Bremen, Germany.
garbe@leibniz-bips.de.
(4)Core Scientific Area 'Health Sciences' at the University of Bremen, Grazer
Str. 2, 28334 Bremen, Germany. garbe@leibniz-bips.de.
In order to assess the effects of prescription-only (Rx) to over-the-counter
(OTC) drug switches and related policies, it is imperative to distinguish
self-medication from OTC drug use. The objective of this study was to estimate
the OTC drug use in the adult population in Germany, to identify its predictors
and to highlight methodological differences when compared to the study of a
self-medication prevalence. Seven-day prevalence of OTC drug use was calculated
on the basis of information provided by 7091 participants of the German Health
Interview and Examination Survey for Adults (DEGS1) conducted between 2008 to
2011. Logistic regression analysis was used to identify predictors of OTC drug
use. Seven-day prevalence of OTC drug use was higher in women (47.16%) than in
men (33.17%). Female gender, an age of more than 60 years, reduced health status,
Rx drug use, and multi-morbidity were identified as predictors of OTC drug use.
The levels of OTC drug use were higher than the self-medication prevalence found
in the same data set probably because some OTC drugs are commonly prescribed by
physicians. Drug utilization studies should, therefore, make a methodological
distinction between self-medication and OTC drug use depending on whether the
focus is on drug safety or the impact of regulatory decisions on the trade
status.
DOI: 10.3390/pharmacy6020052
PMCID: PMC6024976
PMID: 29880765
310. BMC Psychiatry. 2016 Jun 24;16:202. doi: 10.1186/s12888-016-0905-7.
Drinking to ease the burden: a cross-sectional study on trauma, alcohol abuse and
psychopathology in a post-conflict context.
Ertl V(1)(2)(3), Saile R(4)(5), Neuner F(4)(5), Catani C(4)(5).
Author information:
(1)Clinical Psychology and Psychotherapy, Department of Psychology, Bielefeld
University, Universitätsstraße 25, 33615, Bielefeld, Germany.
verena.ertl@uni-bielefeld.de.
(2)vivo international, Konstanz, Germany. verena.ertl@uni-bielefeld.de.
University, P.O. Box 100131, 33501, Bielefeld, Germany.
verena.ertl@uni-bielefeld.de.
University, Universitätsstraße 25, 33615, Bielefeld, Germany.
(5)vivo international, Konstanz, Germany.
BACKGROUND: It is likely that alcohol use and abuse increase during and after
violent conflicts. The most prominent explanation of this phenomenon has been
referred to as self-medication hypothesis. It predicts that psychotropic
substances are consumed to deal with conflict-related psychic strains and trauma.
In northern Uganda, a region that has been affected by a devastating civil war
and is characterized by high levels of alcohol abuse we examined the associations
between war-trauma, childhood maltreatment and problems related to alcohol use.
Deducing from the self-medication hypothesis we assumed alcohol consumption
moderates the relationship between trauma-exposure and psychopathology.
METHODS: A cross-sectional epidemiological survey targeting war-affected families
in post-conflict northern Uganda included data of male (n = 304) and female
(n = 365) guardians. We used standardized questionnaires in an interview format
to collect data on the guardians' socio-demography, trauma-exposure, alcohol
consumption and symptoms of alcohol abuse, PTSD and depression.
RESULTS: Symptoms of current alcohol use disorders were present in 46 % of the
male and 1 % of the female respondents. A multiple regression model revealed the
unique contributions of emotional abuse in the families of origin and trauma
experienced outside the family-context in the prediction of men's alcohol-related
symptoms. We found that alcohol consumption moderated the dose-effect
relationship between trauma-exposure and symptoms of depression and PTSD.
Significant interactions indicated that men who reported more alcohol-related
problems experienced less increase in symptoms of PTSD and depression with
increasing trauma-exposure.
CONCLUSIONS: The gradual attenuation of the dose-effect the more alcohol-related
problems were reported is consistent with the self-medication hypothesis. Hence,
the functionality of alcohol consumption has to be considered when designing and
implementing addiction treatment in post-conflict contexts.
DOI: 10.1186/s12888-016-0905-7
PMCID: PMC4921056
311. Int J Med Educ. 2019 Jul 30;10:149-160. doi: 10.5116/ijme.5d21.b621.
Burnout and associated factors in psychiatry residents: a systematic review.
Chan MK(1), Chew QH(2), Sim K(3).
Author information:
(1)Tan Tock Seng Hospital, Singapore.
(2)Research Division, Institute of Mental Health, Singapore.
(3)West Region, Institute of Mental Health, Singapore.
Objectives: This study aimed to systematically review extant data on the

prevalence of burnout amongst psychiatry residents, examine the contributory
factors, and consider potential ways to manage burnout.
Methods: A systematic literature review was conducted on all relevant articles
within Pubmed/OVID Medline and ScienceDirect digital databases from January 2000
till March 2019 that investigated burnout in psychiatry residents. Variables of
interest included questionnaires used to assess burnout, the prevalence of
burnout, and its clinical correlates. Articles were included if they were
observational or experimental studies and involved a sample consisting solely of
or a subsample of psychiatry residents. The data are summarised and presented as
a narrative synthesis.
Results: Twenty-two studies were included. The overall prevalence of burnout
among psychiatry residents was 33.7%, which was associated with certain
demographic (non-parental status), training (juniors years of training, lower
priority of psychiatry as career choice, lack of clinical supervision,
discontinuation from training), work (high workload, long hours, insufficient
rest), and learner factors (more stressors, greater anxiety, and depressive
symptoms, low self-efficacy, decreased empathic capacity, poor coping, self-
medication, and use of mental health services).
Conclusions: These findings suggest that interventions such as refining candidate
selection, enforcement of work hour limits, enhancement of support and
supervision, and equipping of stress coping skills may ameliorate burnout related
to training, work, and learner factors respectively. These findings and
suggestions may apply to other residency programs. However, future studies should
examine burnout longitudinally and evaluate the effectiveness of different
interventions in reducing burnout within psychiatry residents.
DOI: 10.5116/ijme.5d21.b621
PMID: 31381505
312. Front Psychiatry. 2019 May 15;10:274. doi: 10.3389/fpsyt.2019.00274.
eCollection
2019.
Negative Mood Induction Increases Choice of Heroin Versus Food Pictures in

Opiate-Dependent Individuals: Correlation With Self-Medication Coping Motives and
Subjective Reactivity.
Hogarth L(1), Hardy L(1), Bakou A(1), Mahlberg J(2), Weidemann G(2)(3), Cashel
S(2), Moustafa AA(2)(3).
Author information:
(1)School of Psychology, University of Exeter, Exeter, United Kingdom.
(2)School of Social Sciences and Psychology, Western Sydney University, Sydney,
NSW, Australia.
(3)MARCS Institute for Brain, Behaviour and Development, Western Sydney
University, Sydney, NSW, Australia.
Acute growth in negative affect is thought to play a major role in triggering

relapse in opiate-dependent individuals. Consistent with this view, three lab
studies have demonstrated that negative mood induction increases opiate craving
in opiate-dependent individuals. The current study sought to confirm these
effects with a behavioral measure of heroin seeking, and test whether the effect
is associated with self-reported opiate use to cope with negative affect and
subjective reactivity to mood induction. Participants were heroin-dependent
individuals engaged with treatment services (n = 47) and control participants (n
= 25). Heroin users completed a questionnaire assessing reasons for using heroin:
negative affect, social pressure, and cued craving. Baseline heroin choice was
measured by preference to enlarge heroin versus food thumbnail pictures in
two-alternative forced-choice trials. Negative mood was then induced by
depressive statements and music before heroin choice was tested again. Subjective
reactivity was indexed by negative and positive mood reported at the
pre-induction to post-test timepoints. Heroin users chose heroin images more
frequently than controls overall ( p = .001) and showed a negative mood-induced
increase in heroin choice compared to control participants (interaction p < .05).
Mood-induced heroin choice was associated with self-reported heroin use to cope
with negative affect ( p < .05), but not social pressure ( p = .39) or cued
craving ( p = .52), and with subjective mood reactivity ( p = .007). These data
suggest that acute negative mood is a trigger for heroin seeking in
heroin-dependent individuals, and this effect is pronounced in those who report
using heroin to cope with negative affect, and those who show greater subjective
reactivity to negative triggers. Interventions should seek to target negative
coping motives to build resilience to affective triggers for relapse.
DOI: 10.3389/fpsyt.2019.00274
PMCID: PMC6529569
PMID: 31156470
313. J Ayub Med Coll Abbottabad. 2016 Oct-Dec;28(4):746-749.
Non-steroidal anti-inflammatory drugs vs. Paracetamol: drug availability,

patients' preference and knowledge of toxicity.
Zamir Q(1), Nadeem A(1).
Author information:
(1)Army Medical College, National University of Medical Sciences (NUMS),
Islamabad, Pakistan.
BACKGROUND: Self-medication is a common practice which is influenced by level of

education, society factors and health care facilities availability. In our
region, Pakistan, it is very common and awareness regarding prescription
implementation needs to be ensured. Hence the current study highlights the
preference, availability and knowledge of toxicity of non-steroidal
antiinflammatory medications and paracetamol in Pakistan.
METHODS: It was a Descriptive, cross sectional, conducted in Rawalpindi and
Islamabad, Pakistan from May to august 2012. A total of 1000 questionnaires
comprising of 21 questions were distributed to the persons with age groups from
18 years to 40 years. Non-probability convenience sampling technique was used for
results deduction. Data was analysed using descriptive statistics.
RESULTS: The most commonly used medicine was Mefenamic acid (n=191, 40.8%).
Paracetamol was second on the priority list (n=146, 31.3%). About 178 out of
467(38.1%) used these medications for headache. Very few responders knew about
the toxic doses of the medicines they used. Only 52 (11%) were aware of the
raised bleeding tendency being the most common side effect of acetylsalicylic
acid and 129 (28%) were aware of liver damage by paracetamol toxicity.
CONCLUSIONS: In Pakistan, common people take NSAIDs and Paracetamol without
prescription and majority of them are unaware of the side effects of these
medicines. This is the reason it is important to make the general public aware of
the problems they may face if they misuse or over use the drugs without the
prescription.
314. Health Policy Plan. 2016 Dec;31(10):1384-1390. Epub 2016 Jun 16.
Persistent low adherence to hypertension treatment in Kyrgyzstan: How can we

understand the role of drug affordability?
Murphy A(1), Jakab M(2), McKee M(3), Richardson E(4).
Author information:
(1)Centre for Health and Social Change, London School of Hygiene and Tropical
Medicine, London, UK adrianna.murphy@lshtm.ac.uk.
(2)World Health Organization Office for Europe, Regional Office for Health
Systems Strengthening, Barcelona, Spain.
(3)Centre for Health and Social Change, London School of Hygiene and Tropical
Medicine, London, UK.
(4)European Centre on Health of Societies in Transition, London School of Hygiene
and Tropical Medicine, London, UK.
It is well known that cardiovascular diseases (CVD) are a growing cause of

mortality and morbidity in low-and middle-income countries (LMIC). While
hypertension (HTN), a leading risk factor for CVD, can be easily managed with
widely available medicines, there is a huge gap in treatment for HTN in many
LMIC. One such country is Kyrgyzstan, where HTN is a major public health concern
and adherence to medication is low. The reasons for low adherence in Kyrgyzstan
are not well understood, but some evidence suggests that HTN medicines may be
unaffordable for low-income families, resulting in inequitable access to HTN
treatment. With data from the 2010 Kyrgyzstan Integrated Household Survey, we
estimate the prevalence and factors associated with adherence to HTN medication
in Kyrgyzstan. We then investigate the hypothesis that affordability may be an
important factor in adherence to HTN medication. Using the coarsened exact
matching approach, we estimate the economic burden faced by households with at
least one member with elevated blood pressure (EBP) in Kyrgyzstan and their risk
of catastrophic spending on health care. We find that EBP households have
significantly higher total expenditure on health, as well as on medicines, and
are more likely to experience catastrophic health spending, suggesting that
out-of-pocket expenditure for EBP may be prohibitively expensive for the poorest
in Kyrgyzstan. Our findings also reveal a high prevalence of self-medication
(i.e. purchasing and using medication without a doctor's prescription), and
increased expenditure due to self-medication, among those with EBP. Our research
suggests that affordability of HTN medicines may be an important factor in low
adherence to treatment in Kyrgyzstan. Low affordability may be due partly to the
prescription of medicines that are not reimbursable under the national drug
benefit plan, but more research is needed to identify solutions to the
affordability problem.
© The Author 2016. Published by Oxford University Press in association with The
London School of Hygiene and Tropical Medicine. All rights reserved. For
permissions, please e-mail: journals.permissions@oup.com.
DOI: 10.1093/heapol/czw080
315. Version 2. F1000Res. 2018 Sep 3 [revised 2019 Feb 22];7:1392. doi:
10.12688/f1000research.15886.2. eCollection 2018.
Purchase of medications without prescription in Peru: a cross-sectional

Hernández-Vásquez A(1), Alarcon-Ruiz CA(2), Díaz-Seijas D(3), Magallanes-Quevedo

L(3), Rosselli D(4).
Author information:
(1)Universidad San Ignacio de Loyola, Centro de Excelencia en Estudios Económicos
y Sociales en Salud, Lima, 15024, Peru.
(2)Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación
y Síntesis de Evidencias en Salud, Lima, 15024, Peru.
(3)Universidad Nacional Mayor de San Marcos, Lima, 15081, Peru.
(4)Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad
Javeriana, Bogota, 110311, Colombia.
Background: Low availability of medicines in health services, self-medication,

inadequate use of medicines, and inadequate dispensing practices in pharmacies
are frequent problems in Peru. We aimed to evaluate how frequent the purchase of
medications without medical prescription is in Peru, and which factors are
associated with this practice. Methods: We conducted a secondary analysis of the
2016 ENSUSALUD national survey data. Purchase of one or more medicines that
require a prescription was measured as a dichotomous variable. Crude and adjusted
prevalence ratios (PR) and their 95% confidence intervals (95% CI) were
calculated using Poisson regressions model with robust variance to assess the
association of purchasing of medicines that require prescriptions with
sociodemographic factors. Results: There were 3858 participants in the dataset.
The prevalence of purchasing medications without prescriptions was 47.2%. History
of having previously consumed the same medication (31.6%), and the delay in
receiving an appointment at health facilities (26.9%) were the main reasons to
buy medications without a prescription. Regarding the recommendation of the
medication purchased, the advice of the pharmacy, and remembering a previous old
prescription, were the most frequent reasons (38.3%, and 25.9%, respectively). On
the multivariable analysis, users that buy medications without prescription were
more likely to be of aged 25-44; reside in the Jungle and Highlands regions; and
self-consumption of the purchase. Individuals with Seguro Integral de Salud
(Comprehensive Health Insurance) were less likely to buy medications without
prescription. Conclusions: There is a high prevalence of prescription requiring
medication being bought without one from pharmacies in Peru. It is necessary to
include the evaluation of consumer patterns to develop strategies with the aim to
regulate the consumption of prescription drugs in the Peruvian population.
DOI: 10.12688/f1000research.15886.2
PMCID: PMC6364375.2
PMID: 30800287
Conflict of interest statement: No competing interests were disclosed.
316. J Infect Public Health. 2019 Jul - Aug;12(4):460-464. doi:

10.1016/j.jiph.2019.03.017. Epub 2019 Apr 10.
Antimicrobial overuse and misuse in the community in Greece and link to

antimicrobial resistance using methicillin-resistant S. aureus as an example.
Karakonstantis S(1), Kalemaki D(2).
Author information:
(1)Department of Internal Medicine, General Hospital of Heraklion
"Venizeleio-Pananeio", Leoforos Knossou, Heraklion, 71409, Greece. Electronic
address: stamatiskarakonstantis@gmail.com.
(2)General Medicine, University Hospital of Heraklion, Heraklion, 71410, Greece.
Both antimicrobial consumption and antimicrobial resistance are very high in

Greece, ranking among the highest of Europe. The link between antimicrobial
consumption and resistance is well-known. Here, we discuss the reasons of
antimicrobial overuse in Greece in the community (such as self-medication,
dispersion of antibiotics by pharmacies without prescription, over-prescription
by physicians, patient expectations and liability pressure) and we explore the
misuse of antibiotics for common community infections. Furthermore, we discuss
how such overuse/misuse can drive antimicrobial resistance, using
methicillin-resistance in Staphylococcus aureus as an example. S. aureus is one
of the pathogens with high rates of resistance in Greece. Comparing the rate of
antimicrobial susceptibility to non-beta lactams between methicillin-resistant
and methicillin-sensitive S. aureus we highlight the antibiotics that have the
potential to drive methicillin-resistance through co-selection. Based on the
above we identify targets for intervention in order to reduce antimicrobial
overuse/misuse in the community in Greece.
DOI: 10.1016/j.jiph.2019.03.017
PMID: 30981652
317. J Addict Dis. 2016 Jul-Sep;35(3):194-204. doi: 10.1080/10550887.2015.1127717.

Epub 2015 Dec 15.
Substance use and misuse in burn patients: Testing the classical hypotheses of
the interaction between post-traumatic symptomatology and substance use.
Eiroa-Orosa FJ(1), Giannoni-Pastor A(2)(3), Fidel-Kinori SG(2), Argüello

JM(2)(4).
Author information:
(1)a School of Psychology, The University of East London , London , England, UK.
(2)b Department of Psychiatry , Hospital Universitari Vall d'Hebron, CIBERSAM,
Universitat Autònoma de Barcelona , Barcelona , Catalonia , Spain.
(3)c Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona ,
Barcelona , Catalonia , Spain.
(4)d Department of Psychiatry and Legal Medicine , Universitat Autònoma de
Barcelona , Barcelona , Catalonia , Spain.
The authors aimed to test whether the three classical hypotheses of the
interaction between post-traumatic symptomatology and substance use (high risk of
trauma exposure, susceptibility for post-traumatic symptomatology, and
self-medication of symptoms), may be useful in the understanding of substance use
among burn patients. Substance use data (nicotine, alcohol, cannabis,
amphetamines, cocaine, opiates, and tranquilizers) and psychopathology measures
among burn patients admitted to a burn unit and enrolled in a longitudinal
observational study were analyzed. Lifetime substance use information (n = 246)
was incorporated to analyses aiming to test the high risk hypothesis. Only
patients assessed for psychopathology in a 6-month follow-up (n = 183) were
included in prospective analyses testing the susceptibility and self-medication
hypotheses. Regarding the high risk hypothesis, results show a higher proportion
of heroin and tranquilizer users compared to the general population. Furthermore,
in line with the susceptibility hypothesis, higher levels of symptomatology were
found in lifetime alcohol, tobacco, and drug users during recovery. The
self-medication hypothesis could be tested partially due to the hospital stay
"cleaning" effect, but severity of symptoms was linked to the amount of caffeine,
nicotine, alcohol, and cannabis use after discharge. It was found that the 3
classical hypotheses could be used to understand the link between traumatic
experiences and substance use explaining different patterns of burn patient's
risk for trauma exposure and emergence of symptomatology.
DOI: 10.1080/10550887.2015.1127717
Frequency, character and predisposing factor of headache among students of

medical college of Karachi.
Noor T(1), Sajjad A(1), Asma A(2).
Author information:
(1)Civil Hospital Karachi, Dow University of Health Sciences, Karachi.
(2)Medical Student, Sind Medical College, Jinnah Sindh Medical University,
Karachi.
OBJECTIVE: To evaluate the frequency, predisposing factors and symptomatology of

headache among medical students.
METHODS: The cross-sectional study was conducted from September to December 2013
and comprised students of two medical colleges of Karachi. International
Classification of Headache Disorder-II criterion was used to diagnose and
classify headache. SPSS 17 was used for statistical analysis.
RESULTS: Of the 413 medical students studies, 326(79%) had tension type headache,
and 87 (21%) had migraine. Headache was more frequent among females than males,
with a ratio of 6.5:1. Both types of headache were significantly associated with
self-reported disturbed sleep pattern, stress and various triggering factors
(p<0.05 each). Both types greatly influenced individual's daily life with
significant association with avoiding academics, extra-curricular activities,
family and friends (p<0.05 each). High self-medication rate of 400(96.9%) was
observed.
CONCLUSIONS: The prevalence of headache among medical students was high with
female predominance. Infrequent consultation needs to be addressed through
awareness programmes.
319. Early Interv Psychiatry. 2015 Jun;9(3):207-10. doi: 10.1111/eip.12112. Epub

2013
Nov 26.
Reasons for cannabis use among youths at ultra high risk for psychosis.
Gill KE(1), Poe L, Azimov N, Ben-David S, Vadhan NP, Girgis R, Moore H, Cressman
V, Corcoran CM.
Author information:
(1)Columbia University, Department of Psychiatry, New York State Psychiatric
Institute, New York, New York, USA.
AIM: Cannabis use is prevalent in schizophrenia and its risk states, despite its
association with anxiety and positive symptoms. While schizophrenia patients
report using cannabis for mood enhancement and social motives, it is not known
what motivates clinical high risk (CHR) patients to use cannabis.
METHODS: Among 102 CHR patients, 24 (23%) endorsed cannabis use, and were queried
as to reasons for use, using a scale previously administered in schizophrenia
patients. We hypothesized a primary motivation for mood enhancement related to
anhedonia. We evaluated the 'self-medication' hypothesis by examining if
motivation for symptom relief was associated with concurrent severity of
symptoms.
RESULTS: The rank order of reasons for use in CHR patients was similar to that
previously reported by schizophrenia patients, with mood enhancement and social
motives as primary reasons for use, and the motivation to use cannabis for
symptom relief comparatively less common. Motivation for mood enhancement had a
trend association with anhedonia. Motivation for symptom relief was entirely
unrelated to concurrent severity of positive and anxiety symptoms.
CONCLUSION: As in schizophrenia, CHR patients primarily use cannabis for mood
enhancement, especially in the context of decreased motivation to seek pleasure
otherwise. Negative symptoms may drive cannabis use in schizophrenia and its risk
states, which may exacerbate positive symptoms. By contrast, CHR patients do not
report using cannabis to 'self-medicate' emergent positive symptoms. The
understanding of motives for cannabis use among CHR patients may be informative
for treatments aimed at reducing use, such as motivational interviewing.
© 2013 Wiley Publishing Asia Pty Ltd.
DOI: 10.1111/eip.12112
PMCID: PMC4033707
320. Cad Saude Publica. 2018 Mar 29;34(4):e00040017. doi: 10.1590/0102-

311X00040017.
Prevalence and characteristics of adverse drug events in Brazil.

publisher]
Sousa LAO(1), Fonteles MMF(1), Monteiro MP(1), Mengue SS(2), Bertoldi AD(3),
Pizzol TDSD(4), Tavares NUL(5), Oliveira MA(6), Luiza VL(6), Ramos LR(7), Farias
MR(8), Arrais PSD(1).
Author information:
(1)Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do
Ceará, Fortaleza, Brasil.
(2)Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul,
Porto Alegre, Brasil.
(3)Departamento de Medicina Social, Universidade Federal de Pelotas, Pelotas,
Brasil.
(4)Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto
Alegre, Brasil.
(5)Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brasil.
(6)Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de
Janeiro, Brasil.
(7)Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo,
Brasil.
(8)Centro de Ciências da Saúde, Universidade Federal de Santa Catarina,
Florianópolis, Brasil.
The aim of this study was to describe the prevalence of adverse drug events
(ADEs) and associated factors reported by users of medicines in Brazil. This was
a cross-sectional population-based study conducted from September 2013 to
February 2014 with data from the Brazilian National Survey on Access, Use, and
Promotion of Rational Use of Medicines (PNAUM). The study included all
individuals that reported the use of medicines and identified, among them, all
those reporting at least one problem with the medicine's use. A descriptive
analysis was performed to estimate ADE prevalence and 95% confidence intervals
(95%CI) among the target variables. Crude and adjusted prevalence ratios were
calculated using Poisson regression to investigate factors associated with ADEs.
Overall ADE prevalence in Brazil was 6.6% (95%CI: 5.89-7.41), and after
multivariate analysis, higher prevalence was associated with female gender,
residence in the Central and Northeast regions, consumption of more medicines,
"bad" self-rated health, and self-medication. The drugs most frequently reported
with ADEs were fluoxetine, diclofenac, and amitriptyline. The most frequent ADEs
were somnolence, epigastric pain, and nausea. Most reported ADEs were mild,
avoidable, and associated with medicines used frequently by the population. The
study provided knowledge on the size of the problem with use of medicines in
Brazil.
Publisher: O presente trabalho tem como objetivo descrever a prevalência e

fatores associados a eventos adversos a medicamentos (EAM) referidos por usuários
de medicamentos no Brasil. Trata-se de um estudo transversal de base
populacional, realizado no período de setembro de 2013 a fevereiro de 2014, com
dados coletados na Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso
Racional de Medicamentos (PNAUM). Foram consideradas todas as pessoas que
referiram o uso de medicamentos; entre elas, foram identificadas as que referiram
pelo menos um problema com o uso do medicamento. Realizou-se uma análise
descritiva para estimar a prevalência e os intervalos de 95% de confiança (IC95%)
de EAM entre as variáveis estudadas, e foram calculadas as razões de prevalência
bruta e ajustada, pela regressão de Poisson, na investigação dos fatores
associados aos EAM. A prevalência de EAM no Brasil foi de 6,6% (IC95%:
5,89-7,41), sendo maior e estatisticamente significante após a realização da
análise multivariada, entre pessoas do sexo feminino; residentes nas regiões
Centro-oeste e Nordeste; que consumiam maior número de medicamentos; que
percebiam seu estado de saúde como “ruim”; e que se automedicavam. Os EAM foram
mais relatados para os medicamentos fluoxetina, diclofenaco e amitriptilina. Os
EAM mais referidos pelos entrevistados foram sonolência, dor epigástrica e
náuseas. Os EAM mais referidos pelos entrevistados foram de natureza leve,
considerados evitáveis e estiveram associados a medicamentos de uso frequente
pela população. Em razão desse estudo, foi possível conhecer a dimensão do
problema ocasionado pelo uso de medicamentos no Brasil.Publisher: El presente
trabajo tiene como objetivo describir la prevalencia y factores asociados a
eventos adversos con medicamentos (EAM), informados por usuarios de medicamentos
en Brasil. Se trata de un estudio transversal de base poblacional, realizado
durante el período de septiembre de 2013 a febrero de 2014, con datos recogidos
en la Encuesta Nacional sobre el Acceso, Utilización y Promoción del Uso Racional
de Medicamentos en Brasil (PNAUM). Se consideraron a todas las personas que
informaron del uso de medicamentos; entre ellas, se identificaron a las que
informaron de por lo menos un problema con el uso del medicamento. Se realizó un
análisis descriptivo para estimar la prevalencia y los intervalos de confianza a
95% (IC95%) de EAM entre las variables estudiadas, y se calcularon las razones de
prevalencia bruta y ajustada, por la regresión de Poisson, en la investigación de
los factores asociados a los EAM. La prevalencia de EAM en Brasil fue de un 6,6%
(IC95%: 5,89-7,41), siendo mayor y estadísticamente significante tras la
realización del análisis multivariado, entre personas del sexo femenino;
residentes en las regiones Centro-Oeste y Nordeste; que consumían un mayor número
de medicamentos; que percibían su estado de salud como “malo”; y que se
automedicaban. Se informaron de más EAM en medicamentos como: fluoxetina,
diclofenaco y amitriptilina. Los EAM más referidos por los entrevistados fueron
somnolencia, dolor epigástrico y náuseas. Los EAM más referidos por los
entrevistados fueron de naturaleza leve, considerados evitables y estuvieron
asociados a medicamentos de uso frecuente por la población. Con motivo de este
estudio, fue posible conocer la dimensión del problema ocasionado por el uso de
medicamentos en Brasil.
DOI: 10.1590/0102-311X00040017
321. BJPsych Bull. 2016 Dec;40(6):314-317. doi: 10.1192/pb.bp.115.052886.
Non-medical use of olanzapine by people on methadone treatment.
James PD(1), Fida AS(2), Konovalov P(3), Smyth BP(4).
Author information:
(1)Health Service Executive, Louth/Meath, Ireland.
(2)Chilliwack, British Columbia, Canada.
(3)Dublin North City and County CAMHS, Dublin, Ireland.
(4)Department of Public Health and Primary Care, Trinity College Dublin, Ireland;
Health Service Executive, Dublin, Ireland.
Aims and method We examined non-medical use (NMU) of olanzapine among adults on
methadone treatment. Information was collected on patient demographics and NMU of
olanzapine. The Alcohol, Smoking and Substance Involvement Screening Test
(ASSIST) was administered to assess risk among current users of olanzapine.
Results Ninety-two clients participated and 30% reported lifetime history of NMU
of olanzapine. Nine people reported doses of 30 mg or higher on a typical day of
use, with three typically using 100 mg. The most common reasons for use were to
relieve anxiety and to aid sleep, but a quarter used it to 'get stoned'. Eleven
participants (12%) reported NMU of olanzapine in the preceding month. Eight
completed the ASSIST with four scoring in the high-risk zone. Clinical
implications Self-medication is the dominant motivator for NMU of olanzapine, but
hedonic motivations also occur. A small minority show features of dependency. All
doctors should be aware of the potential NMU of olanzapine, especially among
patients with history of addiction.
DOI: 10.1192/pb.bp.115.052886
PMCID: PMC5353524
PMID: 28377810
Conflict of interest statement: Declaration of interest B.P.S. reports personal

fees from Lilly Pharmaceuticals, Shire Pharmaceuticals and Bayer Limited, outside
the submitted work.
322. BMC Fam Pract. 2016 Jun 3;17:63. doi: 10.1186/s12875-016-0463-6.
Combined assessment of clinical and patient factors on doctors' decisions to

prescribe antibiotics.
Strumiło J(1), Chlabicz S(2), Pytel-Krolczuk B(2), Marcinowicz L(2),

Rogowska-Szadkowska D(2), Milewska AJ(3).
Author information:
(1)Department of Family Medicine and Community Nursing, Medical University of
Białystok, Mieszka I 4B, 15-054, Białystok, Poland.
julia.strumilo@poczta.onet.pl.
(2)Department of Family Medicine and Community Nursing, Medical University of
Białystok, Mieszka I 4B, 15-054, Białystok, Poland.
(3)Department of Statistics and Medical Informatics, Medical University of
Białystok, Białystok, Poland.
BACKGROUND: Antibiotic overprescription is a worldwide problem. Decisions

regarding antibiotic prescription for respiratory tract infections (RTIs) are
influenced by medical and non-medical factors.
METHODS: In family medicine practices in Białystok, Poland, family medicine
residents directly observed consultations with patients with RTI symptoms. The
observing residents completed a questionnaire including patient data, clinical
symptoms, diagnosis, any prescribed antibiotic, and assessment of ten patient
pressure factors.
RESULTS: Of 1546 consultations of patients with RTIs, 54.26 % resulted in
antibiotic prescription. Antibiotic prescription was strongly associated with
rales (OR 26.90, 95 % CI 9.00-80.40), tonsillar exudates (OR 13.03, 95 % CI
7.10-23.80), and wheezing (OR 14.72, 95 % CI 7.70-28.10). The likelihood of
antibiotic prescription was increased by a >7-day disease duration (OR 3.94, 95 %
CI 2.80-5.50), purulent nasal discharge (OR 3.87, 95 % CI 2.40-6.10), starting
self-medication with antibiotics (OR 4.11, 95 % CI 2.30-7.30), and direct request
for antibiotics (OR 1.87, 95 % CI 1.30-2.80). Direct request not to prescribe
antibiotics decreased the likelihood of receiving antibiotics (OR 0.34, 95 % CI
0.27-0.55).
CONCLUSION: While clinical signs and symptoms principally impact prescribing
decisions, patient factors also contribute. The most influential patient pressure
factors were starting self-medication with antibiotics, and directly requesting
antibiotic prescription or no antibiotic prescription. Interventions aiming to
improve clinical sign and symptom interpretation and to help doctors resist
direct patient pressure could be beneficial for reducing unnecessary antibiotic
prescribing.
DOI: 10.1186/s12875-016-0463-6
PMCID: PMC4891944
323. Iran J Med Sci. 2014 Nov;39(6):584-8.
A Case of Self-treatment Induced Recurrent Fixed Drug Eruptions Associated with

the Use of Different Fixed Dose Combinations of Fluoroquinolone-Nitroimidazole.
Pal A(1), Sen S(1), Das S(1), Biswas A(1), Tripathi SK(1).
Author information:
(1)Department of Clinical and Experimental Pharmacology, Calcutta School of
Tropical Medicine, Kolkata, West Bengal, India.
A young male patient used fixed dose combinations of different fluoroquinolones

and nitroimidazoles several times in the last few years for self-treating
repeated episodes of diarrhea and loose motion. Each time, he experienced fixed
drug eruptions that increased in number and severity on subsequent occasions.
Suspecting association between the drug and the rashes, the patient each time
discontinued the treatment prematurely, and preferred to switch to a similar
formulation next time, but with different molecules of fluoroquinolone
(ciprofloxacin or ofloxacin) and nitroimidazole (tinidazole or ornidazole). He
could not however avoid the rash. This time the patient presented with multiple,
round-to-oval, well-defined, hyperpigmented cutaneous patches of different
dimensions, all over the body. He appeared to have run out of options and
therefore consulted us seeking advice on how he should treat himself next time he
suffered from diarrhea. Causality assessment by Naranjo's algorithm revealed a
definite relationship between the cutaneous adverse reaction and the offending
drug. He was counselled regarding medication in general and advised, in
particular, to avoid the tendency to self-treat any future episode of diarrhea.
PMCID: PMC4242996
PMID: 25429184
324. J Anesth Perioper Med. 2017 Nov 28;4(6):274-281. Epub 2017 Nov 2.
Patient-Reported Outcome Measures (PROM) as A Preoperative Assessment Tool.
Kim S(1)(2), Duncan PW(2)(3), Groban L(2)(4), Segal H(5), Abbott RM(3),
Williamson JD(1)(2).
Author information:
(1)Department of Internal Medicine, Winston-Salem, NC, USA.
(2)Sticht Center on Aging, Winston-Salem, NC, USA.
(3)Department of Neurology, Winston-Salem, NC, USA.
(4)Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem,
NC, USA.
(5)Fisher Center for Hereditary Cancer AND Clinical Genomics Research, Georgetown
University, Washington, D.C., USA.
Aim of review: Patient-reported outcomes (PRO) on functional, social, and

behavioral factors might be important preoperative predictors of postoperative
outcomes. We conducted a literature review to explore associations of
preoperative depression, socioeconomic status, social support, functional
status/frailty, cognitive status, self-management skills, health literacy, and
nutritional status with surgical outcomes.
Methods: Two electronic data bases, including PubMed and Google Scholar, were
searched linking either depression, socioeconomic status, social support,
functional status/frailty, cognitive status, self-management skills, health
literacy, or nutritional status with surgery, postoperative complications, or
perioperative period within the past 2 decades.
Recent findings: Preoperative depression has been linked to postoperative
delirium, complications, persistent pain, longer lengths of stay, and mortality.
Socioeconomic status associates with overall and cancer-free survival. Low
socioeconomic status has also been connected to medication noncompliance.
Social support can predict overall and cancer- free survival, as well as
physical, social and emotional quality of life. Poor functional status and
frailty have been related to postoperative complications, longer lengths of stay,
post-discharge institutionalization, and higher costs. Preoperative cognitive
impairment also associates with self-medication management errors, postoperative
cognitive impairment, delirium, complications and mortality. In addition, a
greater tendency for reduced adherence to preoperative medication instructions
has been linked to health illiteracy. Preoperative malnutrition is prevalent and
associates with postoperative morbidity.
Conclusion: Efficient and effective assessments of social and behavioral
determinants of health, functional status, health literacy, patient's perception
of health, and preferences for self-management may improve postoperative
management and surgical outcomes, particularly among vulnerable patients
undergoing elective surgery who might have subtle physical, social, or
psychological deficits or challenges, otherwise missed upon routine evaluation.
Patient Reported Outcome Measures (PROMs) can be used to effectively and
efficiently collect these factors in the preoperative period, thereby identifying
areas that can be intervened preemptively. (Partially Funded by the National
Institute on Aging and the Wake Forest University Claude D. Pepper Older
Americans Independence Center.).
PMCID: PMC5766034
PMID: 29333531
Conflict of interest statement: The authors have no other potential conflicts of

interest for this work.
325. Front Pharmacol. 2017 May 26;8:305. doi: 10.3389/fphar.2017.00305. eCollection

2017.
Campania Preventability Assessment Committee (Italy): A Focus on the

Preventability of Non-steroidal Anti-inflammatory Drugs' Adverse Drug Reactions.
Sessa M(1), Sportiello L(1), Mascolo A(1), Scavone C(1), Gallipoli S(1), di Mauro
G(1), Cimmaruta D(1), Rafaniello C(1), Capuano A(1).
Author information:
(1)Section of Pharmacology "L. Donatelli", Department of Experimental Medicine,
Campania Pharmacovigilance and Pharmacoepidemiology Regional Centre, University
of Campania "Luigi Vanvitelli"Naples, Italy.
Purpose: This study aims to investigate preventability criteria of adverse drug

reactions (ADRs) involving non-steroidal anti-inflammatory drugs (NSAIDs) by
analyzing individual case safety reports (ICSRs) sent through Campania region
(Italy) spontaneous reporting system from July 2012 to October 2016. Methods: For
all the ICSRs that reported NSAIDs as suspected drug, a trained multidisciplinary
team of Campania Pharmacovigilance Regional Centre composed of clinical
pharmacologists and pharmacists with pluriannual experience in Pharmacovigilance
assessed preventability by using the P-method. Results: In all 19,039 ICSRs were
sent to Campania Pharmacovigilance Regional Centre, of which 550 reported NSAIDs
as suspected drug. In total, 94 cases (17.1%) out of 550 ICSRs were preventable.
In the 94 preventable cases, 201 critical criteria were detected of which 182/201
(90.5%) related to healthcare professionals' practices, 0/201 (0.0%) to drug
quality, and 19/201 (9.5%) to patient behavior. The most detected critical
criteria were the necessary medication not given (52/182; 28.6%), labeled
drug-drug interaction (36/182; 19.7%), incorrect drug administration duration
(31/182; 16.9%), wrong indication (26/182; 14.2%), therapeutic duplication
(18/182; 10.0%), and documented hypersensitivity to administered drug or drug
class (10/182; 5.6%). In seventeen (18.1%) preventable cases, there were 19
critical criteria involving non-compliance (15/19 critical criteria; 78.9%) and
self-medication with the non-over-the-counter drugs (4/19 critical criteria;
21.1%). In all, 17 out 94 (18.1%) preventable cases involved over-the-counter
drugs. Conclusion: A call for action for Campania Pharmacovigilance Regional
Centre is necessary in order to promote initiatives to increase the awareness of
healthcare professionals and citizens on the risk associated with inappropriate
use of NSAIDs.
DOI: 10.3389/fphar.2017.00305
PMCID: PMC5445158
PMID: 28603499
326. Biol Pharm Bull. 2016;39(11):1767-1773.
Use of Pharmacist Consultations for Nonprescription Laxatives in Japan: An Online

Survey.
Shibata K(1), Matsumoto A, Nakagawa A, Akagawa K, Nakamura A, Yamamoto T, Kurata

N.
Author information:
(1)Division of Community Healthcare and Pharmacy, Department of Healthcare and
Regulatory Sciences, School of Pharmacy, Showa University.
Community pharmacies in Japan have long been advocated as effective sources of

nonprescription medicines and health-related advice. Consumers sometimes
self-treat symptoms of minor illnesses without consulting a pharmacist because
the benefits of such consultations are not adequately recognized. The aim of this
study was to investigate the use and impact of pharmacist consultations before
purchase of nonprescription laxatives. An online survey was conducted July 14-22,
2012 with 500 respondents (250 men, 250 women), ranging 20-60 years old. All
participants had purchased nonprescription laxatives for constipation within the
past year. Stratified analysis was used to compare responses in groups that had
and had not consulted a pharmacist before purchase. Consulting a pharmacist
appears to improve consumers' awareness and makes them more likely to use
appropriate medication. Those who consulted a pharmacist were better able to
identify side effects and take appropriate action than the group that did not
consult the pharmacist. Those who consulted a pharmacist were also significantly
more likely to say that they would consult a pharmacist in the future. These
results indicate that it is important for consumers to be able to consult with
pharmacists, to improve consumers' awareness of side effects and to self-medicate
appropriately, and hence improve their quality of life. Pharmacists in community
pharmacy could be more active in health promotion campaigns, such as drug safety,
campaigns, to raise their public profile. Increased public awareness of what
pharmacists in community pharmacy do will make it easier for patients to consult
with them.
DOI: 10.1248/bpb.b16-00008
327. Bull World Health Organ. 2018 Feb 1;96(2):141-144. doi: 10.2471/BLT.17.199687.
Epub 2018 Jan 10.
Complex determinants of inappropriate use of antibiotics.
Tangcharoensathien V(1), Chanvatik S(1), Sommanustweechai A(1).
Author information:
(1)International Health Policy Program, Ministry of Public Health, Nonthaburi
11000, Thailand.
DOI: 10.2471/BLT.17.199687
PMCID: PMC5791781
328. Acta Pol Pharm. 2015 Sep-Oct;72(5):1027-38.
OPINIONS AND ATTITUDES OF CZECH CITIZENS ON SELECTED ISSUES OF DRUGS IN SOCIETY.
Kostriba J, Kotlarova J, Vlcek J.
The social sciences within health care and pharmacy provide various points of
view on issues often managed by professionals both inside and outside of the
health care system. This multidisciplinary perspective often leads to divergent
views and sometimes seemingly contradictory viewpoints and solutions. This paper
is devoted to the opinions and attitudes of Czech citizens on selected issues of
healthcare and pharmacy, the elucidation of which could be a source for
understanding the relationships among participants in our pluralist health care
system as a whole. This article presents the results of a sociological survey
featuring a representative sample in terms of gender, age and region of 1,797
respondents from the Czech population aged 15 and over. The research is focused
on the issues of self-medication, choice of pharmacy, out of pocket expenditures
on prescription drugs and over-the-counter medicines, experiences with side
effects and finally an evaluation of patient comprehension of information
leaflets accompanying health care products. According to the results presented
here, at the onset of a health problem most of the population tries to treat the
condition themselves before seeing a doctor (54.1% always, 30.9% sometimes).
Over-the-counter drugs are purchased generally in classic pharmacies without
self-service (96.1%). The choice of pharmacy is determined primarily by
proximity, with much less importance placed on personal experience or lower
price. According to the survey, Czechs spend around 150 CZK (€ 5.9) for
over-the-counter medicines and around 143 CZK (€ 5.6) for prescription drugs per
month; 77.9% of Czech citizens were shown to understand the information provided
on package leaflets. These data help to understand the perception, orientation
and behavior of the patient in the healthcare system, with the ultimate goal of
leading to higher system effectiveness as well as greater satisfaction for all
parties involved.
329. J Ayub Med Coll Abbottabad. 2016 Jul-Sep;28(3):545-549.
Understanding Health Seeking Behavior Of Health Care Professionals In Tertiary

Care Hospitals In Pakistan.
Bana S(1), Yakoob J(2), Jivany N(1), Faisal A(1), Jawed H(1), Awan S(2).
Author information:
(1)Department of Health and Hospital Management,Aga Khan University, Karachi,
Pakistan.
(2)Institute of Business Management & Department of Medicine, Aga Khan
University, Karachi, Pakistan.
BACKGROUND: Health seeking behaviour refers to the behaviour of people towards

seeking their own health through provided health services. The medical
professionals are at a higher risk of avoiding health seeking behaviour because
they believe they are aware of the diseases and their symptoms as well as the
pharmaceutical management of the disease. The aim of this study was to understand
the healthcare seeking behaviour of nurses and doctors as well as the factors
affecting it in hospitals of a major city in a developing country.
METHODS: A cross-sectional study was designed and a self-report questionnaire was
distributed to healthcare workers at four tertiary care hospitals from July, 2012
to December, 2014. A total of 1015 participants responded. There were 234 (23%)
doctors, 664 (65%) nurses, 60 (6%) pharmacist and 57 (6%) paramedical staff.
RESULTS: The doctors 194 (83%) had a greater access to medical facilities
compared to nurses 278 (42%) (p<0.001). Doctors 176 (75%) compared to nurses 262
(39%) were utilizing healthcare service more often (p<0.001). Majority of the
nurses 494 (74%) never visited a doctor for any complaint over a period of one
year compared to doctors 132 (56%) (p=0.002). Doctors 234 (100%) and nurses 662
(99.7%) equally self -medicated themselves (p=0.401). Nurses 134 (20%) were less
aware of the organization policies offered for employees ill-health compared to
doctors 102 (44%) (p<0.001). Nurses 530 (80%) were also less aware of the
significance of regular health check-ups compared to doctor 234 (100%) (p<0.001).
CONCLUSIONS: Among the healthcare workers, doctors have greater access to
healthcare facilities. Majority of nurses do not seek healthcare when they get
sick. Self-medication is common in both groups.
330. Drug Alcohol Depend. 2018 Apr 1;185:10-16. doi:

10.1016/j.drugalcdep.2017.11.035.
Epub 2018 Feb 2.
Factors associated with sedative use and misuse among heroin users.
Moses TEH(1), Lundahl LH(1), Greenwald MK(2).
Author information:
(1)Department of Psychiatry and Behavioral Neurosciences, School of Medicine,
Wayne State University, Detroit, MI 48201, USA.
(2)Department of Psychiatry and Behavioral Neurosciences, School of Medicine,
Wayne State University, Detroit, MI 48201, USA; Department of Pharmacy Practice,
Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University,
Detroit, MI 48201, USA. Electronic address: mgreen@med.wayne.edu.
BACKGROUND: Rates of both opioid and sedative use and misuse are rising. Comorbid
opioid and sedative use is associated with especially severe consequences (e.g.,
overdose and poor health outcomes). Heroin users report multiple motivations for
sedative use, including self-medication. We aimed to understand differences in
lifetime substance use characteristics between heroin users with different
sedative use histories.
METHODS: Substance use data were collected from 385 non-treatment seeking heroin
users. Subjects were divided into four lifetime sedative-use groups: no use,
medical use only, non-medical use only, and mixed medical and non-medical use. We
examined patterns of use of various substances of abuse (tobacco, alcohol,
marijuana, cocaine, heroin, and sedatives) and individual characteristics
associated with each.
RESULTS: Non-medical sedative use (alone or in addition to medical use) was
associated with more negative consequences from using all substances. Medical
sedative use alone was not related to increased overdose or emergency room visits
associated with heroin use. Non-medical sedative use was associated with
increases in 15 of the 21 measured heroin consequences and only one of those -
health problems - was also associated with medical sedative use.
CONCLUSIONS: Concomitant non-medical sedative use and heroin use is associated
with significantly greater negative outcomes than those experienced by heroin
users who report use of sedatives only as prescribed. Understanding these
differences offers insight into risks related to using both substances and may
help treatment providers create targeted harm reduction interventions for this
population.
DOI: 10.1016/j.drugalcdep.2017.11.035
PMCID: PMC5889740
331. Ital J Pediatr. 2018 Apr 4;44(1):44. doi: 10.1186/s13052-018-0486-9.
Clinical characteristics of headache in Italian adolescents aged 11-16 years: a

cross-sectional questionnaire school-based study.
Foiadelli T(1), Piccorossi A(2), Sacchi L(3), De Amici M(4), Tucci M(5),
Brambilla I(4), Marseglia GL(4), Savasta S(4), Verrotti A(2).
Author information:
(1)Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University
of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100,
Pavia, Italy. thomas.foiadelli@gmail.com.
(2)Department of Pediatrics, University of L'Aquila, San Salvatore Hospital,
L'Aquila, Italy.
(3)Department of Electrical, Computer and Biomedical Engineering, University of
Pavia, Pavia, Italy.
(4)Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University
of Pavia, Pediatric Clinic, I.R.C.C.S. Policlinico "S. Matteo" Foundation, 27100,
Pavia, Italy.
(5)Laboratorio Adolescenza association, Pavia, Italy.
BACKGROUND: The purpose of this study was to determine headache characteristics,

impact on daily activities and medication attitudes among a large sample of
adolescents in Italy.
METHODS: Secondary school classes were randomly selected from a national
stratified multistage sampling. Data regarding socio-familial factors, headache
characteristics, impact on daily activities and medication use were recorded with
an anonymous multiple-choice questionnaire.
RESULTS: The survey involved 2064 adolescents. 1950 questionnaires were
considered for analysis. Study population included 944 males (48.4%) and 1006
females (51.6%), aged between 11 and 16 years (mean 13.5 ± 1.87). Headache
prevalence was 65.9%. Mean age at headache onset was 8.33 years. 9.8% suffered
from headache > 1/week, 14.3% > 1/month, 24.2% monthly and 17.7% less than
monthly. The mean duration of a headache episode was less than 30 min in 32.9%, 1
hour in 28.1%, 2 hours in 19.3% and several hours in 19.5%. Pain intensity was
moderate in 52.2% and severe in 9.5%. School represented the main trigger factor
(67%). Impact on daily activities was noted in 57.5%. 69.2% of adolescents
reported the use of pain relievers. Up to 5.7% declared self-medication, while
only 20.6% followed a physician's prescription. Female adolescents experienced
headache more frequently (70.2% vs 60%) and more intensely than male peers. Girls
had a higher family history of headache, could more frequently identify a trigger
factor, and were more affected into their daily activities than boys.
CONCLUSIONS: Population-based studies of headache disorders are important, as
they inform needs assessment and underpin service policy for a disease that is a
public-health priority. Headache has a high prevalence among adolescents and
carries a significant burden in terms of impact on daily activities and use of
medication. Furthermore, underdiagnose is common, while trigger factors are often
detectable. Special consideration should be given to female adolescents and
self-medication attitudes.
DOI: 10.1186/s13052-018-0486-9
PMCID: PMC5885291
332. BMC Infect Dis. 2017 Nov 28;17(1):734. doi: 10.1186/s12879-017-2819-5.
Awareness, discussion and non-prescribed use of HIV pre-exposure prophylaxis

among persons living with HIV/AIDS in Italy: a Nationwide, cross-sectional study
among patients on antiretrovirals and their treating HIV physicians.
Palummieri A(1), De Carli G(2), Rosenthal É(3), Cacoub P(4)(5)(6)(7), Mussini

C(8), Puro V(1); PrEPventHIV Italy Study Group.
Collaborators: Ladisa N, Maggiolo F, Rizzi M, Calza L, Colangeli V, Girometti N,

Ferraresi A, Focà E, Giorgetti PF, Pezzoli MC, Celesia BM, Pinzone MR, Bruno T,
Viada A, Vitullo D, Guardigni V, Sighinolfi L, Ambu S, Bartolozzi D, Campolmi I,
Meli M, Pozzi M, Sterrantino G, Matarazzo F, Purificato F, Anzalone E, Sarracino
L, Lichtner M, Marocco R, Mercurio VS, Castelli P, Paoli Martorelli L, Linzalone
A, Eseme FE, Raise E, Bossolasco S, Castagna A, Cernuschi M, Cinque P, Fumagalli
L, Gaiera G, Gianotti N, Guffanti M, Maillard M, Nozza S, Spagnuolo V,
Uberti-Foppa C, Borghi V, Mussini C, Chessa L, Matta L, Pasetto MC, D'Esposito G,
Franco A, Izzo CM, Manzillo E, Marocco A, Micillo R, Pizzella T, Martini S,
Moretti MV, Schiaroli E, Catalani C, Giorgi M, Menichini B, Trezzi M, Migliore S,
Ballardini G, Barchi E, Garlassi E, Magnani G, Prati F, Testa L, Ursitti MA,
Zoboli G, Teti E, Buonomini AR, Cerva C, D'Anna G, Ilari B, Malagnino V, Sarmati
L, Ammassari A, Bellagamba R, Boumis E, Cicalini S, Liuzzi G, Loiacono L,
Migliorisi P, Nicastri E, Pinnetti C, Sampaolesi A, Tommasi C, Zaccarelli M,
Angileri R, Coscia M, d'Ettorre G, Fantauzzi A, Iaiani G, Mezzaroma I, Paoletti
F, Zaccaria M, De Luca A, Rossetti B, Pomi M, Carnicelli N, Gonnelli A, Marri D,
Toscano L, Armignacco O, Capino AR, Caterini AL, Di Filippo B, Ialungo AM,
Rastrelli E, Sabatini R, De Carli G, Palummieri A, Puro V.
Author information:
(1)National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS,
Department of Epidemiology, Pre-clinical Research and Advanced Diagnostics, via
Portuense, 292, 00149, Roma, Italy.
(2)National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS,
Department of Epidemiology, Pre-clinical Research and Advanced Diagnostics, via
Portuense, 292, 00149, Roma, Italy. gabriella.decarli@inmi.it.
(3)Centre Hospitalier Universitaire de Nice, Service de Médecine Interne,
F-06200, Nice, France.
(4)Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and
Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris,
France.
(5)INSERM, UMR_S 959, F-75013, Paris, France.
(6)CNRS, FRE3632, F-75005, Paris, France.
(7)AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine
and Clinical Immunology, F-75013, Paris, France.
(8)Università degli Studi di Modena e Reggio Emilia, Infectious Diseases Clinics,
Modena, Italy.
BACKGROUND: Before Pre-Exposure Prophylaxis (PrEP) was officially recommended and

made available, a few surveys among gay and bisexual men, and persons living with
HIV/AIDS (PLWHA), identified an informal use of antiretrovirals (ARVs) for PrEP
among HIV-negative individuals. Before PrEP availability in Italy, we aimed to
assess whether PLWHA in Italy shared their ARVs with HIV-negative individuals,
whether they knew people who were on PrEP, and describe the level of awareness
and discussion on this preventive measure among them and people in their close
circle.
METHODS: Two anonymous questionnaires investigating personal characteristics and
PrEP awareness, knowledge, and experience were proposed to HIV specialists and
their patients on ARVs in a one-week, cross-sectional survey (December
2013-January 2014). Among PLWHA, a Multivariable Logistic Regression analysis was
conducted to identify factors associated with PrEP discussion with peers (close
circle and/or HIV associations), and experience (use in close circle and/or
personal ARV sharing).
RESULTS: Eighty-seven specialists in 31 representative Infectious Diseases
departments administered the questionnaire to 1405 PLWHA. Among specialists, 98%
reported awareness, 65% knew the dosage schedule, and 14% had previously
suggested or prescribed PrEP. Among PLWHA, 45.6% were somehow aware, discussed or
had direct or indirect experience of PrEP: 38% "had heard" of PrEP, 24% were
aware of studies in HIV-negative individuals demonstrating a risk reduction
through the use of ARVs, 22% had discussed PrEP, 12% with peers; 9% reported PrEP
use in close circle and 1% personal ARV sharing. Factors predictive of either
PrEP discussion with peers or experience differed between men and women, but
across all genders were mainly related to having access to information, with HIV
association membership being the strongest predictor.
CONCLUSIONS: At a time and place where there were neither official information
nor proposals or interventions to guide public policies on PrEP in Italy, a
significant number of PLWHA were aware of it, and approximately 10% reported PrEP
use in their close circle, although they rarely shared their ARVs with uninfected
people for this purpose. Official policies and PrEP availability, along with
implementation programs, could avoid risks from uncontrolled PrEP procurement and
self-administration practices.
DOI: 10.1186/s12879-017-2819-5
PMCID: PMC5704632
333. Med Sante Trop. 2018 Feb 1;28(1):5-11. doi: 10.1684/mst.2018.0750.
State of the fight against informal market of medicines in Togo: approaches and
limitations.
Gnassingbe A(1), Flahault A(1), Geissbuhler A(2), Sprumont D(3), Awesso A(4).
Author information:
(1)Institut de santé globale, Faculté de médecine, Université de Genève, Suisse.
(2)Département de radiologie et informatique médicale, Faculté de médecine,
Université de Genève, Suisse.
(3)Institut de droit de la santé, Université de Neuchâtel, Neuchâtel, Suisse,
Swiss School of Public Health, Zurich, Suisse.
(4)Département d'Anthropologie, Université de Lomé, Togo.
The extent of medicines sales and consumption in the informal market in Togo
raises many ethical and public health issues. In order to report on the situation
of public action in the fight against this practice, we conducted a qualitative
survey from 15 to 25 February 2016 in the commune of Lomé and in the Maritime
Region among the actors of control system and resource people in the general
population. This was supplemented by an analysis of Togo's pharmaceutical and
health policy documents and a literature review on the illicit drug market issues
relating to public health, political science, the social sciences applied to
health. In spite of the existence of national and international tools, household
poverty, cultural self-medication, ignorance of the population concerning the
health risks of informal market medicines, weak political commitment, weakness
regulation and enforcement, corruption, constitute obstacles to the success of
actions to combat this practice.
DOI: 10.1684/mst.2018.0750
334. Trop Med Health. 2015 Mar;43(1):11-9. doi: 10.2149/tmh.2014-19. Epub 2014 Oct
16.
Treatment-seeking Paths in the Management of Severe Malaria in Children under 15

Years of Age Treated in Reference Hospitals of Kinshasa, Democratic Republic of
Congo.
Ilunga-Ilunga F(1), Levêque A(2), Ngongo LO(3), Laokri S(4), Dramaix M(2).
Author information:
(1)Institut Supérieur des Techniques Médicales de Kinshasa , RD Congo ;
Université Libre de Bruxelles, School of Public Health, Research Centre in
Epidemiology, Biostatistics and Clinical Research , Brussels, Belgium.
(2)Université Libre de Bruxelles, School of Public Health, Research Centre in
Epidemiology, Biostatistics and Clinical Research , Brussels, Belgium.
(3)Université Notre-Dame de Tshiumbe, Democratic Republic of Congo.
(4)Université Libre de Bruxelles, School of Public Health, Health Policies &
Systems Department , Brussels, Belgium.
BACKGROUND: In the Democratic Republic of Congo (DRC), few studies have focused
on treatment-seeking paths selected by caretakers for the management of severe
childhood malaria in an urban environment. The present study aims at describing
the treatment-seeking paths according to the characteristics of households, as
well as the subsequent impact on pre-hospitalisation delay and malarial fatality
and on the main syndromes associated with severe childhood malaria.
METHODS: This descriptive study included data collected at nine hospitals in
Kinshasa between January and November 2011. A total of 1,350 children, under 15
years of age and hospitalised for severe malaria, were included in the study.
RESULTS: Regarding the management of malaria, 31.5% of households went directly
to the health centre or hospital while 68.5% opted for self-medication, church
and/or traditional healing therapy. The most frequent first-line option was
self-medication, adopted by more than 61.5% of households. Nevertheless, rational
self-medication using antimalarial drugs recommended by the WHO
(artemisinin-based combinations) was reported for only 5.5% of children. Only
12.5% of households combined 2 or 3 traditional options. The following criteria
influenced the choice of a modern vs. traditional path: household socioeconomic
level, residential environment, maternal education level and religious beliefs.
When caretakers opted for traditional healing therapy, the pre-hospitalisation
delay was longer and the occurrence of respiratory distress, severe anaemia and
mortality was higher.
CONCLUSION: The implementation of a malaria action plan in the Democratic
Republic of Congo should take into account the diversity and pluralistic
character of treatment-seeking behaviours in order to promote the most
appropriate options (hospital and rational self-medication) and to avoid
detrimental outcomes.
DOI: 10.2149/tmh.2014-19
PMCID: PMC4317488
PMID: 25729313
335. J Adolesc Health. 2016 Dec;59(6):681-687. doi:

10.1016/j.jadohealth.2016.07.010.
Epub 2016 Aug 25.
Testing Longitudinal Relationships Between Binge Drinking, Marijuana Use, and

Depressive Symptoms and Moderation by Sex.
Wilkinson AL(1), Halpern CT(2), Herring AH(3), Shanahan M(4), Ennett ST(5),
Hussey JM(2), Harris KM(6).
Author information:
(1)Carolina Population Center, University of North Carolina at Chapel Hill,
Chapel Hill, North Carolina; Department of Maternal and Child Health, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill,
Chapel Hill, North Carolina. Electronic address: wilkina@live.unc.edu.
Chapel Hill, North Carolina; Department of Maternal and Child Health, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill,
Chapel Hill, North Carolina.
Chapel Hill, North Carolina; Department of Biostatistics, Gillings School of
Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill,
North Carolina.
(4)Department of Maternal and Child Health, Gillings School of Global Public
Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
Injury Prevention Research Center, University of North Carolina at Chapel Hill,
Chapel Hill, North Carolina.
(5)Department of Health Behavior, Gillings School of Global Public Health,
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Chapel Hill, North Carolina; Department of Sociology, University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina.
PURPOSE: Both substance use and depression are common in adolescence and often
comorbid. Past research has produced conflicting results on whether there is a
temporal relationship, and if so, in which direction it operates and how it may
vary by sex. We examined the longitudinal associations between substance use
frequency and depressive symptoms from adolescence into young adulthood and
whether the associations were moderated by sex.
METHODS: With data from Waves I, III, and IV of the National Longitudinal Study
of Adolescent to Adult Health (n = 9,816), we used growth curve models to test if
depressive symptoms predicted marijuana use or binge drinking frequency
(Self-Medication Model) or if substance use frequency predicted depressive
symptoms (Stress Model). Moderation by sex and age was tested for both potential
pathways.
RESULTS: Increases in adolescent depressive symptoms, compared to no symptoms,
were associated with a steeper predicted increase in marijuana use frequency from
adolescence to young adulthood. Increases in persistent binge drinking or
marijuana use frequency had concurrent positive associations with depressive
symptoms from adolescence to young adulthood, and these associations were
significantly stronger for females compared to males.
CONCLUSIONS: The results not only support the Self-Medication Model for marijuana
use but also provide modest support for the Stress Model, that substance use is
associated with depressive symptoms, especially for females.

DOI: 10.1016/j.jadohealth.2016.07.010
PMCID: PMC5123943
Conflict of interest statement: The authors have no conflicts of interest to

disclose.
336. J Child Adolesc Subst Abuse. 2015;24(1):37-45.
The Association Between Attention-Deficit Hyperactivity Disorder and Nicotine Use

Among Adolescents and Young Adults.
Symmes A(1), Winters KC(2), Fahnhorst T(2), Botzet A(2), Lee S(2), August G(2),
Realmuto G(2).
Author information:
(1)Augsburg College, Minneapolis, MN.
(2)University of Minnesota, Minneapolis, MN.
Previous research indicates that youth with ADHD are more susceptible to nicotine
use compared to those without ADHD and one explanation for this association is
the self-medication theory. The present study examines nicotine use in a
prospective sample derived from a community sampling procedure rather than a
clinical setting. Nicotine use was measured through young adulthood (mean ages:
18, 20 and 22) and three groups were compared based on childhood status:
ADHD-only, ADHD-extemalizers and control groups. Results indicated that at all
three data points, individuals with childhood ADHD plus an externalizing disorder
reported higher nicotine use on all variables compared to the ADHD group absent
of an externalizing disorder and the comparison group of non-ADHD youth. The
group differences were significant even after controlling for possible
confounding variables (age, gender, and current treatment with psychostimulant
medication). Study results are discussed in light of the self-medication
hypothesis and of the importance of including nicotine prevention programs for
adolescents and young adults with ADHD and externalizing problems.
DOI: 10.1080/1067828X.2012.756442
PMCID: PMC4306279
PMID: 25632218
337. Biomed Rep. 2017 May;6(5):539-544. doi: 10.3892/br.2017.888. Epub 2017 Apr 10.
Rosehip inhibits xanthine oxidase activity and reduces serum urate levels in a
mouse model of hyperuricemia.
Kikuchi H(1), Kogure S(1), Arai R(1), Saino K(1), Ohkubo A(2), Tsuda T(1), Sunaga
K(1).
Author information:
(1)Department of Clinical Dietetics and Human Nutrition, Faculty of
Pharmaceutical Sciences, Josai University, Sakado, Saitama 350-0295, Japan.
(2)Development Division, Ryusendo Co., Ltd., Toshimaku, Tokyo 171-0021, Japan.
Rosehip, the fruit of Rosa canina L., has traditionally been used to treat urate
metabolism disorders; however, its effects on such disorders have not been
characterized in detail. Therefore, the present study investigated the effects of
hot water, ethanol and ethyl acetate extracts of rosehip on xanthine oxidase (XO)
activity in vitro. In addition, the serum urate lowering effects of the rosehip
hot water extract in a mouse model of hyperuricemia (male ddY mice, which were
intraperitoneally injected with potassium oxonate) were investigated.
Furthermore, the influence of rosehip hot water extract on CYP3A4 activity, which
is the most important drug-metabolizing enzyme from a herb-drug interaction
perspective, was investigated. Rosehip extracts of hot water, ethanol and ethyl
acetate inhibited XO activity [half maximal inhibitory concentration (IC50)
values: 259.6±50.6, 242.5±46.2 and 1,462.8±544.2 µg/ml, respectively].
Furthermore, the administration of 1X rosehip hot water extract significantly
reduced the levels of serum urate at 8 h, which was similar when compared with
the administration of 1 mg/kg allopurinol. Rosehip hot water extract only
marginally affected CYP3A4 activity (IC50 value, >1 mg/ml). These findings
indicate that rosehip hot water extract may present as a functional food for
individuals with a high urate level, and as a therapeutic reagent for
hyperuricemic patients.
DOI: 10.3892/br.2017.888
PMCID: PMC5431748
PMID: 28529735
338. BMC Infect Dis. 2016 Sep 20;16:499. doi: 10.1186/s12879-016-1821-7.
Healthcare seeking behavior of patients with influenza like illness: comparison

of the summer and winter influenza epidemics.
Meng H(1), Liao Q(2), Suen LK(1), O'Donoghue M(1), Wong CM(2), Yang L(3).
Author information:
(1)School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
Special Administrative Region (HKSAR), China.
(2)School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
Special Administrative Region (HKSAR), China.
(3)School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
Special Administrative Region (HKSAR), China. l.yang@polyu.edu.hk.
BACKGROUND: Influenza often causes winter and summer epidemics in subtropical

regions, but few studies have investigated the difference in healthcare seeking
behavior of patients with influenza-like illness (ILI) between these two
epidemics.
METHODS: Household telephone surveys were conducted using random digit dialing in
Hong Kong during July-August 2014 and March-April 2015. One adult from each
household was interviewed for ILI symptoms and associated healthcare seeking
behaviour of themselves and one child in the household (if any), during the
preceding 30 days. Healthcare seeking behavior of respondents with self-reported
ILI was compared between summer and winter influenza. Logistic regression was
used to explore the factors associated with healthcare seeking behavior.
RESULTS: Among 516 and 539 adult respondents in the summer and winter surveys,
22.6 and 38.0 % reported ILI symptoms, and 40.9 and 46.8 % of them sought medical
care, respectively. There was no significant difference in healthcare seeking
behavior between the summer and winter epidemics, except a higher proportion of
self-medication in summer in the adult respondents. Among 155 and 182 children
reported by the adults in both surveys, the proportion of self-reported ILI was
32.9 and 40.1 % in the summer and winter surveys, respectively. Of these
children, 47.1 and 56.2 % were brought for medical consultation in summer and
winter, respectively. Women, adults with diabetes and those with symptoms of
cough, shortness of breath, and runny nose were more likely to seek medical
consultations for ILI symptoms. The factors associated with seeking medical
consultations in children with ILI symptoms included being female, age under
10 years, and with symptoms of sore throat or vomiting. Those older than 60 years
were less likely to self-medicate, whereas regular smokers and those with symptom
of sore throat were more likely to do so.
CONCLUSION: Healthcare seeking behavior of the general public was not
significantly different between these two epidemics. However ILI was associated
with increased healthcare utilization in both winter and summer epidemics in Hong
Kong.
DOI: 10.1186/s12879-016-1821-7
PMCID: PMC5029067
339. Hong Kong Med J. 2016 Feb;22 Suppl 2:S23-8.
Adverse events and poisoning from over-the-counter traditional Chinese medicine:

a population-based survey.
Kim JH(1), Chung CH, Lau CH, Goggins WB, Lau JT, Griffiths SM.
Author information:
(1)The Jockey Club School of Public Health & Primary Care, The Chinese University
of Hong Kong.

eCollection 2017.
Utilization of alternative systems of medicine as health care services in India:

Evidence on AYUSH care from NSS 2014.
Rudra S(1), Kalra A(2), Kumar A(2), Joe W(2).
Author information:
(1)Associate Fellow, Observer Research Foundation, New Delhi, India.
(2)Population Research Centre, Institute of Economic Growth, Delhi University
North Campus, Delhi, India.
AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa
and Homeopathy represents the alternative systems of medicine recognized by the
Government of India. Understanding the patterns of utilization of AYUSH care has
been important for various reasons including an increased focus on its
mainstreaming and integration with biomedicine-based health care system. Based on
a nationally representative health survey 2014, we present an analysis to
understand utilization of AYUSH care across socioeconomic and demographic groups
in India. Overall, 6.9% of all patients seeking outpatient care in the reference
period of last two weeks have used AYUSH services without any significant
differentials across rural and urban India. Importantly, public health facilities
play a key role in provisioning of AYUSH care in rural areas with higher
utilization in Chhattisgarh, Kerala and West Bengal. Use of AYUSH among
middle-income households is lower when compared with poorer and richer
households. We also find that low-income households display a greater tendency
for AYUSH self-medication. AYUSH care utilization is higher among patients with
chronic diseases and also for treating skin-related and musculo-skeletal
ailments. Although the overall share of AYUSH prescription drugs in total medical
expenditure is only about 6% but the average expenditure for drugs on AYUSH and
allopathy did not differ hugely. The discussion compares our estimates and
findings with other studies and also highlights major policy issues around
mainstreaming of AYUSH care.
PMCID: PMC5417584
341. Rev Bras Enferm. 2018;71(suppl 1):646-651. doi: 10.1590/0034-7167-2016-0680.
Factors associated with delay in seeking care by tuberculosis patients.
Dantas DNA(1), Enders BC(1), Oliveira DRC(1), Vieira CENK(1), Queiroz AAR(2),
Arcêncio RA(2).
Author information:
(1)Universidade Federal do Rio Grande do Norte, Postgraduate Program in Nursing.
Natal, Rio Grande do Norte, Brazil.
(2)Universidade de São Paulo, Ribeirão Preto College of Nursing, Nursing Doctoral
Interunits Undergraduate Program. Ribeirão Preto, São Paulo, Brazil.
OBJECTIVE: To identify social, clinical and behavioral factors of tuberculosis

patients that are associated with delay in the search for primary health care.
METHOD: This is a cross-sectional, quantitative study conducted with 56 people on
treatment for pulmonary tuberculosis in the city of Natal, in the state of Rio
Grande do Norte, Brazil. The data were collected through a structured instrument.
The Chi-square and Fisher tests were applied to test the association between
independent and dependent variables (search time). A value of p <0.05 was set as
statistically significant.
RESULTS: No social or clinical variables were statistically associated with
patient delays in the search for primary health care. Among the behavioral
variables, self-medication and the first health service sought had a
statistically significant association with the time for seeking care (p = 0.020,
and p = 0.033, respectively).
CONCLUSION: Self-medication contributes to the delay in the search for primary
health care by tuberculosis patients.
DOI: 10.1590/0034-7167-2016-0680
342. J Trauma Stress. 2018 Aug;31(4):602-612. doi: 10.1002/jts.22304. Epub 2018 Jul
20.
The Indirect Effect of Posttraumatic Stress Disorder Symptoms on Current Alcohol
Use Through Negative Cognitions in Sexual Minority Men.
Banerjee N(1), Ironson G(1), Fitch C(1), Boroughs MS(2), Safren SA(1), Powell
A(3), O'Cleirigh C(4).
Author information:
(1)Department of Psychology, University of Miami, Coral Gables, Florida, USA.
(2)Department of Psychology, University of Windsor, Windsor, Canada.
(3)Miller School of Medicine, University of Miami, Miami, Florida, USA.
(4)Department of Psychiatry, Harvard Medical School/Massachusetts General
Hospital, Boston, Massachusetts, USA.
Self-medication theory posits that some trauma survivors use alcohol to cope with
posttraumatic stress disorder (PTSD) symptoms, but the role of negative
posttraumatic cognitions in this relationship is not well defined. We examined
associations among PTSD symptoms, posttraumatic cognitions, and alcohol
intoxication frequency in 290 men who have sex with men (MSM), who reported a
history of childhood sexual abuse (CSA). Using a bootstrap approach, we examined
the indirect effects of PTSD symptoms on alcohol intoxication frequency through
posttraumatic cognitions regarding the self, world, and self-blame. In separate
regression models, higher levels of PTSD symptoms and posttraumatic cognitions
were each associated with more frequent intoxication, accounting for 2.6% and
5.2% of the variance above demographics, respectively. When examined
simultaneously, posttraumatic cognitions remained significantly correlated with
intoxication frequency whereas PTSD symptoms did not. Men reporting elevated
posttraumatic cognitions faced increased odds for current alcohol dependence,
odds ratio (OR) = 2.19, 95% CI [1.13, 4.22], compared with men reporting low
posttraumatic cognitions, independent of current PTSD diagnosis. A higher level
of PTSD symptom severity was indirectly associated with more frequent alcohol
intoxication through cognitions about the self and world; the indirect to total
effect ratios were 0.74 and 0.35, respectively. Negative posttraumatic cognitions
pertaining to individuals' self-perceptions and appraisals of the world as
dangerous may play a role in self-medication with alcohol among MSM with a
history of CSA. Interventions targeting these cognitions may offer potential for
reducing alcohol misuse in this population, with possible broader implications
for HIV-infection risk.
© 2018 International Society for Traumatic Stress Studies.
DOI: 10.1002/jts.22304
PMCID: PMC6286675
PMID: 30028033
343. Drug Alcohol Depend. 2016 Feb 1;159:101-8. doi:

10.1016/j.drugalcdep.2015.11.039.
Epub 2015 Dec 17.
Nonmedical prescription pain reliever and alcohol consumption among cannabis

users.
Novak SP(1), Peiper NC(2), Zarkin GA(3).
Author information:
(1)RTI International, Research Triangle Park, 3040 East Cornwallis Road, NC
27709, United States. Electronic address: snovak@rti.org.
27709, United States. Electronic address: npeiper@rti.org.
27709, United States. Electronic address: gaz@rti.org.
BACKGROUND: This study examined poly-drug use involving the use of cannabis with
nonmedical prescription pain reliever use (NMPR) and alcohol use.
METHODS: Computer-assisted survey data from the National Survey on Drug Use and
Health were examined. The NSDUH is an annual, cross-sectional survey of
non-institutionalized citizens in the United States (ages 12+). Replicate
analyses were conducted using the 2013 and 2003 survey waves.
RESULTS: Higher levels of cannabis use were consistently associated with more
frequent consumption of prescription pain relievers, with findings replicating in
both 2013 and 2003. While the prevalence of dual users declined from 2003 (2.5%)
to 2013 (2.3%), the average number of days used among dual users increased by an
average of 20 days over that period. These changes largely occurred among those
aged 35 or older, males, whites, and non-illicit drug users. Past-year marijuana
use increased by 16% (10.8-12.6%, p-value<.001) whereas NMPR decreased by 15%
(4.9-4.2%, p-value<.001). The largest changes occurred after 2011. Persons using
the most cannabis generally had higher levels of alcohol use relative to those
using the least amount of cannabis. There was a significant increase in the
prevalence of dual use between 2003 (10.2%) and 2013 (11.6%), while the
prevalence of past-year alcohol use remained relatively stable.
CONCLUSIONS: Clinical efforts and public health interventions should consider the
possible co-ingestion of cannabis with NMPR and alcohol, as concomitant use may
portend negative health effects in the short and long-term.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
DOI: 10.1016/j.drugalcdep.2015.11.039
PMCID: PMC4739852
344. Dermatology. 2015;231(2):99-102. doi: 10.1159/000433423. Epub 2015 Jul 1.
The Phytotherapeutic Fenugreek as Trigger of Toxic Epidermal Necrolysis.
Bentele-Jaberg N(1), Guenova E, Mehra T, Nägeli M, Chang YT, Cozzio A, French LE,
Hoetzenecker W.
Author information:
(1)Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
We describe the case of a 32-year-old woman who presented to the hospital with
generalized painful exanthema, blisters and erosions 1 month after giving birth
to a healthy girl. The patient's medical history was inconspicuous for
comorbidities; however, it included the incidental intake of pain killers and a
herbal preparation (fenugreek), which she took regularly over the last 4 weeks to
improve lactation. Based on the clinical characteristics, we suspected toxic
epidermal necrolysis (TEN), a severe cutaneous adverse drug reaction, which was
confirmed by skin biopsy. The patient was treated with high-dose intravenous
human immunoglobulins and was discharged 2 weeks after hospital admission in good
condition. The allergological workup identified fenugreek as the most likely
causative agent. Given the increased self-medication of freely available
phytotherapeutics by patients in industrialized countries, herbal mixtures should
be taken into consideration in the diagnostic workup of TEN.
DOI: 10.1159/000433423
345. Int J Drug Policy. 2018 Aug;58:64-70. doi: 10.1016/j.drugpo.2018.05.004. Epub
2018 May 26.
Quantity fluctuations of illicitly used opioids and overdose risk.
Rowe C(1), Wheeler E(2), Vittinghoff E(3), Santos GM(4), Behar E(5), Coffin
PO(6).
Author information:
(1)San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San
Francisco, CA 94102, USA. Electronic address: chris.rowe@sfdph.org.
(2)Harm Reduction Coalition, 1440 Broadway, Suite 902, Oakland, CA 94612, USA.
Electronic address: wheeler@harmreduction.org.
(3)University of California, San Francisco, 500 Parnassus Avenue, San Francisco,
CA 94143, USA. Electronic address: eric.vittinghoff@ucsf.edu.
Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus
Avenue, San Francisco, CA 94143, USA. Electronic address:
glenn-milo.santos@sfgov.org.
Francisco, CA 94102, USA. Electronic address: emily.behar@sfdph.org.
Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus
Avenue, San Francisco, CA 94143, USA. Electronic address:
phillip.coffin@sfdph.org.
BACKGROUND: Reduced opioid tolerance is believed to be associated with overdose

risk, although this relationship has primarily been examined in the context of
gaps and frequency of opioid use. We sought to assess how changes in the quantity
of opioids used, as opposed to periods of abstinence or overall frequency of use,
relate to overdose risk.
METHODS: Among repeated visits of participants of a behavioral intervention trial
from 2014 to 2016, we used multivariable logistic regression models fit with
generalized estimating equations to examine the relationship between the
percentage of opioid use days on which individuals used more or less than the
quantity they used on average (i.e., quantity volatility) and the occurrence of
opioid overdose.
RESULTS: Our sample included 290 four-month reporting periods among 63
participants (67% male). Opioid overdose events were reported by 28 (44%)
participants during 48 (17%) reporting periods. Our measure of quantity
volatility had a median of 20% (IQR 0.0-50.0). In multivariable analysis, using a
quantity different than the quantity used on average on more than 20% of all
opioid use days in the reporting period was significantly associated with odds of
any opioid overdose (Adjusted OR = 3.55, 95%CI = 1.55-8.13, p = 0.003),
controlling for confounders.
CONCLUSION: Quantity volatility of illicitly used opioids was positively
associated with overdose risk and may contribute to the complex system of
overlapping factors that influence overdose risk. Future observational research
among opioid users should collect detailed opioid use data, including quantity
used over time, to clarify the patterns that most elevate overdose risk.
DOI: 10.1016/j.drugpo.2018.05.004
PMCID: PMC6419728
346. J Clin Pharm Ther. 2017 Jun;42(3):370-371. doi: 10.1111/jcpt.12511. Epub 2017
Mar
1.
Successful intervention to mitigate an acetylcholinesterase inhibitor-induced

rhinorrhea prescribing cascade: a case report.
Vouri SM(1), Chung JM(2), Binder EF(3).
Author information:
(1)Department of Pharmacy Practice, Center for Health Outcomes Research and
Education, St. Louis College of Pharmacy, St. Louis, MO, USA.
(2)Mercy Clinic Internal Medicine and Geriatrics - Old Tesson, St. Louis, MO,
USA.
(3)Division of Geriatrics and Nutritional Science, Department of Internal
Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO,
USA.
WHAT IS KNOWN AND OBJECTIVE: A prescribing cascade if often treated by

discontinuing both medications. We describe an intervention to mitigate a
prescribing cascade while continuing a clinically necessary medication without
negatively impacting the patient.
CASE SUMMARY: A 77-year-old women experienced probable acetylcholinesterase
inhibitor-induced rhinorrhea and subsequently self-medicated with diphenhydramine
which lead to worsening cognitive function. We reduced the dose of the
acetylcholinesterase inhibitor and discontinued the diphenhydramine. The symptoms
of rhinorrhea were subsequently reduced without negatively impacting cognition.
WHAT IS NEW AND CONCLUSION: This was the first published prescribing cascade
intervention that did not require discontinuation of both medications, which may
be emulated in future prescribing cascade cases.
DOI: 10.1111/jcpt.12511
PMCID: PMC5516898
347. Afr J Prim Health Care Fam Med. 2015 May 5;7(1). doi: 10.4102/phcfm.v7i1.735.
Utilisation of a community-based health facility in a low-income urban community

in Ibadan, Nigeria.
Adebayo AM(1), Asuzu MC.
Author information:
(1)Department of Preventive Medicine and Primary Care, College of Medicine,
University of Ibadan. davidsonone@yahoo.com.
BACKGROUND: Primary healthcare is established to ensure that people have access

to health services through facilities located in their community. However,
utilisation of health facilities in Nigeria remains low in many communities.
AIM: To assess the utilisation of community-based health facility (CBHF) amongst
adults in Ibadan, Nigeria.
SETTINGS: A low-income community in Ibadan North West Local Government Area of
Oyo State.
METHODS: A cross-sectional survey was conducted using a simple random sampling
technique to select one adult per household in all 586 houses in the community. A
semi-structured interviewer-administered questionnaire was used to collect
information on respondents' sociodemographic characteristics, knowledge and
utilisation of the CBHF. Data analysis included descriptive statistics and
association testing using the Chi-square test at p = 0.05.
RESULTS: The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men
and 81.0% married; 26% had no formal education and 38.0% had secondary-level
education and above; traders constituted 52.0% of the sample; and 85.2% were of
low socioeconomic standing; 90%had patronised the CBHF. The main reasons for
non-utilisation were preference for general hospitals (13.8%) and self-medication
(12.1%). Respondents who had secondary education and above, were in a higher
socioeconomic class, who had good knowledge of the facility and were satisfied
with care, utilised the CBHF three months significantly more than their
counterparts prior to the study (p < 0.05). However, only satisfaction with
care was found to be a significant predictor of utilisation of the CBHF.
CONCLUSION: The utilisation of the CBHF amongst adults in the study setting is
high, driven mostly by satisfaction with the care received previously.
Self-medication, promoted by uncontrolled access to drugs through pharmacies and
patent medicine stores, threatens this high utilisation.
DOI: 10.4102/phcfm.v7i1.735
PMCID: PMC4564905

eCollection 2015.
Knowledge, attitude and practice towards antibiotic use among the public in
Kuwait.
Awad AI(1), Aboud EA(2).
Author information:
(1)Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University,
Kuwait City, Kuwait.
(2)Ministry of Health, Kuwait City, Kuwait.
BACKGROUND: The emergence and spread of bacterial resistance to antibiotics is a

growing problem worldwide, which presents a significant threat to public health
globally in the 21st century. A substantial evidence has shown that the general
community plays a role in the increase and spread of antibiotic resistance. The
present study was designed to determine knowledge, attitude and practice towards
antibiotic use.
METHODS: A cross-sectional survey was performed using a pretested
self-administered questionnaire on a sample of 770 randomly selected Kuwaiti
individuals. Descriptive and multivariate logistic regression analysis were used
in data analysis.
RESULTS: The response rate was 88.3%. Nearly three-quarters (72.8%) of
respondents had been prescribed antibiotics within 12 months prior to the study
period, and 36% of them had not finished the course of treatment. Over
one-quarter (27.5%) were self-medicated with antibiotics to treat mainly common
cold, sore throat and cough. Self-medication was more prevalent among those who
were prescribed antibiotics and those who had attitudes towards using and
accessing antibiotic inappropriately. Almost 47% of participants had low
knowledge regarding action, use, safety and resistance of antibiotics. Forty one
percent of respondents had attitudes towards using and accessing antibiotic
inappropriately. Better knowledge was found to be a predictor for positive
attitude. Respondents level of agreement that doctors often prescribe antibiotics
to meet the patient's expectation, and that doctors often take time to consider
carefully the need for an antibiotic were 52.7% and 35.3%, respectively.
CONCLUSIONS: These findings will aid in the assessment of the adequacy of present
public educational campaigns. Also, it will provide further insight in designing
future multifaceted interventions to promote specific messages to rationalize
antibiotic use, and compensate for knowledge and attitude gaps as an effort
towards preventing development of antibiotic resistance.
PMCID: PMC4326422

eCollection 2016.
Sport-Induced Substance Use-An Empirical Study to the Extent within a German

Sports Association.
Frenger M(1), Pitsch W(1), Emrich E(1).
Author information:
(1)Department Economics and Sociology of Sport, Faculty of Human Sciences and
Economics, Saarland University, Saarbrücken, Germany.
In cooperation with the Sports Association of the Palatinate (SBP), a survey was
conducted on substance use by recreational and amateur athletes. Distribution of
the online questionnaire took place by means of chain-referral sampling, and
questions on substance use were presented using the randomized response technique
(RRT) to protect the anonymity of respondents and prevent socially desirable
answers. The estimated lowest limit for the population share for use of
prohibited substances during the last season (4%) and for lifetime use (3.6%) did
not differ significantly. Approximately 21% of respondents had used substances
for training or competitions that were taken for a purpose other than performance
enhancement (e.g., to improve their mood or to help with recuperation from a
minor injury or illness) in the last year. 49% had done so at some point in their
life.
PMCID: PMC5082616

interests exist.
350. Saudi Pharm J. 2018 Feb;26(2):211-216. doi: 10.1016/j.jsps.2017.12.009. Epub

2017
Dec 15.
Top 10 most used drugs in the Kingdom of Saudi Arabia 2010-2015.
AlKhamees OA(1), AlNemer KA(2), Bin Maneea MW(3), AlSugair FA(4), AlEnizi BH(5),
Alharf AA(6).
Author information:
(1)Department of Pharmacology, College of Medicine, Al Imam Mohammad Ibn Saud
Islamic University (IMSIU), P.O. Box 11623, Riyadh 11544, Saudi Arabia.
(2)Department of Medicine, College of Medicine, Al Imam Mohammad Ibn Saud Islamic
University (IMSIU), P.O. Box 11623, Riyadh 11544, Saudi Arabia.
(3)Ophthalmology Resident, Ophthalmology Dep., Security Forces Hospital (SFH),
(4)Radiology Resident, Radiology Dep., King Faisal Specialist Hospital and
Research Cente (KFSHRC), Riyadh, Saudi Arabia.
(5)Orthopaedic Resident, Orthopaedics Dep., King Saud Medical City (KSMC),
(6)Saudi Food and Drug Authority, Riyadh, Saudi Arabia.
Medications usage has become a significant part of contemporary life. Many

studies indicate that there is an excessive use and a considerable waste of
medicines. This descriptive study aims at identifying the most used medicines in
Saudi Arabia from 2010 to 2015 according to the statistics of specialized
companies in the field. Comparison of the most commonly used drugs with those in
the United States aims at clarifying similarities and differences. The results
showed that the use of antibiotics and analgesics still accounted for the bulk,
followed by proton pump inhibitors and anti-diabetics respectively, then
anti-hyperlipidemic agents and erectile dysfunction treatments. The causes of
this overuse vary according to the studies concerned between the self-medications
and the over-prescription of the medication and the failure of the diagnostic and
treatment procedures (malpractice). The recommendations are the strict
application of prescribed and non-prescribed dispensing systems and the further
establishment and application of national guides in the diagnosis and treatment
of communicable diseases. The repetition of such studies is useful in reviewing
health policies and regulations related to health practice in general and
pharmacological policies in particular.
DOI: 10.1016/j.jsps.2017.12.009
PMCID: PMC6111197
PMID: 30166918
351. World J Oncol. 2016 Feb;7(1):17-20. doi: 10.14740/wjon957w. Epub 2016 Apr 3.
Unresectable Pancreatic Adenocarcinoma: Eight Years Later.
Smiley K(1), Malhotra R(2), Peche W(1), Langell JT(1)(2).
Author information:
(1)Department of Surgery, University of Utah, 50 North Medical Drive, Salt Lake
City, UT, USA.
(2)Center for Medical Innovation, University of Utah, 10 North 1900 East, Eccles
Library, Room 15, Salt Lake City, UT 84132, USA.
Pancreatic cancer is the fourth leading cause of cancer deaths in the United
States, and is considered uniformly fatal when patients present with
unresectable, advanced-stage disease at the time of diagnosis. Long-term survival
of patients with advanced-stage pancreatic adenocarcinoma remains rare, despite
advances in adjuvant chemoradiation protocols. A 73-year-old male presented to
our emergency department with abdominal pain and a history of biopsy-proven,
stage III pancreatic adenocarcinoma. His initial staging CT scan and
trans-duodenal ultrasound had demonstrated a stage IIa (T3, N0, Mx) lesion. On
surgical exploration, he was up-staged to stage III (T4, N0, Mx), noting
encasement of the superior mesenteric vessels and involvement of the portal vein.
He underwent palliative choledochojejunostomy and was treated with 4 months of
oxaliplatin and capecitabine, with concurrent radiation therapy (50.4 Gy),
followed by 4 months of gemcitabine. After 7 months, the patient withdrew from
therapy due to treatment intolerance. He then turned to self-medication with
non-traditional herbal therapies. After 3 years of surveillance, he was lost to
follow-up until presenting to our facility with abdominal pain 8 years after his
initial diagnosis. On diagnostic CT scan during his current presentation for
abdominal pain, he was found to have no evidence of pancreatic cancer. Based on
our review of the literature, we present the longest known survival of a patient
with surgically unresectable pancreatic adenocarcinoma. Further study of this
patient's phenotypic or genotypic characteristics may provide insight into better
therapeutic agents, or a predictive subset of patients who will benefit from
specific chemotherapeutic options.
DOI: 10.14740/wjon957w
PMCID: PMC5624684
PMID: 28983358
352. Rural Remote Health. 2018 Aug;18(3):4393. doi: 10.22605/RRH4393. Epub 2018 Aug
15.
Access to medicines for hypertension: a survey in rural Yogyakarta province,

Indonesia.
Rahmawati R(1), Bajorek BV(2).
Author information:
(1)Graduate School of Health, University of Technology Sydney, NSW, Australia
riana.rahmawati@uii.ac.id.
(2)Graduate School of Health, University of Technology Sydney, NSW, Australia
beata.bajorek@uts.edu.au.
INTRODUCTION: Obtaining an adequate supply of medicines is an important step in

facilitating medication adherence. This study aimed to determine (1) how people
with hypertension in rural villages in Indonesia obtain their supply of
anti-hypertensive medications, (2) the type of hypertension medication taken and
(3) factors associated with where and how people obtain their medicines supplies.
METHOD: Data pertaining to people with hypertension (age ≥45 years) were
collected from eight rural villages in the Bantul district, Yogyakarta province,
Indonesia, using a researcher-administered questionnaire.
RESULTS: Of 384 participants, 203 (52.9%) obtained anti-hypertensive medications
from public or private healthcare services. The most common way was by purchasing
these medicines without prescription in community pharmacies (n=64, 17%). The
medicines obtained this way included captopril, amlodipine, nifedipine, and
bisoprolol. One-hundred and nineteen (15%) participants obtained their medicines
at no cost by visiting public healthcare services such as community health
centres (n=51), the Integrated Health Service Post for the Elderly (n=53), and
the public hospitals (n=15). Direct dispensing from clinicians was reported by
participants who visited a doctor (n=15), midwife (n=23) or nurse (n=21). Having
access to an adequate medication supply (ie for an entire 30 days) was reported
by 40 (10.4%) participants, who obtained the medication from a community health
centre (n=18), public hospital (n=4), community pharmacy (n=5), private hospital
(n=2), or multiple sources (n=11). A higher formal education level was associated
with obtaining medicines from multiple sources rather than from the public or
private provider only. Living near a community health centre and having
government insurance were associated with obtaining medicines from the public
health service. Age, gender, employment, presence of other chronic diseases, and
knowledge about hypertension were not significantly associated with how
participants obtained their medications.
CONCLUSION: These Indonesian participants obtained their anti-hypertensive
medications from various sources; however, the inadequate supplies found in this
study could compromise both short- and long-term management of hypertension.
Direct dispensing, non-doctor prescribing, and self-medication with
anti-hypertensive medications indicate the current complex healthcare system in
Indonesia. This study also shows some challenges involved in managing patients
with chronic diseases such as hypertension in resource-poor settings. It provides
important findings for quality improvement practices that should be considered to
improve the health lifespan in populous countries such as Indonesia.
DOI: 10.22605/RRH4393
353. J Infect Dev Ctries. 2014 Oct 15;8(10):1353-5. doi: 10.3855/jidc.4957.
Therapeutic itinerary of severe malaria in adults admitted to a teaching hospital

in Dakar, Senegal.
Diop SA(1), Attinsounon CA, Fortes-Deguenonvo L, Cisse Dialo VM, Seydi M.
Author information:
(1)Centre Hospitalier Universitaire de Fann, Université Cheikh Anta Diop de
Dakar, Sénégal. sylviediop@gmail.com.
INTRODUCTION: Despite prevention efforts, malaria remains a public health

problem.
METHODOLOGY: This was a prospective study conducted between October and December
2010 that aimed to describe the therapeutic route of adults presenting with
severe malaria prior to being admitted to Fann Teaching Hospital in Dakar,
Senegal.
RESULTS: A total of 90 patients were included. The majority of them had consulted
a public or private health care facility (92%) prior to admission. First
consultation occurred on average two days after the onset of the disease.
Self-medication (67.4%) and traditional medicine (26.1%) were the main causes of
delaying care.
CONCLUSIONS: Early care and adequate management are needed to reduce malaria
mortality.
DOI: 10.3855/jidc.4957
354. Front Psychol. 2018 Mar 6;9:288. doi: 10.3389/fpsyg.2018.00288. eCollection

2018.
Tobacco Use Decreases Visual Sensitivity in Schizophrenia.
Fernandes TMP(1)(2), de Andrade MJO(1)(2), Santana JB(1)(2), Nogueira RMTBL(2),

Dos Santos NA(1)(2).
Author information:
(1)Department of Psychology, Federal University of Paraiba, João Pessoa, Brazil.
(2)Perception, Neuroscience and Behavior Laboratory, Federal University of
Paraiba, João Pessoa, Brazil.
Smoking prevalence in patients who are diagnosed with schizophrenia (SCZ) is

higher than in the general population. Chronic tobacco use in SCZ patients may
reduce the side effects of antipsychotic drugs, thus serving as a self-medication
for such side effects. Understanding the ways in which chronic tobacco use
influences visual sensitivity has clinical implications, which may serve as a
tool for non-invasively diagnosing early-stage visual processing deficits. The
present study evaluated the effects of chronic tobacco use on visual sensitivity
in SCZ patients. Our purpose was to provide new directions for future research,
mainly psychophysical and electrophysiological studies. In the present study, 40
smoker controls (SC), 20 SCZ tobacco users, and 20 SCZ tobacco nonusers were
recruited from the Psychosocial Care Center. Visual sensitivity was compared
between both SCZ groups and the SC group. Patients with SCZ who were chronic
tobacco users presented lower visual sensitivity for chromatic (p < 0.001) and
achromatic (p < 0.001) stimuli compared with the other groups. Our findings
highlight the need to evaluate possible addictive behavior in patients with SCZ,
which may contribute to public policies that seek to improve the quality of life
of SCZ patients and their families.
DOI: 10.3389/fpsyg.2018.00288
PMCID: PMC5845747
PMID: 29559947
355. Sociol Health Illn. 2015 Jul;37(6):870-87. doi: 10.1111/1467-9566.12239. Epub

2015 Feb 16.
Explanations and expectations: drug narratives among young cannabis users in

treatment.
Järvinen M(1), Ravn S(2).
Author information:
(1)Department of Sociology, University of Copenhagen and SFI - The Danish
National Centre for Social Research, Copenhagen, Denmark.
(2)SFI - The Danish National Centre for Social Research, Copenhagen, Denmark.
This article analyses how young people enrolled in drug addiction treatment in
Copenhagen, Denmark, explain their cannabis careers and how they view their
possibilities for quitting drug use again. Inspired by Mead and narrative studies
of health and illness, the article identifies four different drug use
'aetiologies' drawn upon by the interviewees. These cover childhood experiences,
self-medication, the influence of friends and cannabis use as a specific
lifestyle. A central argument of the article is that these explanations not only
concern the past but also point towards the future by assigning the interviewee a
more or less agential position in relation to drugs. Further, the drug narratives
are viewed as interactional achievements, related to the social context in which
they were produced, namely, the institutional setting of the treatment centres.
The article is based on 30 qualitative interviews with young people in drug
addiction treatment.
© 2015 The Authors. Sociology of Health & Illness published by John Wiley & Sons
Ltd on behalf of Foundation for SHIL.
DOI: 10.1111/1467-9566.12239
PMCID: PMC4690517

eCollection 2015.
Inappropriate Use of Antibiotics and Its Associated Factors among Urban and Rural
Communities of Bahir Dar City Administration, Northwest Ethiopia.
Gebeyehu E(1), Bantie L(1), Azage M(2).

Author information:
(1)Department of Pharmacology, College of Medicine and Health Sciences, Bahir Dar
University, P.O Box 79, Bahir Dar, Ethiopia.
(2)Department of Public Health, College of Medicine and Health Sciences, Bahir
Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
BACKGROUND: Inappropriate use of antibiotics in the community plays a role in the

emergence and spread of bacteria resistant to antibiotics which threatens human
health significantly. The present study was designed to determine inappropriate
use of antibiotics and its associated factors among urban and rural communities
of Bahir Dar city administration.
METHODS: A comparative cross sectional study design was conducted in urban and
rural kebeles of Bahir Dar city administration from February 1 to March 28, 2014.
A total of 1082 participants included in the study using a systematic random
sampling technique. Data was collected using pre-tested and structured
questionnaire. Data was coded and entered into SPSSS version 16 for statistical
analysis. Bivariate and multivariate logistic regression model were used to
identify factors associated with inappropriate use of antibiotics.
RESULTS: Inappropriate use of antibiotics was 30.9% without significant
difference between urban (33.1%) and rural (29.2%) communities. From the
inappropriate antibiotic use practice, self-medication was 18.0% and the
remaining (12.9%) was for family member medication. Respiratory tract symptoms
(74.6%), diarrhea (74.4%), and physical injury/wound (64.3%) were the three main
reasons that the communities had used antibiotics inappropriately. Factors
associated with inappropriate use of antibiotics were low educational status,
younger age, unsatisfaction with the health care services, engagement with a job,
and low knowledge on the use of antibiotic preparations of human to animals.
CONCLUSIONS: Inappropriate use of antibiotic exists in the study area with no
significant difference between urban and rural communities. The study indicated
an insight on what factors that intervention should be made to reduce
inappropriate use of antibiotics in the community. Interventions that consider
age groups, educational status, common health problems and their jobs together
with improvement of health care services should be areas of focus to reduce
inappropriate use of antibiotics.
PMCID: PMC4574735
357. Alcohol Res. 2018;39(2):113-120.
The Epidemiology of Post-Traumatic Stress Disorder and Alcohol Use Disorder.
Smith NDL(1), Cottler LB(1).
Author information:
(1)Nathan D. L. Smith, A.L.M., is a doctoral student in the Department of
Epidemiology, University of Florida, Gainesville, Florida. Linda B. Cottler,
Ph.D., M.P.H., F.A.C.E., is the dean's professor in the Department of
Epidemiology, University of Florida, Gainesville, Florida.
For more than 40 years, research has shown that individuals with post-traumatic
stress disorder (PTSD) use alcohol and experience alcohol use disorder (AUD) to a
greater degree than those with no PTSD. AUD and PTSD have shown a durable
comorbidity that has extended through decades and through changes in disorder
definitions. Some research shows that veterans who have experienced PTSD have a
high likelihood of developing AUD, perhaps reflecting the self-medication
hypothesis. Other research shows that people with substance use disorder are
likely to be exposed to traumatic situations and develop PTSD. These two areas of
research could represent two separate relationships between PTSD and AUD.
Finally, there is still no clear determination of which cluster of PTSD symptoms
is most closely associated with AUD.
PMCID: PMC6561398
PMID: 31198651
Conflict of interest statement: Financial Disclosure The authors declare that

they have no competing financial interests.
358. Am J Addict. 2015 Sep;24(6):532-7. doi: 10.1111/ajad.12257. Epub 2015 Aug 18.
Factors associated with illicit methadone injecting in a Canadian setting.
Tucker D(1), Milloy MJ(1)(2), Hayashi K(1)(2), Nguyen P(1)(2), Kerr T(1)(2), Wood
E(1)(2).
Author information:
(1)British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital,
Vancouver, BC, Canada.
(2)Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
BACKGROUND AND OBJECTIVES: While methadone is well established as an

evidence-based treatment for opioid use disorder, safety concerns persist
regarding its diversion. The authors examine the prevalence of and risk factors
associated with injection of methadone in an urban population.
METHODS: Between December 2005 and November 2013, data were derived from two open
prospective studies of persons who inject drugs (PWID) in Vancouver, Canada.
Generalized estimating equations (GEE) logistic regression was used to determine
factors independently associated with illicit methadone injecting.
RESULTS: During the study, 1911 individuals (34% women) were recruited; 134 (7%)
participants reported methadone injecting at least once. In multivariable
analysis, Caucasian ethnicity [adjusted odds ratio (AOR) = 1.90, 95% confidence
interval (CI) = 1.20-3.00]; homelessness (AOR = 1.46, 95% CI = 1.09-1.95); drug
dealing (AOR = 2.10, 95% CI = 1.50-2.93); ≥daily heroin injection (AOR = 1.57,
95% CI = 1.08-2.26); ≥daily crack smoking (AOR = 2.06, 95% CI = 1.44-2.95); being
a victim of violence (AOR = 1.48, 95% CI = 1.04-2.12); and non-fatal overdose
(AOR = 1.67, 95% CI = 1.67 (1.00-2.79) were independently and positively
associated with methadone injection; female gender (AOR = 0.47, 95%
CI = 0.30-0.75) was negatively associated.
DISCUSSION AND CONCLUSIONS: The diversion of methadone for illicit injection in
this urban setting was associated with several markers of addiction severity and
other health and social vulnerabilities.
SCIENTIFIC SIGNIFICANCE: These findings underscore the need to ensure methadone
accessibility while limiting diversion-related risk.
DOI: 10.1111/ajad.12257
PMCID: PMC4576827
359. Saudi Pharm J. 2014 Dec;22(6):550-4. doi: 10.1016/j.jsps.2014.02.014. Epub

2014
Mar 20.
Public attitude and justification to purchase antibiotics in the Eastern region
Al Ahsa of Saudi Arabia.
Emeka PM(1), Al-Omar M(1), Khan TM(2).
Author information:
(1)Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King
Faisal University, Alahsa, Saudi Arabia.
(2)School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500
Bandar Sunway, Selangor Darul Ehsan, Malaysia.
Use of non-prescription antibiotics can portend danger and predispose the

populace to changes in bacterial resistance pattern. The aims of this study were
to (a) evaluate the knowledge and attitudes of residents of Al-Ahsa community,
Saudi Arabia on the use of non-prescribed antibiotics. (b) To identify possible
predictors (if any) for self-medication within the community. A cross-sectional
survey study, using self-administered questionnaire was conducted in two
sections; demographics and self-medication attitude (in form of self-antibiotic
use). Questions contained the following outcomes; for demographics; gender, age,
education level and common disease within the community. Whereas the second part
evaluated sources of information, knowledge of antibiotics, frequency/duration of
use, underlined illness in which drug use was employed, names of antibiotics used
and awareness of adverse effects of antibiotics. Results revealed that the adult
population in the 18-40 year age range constituted about 82.5% of the
respondents. Also 18-29 age group made of 60.5% of the respondents and that 56.8%
the respondents are university graduates. Cold (18.8%) and sore throat (13.0%)
were the diseases commonly found among the community that drove them to using
non-prescribed antibiotics. About 337 (72.8%) of the respondent mention the use
of antibiotics to treat the illness, and 21 (4.5%) were aiming to prevent the
illness. While, 19.4% of the respondents admitted to taking non-prescribed
antibiotics for both prevention and treatment of illness. 43.6% of the
respondents disclosed that they are not aware of the dangers of using
non-prescribed antibiotics. In conclusion the use of non-prescribed antibiotics
in this community is evident, as a significant number use them from previous
experience for prevention and treatment of illness. Therefore introduction of
rational use of drugs will help in limiting the attendant development of
bacterial resistance.
DOI: 10.1016/j.jsps.2014.02.014
PMCID: PMC4281610
PMID: 25561868
360. Int J Reprod Med. 2018 Jan 21;2018:9730328. doi: 10.1155/2018/9730328.

eCollection 2018.
Dysmenorrhea among University Health Science Students, Northern Ethiopia: Impact

and Associated Factors.
Yesuf TA(1), Eshete NA(1), Sisay EA(1).
Author information:
(1)Department of Pharmacy, College of Health Sciences, Mekelle University, P.O.
Box 1871, Mekelle, Ethiopia.
Background: It is estimated that more than half of all women in adolescence age
suffer from dysmenorrhea and it often interferes with their daily physical and
emotional aspects. It is the leading cause of short-term school absenteeism and
is associated with a negative impact on academic and daily activities.
Objectives: To investigate impacts of dysmenorrhea, factors associated with it,
and its self-management strategies used by health science students.
Methods: A cross-sectional institution based study was conducted among 246
Mekelle University health science students selected by stratified random sampling
technique. Data were collected using self-administered semistructured
questionnaire. Data were analyzed using SPSS 16.
Results: The prevalence of dysmenorrhea was 71.8%. Participants who had long
menstrual cycle interval, long menses flows, and positive family history and who
were alcohol users were more likely to had dysmenorrhea. Participants reported
that 28.6% feel depressed, 16.2% are absent from class, and 22.9% had poor
personal relationship due to dysmenorrhea and 78.2% of them practiced
self-medication.
Conclusion: Dysmenorrhea is common among Mekelle University health science
students and it is major problem representing the cause of feeling depressed,
poor personal relationship, and class absenteeism. Majority of the study
participants used self-medication to treat dysmenorrhea.
DOI: 10.1155/2018/9730328
PMCID: PMC5828460
PMID: 29610764
361. J Clin Diagn Res. 2015 May;9(5):FD01-2. doi: 10.7860/JCDR/2015/12110.5939.

Epub
2015 May 1.
Multiple Adverse Effects of Systemic Corticosteroids: A Case Report.
Satyanarayanasetty D(1), Pawar K(2), Nadig P(3), Haran A(4).
Author information:
(1)Post Graduate, Department of Pharmacology, Vydehi Institute of Medical
Sciences & Research Centre , Bangalore, India .
(2)Technical Associate, Pharmacovigilance Unit, Vydehi Institute of Medical
Sciences & Research Centre , Bangalore, India .
(3)Professor, Department of Pharmacology, Head, Pharmacovigilance Unit, Vydehi
Institute of Medical Sciences & Research Centre , Bangalore, India .
(4)Professor and Head, Department of Pulmonary Medicine, Vydehi Institute of
Medical Sciences & Research Centre , Bangalore, India .
Corticosteroids are among the effective treatments available for many medical
conditions. Adverse effects such as osteoporosis, cataract and muscle weakness
are widely recognized on long term administration and have considerable public
health implications. Many reports are available that have dealt with individual
adverse effects.Here, we report a case of a 55-year-old female, with systemic
glucocorticoid induced bilateral cataract, osteoporosis, diabetes mellitus and
hypothalamic pituitary axis (HPA) suppression. These were induced through self
-medication. She presented to the hospital for the treatment of acute
exacerbation of bronchial asthma.
DOI: 10.7860/JCDR/2015/12110.5939
PMCID: PMC4484083
PMID: 26155491
362. Am J Trop Med Hyg. 2016 Oct 5;95(4):897-901. Epub 2016 Jul 25.
Changes in Health-Seeking Behavior Did Not Result in Increased All-Cause

Mortality During the Ebola Outbreak in Western Area, Sierra Leone.
Vygen S(1), Tiffany A(2), Rull M(3), Ventura A(3), Wolz A(3), Jambai A(4), Porten
K(5).
Author information:
(1)French Institute of Public Health Surveillance, Alerts and Regions
Coordination Department, Regional office in Aquitaine, Bordeaux, France. European
Program for Intervention Epidemiology Training (EPIET), European Centre for
Disease Prevention and Control (ECDC), Stockholm, Sweden. Robert Koch-Institut,
Berlin, Germany.
(2)Epicentre, Geneva, Switzerland. amanda.tiffany@geneva.msf.org.
(3)Médecins Sans Frontières, Geneva, Switzerland.
(4)Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone.
(5)Epicentre, Paris, France.
Little is known about the residual effects of the west African Ebola virus
disease (Ebola) epidemic on non-Ebola mortality and health-seeking behavior in
Sierra Leone. We conducted a retrospective household survey to estimate mortality
and describe health-seeking behavior in Western Area, Sierra Leone, between May
25, 2014, and February 16, 2015. We used two-stage cluster sampling, selected 30
geographical sectors with probability proportional to population size, and
sampled 30 households per sector. Survey teams conducted face-to-face interviews
and collected information on mortality and health-seeking behavior. We calculated
all-cause and Ebola-specific mortality rates and compared health-seeking behavior
before and during the Ebola epidemic using χ2 and Fisher's exact tests.
Ninety-six deaths, 39 due to Ebola, were reported in 898 households. All-cause
and Ebola-specific mortality rates were 0.52 (95% confidence interval [CI] =
0.29-0.76) and 0.19 (95% CI = 0.01-0.38) per 10,000 inhabitants per day,
respectively. Of those households that reported a sick family member during the
month before the survey, 86% (73/85) sought care at a health facility before the
epidemic, compared with 58% (50/86) in February 2015 (P = 0.013). Reported
self-medication increased from 4% (3/85) before the epidemic to 23% (20/86)
during the epidemic (P = 0.013). Underutilization of health services and
increased self-medication did not show a demonstrable effect on non-Ebola-related
mortality. Nevertheless, the residual effects of outbreaks need to be taken into
account for the future. Recovery efforts should focus on rebuilding both the
formalized health system and the population's trust in it.
© The American Society of Tropical Medicine and Hygiene.
DOI: 10.4269/ajtmh.16-0295
PMCID: PMC5062797
363. J Obstet Gynaecol India. 2016 Aug;66(4):239-43. doi: 10.1007/s13224-015-0673-

1.
Epub 2015 Feb 5.
A Study of Incomplete Abortion Following Medical Method of Abortion (MMA).
Pawde AA(1), Ambadkar A(1), Chauhan AR(1).
Author information:
(1)Department of Obstetrics & Gynaecology, Seth G S Medical College and KEM
Hospital, Parel, Mumbai, 400012 India.
BACKGROUND: Medical method of abortion (MMA) is a safe, efficient, and affordable

method of abortion. However, incomplete abortion is a known side effect.
OBJECTIVE: To study incomplete abortion due to medication abortion and compare to
spontaneous incomplete abortion and to study referral practices and prescriptions
in cases of incomplete abortion following MMA.
METHOD: Prospective observational study of 100 women with first trimester
incomplete abortion, divided into two groups (spontaneous or following MMA), was
administered a questionnaire which included information regarding onset of
bleeding, treatment received, use of medications for abortion, its prescription,
and administration. Comparison of two groups was done using Fisher exact test
(SPSS 21.0 software).
RESULTS: Thirty percent of incomplete abortions were seen following MMA; possible
reasons being self-administration or prescription by unregistered practitioners,
lack of examination, incorrect dosage and drugs, and lack of follow-up.
Complications such as collapse, blood requirement, and fever were significantly
higher in these patients compared to spontaneous abortion group.
CONCLUSION: The side effects of incomplete abortions following MMA can be avoided
by the following standard guidelines. Self medication, over- the-counter use, and
prescription by unregistered doctors should be discouraged and reported, and need
of follow-up should be emphasized.
DOI: 10.1007/s13224-015-0673-1
PMCID: PMC4912486
PMID: 27382216
364. Niger Med J. 2015 Nov-Dec;56(6):390-3. doi: 10.4103/0300-1652.171620.
Cerumen impaction: Challenges and management profile in a rural health facility.
Gabriel OT(1).
Author information:
(1)Department of Ear, Nose and Throat Surgery, Federal Medical Centre, Ido Ekiti,
Nigeria.
BACKGROUND: Cerumen impaction is a worldwide problem. It constitutes a

significant proportion of health problems in many settings and its prevalence
varies. Very few studies were done in this region with none from our center. The
aim of this study is to review the challenges and management profile of cerumen
impaction in a rural health facility in Nigeria.
MATERIALS AND METHODS: This was a 3-year retrospective study of all patients that
were managed for cerumen impaction from June 2008 to May 2011, in the Department
of Otorhinolaryngology, Federal Medical Centre, Ido-Ekiti, Nigeria.
RESULTS: A total of 239 patients, aged 3-98 years were managed for cerumen
impaction. The male: female ratio was 1.6:1. The age group 1-20 years was mostly
affected in 29.3%. Major complaints were hearing impairment in 120 cases. Both
ears were mostly affected in 48.5% of the patients. Olive oil was a major
ceruminolytic agent used in 95.4%. Ear syringing was carried out in 91.2% of
cases. Major complications were bruises of external auditory canal and otalgia in
7.3% of cases each. Forty-two (17.8%) of our patients were asymptomatic, and they
did not complained of ear problem. Out of those patients that were symptomatic,
44.3% had visited general medical practitioners and non-otolaryngologist, while
27.6% had self-medication or visited chemist for their ear complaints. Only 3.7%
of them had been seen by ear, nose, and throat (ENT) specialist in the past.
CONCLUSION: Cerumen impaction is a common otolaryngological problem that presents
to ENT surgeon, children, and elderly are more affected. Hearing impairment is
the major complaint which may increase the burden of disability on society.
Syringing is the most common mode of treatment of our patients. Continuing
medical education, proper otological examination by the non-otolaryngologist and
public health education to improve the low level of awareness on danger of
self-medication is essential.
DOI: 10.4103/0300-1652.171620
PMCID: PMC4743287
PMID: 26903695
365. BMJ Open. 2018 Jan 5;8(1):e018980. doi: 10.1136/bmjopen-2017-018980.
Community pharmacists' services for women during pregnancy and breast feeding in
Kuwait: a cross-sectional study.
Albassam A(1), Awad A(1).
Author information:
Kuwait.
OBJECTIVES: This study was designed to identify the services provided by

community pharmacists in Kuwait and their views regarding self-care in pregnancy
and lactation. In addition, it determined the pharmacists' recommendations for
treatment of pregnancy-related and breast feeding-related ailments.
DESIGN: Cross-sectional questionnaire-based survey.
SETTING: Community pharmacies in Kuwait.
PARTICIPANTS: 207 pharmacies were randomly selected from the Ministry of Health
database. One registered pharmacist was approached from each pharmacy. One
hundred and ninety-two (92.8%) pharmacists agreed to participate and completed a
self-administered questionnaire.
OUTCOMES: The proportions of pharmacists offering particular advice for health
conditions in pregnancy and lactation, pharmacists' recommendations for common
and specific ailments during pregnancy and breast feeding, and pharmacists' views
about self-care in pregnancy and breast feeding.
RESULTS: The top services provided to pregnant and lactating women were
recommending vitamins and food supplements (89.8%) and contraception advice
(83.4%), respectively. More than half of participants indicated that they would
recommend medications for headache, constipation, cough, runny nose, sore throat,
nausea/vomiting, indigestion, sore or cracked nipple and insufficient milk.
Diarrhoea, haemorrhoids, insomnia, varicose vein, swelling of the feet and legs,
vaginal itching, back pain, fever, mastitis and engorgement were frequently
referred to the physician. Recommendations on medication use were occasionally
inappropriate in terms of unneeded drug therapy, off-label use and safety. In
relation to offering advice and solving medication and health problems of
pregnant and lactating women, more than half of pharmacists indicated that they
have sufficient knowledge (61.5%; 50.5%) and confidence (58.3%; 53.1%),
respectively. Most of the respondents (88.5%) agreed that a continuing education
programme on this topic would be of value for their practice.
CONCLUSION: The present findings show that respondents had different
recommendations for treatment of pregnancy-related and lactation-related
ailments; and also highlight the need for interventions, including continuing
professional development and revision of the undergraduate pharmacy curriculum.
DOI: 10.1136/bmjopen-2017-018980
PMCID: PMC5780848
366. Front Public Health. 2018 Aug 2;6:212. doi: 10.3389/fpubh.2018.00212.

eCollection
2018.
Antibiotic Resistance in Syria: A Local Problem Turns Into a Global Threat.
Jakovljevic M(1), Al Ahdab S(2), Jurisevic M(3), Mouselli S(4).
Author information:
(1)Global Health, Economics and Policy, Faculty of Medical Sciences, University
of Kragujevac, Kragujevac, Serbia.
(2)Faculty of Pharmacy, Arab International University, Daraa, Syria.
(3)Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac,
Kragujevac, Serbia.
(4)Faculty of Business Administration, Arab International University, Daraa,
Syria.
Pharmaceutical sector of Syrian Arab Republic before the war was characterized by
bold and successful development since the late 1980s. With the beginning of war
in the country back in March 2011, momentum has changed significantly.
Traumatism, communicable diseases related to morbidity and mortality as well as
wound infections became particularly hot public health concern. This relates not
only to the direct victims of military conflict but also to the displaced
civilians, refugees, and ordinary citizens alike. Evolving legislative framework
in Syria since 1980s tolerated dispensing of antibiotics without appropriate
prescription. Such practice led to spreading of antibiotic resistance among the
local bacteria frequently causing both community-acquired and nosocomial
infections. Laboratory findings of resistant bacteria strains among the Syrian
refugees in some European countries serve as evidence of concern spreading far
beyond Middle East. Practice of self-diagnosis and self-medication with
antibiotics by patients themselves and restraint to pharmacist advice is
widespread. A number of recommendations is presented to stakeholders to compact
antibiotic resistance after the peace is established in the country. The
successful implementation of such recommendations is the way to preserve
shrinking golden reserve of highly potent antibiotics as it is the last defense
line against resistant bacterial strains causing severe life-threatening
infections.
DOI: 10.3389/fpubh.2018.00212
PMCID: PMC6084506
PMID: 30116726
367. Indian J Pharmacol. 2016 Jul-Aug;48(4):365-371.
Knowledge and perceptions on antibiotic use and resistance among high school
students and teachers in New Delhi, India: A qualitative study.
Kotwani A(1), Wattal C(2), Joshi PC(3), Holloway K(4).
Author information:
(1)Department of Pharmacology, V. P. Chest Institute, New Delhi, India.
(2)Department of Microbiology, Sir Ganga Ram Hospital, New Delhi, India.
(3)Department of Anthropology, University of Delhi, New Delhi, India.
(4)Department of Essential Drugs and other Medicines, South East Asia Regional
Office, WHO, New Delhi, India.
OBJECTIVE: To explore the perceptions and knowledge of school teachers and

students about antibiotic use, resistance, and suggestions for practical
interventions for the rational use of antibiotics.
METHODOLOGY: Five focus group discussions (FGDs) with high school students
(Class: 9-11) and five with teachers were conducted in two private and three
public schools (one teacher and one student FGD per school) in five municipal
wards of Delhi. Qualitative data on antibiotic knowledge, resistance, and
behaviors with respect to antibiotics use were collected. There were 4-8 persons
per teacher FGD and 15-20 persons per student FGD. FGDs were analyzed using
"thematic analyses."
RESULTS: Students had poor knowledge regarding antibiotics and antibiotic
resistance, while only some teachers had a basic understanding. Four broad themes
needing attention emerged: definition of antibiotic and antibiotic resistance,
antibiotic use behavior, doctor-patient relationship, and interventional
strategies suggested to curtail the misuse of antibiotics and to spread
awareness. In order to tackle these problems, both groups suggested a
multipronged approach including robust public awareness campaigns also involving
schools, better doctor-patient relationships, and stronger regulations.
CONCLUSIONS: Although students and teachers exhibited poor knowledge about
antibiotic use and resistance, they were keen to learn about these issues. School
education programs and public education could be used to shape correct
perceptions about antibiotic use among all stakeholders including children. This
may help in the containment of antibiotic resistance and thus preservation of
antibiotics for future generations.
DOI: 10.4103/0253-7613.186208
PMCID: PMC4980922
368. J Appl Gerontol. 2016 Oct;35(10):1058-76. doi: 10.1177/0733464815570662. Epub

2015 Feb 9.
It's a Matter of Trust: Older African Americans Speak About Their Health Care
Encounters.
Hansen BR(1), Hodgson NA(1), Gitlin LN(2).
Author information:
(1)The Johns Hopkins University School of Nursing, Baltimore, MD, USA.
(2)The Johns Hopkins University School of Nursing, Baltimore, MD, USA
lgitlin1@jhu.edu.
PURPOSE: To examine perceptions of older African Americans' encounters with

health care providers and ways to enhance trust.
METHOD: Transcribed semi-structured interviews with African American senior
center members were analyzed, using Pattern Coding method.
RESULTS: Four themes emerged: "Added Insult of Ageism," "Alternative Remedies,"
"Good Providers in a 'Broken' System," and "The Foundation of Trust Is Person
Recognition." Provider behaviors leading to mistrust included erroneously
assuming stereotypical preferences and competence, spending inadequate time
listening to patients, disregarding patient preferences, and insufficiently
explaining treatments.
DISCUSSION: Of importance to improving trust among older African American
patients is valuing individual histories and preferences by reallocating scarce
time to person-centered listening, individualizing treatments, more completely
explaining interventions, and assuring that patients understand and agree with
treatment plans.
© The Author(s) 2015.
DOI: 10.1177/0733464815570662
PMCID: PMC4530080
Conflict of interest statement: Declaration of Conflicting Interests The

author(s) declared no potential conflicts of interest with respect to the
research, authorship, and/or publication of this article.
369. BMC Public Health. 2018 Oct 16;18(1):1177. doi: 10.1186/s12889-018-6088-z.
"Antibiotics kill things very quickly" - consumers' perspectives on

non-prescribed antibiotic use in Saudi Arabia.
Alhomoud F(1), Aljamea Z(2), Basalelah L(2).
Author information:
Abdulrahman Bin Faisal University, Dammam, 31952, Saudi Arabia.
f.k.alhomoud@gmail.com.
(2)College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam,
Saudi Arabia.
BACKGROUND: In recent decades, the Kingdom of Saudi Arabia has seen an

exponentially growing antibiotic resistance, which is exacerbated by the use of
antibiotics without a prescription and other various factors. However, no
published data are available on factors influencing non-prescription use of
antibiotics among the general public in Saudi Arabia using an in-depth interview
technique.
METHODS: Semi-structured interviews were carried out with 40 Saudi participants
from the Eastern Province of Saudi Arabia, selected via snowball sampling
technique. Participants were enrolled based on the following inclusion criteria:
18 years of age or older and had self-medicated themselves with antibiotics in
the past two years. Data collection was continued until data saturation was
attained. Interviews were audiotaped, transcribed verbatim and analysed using
NVivo 10 software.
RESULTS: Participants (80% female) had a mean (SD) age of 30 years (10.2).
Self-medication with antibiotics was associated with various inappropriate
antibiotic use behaviours and negative outcomes such as antibiotic resistance,
treatment failures and adverse events. Interviews revealed that different reasons
contribute to the rise of self-medication with antibiotics, ranging from
difficulty accessing healthcare services, participant's cultural beliefs and
practices, lack of knowledge about antibiotics and antibiotic resistance, and
weak regulatory enforcement.
CONCLUSIONS: The findings of the present study will aid in generating data that
may provide an insight when designing future interventions to promote public
health awareness regarding safe and effective use of antibiotics.
DOI: 10.1186/s12889-018-6088-z
PMCID: PMC6192199
370. BMC Public Health. 2015 Apr 10;15:352. doi: 10.1186/s12889-015-1670-0.

Malaria policies versus practices, a reality check from Kinshasa, the capital of
the Democratic Republic of Congo.
Muhindo Mavoko H(1)(2), Ilombe G(3), Inocêncio da Luz R(4), Kutekemeni A(5), Van
geertruyden JP(6), Lutumba P(7).
Author information:
(1)Département de Médecine Tropicale, Université de Kinshasa, B.P. 747, Kin XI,
Kinshasa, République Démocratique du Congo. mavoko@yahoo.com.
(2)International Health Unit, Department of Epidemiology, University of Antwerp,
Campus Drie Eiken, Universiteitsplein 1, 2610, Kinshasa, République Démocratique
du Congo. mavoko@yahoo.com.
Kinshasa, République Démocratique du Congo. gillonilombe@yahoo.fr.
du Congo. raquel.daluz@uantwerpen.be.
(5)Programme National de Lutte contre le Paludisme, Ministère de la Santé
Publique, Kinshasa, République Démocratique du Congo. albkutek@yahoo.fr.
du Congo. jean-pierre.vangeertruyden@uantwerpen.be.
Kinshasa, République Démocratique du Congo. pascal_lutumba@yahoo.fr.
BACKGROUND: Artemisinin-based combination therapy (ACT) following a confirmed

parasitological diagnosis is recommended by the World Health Organization (WHO)
and the Congolese National Malaria Control Program (NMCP). However, commitment
and competence of all stakeholders (patients, medical professionals, governments
and funders) is required to achieve effective case management and secure the
"useful therapeutic life" of the recommended drugs. The health seeking behaviour
of patients and health care professionals' practices for malaria management were
assessed.
METHODS: This was an observational study embedded in a two-stage cluster
randomized survey conducted in one health centre (HC) in each of the 12 selected
health zones in Kinshasa city. All patients with clinical malaria diagnosis were
eligible. Their health seeking behaviour was recorded on a specific
questionnaire, as well as the health care practitioners' practices. The last were
not aware that their practices would be assessed.
RESULTS: Six hundred and twenty four patients were assessed, of whom 136 (21.8%)
were under five years. Three hundred and thirty five (55%) had taken medication
prior to the current consultation (self -medication with any product or visiting
another HC) of whom 47(14%) took an antimalarial drug, and 56 (9%) were treated
presumptively. Among those, 53.6% received monotherapy either with quinine,
artesunate, phytomedicines, sulfadoxine-pyrimethamine or amodiaquine. On the
other side, when clinicians were informed about laboratory results, monotherapy
was prescribed in 39.9% of the confirmed malaria cases. Only 285 patients (45.7%)
were managed in line with WHO and NMCP guidelines, of whom 120 (19.2%) were
prescribed an ACT after positive blood smear and 165 (26.4%) received no
antimalarial after a negative result.
CONCLUSION: This study shows the discrepancy between malaria policies and the
reality on the field in Kinshasa, regarding patients' health seeking behaviour
and health professionals' practices. Consequently, the poor compliance to the
policies may contribute to the genesis and spread of antimalarial drug resistance
and also have a negative impact on the burden of the disease.
DOI: 10.1186/s12889-015-1670-0
PMCID: PMC4396810
371. Adv Clin Exp Med. 2016 Mar-Apr;25(2):349-60. doi: 10.17219/acem/58887.
Correlates of Abusing and Misusing Over-the-Counter Pain Relievers Among Adult

Population of Wrocław (Poland).
Wójta-Kempa M(1), Krzyżanowski DM(1).
Author information:
(1)Department of Public Health, Faculty of Health Science, Wroclaw Medical
University, Poland.
BACKGROUND: Almost 90% of households in Poland buy medicines on their own

initiative. The most popular OTC medicines bought by Polish consumers are
painkillers and non-steroid-anti-inflammatory drugs.
OBJECTIVES: The aim of this article was to recognize and describe the most
important predictive factors of the abuse and misuse of over-the-counter pain
relievers among adults in Wrocław (Poland). The groups of users were selected and
described. Some examples of misuse were analyzed.
MATERIAL AND METHODS: Three hundred eighty six adult inhabitants of Wrocław took
part in the survey. The quota sample was representative referring to the most
important socio-demographic factors (sex and median age).
RESULTS: Almost 91% of participants declare taking OTC pain relievers, and 1.3%
of them are their daily users. Only 6.2% of adult inhabitants of Wrocław never
take OTC pain relievers. The category of "heavy users" embraces 11% of
participants. The most important risk factors of overusing OTC pain relievers are
sex (female), age over 55 years and the low health status. Only half of
participants read the box label regularly and 25% of users admit they have
modified recommended doses. Over 60% shortened recommended intervals between
doses and 16% took two or more different pain medications (containing different
substances). The non-medical purposes of using OTC pain relievers were: tiredness
(7%), stressful situations (5.4%), and discomfort (18.4%). Some users take pain
medications to cure hangovers (26%), or instead of the appropriate medicine (7%).
About 20% take pain medications without a doctor's advice for longer than the
recommended 3 days, and 10% never consult taking such medications with doctors.
CONCLUSIONS: Pain should be treated aggressively and successfully, especially
among chronically ill patients. We should monitor the consumption of OTC pain
relievers and limit their current excessively supply and high availability.
DOI: 10.17219/acem/58887
372. Int J Health Policy Manag. 2015 Mar 3;4(4):235-42. doi:

10.15171/ijhpm.2015.45.
eCollection 2015 Apr.
Substitutes or complements? Diagnosis and treatment with non-conventional and

conventional medicine.
Tavares AI(1).
Author information:
(1)Center of Study and Research in Health/Centro de Estudos e Investigação em
Saúde (CEISUC), University of Coimbra, Coimbra, Portugal.
Comment in
Int J Health Policy Manag. 2015 Sep;4(9):625-6.
Int J Health Policy Manag. 2015;4(12):835.
Int J Health Policy Manag. 2016 Jan;5(1):77-8.
BACKGROUND: Portugal has a strong tradition of conventional western healthcare.

So it provides a natural case study for the relationship between
Complementary/Alternative Medicine (CAM) and Western Medicine (WM). This work
aims to test the relationship between CAM and WM users in the diagnosis and
treatment stages and to estimate the determinants of CAM choice.
METHODS: The forth Portuguese National Health Survey is employed to estimate two
single probit models and obtain the correlation between the consumption of CAM
and WM medicines in the diagnosis and treatment stages.
RESULTS: Firstly, both in the diagnosis and the treatment stage, CAM and WM are
seen to be complementary choices for individuals. Secondly, self-medication also
shows complementarity with the choice of CAM treatment. Thirdly, education has a
non-linear relationship with the choice of CAM. Finally, working status, age,
smoking and chronic disease are determinant factors in the decision to use CAM.
CONCLUSION: The results of this work are relevant to health policy-makers and for
insurance companies. Patients need freedom of choice and, for the sake of safety
and efficacy of treatment, WM and CAM healthcare ought to be provided in a joint
and integrated health system.
DOI: 10.15171/ijhpm.2015.45
PMCID: PMC4380566
PMID: 25844385
373. Cureus. 2018 Jul 11;10(7):e2965. doi: 10.7759/cureus.2965.
Drug-induced Angioedema: A Rare Side Effect of Rosuvastatin.
Shahbaz A(1), Mahendhar R(2), Fransawy Alkomos M(3), Zarghamravanbakhsh P(4),

Sachmechi I(5).
Author information:
(1)Internal Medicine, Icahn School of Medicine at Mount Sinai/Queen Hospital
Center, New York, USA.
(2)Internal Medicine, Icahn School of Medicine, Mount Sinai/Queens Hospital
(3)Research, California Institute of Behavioral Neurosciences & Psychology,
Sacramento, USA.
(4)Endocrinology, Icahn School of Medicine at Mount Sinai Queen Hospital Center,
New York, USA.
(5)Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital
Hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) are first-line

medication for lowering serum cholesterol levels in the prevention of
cardiovascular disease. Angioedema is the swelling of mucosa and submucosal
tissue. There are no published cases of drug-induced angioedema involving
rosuvastatin. We report a case of a 45-year-old female who presented with
episodes of self-resolving edema of face, lips, and tongue after being on
rosuvastatin. The patient denied any rash during these episodes and mentioned
that self-medication with diphenhydramine did not relieve her symptoms. The
patient was hemodynamically stable. The complement component 4 (C4), C1 esterase
inhibitor, and complement component 1q (C1q) binding assay were within normal
range. Therefore, the diagnosis of hereditary angioedema was effectively ruled
out. The temporal relation between rosuvastatin and the development of angioedema
and prompt resolution of symptoms after the drug discontinued suggest that
rosuvastatin was the most probable culprit in the development of angioedema in
our patient.
DOI: 10.7759/cureus.2965
PMCID: PMC6135297
PMID: 30210953

interests exist.
374. Pan Afr Med J. 2018 Nov 8;31:165. doi: 10.11604/pamj.2018.31.165.15991.

eCollection 2018.
Irrational use of antibiotics in the Moshi Municipality Northern Tanzania: a

Mboya EA(1), Sanga LA(1), Ngocho JS(1)(2).
Author information:
(1)Kilimanjaro Christian Medical University College, P.O. Box 2240 Moshi,
Tanzania.
(2)Institute of Public Health, Kilimanjaro Christian Medical University College,
P.O. Box 2240 Moshi, Tanzania.
Introduction: Irrational use of antibiotics includes prescription of incorrect

doses, self-medication and treatment of non-bacterial illness. As a direct
consequence of irrational antibiotic use, resistance to the commonly available
antibiotics has been increasing rapidly. This phenomenon is associated with
poorer health outcomes, longer hospitalization, increased cost to both the
patient and government, and increased mortality. The aim of this study was to
determine the prevalence of, and examine factors associated with, irrational use
of antibiotics in the Moshi municipality, Northern Tanzania.
Methods: We conducted a cross-sectional descriptive study between April and May
2017 in the Moshi municipality. Twelve drug outlets, of which five were
pharmacies and seven accredited drug dispensing outlets (ADDOs), were selected at
random. On exiting these outlets, all adults who had purchased antibiotics were
interviewed using structured questionnaires.
Results: A total of 152 adults were enrolled in this study. The median (QR) age
was 31 years (25-42). The majority, 94 (61.8%), of the participants were female.
ADDOs contributed 81 (53.3%) and pharmacies contributed 71 (46.7%) of all
participants. Overall, 135 (88.8%) of antibiotic purchases were irrational. The
most prevalent form of irrational antibiotic use was non-prescription usage; 116
of the 152 (76.3%) purchases fell in this category. Purchases of the incomplete
dosage and purchases for non-bacterial illness were also widespread. Poor
knowledge about the use of antibiotics had a significant association with
irrational use of antibiotics (aOR=5.1, 95% CI: 1.80-15.15).
Conclusion: Irrational use of antibiotics is highly prevalent in this population.
Non-prescription use of antibiotics is the most prevalent form. Poor knowledge
about antibiotic use plays a significant role in irrational antibiotic use. There
is a need to review the accessibility of antibiotics in drug outlets.
DOI: 10.11604/pamj.2018.31.165.15991
PMCID: PMC6492205
375. Drugs Aging. 2018 Jun;35(6):559-568. doi: 10.1007/s40266-018-0550-6.
Potential Drug-Drug Interactions in a Cohort of Elderly, Polymedicated Primary

Care Patients on Antithrombotic Treatment.
Schneider KL(1)(2), Kastenmüller K(3), Weckbecker K(3), Bleckwenn M(3), Böhme

M(4)(5), Stingl JC(4)(5).
Author information:
(1)Research Division, Federal Institute for Drugs and Medical Devices,
Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany.
katharina.schneider@bfarm-research.de.
(2)Centre for Translational Medicine, Medical Faculty of the University of Bonn,
Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
katharina.schneider@bfarm-research.de.
(3)Institute of General Practice and Family Medicine, Medical Faculty of the
University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
(4)Research Division, Federal Institute for Drugs and Medical Devices,
Kurt-Georg-Kiesinger-Allee 3, 53175, Bonn, Germany.
(5)Centre for Translational Medicine, Medical Faculty of the University of Bonn,
Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
INTRODUCTION: Drug-drug interactions (DDIs) are an important risk factor for

adverse drug reactions. Older, polymedicated patients are particularly affected.
Although antithrombotics have been detected as high-risk drugs for DDIs, data on
older patients exposed to them are scarce.
METHODS: Baseline data of 365 IDrug study outpatients (≥ 60 years, use of an
antithrombotic and one or more additional long-term drug) were analyzed regarding
potential drug-drug interactions (pDDIs) with a clinical decision support system.
Data included prescription and self-medication drugs.
RESULTS: The prevalence of having one or more pDDI was 85.2%. The median number
of alerts per patient was three (range 0-17). For 58.4% of the patients,
potential severe/contraindicated interactions were detected. Antiplatelets and
non-steroidal anti-inflammatory drugs (NSAIDs) showed the highest number of
average pDDI alert involvements per use (2.9 and 2.2, respectively). For NSAIDs,
also the highest average number of severe/contraindicated alert involvements per
use (1.2) was observed. 91.8% of all pDDI involvements concerned the 25 most
frequently used drug classes. 97.5% of the severe/contraindicated pDDIs were
attributed to only nine different potential clinical manifestations. The most
common management recommendation for severe/contraindicated pDDIs was to
intensify monitoring. Number of drugs was the only detected factor significantly
associated with increased number of pDDIs (p < 0.001).
CONCLUSION: The findings indicate a high risk for pDDIs in older, polymedicated
patients on antithrombotics. As a consequence of patients' frequently similar
drug regimens, the variety of potential clinical manifestations was small.
Awareness of these pDDI symptoms and the triggering drugs as well as patients'
self-medication use may contribute to increased patient safety.
DOI: 10.1007/s40266-018-0550-6
PMCID: PMC5999138
376. BMC Infect Dis. 2014 Nov 25;14:624. doi: 10.1186/s12879-014-0624-y.
Delay in the diagnosis and treatment of pulmonary tuberculosis in Uzbekistan: a

Belkina TV, Khojiev DS, Tillyashaykhov MN, Tigay ZN, Kudenov MU, Tebbens JD,
Vlcek J.
BACKGROUND: Early diagnosis and prompt effective therapy are crucial for the
prevention of tuberculosis (TB) transmission, particularly in regions with high
levels of multi-drug resistant TB. This study aimed to evaluate the extent of
delay in diagnosis and treatment of TB in Uzbekistan and identify associated risk
factors.
METHODS: A cross-sectional study was performed on hospital patients with newly
diagnosed TB. The time between the onset of respiratory symptoms and initiation
of anti-TB treatment was assessed and delays were divided into patient, health
system and total delays. Univariable and multivariable logistic regression
analysis was used to evaluate determinants of diagnostic and treatment delay.
RESULTS: Among 538 patients enrolled, the median delay from onset of symptoms
until treatment with anti-TB drugs was 50 days. Analysis of the factors affecting
health-seeking behaviour and timely treatment showed the presence of the patient
factor. Self-medication was the first health-seeking action for 231 (43%)
patients and proved to be a significant predictor of delay (p = 0.005), as well
as coughing (p = 0.009), loss of weight (p = 0.001), and visiting private and
primary healthcare facilities (p = 0.03 and p = 0.02, respectively).
CONCLUSION: TB diagnostic and treatment delay was mainly contributed to by
patient delay and should be reduced through increasing public awareness of TB
symptoms and improving public health-seeking behaviour for timely initiation of
anti-TB treatment. Efforts should be made to minimise irrational use of
antibiotics and support interventions to restrict over-the-counter availability
of antibiotics.
DOI: 10.1186/s12879-014-0624-y
PMCID: PMC4248454
377. Pharmacy (Basel). 2018 Jul 2;6(3). pii: E59. doi: 10.3390/pharmacy6030059.
Double-Dosing and Other Dangers with Non-Prescription Medicines: Pharmacists'

Views and Experiences.
Gauld N(1), Sullivan T(2).
Author information:
(1)Natalie Gauld Ltd., P. O. Box 9349, Newmarket, Auckland 1149, New Zealand.
n.gauld@gmail.com.
(2)Independent Researcher, Wellington, New Zealand. traceyinwales@yahoo.com.
The aim of this paper was to explore pharmacists' views on reclassifications from
pharmacy-only to general sales and their experiences with the supply of these
medicines, in addition to pharmacists' views on the reclassification of the
shingles vaccine and sildenafil to be available through 'accredited' pharmacists.
New Zealand community pharmacists were surveyed in 2013 with a written
questionnaire of six Likert-style or open-ended questions sent to Pharmacy Guild
member pharmacies. The analysis involved descriptive statistics. Responses were
received from 246 pharmacies. Two thirds of pharmacists supported the
reclassification of the shingles vaccine and sildenafil, although 14% disagreed
with the sildenafil reclassification. Over 90% of pharmacists disagreed with the
reclassification of paracetamol and ibuprofen liquids, omeprazole, naproxen, and
oxymetazoline from pharmacy-only medicine to general sales. This opinion was
strongest for omeprazole. With liquid paracetamol and ibuprofen, pharmacists
described consumer confusion with dosing, and particularly potentially
doubling-up on liquid analgesics/antipyretics including using both prescription
and non-prescription variants. Many reported giving safety advice frequently.
Anti-inflammatories and omeprazole were also subject to potential double-dosing,
as well as requests by consumers with contraindications, precautions, and drug
interactions, and for inappropriate indications. Pharmacists described various
interventions, including some that were potentially life-saving. Pharmacy
availability of medicines provides the potential for intervention that would not
happen in a general sales environment.
DOI: 10.3390/pharmacy6030059
PMCID: PMC6165278
PMID: 30004399
378. Schizophr Res Cogn. 2015 Jun 20;2(2):93-99. doi: 10.1016/j.scog.2015.04.006.

eCollection 2015 Jun.
Does chronic nicotine consumption influence visual backward masking in

schizophrenia and schizotypy?
Shaqiri A(1), Willemin J(2), Sierro G(2), Roinishvili M(3), Iannantuoni L(2),
Rürup L(4), Chkonia E(3)(5), Herzog MH(1), Mohr C(2).
Author information:
(1)Laboratory of Psychophysics, Brain Mind Institute, Ecole Polytechnique
Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.
(2)Institute of Psychology, Faculty of Social and Political Sciences, Bâtiment
Geopolis, Quartier Mouline, 1015 Lausanne, Switzerland.
(3)Institute of Cognitive Neurosciences, Agricultural University of Georgia,
Tbilisi, Georgia.
(4)Institute for Psychology and Cognition Research, University Bremen, Bremen,
Germany.
(5)Department of Psychiatry, Tbilisi State Medical University, Tbilisi, Georgia.
Nicotine consumption is higher for people within the schizophrenia spectrum

compared to controls. This observation supports the self-medication hypothesis,
that nicotine relieves symptoms in, for example, schizophrenia patients. We
tested whether performance in an endophenotype of schizophrenia (visual backward
masking, VBM) is modulated by nicotine consumption in i) smoking and non-smoking
schizophrenia patients, their first-degree relatives, and age-matched controls,
ii) non-smoking and smoking university students, and iii) non-smoking, early and
late onset nicotine smokers. Overall, our results confirmed that VBM deficits are
an endophenotype of schizophrenia, i.e., deficits were highest in patients,
followed by their relatives, students scoring high in Cognitive Disorganisation,
and controls. Moreover, we found i) beneficial effects of chronic nicotine
consumption on VBM performance, in particular with increasing age, and ii) little
impact of clinical status alone or in interaction with nicotine consumption on
VBM performance. Given the younger age of undergraduate students (up to 30 years)
versus controls and patients (up to 66 years), we propose that age-dependent VBM
deficits emerge when schizotypy effects are targeted in populations of a larger
age range, but that nicotine consumption might counteract these deficits
(supporting the self-medication hypothesis).
DOI: 10.1016/j.scog.2015.04.006
PMCID: PMC5609643
PMID: 29114459
379. BMC Public Health. 2015 Jun 27;15:590. doi: 10.1186/s12889-015-1948-2.
Population awareness of risks related to medicinal product use in Vientiane

Capital, Lao PDR: a cross-sectional study for public health improvement in low
and middle income countries.
Caillet C(1), Sichanh C(2), Syhakhang L(3), Delpierre C(4), Manithip C(5), Mayxay
M(6)(7), Lapeyre-Mestre M(8), Newton PN(9)(10)(11), Roussin A(12).
Author information:
(1)Faculté de Médecine, Equipe de Pharmacoépidémiologie UMR 1027
INSERM-Université de Toulouse III, Service de Pharmacologie Médicale et Clinique,
Centre Hospitalier Universitaire de Toulouse, 37 allées Jules Guesde, 31000,
Toulouse, France. celine.caillet@univ-tlse3.fr.
(2)WorldWide Antimalarial Resistance Network, University of Oxford, Wellington
Square, OX1 2JD, Oxford, UK. singsing_chanvilay@yahoo.fr.
(3)Food and Drug Department, Ministry of Health, Simuang Road, Vientiane Capital,
Lao People's Democratic Republic. syhakhangl@yahoo.com.
(4)Faculté de Médecine, Cancer et maladies chroniques, UMR1027 INSERM- Université
de Toulouse III, 37 Allées Jules Gusede, 31000, Toulouse, France.
cyrildelpierre@yahoo.fr.
(5)Faculty of Pharmacy, University of Health Sciences, P.O.Box 7444, Samsenthai
Road, Vientiane, Lao People's Democratic Republic. manithipchanthanom@gmail.com.
(6)Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology
Laboratory, Mahosot Hospital, FaNgum Rd, Vientiane, Lao People's Democratic
Republic. mayfong@tropmedres.ac.
(7)Faculty of Postgraduate Studies, University of Health Sciences, P.O.Box 7444,
Samsenthai Road, Vientiane, Lao People's Democratic Republic.
mayfong@tropmedres.ac.
Toulouse, France. maryse.lapeyre-mestre@univ-tlse3.fr.
(9)WorldWide Antimalarial Resistance Network, University of Oxford, Wellington
Square, OX1 2JD, Oxford, UK. paul@tropmedres.ac.
(10)Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology
Laboratory, Mahosot Hospital, FaNgum Rd, Vientiane, Lao People's Democratic
Republic. paul@tropmedres.ac.
(11)Centre for Tropical Medicine and Global Health, Nuffield Department of
Medicine, Churchill Hospital, University of Oxford, Wellington Square, OX1 2JD,
Oxford, UK. paul@tropmedres.ac.
Toulouse, France. anne.roussin@univ-tlse3.fr.
BACKGROUND: While essential medicines have been made more available in all but
the most remote areas in low and middle income countries (L/MICs) over the past
years, inappropriate and incorrect use of good quality medicines remains a key
impediment for public health. In addition, as medicines have a potential to cause
harm (medicine risks), adequate awareness by medicine users of the risks of
adverse reactions is essential, especially as self-medication is common in
L/MICs. This study aimed to investigate the awareness of Lao residents regarding
medicine risks in Vientiane Capital, Lao People's Democratic Republic.
METHODS: Face-to-face interviews using structured questionnaires of 144 residents
older than 16 years were carried out in 12 randomly selected villages out of the
146 villages of Vientiane Capital with at least one health facility.
RESULTS: The respondents were mainly (85.0 %) the heads of households or their
husband/spouse . The majority of the respondents were unaware (61.8 %) of
medicine risks. Compared to residents living in the urban district of Xaysetha,
living in peri-urban and even more in rural areas were identified as factors
associated with being unaware of medicine risks [adjusted odds ratio (aOR) =3.3,
95 % Confidence Interval (CI) = 1.1-9.4]) and aOR =7.5 (95 % CI = 2.3-24.2),
respectively]. In addition, more than half of the respondents had never heard of
poor quality medicines, with a higher rate in rural/peri-urban compared to urban
districts (55.6 % vs 38.9 %, respectively, p = 0.02). Finally, approximately one
third of all respondents thought that traditional medicines could not cause harm.
CONCLUSIONS: Overall, these results suggest a lack of awareness about medicinal
product risks. Differences according to the place of residence are apparent and
could be partly explained by a lower level of training of healthcare providers in
contact with the population in the rural districts in particular. Communication
on medicinal product risks to patients through well-trained healthcare providers
could probably make a valuable contribution towards the appropriate use of
medicines in L/MICs.
DOI: 10.1186/s12889-015-1948-2
PMCID: PMC4483223
380. Indian J Dermatol. 2015 Mar-Apr;60(2):194-7. doi: 10.4103/0019-5154.152529.
Psoriatic erythroderma and hypothalamus-pituitary axis suppression due to misuse

of systemic steroid: two challenging cases.
Singh GK(1), Chatterjee M(2).
Author information:
(1)Classified specialist, MH Ahmedabad, Gujrat, (Dermatology, Venereology and
Leprosy), Command Hospital, Eastern Command, Kolkata, West Bengal, India.
(2)Senior Advisor, MH Ahmedabad, Gujrat, (Dermatology, Venereology and Leprosy),
Command Hospital, Eastern Command, Kolkata, West Bengal, India.
Adding corticosteroid in homeopathic pills, self medication of steroid in the

backdrop permanent cure in cases of psoriasis is not very uncommon in clinical
practice in Indian subcontinent. First case a 52 year man, a known case of
psoriasis vulgaris with psoriatic arthropathy of 15 years duration received
multiple modalities of therapies without any satisfactory response. He was on
self medication of tab prednisolone 10 mg daily with Cushingoid features. Second
case a 22 year old boy, a known case of psoriasis from last 06 years was on
Homeopathic treatment with Cushinoid features. Tapering of systemic steroid in
first case and discontinuation of homeopathic drug in second case resulted in
erythroderma and features of adrenal insufficiiency. Investigation revealed low
morning cortisol and low cortisol following ACTH stimulation suggestive of HPA
axis suppression. Planned withdrawal of steroid under the cover of short acting
systemic steroid for short duration along with combination of immunosuppressants
and supportive care gave an excellent result in both the cases.
DOI: 10.4103/0019-5154.152529
PMCID: PMC4372917
PMID: 25814713
381. Pharm Pract (Granada). 2018 Apr-Jun;16(2):1172. doi:

10.18549/PharmPract.2018.02.1172. Epub 2018 Jun 27.
What drives using antibiotic without prescriptions? A qualitative interview study

of university students in United Arab Emirates.
Al-Kubaisi KA(1), De Ste Croix M(2), Vinson D(3), Sharif SI(4), Abduelkarem
AR(5).
Author information:
(1)University of Gloucestershire. Cheltenham (United Kingdom). Khalid@glos.ac.uk.
(2)University of Gloucestershire. Cheltenham (United Kingdom).
mdestecroix@glos.ac.uk.
(3)St John's Campus, University of Worcester, Worcester (United Kingdom).
d.vinson@worc.ac.uk.
(4)Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy,
University of Sharjah. Sharjah (United Arab Emirates). sharifsi@sharjah.ac.ae.
(5)Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy,
University of Sharjah. Sharjah (United Arab Emirates). aabdelkarim@sharjah.ac.ae.
Erratum in
Pharm Pract (Granada). 2018 Jul-Sep;16(3):1326. Ellis, Liz [removed].
Background: Bacterial resistance to antibiotics is considered as natural

phenomenon that occurs over the time due to genetic changes. Bacterial resistance
to antibiotics is significantly increasing in the UAE. Self-medication with
antibiotics has been identified as a major factor for the development of
antibiotic resistance, which is significantly increasing in the UAE.
Objectives: The purpose of this study was to explore the factors that contribute
to the use of antibiotics without prescriptions among first year healthcare
university students in UAE.
Methods: Based on the findings of an earlier survey study, a qualitative
interview study was designed to explore common themes related to student's
knowledge, awareness, attitude, views, and perceptions. Data were analyzed
thematically for the identification of themes and subthemes within the data
through the use of coding.
Results: The interview study identified four main themes with multiple subthemes
related to the use of antibiotics without a physician's prescription by
first-year healthcare students. The thematic analysis of the interviews revealed
four main themes; medication habits and practices; reasons for self-medication;
access to antibiotics without a prescription and gaps in students' knowledge
regarding antibiotic resistance.
Conclusions: Healthcare students in UAE are influenced by several factors
including parents and friends influence, successful previous experience and
investment of time and money to visit a physician. Our sample of healthcare
students has a misconception about the use of antibiotics. The current interview
study identified six new reasons for using antibiotics without prescriptions as
compared to our earlier survey study. There is a need of multifaceted strategies
to decrease unnecessary antibiotic use in our population sample.
DOI: 10.18549/PharmPract.2018.02.1172
PMCID: PMC6041208
PMID: 30023027
Conflict of interest statement: The authors declare that they have no conflicts
of interest.
382. Int J Drug Policy. 2018 May;55:256-262. doi: 10.1016/j.drugpo.2018.02.019.

Epub
2018 Mar 28.
The management of methamphetamine use in sexual settings among men who have sex
with men in Malaysia.
Lim SH(1), Akbar M(2), Wickersham JA(3), Kamarulzaman A(2), Altice FL(4).
Author information:
(1)Department of Social and Preventive Medicine, Faculty of Medicine, University
of Malaya, Kuala Lumpur, Malaysia; Centre of Excellence for Research in AIDS
(CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Electronic address: sinhow.lim@ummc.edu.my.
(2)Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine,
University of Malaya, Kuala Lumpur, Malaysia.
(3)Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine,
University of Malaya, Kuala Lumpur, Malaysia; Yale School of Medicine, Department
of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven,
CT, USA.
(4)Yale School of Medicine, Department of Internal Medicine, Section of
Infectious Diseases, AIDS Program, New Haven, CT, USA.
BACKGROUND: The intentional use of illicit drugs for sexual purposes (also known
as 'chemsex') is well known within the MSM communities in Malaysia although
research in this population is scarce primarily because both drug use and
homosexuality are illegal and stigmatised in Malaysia.
METHODS: From April to December 2014, interviews were conducted with twenty men
(age range 21-43) living in Greater Kuala Lumpur who had sexual intercourse with
other men in the past 6 months and who used illicit drugs at least monthly in the
past 3 months. Fourteen men were recruited via gay social networking smartphone
applications or websites while six were referred by the participants. Data were
analsed using thematic analytic approach.
FINDINGS: The average duration of illicit drug use was 6.4 years (range 1-21) and
all participants were using methamphetamine ("ice" or crystal meth) with
frequency of use ranged from daily to once a month. Participants came from
diverse ethnic, economic, and occupational backgrounds. Most participants used an
inhalation apparatus ("bong") to consume methamphetamine and injection was rare
in the sample. The primary motivation of methamphetamine use was to increase
sexual capacity, heighten sexual pleasure and enhance sexual exploration and
adventurism. Socializing with friends ("chilling"), and increased energy for work
were secondary motivations. Participants emphasized the need to control the use
of methamphetamine and some have established rules to control the amount and
duration of use and a minority of men have maintained condom use during anal sex
while under the influence of methamphetamine. Participants who professed to be in
control of their drug use characterized themselves as functional users regardless
of the health and social consequences from continuing use. Overall, participants
perceived themselves differently from the traditional opioid users and reported
limited access to sexual health and substance use treatment services.
CONCLUSION: There is a need to increase access to HIV prevention services such as
PrEP and PEP, professional support, and substance abuse treatment for drug-using
MSM. A more open and friendly environment towards drug-using MSM may help them
access and engage with the health services.
Copyright © 2018. Published by Elsevier B.V.
DOI: 10.1016/j.drugpo.2018.02.019
PMCID: PMC6336456
383. Neurosciences (Riyadh). 2016 Oct;21(4):338-344. doi:

10.17712/nsj.2016.4.20160245.
Patients reasons for obtaining psychotropic medications without a prescription at

retail pharmacies in Central Saudi Arabia.
Alosaimi FD(1), Alruwais FS, Alanazi FA, Alabidi GA, Aljomah NA, Alsalameh NS.
Author information:
(1)Department of Psychiatry, King Saud University Medical City, King Saud
University, Riyadh, Kingdom of Saudi Arabia. E-mail: dr.fahad.alosaimi@gmail.com.
OBJECTIVE: To explore the possible causes behind adults seeking psychotropic

medications without a prescription; identify the most commonly used psychotropic
medications without a prescription; and determine the prevalence of depression
and anxiety disorders among adults who used psychotropic medications without a
prescription in Riyadh, Kingdom of Saudi Arabia.
METHODS: A cross-sectional study was conducted from November 2014 to August 2015.
A convenience sample was taken by distributing a self-administered questionnaire
among participants who had obtained psychotropic medications without a
prescription from retail pharmacies during the 4 weeks prior to study intake in
Riyadh, Kingdom of Saudi Arabia. In addition to the study questionnaire, the
9-item Patient Health Questionnaire was used to screen for major depressive
disorder, and the 7-item Generalized Anxiety Disorder Scale was used to screen
for general anxiety disorders.
RESULTS: Of the 302 subjects, 42.4% attributed their use of psychotropic
medications without a prescription to the non-seriousness of their symptoms and
28.5% to the high cost of psychiatric services. Escitalopram was the most
commonly used medication (31.8%), and 3 atypical antipsychotics were used by more
than one-fifth of the study participants. The prevalence for major depressive
disorder was 46.0% and 41.7% for generalized anxiety disorder.
CONCLUSION: Most of the participants were able to easily obtain psychotropic
medications without a prescription. We recommend implementing strong policies to
prevent retail pharmacies from dispensing psychotropic medications without a
prescription.
DOI: 10.17712/nsj.2016.4.20160245
PMCID: PMC5224432
384. Drug Alcohol Depend. 2015 Sep 1;154:287-90. doi:

10.1016/j.drugalcdep.2015.06.025. Epub 2015 Jun 28.
Sexual risk behaviors and steroid use among sexual minority adolescent boys.
Blashill AJ(1), Safren SA(2), Jampel JD(3).
Author information:
(1)Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United
States; Department of Psychiatry, Harvard Medical School, Boston, MA, United
States; The Fenway Institute, Fenway Health, Boston, MA, United States.
Electronic address: aaron.blashill@sdsu.edu.
(2)Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United
States; Department of Psychiatry, Harvard Medical School, Boston, MA, United
States; The Fenway Institute, Fenway Health, Boston, MA, United States.
Electronic address: ssafren@mgh.harvard.edu.
(3)The Fenway Institute, Fenway Health, Boston, MA, United States. Electronic
address: jjampel@fenwayhealth.org.
BACKGROUND: Previous research has extensively examined the relationship between

the use of alcohol and illicit substances with sexual risk behaviors among sexual
minority (i.e., gay and bisexual) male youth; however, no known studies have
assessed the association of steroid use to risk behaviors among this population.
METHODS: Participants were 556 sexually active sexual minority adolescent boys (M
age=16.2, SD=1.3), taken from a pooled dataset of the 14 jurisdictions from the
2005 and 2007 Youth Risk Behavior Surveys that assessed sexual orientation. The
association between lifetime use of steroids and sexual risk behaviors were
examined.
RESULTS: Controlling for number of sexual partners, depression, victimization,
and race, boys who reported increased steroid use were at increased odds of
engaging in condomless sex, OR=1.55, p=.003, and use of alcohol/drugs during sex,
OR=1.48, p=.002.
CONCLUSIONS: Steroid use among sexual minority adolescent boys is prevalent and
associated with HIV/STI sexual transmission risk behaviors.
DOI: 10.1016/j.drugalcdep.2015.06.025
PMCID: PMC4646078
385. Med Arch. 2014 Dec;68(6):426-7. doi: 10.5455/medarh.2014.68.426-427. Epub 2014

Dec 16.
A Cases of Near-fatal Anaphylaxis: Parsley "Over-use" as an Herbal Remedy.
Arslan S(1), Ucar R(1), Caliskaner AZ(1).
Author information:
(1)Necmettin Erbakan University Medical Faculty, Division of Immunology and
Allergic Disease, Konya, Turkey. Necmettin Erbakan University Medical Faculty,
Division of Immunology and Allergic Disease, Konya, Turkey.
The use of herbal products in patients with allergic diseases is a special

problem and still controversial. But, many people often use herbs to maintain
good health. The patients use self-prescribed remedies as medications but do not
inform their physicians about herbal use. Unfortunately, some herbal
self-medications may have unexpected effects and interactions which may lead to
fatal complications. In this report, we describe a female patient who suffered
near-fatal anaphylaxis to parsley.
DOI: 10.5455/medarh.2014.68.426-427
PMCID: PMC4314155
386. Front Pharmacol. 2018 Oct 17;9:1069. doi: 10.3389/fphar.2018.01069.

eCollection
2018.
The Economic Impact of a Switch From Prescription-Only to Non-prescription Drugs

in Italy.
Otto MH(1)(2), Pillarella C(3), Jommi C(1)(4).
Author information:
(1)Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi
School of Management, Milan, Italy.
(2)Department of Social and Political Sciences, Bocconi University, Milan, Italy.
(3)Federchimica Assosalute, Milan, Italy.
(4)Department of Pharmaceutical Sciences, Università del Piemonte Orientale,
Novara, Italy.
Erratum in
Front Pharmacol. 2019 Mar 05;10:129.
The paper analyses the potential economic impact of switching drugs from
prescription-only to over the counter status, using Italy as a case-study. The
study assumes a societal perspective, investigating the effects of switches (and
consequent delisting) on drugs spending, avoided visits by GPs (General
Practitioners) and avoided time spent by patients for these visits. It overcomes
the main pitfalls of previous studies, providing a rational for listing
switchable products and applying both a static (no impact of switch on prices and
volumes consumed) and a dynamic approach (impact on pricing policies and volumes
depending on price-elasticity). Different scenarios were assumed including
shorter/longer time spent for visits and inclusion/exclusion of the economic
value of time of retiree patients. Results show that switching policy provides
with societal savings ranging from 1 to 2.1 1 billion Euro. The economic impact
on patients is less straightforward and depends on the scenarios used. If a
longer time is spent on visits, the economic value of this time will compensate
the cost of the switch to patients due to delisting. Despite the net economic
benefit should be carefully interpreted, the results demonstrate how switching
can contribute to the sustainability of the health care system in the middle-long
run thanks to the more rational use of resources, combined with an increased
awareness and responsibility of the involved stakeholders.
DOI: 10.3389/fphar.2018.01069
PMCID: PMC6199397
PMID: 30386233
387. Int J Drug Policy. 2015 Dec;26(12):1171-6. doi: 10.1016/j.drugpo.2015.07.013.

Epub 2015 Jul 26.
"Chemsex" and harm reduction need among gay men in South London.
Bourne A(1), Reid D(2), Hickson F(2), Torres-Rueda S(3), Steinberg P(4),
Weatherburn P(2).
Author information:
(1)Sigma Research, Department of Social & Environmental Health Research, London
School of Hygiene & Tropical Medicine, London, United Kingdom. Electronic
address: adam.bourne@lshtm.ac.uk.
(2)Sigma Research, Department of Social & Environmental Health Research, London
School of Hygiene & Tropical Medicine, London, United Kingdom.
(3)Department of Global Health and Development, London School of Hygiene &
Tropical Medicine, London, United Kingdom.
(4)Public Health, London Borough of Lambeth, London, United Kingdom.
BACKGROUND: Chemsex is a colloquial term used by gay men in some parts of the UK
to describe the use of psychoactive substances (typically mephedrone, GHB/GBL or
crystal methamphetamine) during sex. Use of these drugs by gay men in London
appears to have risen sharply from relatively low levels and, as yet, there is
little data to inform appropriate harm reduction services. This study sought to
understand the personal and social context of chemsex and the nature of harm
reduction need.
METHODS: In-depth interviews were conducted with 30 self-identifying gay men (age
range 21-53) who lived in three South London boroughs, and who had used either
crystal methamphetamine, mephedrone or GHB/GBL either immediately before or
during sex with another man during the previous 12 months. Data were subjected to
a thematic analysis.
RESULTS: While around half of participants had utilised a range of drugs over
many years, others had only recently been introduced to drugs, often by sexual
partners who wished to enhance the sexual session. As relatively new drugs on the
gay scene, understanding of appropriate dosing was lacking and a majority
described overdoses, particularly in relation to GHB/GBL. Negotiation of sex,
especially in group sex environments, was complicated by the effects of the drugs
and a small number of men reported concerns relating to sexual consent. While a
significant proportion of men had experienced a range of physical and mental
health harms, few had accessed professional support for fear of judgement or
concern about chemsex expertise.
CONCLUSION: Findings from this study indicate a substantial degree of harm in the
usage of relatively new psychoactive substances in highly sexual circumstances.
Generic drug services, typically designed to address the needs of opiate users,
may not be sufficiently resourced to address the specific and acute needs of gay
men engaging in chemsex.
DOI: 10.1016/j.drugpo.2015.07.013
388. Rev Paul Pediatr. 2018 Oct-Dec;36(4):437-444. doi:

10.1590/1984-0462/;2018;36;4;00008. Epub 2018 Nov 14.
USE OF DRUGS IN CHILDREN AGED ZERO TO FIVE YEARS OLD IN TUBARÃO, SANTA CATARINA,
BRAZIL.

publisher]
Maniero HK(1), Martins AA(1), Melo AC(2), Paz LPDS(1), Schraiber RB(3), Galato
D(1).
Author information:
(1)Universidade de Brasília, Brasília, DF, Brasil.
(2)Universidade Federal de São João Del-Rei, Divinópolis, MG, Brasil.
(3)Universidade do Sul de Santa Catarina, Tubarão, SC, Brasil.
OBJECTIVE: To analyze the context of drug use in children aged zero to five years
old.
METHODS: Cross-sectional study based on interviews conducted at home with
caregivers (parents, uncles or grandparents) of the children enrolled in ten
Family Health Strategy units across different geographical points of the city of
Tubarão, Santa Catarina, Brazil.
RESULTS: A total of 350 caregivers were interviewed, whose children's mean age
was 2.6 years. Of these, 56.9% had used at least one drug in the 15 days prior to
the interview, 31.1% had been exposed to self-medication and 35.7% had used at
least one medication obtained by current prescription. The use of medication was
associated with the age range up to 24 months, periodic consultation with
pediatricians and diagnosis of chronic and acute diseases. Among medicated
children, 19.1% inappropriately had been exposed to at least one medication
(considering dose, dose interval or period of treatment). Regarding medication
storage, 55.2% of interviewees stored them in unsafe places that could be
accessed by children and 32.0% in inappropriate places, with exposure to light,
heat or humidity. Moreover, 45.2% of the interviewees stored drugs out of their
packages, 38.9% without secondary packaging, and 1.6% of drugs had expired date.
CONCLUSIONS: Drug use is high among children in this age range, and actions aimed
at the safe and rational use of these substances in this population should be
encouraged.
Publisher: Analisar o perfil de utilização de medicamentos em crianças de zero a

cinco anos de idade.Estudo transversal baseado em entrevistas realizadas em
domicílio com cuidadores (pais, tios ou avós) das crianças cadastradas em dez
unidades de Estratégia Saúde da Família (ESF), distribuídas em diferentes pontos
geográficos do município de Tubarão, Santa Catarina.Foram entrevistados 350
cuidadores, cujas crianças sorteadas possuíam, em média, 2,6 anos de idade.
Destas, 56,9% utilizaram, pelo menos, um medicamento nos 15 dias anteriores à
entrevista, sendo que 31,1% foram expostas à automedicação e 35,7% utilizaram,
pelo menos, um medicamento obtido por prescrição atual. O uso de medicamentos foi
associado à faixa etária de até 24 meses, consulta periódica com pediatra e
diagnóstico de doenças agudas e doenças crônicas. Entre as crianças medicadas,
19,1% foram expostas a pelo menos um medicamento de forma inadequada
(considerando dose, intervalo entre doses ou período de tratamento). Quanto ao
armazenamento, 55,2% dos medicamentos estavam guardados em lugar inseguro, ou
seja, ao acesso das crianças, e 32,0% em locais inadequados, por estarem expostos
a luz, calor ou umidade. Ainda, 45,2% estavam sem bula, 38,9% sem embalagem
secundária e 1,6% fora do prazo de validade.As crianças estudadas apresentam uma
frequência elevada de uso de medicamentos, devendo ser incentivadas ações que
visem ao uso seguro e racional de fármacos nessa população.
DOI: 10.1590/1984-0462/;2018;36;4;00008
PMCID: PMC6322813
389. Glob Health Action. 2018;11(1):1496973. doi: 10.1080/16549716.2018.1496973.
Antibiotic misuse among university students in developed and less developed

regions of China: a cross-sectional survey.
Peng D(1), Wang X(1), Xu Y(1), Sun C(1), Zhou X(1).
Author information:
(1)a School of Public Health , Zhejiang University , Hangzhou , PR China.
BACKGROUND: Antimicrobial resistance (AMR) is a great threat to public health.

The primary cause of AMR is human antibiotic misuse. Little is known about
regional differences of antibiotic misuse behaviours in China.
OBJECTIVES: To explore the antibiotic misuse behaviours among university students
in western and eastern China and find out the regional differences.
METHODS: Participants were recruited from universities in less developed Guizhou
Province and developed Zhejiang Province using a cluster random sampling method.
A self-administered questionnaire was designed to collect data, and the χ2 test
and logistic regression were adopted to assess the associations between region
and antibiotic misuse behaviours.
RESULTS: A total of 2073 university students from Guizhou and 1922 from Zhejiang
completed questionnaires. Students in Guizhou had lower household income,
parents' education, and urban residence proportion than those in Zhejiang.
Compared with those in Zhejiang, students in Guizhou had higher antibiotic use
prescribed by doctors (79.8% vs 56.2%) and self-medication with antibiotics
(33.0% vs 16.1%). Students in Guizhou were more likely to buy over-the-counter
antibiotics without prescriptions (73.9% vs 63.4%), ask for antibiotics from
doctors (21.4% vs 15.6%), and use antibiotics prophylactically (29.9% vs 15.7%).
Adjusted models showed that the less developed region was significantly
associated with higher antibiotic misuse behaviours.
CONCLUSIONS: Misuse of antibiotics by well-educated young adults was very high in
two regions but most serious in the less developed one. Campaigns are urgently
needed to promote appropriate antibiotic use especially in less developed
regions.
DOI: 10.1080/16549716.2018.1496973
PMCID: PMC6104601
390. J Med Humanit. 2015 Dec;36(4):359-68. doi: 10.1007/s10912-013-9259-z.
Dr Junkie. The Doctor Addict in Bulgakov's Morphine: What are the Lessons for
Contemporary Medical Practice?
Tischler V(1).
Author information:
(1)Division of Psychiatry and Applied Psychology, Institute of Mental Health,
University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.
victoria.tischler@nottingham.ac.uk.
Historical, cultural and professional factors have contributed to stigma and

secrecy regarding addiction in the medical profession and there are calls to
improve education in this area. This paper argues that physician-penned
literature plays an important role in raising awareness of substance misuse in
the medical profession. Bulgakov's short story Morphine documents the decline of
Dr Polyakov and illustrates a number of salient professional issues such as
self-medication, abuse of authority and risks to patients. Physician-penned
literature such as Morphine is of value in medical education as it offers a route
into sensitive topics and an authoritative and insider perspective that is
attractive to students and physicians alike.
DOI: 10.1007/s10912-013-9259-z
PMCID: PMC4642586
391. Exp Clin Psychopharmacol. 2015 Oct;23(5):303-13. doi: 10.1037/pha0000022. Epub

2015 Jun 8.
A laboratory-based test of the relation between adolescent alcohol use and

panic-relevant responding.
Blumenthal H(1), Cloutier RM(1), Zamboanga BL(2), Bunaciu L(3), Knapp AA(4).
Author information:
(1)Department of Psychology, University of North Texas.
(2)Department of Psychology, Smith College.
(3)Houston OCD Program.
(4)Department of Psychological Science, University of Arkansas.
A burgeoning literature supports a link between alcohol use and panic-spectrum

problems (e.g., panic attacks, disorder) among adolescents, but the direction of
influence has yet to be properly examined. From a theoretical perspective,
panic-spectrum problems may increase risk for problematic drinking via affect
regulation efforts (e.g., self-medication), and problematic consumption also may
increase or initiate panic-relevant responding (e.g., learning or kindling
models). The objective of the current investigation was to examine the role of
prior alcohol use in predicting panic-relevant responding, as well as panic
symptom history in predicting the desire to consume alcohol, in the context of
either a voluntary hyperventilation or a low-arousal task. Participants were
community-recruited adolescents aged 12-17 years (n = 92, Mage = 15.42, SD =
1.51; 39.1% girls). Results indicated that prior alcohol use predicted
panic-relevant responding among those undergoing the hyperventilation task (but
not the low-arousal task), and that this finding was robust to the inclusion of
theoretically relevant covariates (i.e., age, sex, negative affectivity).
However, panic symptom history did not predict the desire to consume alcohol as a
function of either the hyperventilation or low-arousal condition. This work sheds
further light on the nature of the relation between panic-spectrum problems and
problematic alcohol use in adolescence. Specifically, the current findings
suggest that frequent alcohol use may increase panic vulnerability among
adolescents, whereas acute panic symptoms may not elicit the immediate
(self-reported) desire to drink.
DOI: 10.1037/pha0000022
PMCID: PMC4578981
392. Drug Alcohol Depend. 2015 Jul 1;152:224-9. doi:

10.1016/j.drugalcdep.2015.03.034.
Epub 2015 Apr 9.
Peak ages of risk for starting nonmedical use of prescription stimulants.
Austic EA(1).
Author information:
(1)Injury Center, Department of Emergency Medicine, University of Michigan, 2800
Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800, United States.
Electronic address: emeier@umich.edu.
Erratum in
Drug Alcohol Depend. 2016 Feb 1;159:289. Meier, E A Austic Formerly E A
[corrected to Austic, E A].
BACKGROUND: To produce population-level, year- and age-specific risk estimates of

first time nonmedical use of prescription stimulants among young people in the
United States.
METHODS: Data are from the National Surveys on Drug Use and Health 2004-2012; a
nationally representative probability sample survey administered each year.
Subpopulations included youths aged 12 to 21 years (n=240,160) who had not used
prescription stimulants nonmedically prior to their year of survey assessment. A
meta-analytic approach was used to produce population-level age-, year-, and
cohort-specific risk estimates of first time nonmedical use of prescription
stimulants.
RESULTS: Peak risk of starting nonmedical use of prescription stimulants was
concentrated between ages 16 and 19 years, when an estimated 0.7% to 0.8% of
young people reported nonmedical use of these medicines for the first time in the
past twelve months. Smaller risk estimates ranging from 0.1% to 0.6% were
observed at ages 12 to 15 years and 20 to 21 years. Compared with males, females
were more likely to have started nonmedical use of prescription stimulants (odds
ratio=1.35; 95% CI, 1.13-1.62), particularly between the ages of 14 and 19.
Females showed a peak annual incidence rate of 1% at age 18, while males the same
age showed an incidence rate of 0.5%.
CONCLUSIONS: Peak annual incidence rates for nonmedical use of prescription
stimulants were observed between the ages of 16 and 19 years. There is reason to
initiate interventions during the earlier adolescent years to prevent youths from
starting nonmedical use of prescription stimulants.

DOI: 10.1016/j.drugalcdep.2015.03.034
PMCID: PMC4458195
393. Child Abuse Negl. 2015 Aug;46:8-15. doi: 10.1016/j.chiabu.2015.03.006. Epub

2015
Mar 29.
Posttraumatic stress avoidance symptoms as mediators in the development of

alcohol use disorders after exposure to childhood sexual abuse in a Swiss
community sample.
Müller M(1), Vandeleur C(2), Rodgers S(1), Rössler W(3), Castelao E(2), Preisig
M(2), Ajdacic-Gross V(1).
Author information:
(1)Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University
Hospital of Psychiatry, Militärstrasse 8, 8021 Zurich, Switzerland.
(2)Department of Psychiatry, CHUV, Site de Cery, 1008 Prilly, Lausanne,
Switzerland.
Hospital of Psychiatry, Militärstrasse 8, 8021 Zurich, Switzerland; Collegium
Helveticum, University of Zurich and Swiss Federal Institute of Technology,
Schmelzbergstrasse 25, 8092 Zurich, Switzerland; Institute of Psychiatry,
Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Medical School,
05403-010 Sao Paulo, SP, Brazil.
This study examined the role of posttraumatic stress disorder (PTSD) symptoms of
re-experience, avoidance, and hyperarousal in the relationship between different
types of trauma and alcohol use disorders (AUD). We used data from 731
trauma-exposed individuals who participated in the first wave of the
PsyCoLaus-study. Trauma characteristics were assessed relatively to the
occurrence of lifetime PTSD symptoms and AUD. The results suggest that lifetime
and childhood sexual abuse as well as overall childhood trauma were directly
linked to AUD and PTSD symptoms, in particular to avoidance symptoms. From single
symptom clusters PTSD avoidance was found to specifically mediate the trauma-AUD
pathway. Both childhood and sexual trauma strongly contribute to the comorbidity
of PTSD and AUD and avoidance-type symptoms appear to play a central role in
maintaining this association. Hence, the alleviation of avoidance symptoms might
be an important target for therapeutic intervention among victims of sexual abuse
before specific addiction treatment is initiated.
DOI: 10.1016/j.chiabu.2015.03.006
394. Malar J. 2018 Apr 16;17(1):168. doi: 10.1186/s12936-018-2311-8.
Factors associated with treatment-seeking for malaria in urban poor communities

in Accra, Ghana.
Awuah RB(1), Asante PY(2), Sakyi L(3), Biney AAE(1), Kushitor MK(1), Agyei F(2),
de-Graft Aikins A(4).
Author information:
(1)Regional Institute for Population Studies, University of Ghana, Accra, Ghana.
(2)Department of Psychology, University of Ghana, Accra, Ghana.
(3)Centre for Migration Studies, University of Ghana, Accra, Ghana.
(4)Regional Institute for Population Studies, University of Ghana, Accra, Ghana.
adaikins@ug.edu.gh.
BACKGROUND: In Ghana, about 3.5 million cases of malaria are recorded each year.
Urban poor residents particularly have a higher risk of malaria mainly due to
poor housing, low socio-economic status and poor sanitation. Alternative
treatment for malaria (mainly African traditional/herbal and/or self-medication)
is further compounding efforts to control the incidence of malaria in urban poor
communities. This study assesses factors associated with seeking alternative
treatment as the first response to malaria, relative to orthodox treatment in
three urban poor communities in Accra, Ghana.
METHODS: This cross-sectional study was conducted in three urban poor localities
in Accra, Ghana among individuals in their reproductive ages (15-59 years for men
and 15-49 years for women). The analytic sample for the study was 707. A
multinomial regression model was used to assess individual, interpersonal and
structural level factors associated with treatment-seeking for malaria.
RESULTS: Overall, 31% of the respondents sought orthodox treatment, 8% sought
traditional/herbal treatment and 61% self-medicated as the first response to
malaria. At the bivariate level, more males than females used traditional/herbal
treatment and self-medicated for malaria. The results of the regression analysis
showed that current health insurance status, perceived relative economic
standing, level of social support, and locality of residence were associated with
seeking alternative treatment for malaria relative to orthodox treatment.
CONCLUSIONS: The findings show that many urban poor residents in Accra
self-medicate as the first response to malaria. Additionally, individuals who
were not enrolled in a health insurance scheme, those who perceived they had a
low economic standing, those with a high level of social support, and locality of
residence were significantly associated with the use of alternative treatment for
malaria. Multi-level strategies should be employed to address the use of
alternative forms of treatment for malaria within the context of urban poverty.
DOI: 10.1186/s12936-018-2311-8
PMCID: PMC5902882
395. Nutrients. 2015 Apr 16;7(4):2947-60. doi: 10.3390/nu7042947.
Concomitant use of dietary supplements and medicines in patients due to

miscommunication with physicians in Japan.
Chiba T(1), Sato Y(2), Suzuki S(3), Umegaki K(4).
Author information:
(1)Information Center, National Institute of Health and Nutrition, 1-23-1 Toyama,
Shinjuku-ku, Tokyo 162-8636, Japan. tyschiba@nih.go.jp.
Shinjuku-ku, Tokyo 162-8636, Japan. satoyoko@nih.go.jp.
Shinjuku-ku, Tokyo 162-8636, Japan. sachina-s@nih.go.jp.
Shinjuku-ku, Tokyo 162-8636, Japan. umegaki@nih.go.jp.
We previously reported that some patients used dietary supplements with their
medication without consulting with physicians. Dietary supplements and medicines
may interact with each other when used concomitantly, resulting in health
problems. An Internet survey was conducted on 2109 people who concomitantly took
dietary supplements and medicines in order to address dietary supplement usage in
people who regularly take medicines in Japan. A total of 1508 patients (two
admitted patients and 1506 ambulatory patients) and 601 non-patients, who were
not consulting with physicians, participated in this study. Purpose for dietary
supplement use was different among ages. Dietary supplements were used to treat
diseases in 4.0% of non-patients and 11.9% of patients, while 10.8% of patients
used dietary supplements to treat the same diseases as their medication. However,
70.3% of patients did not declare dietary supplement use to their physicians or
pharmacists because they considered the concomitant use of dietary supplements
and medicines to be safe. A total of 8.4% of all subjects realized the potential
for adverse effects associated with dietary supplements. The incidence of adverse
events was higher in patients who used dietary supplements to treat their
disease. Communication between patients and physicians is important for avoiding
the adverse effects associated with the concomitant use of dietary supplements
and medicines.
DOI: 10.3390/nu7042947
PMCID: PMC4425182

eCollection 2015.
The effect of active learning methodologies on the teaching of pharmaceutical

care in a Brazilian pharmacy faculty.
Mesquita AR(1), Souza WM(1), Boaventura TC(1), Barros IM(1), Antoniolli AR(1),
Silva WB(1), Lyra Júnior DP(1).
Author information:
(1)Department of Pharmacy, Federal University of Sergipe, São Cristovão, Sergipe,
Brazil.
BACKGROUND: In recent years, pharmacists have been involved in expanded patient

care responsibilities, for example patient counseling in self-medication,
medication review and pharmaceutical care, which require graduates to develop the
necessary competences. Consequently, reorientation of pharmacy education has
become necessary. As such, active learning strategies have been introduced into
classrooms to increase problem-solving and critical thinking skills of students.
The objective of this study was to evaluate the performance and perceptions of
competency of students in a new pharmaceutical care course that uses active
learning methodologies.
METHODS: This pharmaceutical care course was conducted in the first semester of
2014, in the Federal University of Sergipe. In the pharmaceutical care course,
active learning methods were used, consisting of dialogic classroom expository,
simulation and case studies. Student learning was evaluated using classroom tests
and instruments that evaluated the perception of competency in pharmaceutical
care practice. Furthermore, students' satisfaction with the course was evaluated.
RESULTS: Thirty-three students completed the four evaluations used in the course
(i.e., a discursive written exam, seminars, OSCE, and virtual patient); 25 were
female (75.75%), and the median age was 23.43 (SD 2.82) years. The overall mean
of student scores, in all evaluation methods was 7.97 (SD 0.59) on a scale of 0
to 10 points, and student performance on the virtual patient method was
statistically superior to other methods. With respect to the perception of
competency in pharmaceutical care practice, a comparison of pre- and post-test
scores revealed statistically significant improvement for all evaluated
competences. At the end of the semester, the students presented positive opinions
of the pharmaceutical care course.
CONCLUSIONS: The results suggest that an active learning course can enhance the
learning of pharmaceutical care competences. In future studies it will be
necessary to compare active learning to traditional methods.
PMCID: PMC4430170

eCollection 2014.
Males of a strongly polygynous species consume more poisonous food than females.
Bravo C(1), Bautista LM(1), García-París M(2), Blanco G(1), Alonso JC(1).
Author information:
(1)Department of Evolutionary Ecology, Museo Nacional de Ciencias Naturales,
CSIC, Madrid, Madrid, Spain.
(2)Department of Biodiversity and Evolutionary Biology, Museo Nacional de
Ciencias Naturales, CSIC, Madrid, Madrid, Spain.
We present evidence of a possible case of self-medication in a lekking bird, the

great bustard Otis tarda. Great bustards consumed blister beetles (Meloidae), in
spite of the fact that they contain cantharidin, a highly toxic compound that is
lethal in moderate doses. In addition to anthelminthic properties, cantharidin
was effective against gastrointestinal bacteria that cause sexually-transmitted
diseases. Although both sexes consumed blister beetles during the mating season,
only males selected them among all available insects, and ingested more and
larger beetles than females. The male-biased consumption suggests that males
could use cantharidin to reduce their parasite load and increase their sexual
attractiveness. This plausibly explains the intense cloaca display males perform
to approaching females, and the meticulous inspection females conduct of the
male's cloaca, a behaviour only observed in this and another similar species of
the bustard family. A white, clean cloaca with no infection symptoms (e.g.,
diarrhoea) is an honest signal of both, resistance to cantharidin and absence of
parasites, and represents a reliable indicator of the male quality to the
extremely choosy females. Our results do not definitely prove, but certainly
strongly suggest that cantharidin, obtained by consumption of blister beetles,
acts in great bustards as an oral anti-microbial and pathogen-limiting compound,
and that males ingest these poisonous insects to increase their mating success,
pointing out that self-medication might have been overlooked as a
sexually-selected mechanism enhancing male fitness.
PMCID: PMC4206510
398. Soc Sci Med. 2015 Apr;131:280-8. doi: 10.1016/j.socscimed.2014.04.033. Epub

2014
Apr 21.
The drugs don't sell: DIY heart health and the over-the-counter statin
experience.
Will CM(1), Weiner K(2).
Author information:
(1)Department of Sociology, University of Sussex, Brighton BN1 9SN, UK.
Electronic address: c.will@sussex.ac.uk.
(2)Institute for Science and Society, University of Nottingham, Nottingham NG7
2RD, UK; School of Psychological Sciences, University of Manchester, Manchester
M13 9PL, UK. Electronic address: k.weiner@sheffield.ac.uk.
This paper draws on a study of over-the-counter statins to provide a critical

account of the figure of the 'pharmaceutical consumer' as a key actor in the
pharmaceuticalisation literature. A low dose statin, promising to reduce
cardiovascular risk, was reclassified to allow sale in pharmacies in the UK in
2004. We analysed professional and policy debates about the new product,
promotional and sales information, and interviews with consumers and potential
consumers conducted between 2008 and 2011, to consider the different consumer
identities invoked by these diverse actors. While policymakers constructed an
image of 'the citizen-consumer' who would take responsibility for heart health
through exercising the choice to purchase a drug that was effectively rationed on
the NHS and medical professionals raised concerns about 'a flawed consumer' who
was likely to misuse the product, both these groups assumed that there would be a
market for the drug. By contrast, those who bought the product or potentially
fell within its target market might appear as 'health consumers', seeking out and
paying for different food and lifestyle products and services, including those
targeting high cholesterol. However, they were reluctant 'pharmaceutical
consumers' who either preferred to take medication on the advice of a doctor, or
sought to minimize medicine use. In comparison to previous studies, our analysis
builds understanding of individual consumers in a market, rather than collective
action for access to drugs (or, less commonly, compensation for adverse effects).
Where some theories of pharmaceuticalisation have presented consumers as creating
pressure for expanding markets, our data suggests that sociologists should be
cautious about assuming there will be demand for new pharmaceutical products,
especially those aimed at prevention or asymptomatic conditions, even in
burgeoning health markets.
DOI: 10.1016/j.socscimed.2014.04.033

eCollection 2016.
Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical

Care: A Qualitative Study.
Bilardi J(1)(2)(3), Walker S(1)(2), McNair R(3), Mooney-Somers J(4), Temple-Smith

M(3), Bellhouse C(1)(2), Fairley C(1)(2), Chen M(1)(2), Bradshaw C(1)(2)(5).
Author information:
(1)Central Clinical School, Monash University, Melbourne, Victoria, Australia.
(2)Melbourne Sexual Health Centre, The Alfred Hospital, Melbourne, Victoria,
Australia.
(3)Department of General Practice, The University of Melbourne, Melbourne,
Victoria, Australia.
(4)Centre for Values, Ethics and the Law in Medicine, The University of Sydney,
Sydney, New South Wales, Australia.
(5)Melbourne School of Population and Global Health, The University of Melbourne,
Melbourne, Victoria, Australia.
BACKGROUND: Few data are available on how women manage recurring bacterial
vaginosis (BV) and their experiences of the clinical care of this condition. This
study aimed to explore women's recurrent BV management approaches and clinical
care experiences, with a view to informing and improving the clinical management
of BV.
METHODS: A descriptive, social constructionist approach was chosen as the
framework for the study. Thirty-five women of varying sexual orientation who had
experienced recurrent BV in the past 5 years took part in semi-structured
interviews.
RESULTS: The majority of women reported frustration and dissatisfaction with
current treatment regimens and low levels of satisfaction with the clinical
management of BV. Overall, women disliked taking antibiotics regularly, commonly
experienced adverse side effects from treatment and felt frustrated at having
symptoms recur quite quickly after treatment. Issues in clinical care included
inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and
insensitive or dismissive attitudes. Women were more inclined to report positive
clinical experiences with sexual health physicians than primary care providers.
Women's frustrations led most to try their own self-help remedies and lifestyle
modifications in an attempt to treat symptoms and prevent recurrences, including
well-known risk practices such as douching.
CONCLUSION: In the face of considerable uncertainty about the cause of BV, high
rates of recurrence, unacceptable treatment options and often insensitive and
inconsistent clinical management, women are trying their own self-help remedies
and lifestyle modifications to prevent recurrences, often with little effect.
Clinical management of BV could be improved through the use of standardised
diagnostic approaches, increased sensitivity and understanding of the impact of
BV, and the provision of evidence based advice about known BV related risk
factors.
PMCID: PMC4807032
400. J Stud Alcohol Drugs. 2016 Mar;77(2):287-97.
Bidirectional Associations Between Cannabis Use and Depressive Symptoms From

Adolescence Through Early Adulthood Among At-Risk Young Men.
Womack SR(1), Shaw DS(1), Weaver CM(1), Forbes EE(1)(2).
Author information:
(1)Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania.
(2)Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
OBJECTIVE: Previous studies have established a relationship between cannabis use

and affective problems among adolescents and young adults; however, the direction
of these associations remains a topic of debate. The present study sought to
examine bidirectional associations between cannabis use and depressive symptoms,
specifically testing the validity of two competing hypotheses: the cannabis
effect hypothesis, which suggests that cannabis use contributes to the onset of
later depressive symptoms; and the self-medication hypothesis, which posits that
individuals increase their use of a substance to alleviate distressing
psychological symptoms.
METHOD: Participants in this study were 264 low-socioeconomic-status males
assessed at ages 17, 20, and 22. Cross-lag panel models were fit to test
bidirectional associations between cannabis use frequency and depressive symptoms
across the transition from adolescence to early adulthood. In addition, analyses
were conducted within two high-risk subsamples to examine whether associations
between cannabis use frequency (ranging from never used to daily use) and
depressive symptoms differed among regular cannabis users (used cannabis more
than once per week) or subjects reporting at least mild levels of depressive
symptoms.
RESULTS: Cannabis use and depressive symptoms were concurrently correlated.
Cannabis use predicted increases in later depressive symptoms, but only among the
mild-depression subsample. Depressive symptoms predicted only slight increases in
later cannabis use, among the subsample of regular cannabis users.
CONCLUSIONS: Temporal patterns of cannabis use and depressive symptoms provide
evidence for the cannabis effect but limited evidence for the self-medication
hypothesis. Adolescents higher in depressive symptoms may be vulnerable to the
adverse psychological effects of using cannabis. Results are discussed in terms
of implications for basic research, prevention, and intervention.
DOI: 10.15288/jsad.2016.77.287
401. S Afr J Psychiatr. 2017 Apr 10;23:1022. doi: 10.4102/sajpsychiatry.v23i0.1022.

eCollection 2017.
An exploration of alcohol use amongst undergraduate female psychology students at

a South African university.
Govender I(1), Nel K(2), Sibuyi XM(3).
Author information:
(1)Department of Family Medicine and Primary Health Care, Sefako Makgatho Health
Sciences University, South Africa.
(2)Department of Psychology, University of Limpopo, South Africa.
(3)Elim Hospital, South Africa.
Background: Alcohol use amongst tertiary education students, particularly female

undergraduates, is increasing. Heavy alcohol use by tertiary students leads to a
variety of alcohol-related problems such as damage to property, poor academic
performance, problematic peer relationships, high dropout rates, unprotected
sexual activity, physical injuries, date rape and suicide. Abuse of alcohol is
attributed to curiosity and experimentation, peer pressure, low self-esteem,
enjoyment, parental modelling, socio-cultural influences, stress and life events,
self-medication and concerns about weight and appearance.Our study explores
alcohol use and the reasons behind it amongst undergraduate female psychology
students at the University of Limpopo. The findings will be important, as these
students represent many future psychologists who are going to advise others on
harms related to alcohol use.
Methods: This was a descriptive survey, and the qualitative results are
presented. The sample consists of 700 undergraduate female psychology students. A
self-administered questionnaire included five open-ended questions which elicited
the thoughts and experiences of these students about alcohol use. Responses to
these questions were analysed using thematic content analysis.
Results: The themes that arose were as follows: fun and enjoyment, socio-cultural
influences, alcohol use leads to negative behaviour(s), peer influence, destress,
concerns about weight and appearance, abstinence from alcohol and it improves
self-esteem.
Conclusion: The themes were reasons that female students gave for consuming
alcohol. The majority of participants reported responsible drinking behaviour,
but a notable proportion of female students' drinking behaviours (across all year
levels) are cause for concern in terms of negative impact at both social and
academic levels.
DOI: 10.4102/sajpsychiatry.v23i0.1022
PMCID: PMC6138216
PMID: 30263187
Conflict of interest statement: The authors declare that they have no financial
or personal relationships which may have inappropriately influenced them in
writing this article.
402. Euro Surveill. 2015;20(34):30002. doi: 10.2807/1560-7917.ES.2015.20.34.30002.
Analysis of licensed over-the-counter (OTC) antibiotics in the European Union and

Norway, 2012.
Both L(1), Botgros R, Cavaleri M.
Author information:
(1)Public Health England (PHE), London, United Kingdom.
Antimicrobial resistance is recognised as a growing problem that seriously

threatens public health and requires prompt action. Concerns have therefore been
raised about the potential harmful effects of making antibiotics available
without prescription. Because of the very serious concerns regarding further
spread of resistance, the over-the-counter (OTC) availability of antibiotics was
analysed here. Topical and systemic OTC antibiotics and their indications were
determined across 26 European Union (EU) countries and Norway by means of a
European survey. We identified a total of 48 OTC products containing 20 different
single antibiotics and three antibiotic combinations as active substances, used
mainly as topical preparations in short treatment courses. Given the relevance of
these medicines and the increasing risk of antimicrobial resistance, it is
important to limit the availability of OTC antibiotics and to monitor their use.
DOI: 10.2807/1560-7917.ES.2015.20.34.30002
403. Niger J Clin Pract. 2018 Nov;21(11):1476-1483. doi: 10.4103/njcp.njcp_69_18.
Knowledge, risk perception and practices related to antibiotic resistance among

patent medicine vendors in Sokoto metropolis, Nigeria.
Awosan KJ(1), Ibitoye PK(2), Abubakar AK(1).
Author information:
(1)Department of Community Health, Usmanu Danfodiyo University, Sokoto, Nigeria.
(2)Department of Paediatrics, Usmanu Danfodiyo University, Sokoto, Nigeria.
Background: Resistance to antibiotics is now a serious threat to global health,

and inappropriate use of drugs has been identified as a major contributing factor
in the developing countries.
Objectives: The aim of this study is to assess the knowledge, risk perception,
and practices related to antibiotic resistance among patent medicine vendors
(PMVs) in Sokoto metropolis, Nigeria.
Materials and Methods: A cross-sectional study was conducted among 200 PMVs
selected by multi-stage sampling technique. Data were collected with a set of
pretested, self administered, semi structured questionnaire.
Results: A larger proportion (83, 42.1%) of the 197 respondents who completed the
questionnaire were aged 20 29 years. Most of them were males (80.2%) and had
tertiary education (80.7%). Most of the respondents had adequate knowledge of the
causes of antibiotic resistance (94.9%), and its prevention (98.0%). Most of the
respondents also perceived antibiotic resistance as a serious threat to their own
health (95.4%), and the health of their clients (89.4%). Practices favorable to
the development of antibiotic resistance were very prevalent among the
respondents. Majority of respondents (59.9%) consistently sell antibiotics to
clients without doctor's prescription, and close to half of them (49.2%)
consistently practice self-medication.
Conclusion: Despite high levels of knowledge of the causes, prevention, and
perception of the risks associated with antibiotics resistance, practices
favorable to its development were very prevalent among PMVs in Sokoto, Nigeria.
Government should regulate and closely monitor PMVs' practices in order to avert
the looming crisis in medical practice that will become inevitable if there are
no potent antibiotics.
DOI: 10.4103/njcp.njcp_69_18
404. Arq Neuropsiquiatr. 2015 Jul;73(7):586-92. doi: 10.1590/0004-282X20150072.
Study of the use of analgesics by patients with headache at a specialized

outpatient clinic (ACEF).
Chagas OF(1), Éckeli FD(2), Bigal ME(3), Silva MO(4), Speciali JG(2).
Author information:
(1)Universidade de Ribeirão Preto, Ribeirão Preto, SP, Brazil.
(2)Divisão de Neurologia, Faculdade de Medicina de Ribeirão Preto, Universidade
de São Paulo, Ribeirão Preto, SP, Brazil.
(3)Migraine & Headache Clinical Development.
(4)Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo,
Ribeirão Preto, SP, Brazil.
OBJECTIVE: To evaluate the use of analgesics in headache diagnosed in Outpatients

Headache Clinic (ACEF), as well as his involvement in the activities of the
patients.
METHOD: 145 patients with headache seen at ACEF during the period August/July
2009/2010 underwent a questionnaire and interview with neurologist responsible
for the final diagnosis according to ICHD-II.
RESULTS: Relationship Women:Men 7:1. 1) Prevalence: Migraine without aura
(52.4%), migraine with aura (12.4%), chronic migraine (15.2%) and medication
overuse headache (MOH) (20%). 2) Analgesic drugs used: Compounds with Dipyrone
(37%), Dipyrone (23%), Paracetamol (16%) compound with Paracetamol (6%), triptans
(6%) and non steroidal anti-inflammatory drugs (12%). There was a significant
decrease in the duration of pain and less interference in the activities of the
headache patients after the use of analgesics.
CONCLUSION: Prevalence of MOH has been increasing in population level and
specialized services. New studies emphasizing the MOH are needed to assist in the
improvement of their diagnostic and therapeutic approach.
DOI: 10.1590/0004-282X20150072
405. Pharm Pract (Granada). 2014 Oct;12(4):451. Epub 2014 Mar 15.
Impact of pharmaceutical counseling in minor health problems in rural Portugal.

Coelho RB(1), Costa FA(2).
Author information:
(1)Master in Pharmaceutical Sciences. Pharmaceutical Care Specialist Pharmacy in
Pharmaceutical Alfeirao. Vila Nova de Milfontes ( Portugal ).
rakacoelho@hotmail.com.
(2)Higher Institute of Health Sciences Egas Moniz . Centre for Interdisciplinary
Research Egas Moniz (CiiEM). Almada ( Portugal ). alvesdacosta.f@gmail.com.
OBJECTIVES: The objectives of this study were to determine the prevalence of

self-medication and to evaluate the clinical impact of pharmaceutical counseling.
METHODS: A cross-sectional study was used with a prospective component, the
latter to evaluate the impact of pharmaceutical counseling. The study was
conducted in a rural community pharmacy for 14 consecutive days in December 2012,
recruiting all individuals who agreed to participate and met the eligibility
criteria. During a face-to-face direct interview demographic and clinical
characteristics of patients were registered, followed by a pharmaceutical
intervention, which consisted of evaluating the symptoms, selecting the most
appropriate non-prescription medicine (NPM) available and advising the patient on
pharmacologic and non-pharmacologic measures, all according to established
protocols for minor health problems. When appropriate, the patient was referred
to a medical appointment. One week later, the clinical outcome of such
intervention was measured by asking the patients about the resolution of their
minor health problems.
RESULTS: Data from 298 patients were analyzed, the majority being female (60.1%)
with an average age of 44.84 years (SD=22.41). Respiratory problems were the most
frequent (n=78; 26.2%) and respiratory tract medication was the most frequently
indicated (n= 77; 27.8%). The observed prevalence of self-medication was 40.7%.
Of the 271 patients' beneficiaries of pharmaceutical counseling, 86.8% had their
minor health problems solved after one week (ranging from 77.5% to 88.2%
according to a sensibility analysis for drop-outs).
CONCLUSIONS: This work is important as it demonstrates the beneficial impact of
pharmaceutical counseling, a very relevant area for the pharmacist and where
literature is particularly scarce.
PMCID: PMC4282762
PMID: 25580167
406. Violence Against Women. 2015 Aug;21(8):917-38. doi: 10.1177/1077801215589375.

Epub 2015 Jun 10.
Emotional Distress, Alcohol Use, and Bidirectional Partner Violence Among Lesbian
Women.
Lewis RJ(1), Padilla MA(2), Milletich RJ(2), Kelley ML(2), Winstead BA(3),
Lau-Barraco C(3), Mason TB(2).
Author information:
(1)Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA Old
Dominion University, Norfolk, VA, USA rlewis@odu.edu.
(2)Old Dominion University, Norfolk, VA, USA.
(3)Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA Old
Dominion University, Norfolk, VA, USA.
This study examined the relationship between emotional distress (defined as

depression, brooding, and negative affect), alcohol outcomes, and bidirectional
intimate partner violence among lesbian women. Results lend support to the
self-medication hypothesis, which predicts that lesbian women who experience more
emotional distress are more likely to drink to cope, and in turn report more
alcohol use, problem drinking, and alcohol-related problems. These alcohol
outcomes were, in turn, associated with bidirectional partner violence (BPV).
These results offer preliminary evidence that, similar to findings for
heterosexual women, emotional distress, alcohol use, and particularly,
alcohol-related problems are risk factors for BPV among lesbian women.
DOI: 10.1177/1077801215589375
PMCID: PMC4490938
407. Addict Behav. 2015 Feb;41:152-61. doi: 10.1016/j.addbeh.2014.10.006. Epub 2014

Oct 30.
Drowning the pain: intimate partner violence and drinking to cope prospectively
predict problem drinking.
Øverup CS(1), DiBello AM(2), Brunson JA(3), Acitelli LK(2), Neighbors C(2).
Author information:
(1)University of Houston, United States. Electronic address: coverup@uh.edu.
(2)University of Houston, United States.
(3)Pennsylvania State University, United States.
INTRODUCTION: The present study examined the longitudinal association among

drinking problems, drinking to cope, and degree of intimate partner violence
(IPV). Two competing models were tested; the first model posited that drinking to
cope leads to greater drinking problems and this subsequently leads to more
violence in the relationship (an intoxication-violence model). The second model
speculated that violence in the relationship leads to drinking to cope, which in
turn leads to greater drinking problems (a self-medication model).
METHODS: Eight hundred and eighteen undergraduate students at a large
north-western university participated in the study over a two year period,
completing assessments of IPV, alcohol related problems and drinking to cope at
five time points over a two year period as part of a larger social norms
intervention study.
RESULTS: Analyses examined two competing models; analyses indicated that there
was support for the self-mediation model, whereby people who have experienced
violence have more drinking problems later, and this association is temporally
mediated by drinking to cope.
DISCUSSION: The current results are discussed in light of past research on the
self-medication model.
DOI: 10.1016/j.addbeh.2014.10.006
PMCID: PMC4948194
408. Indian J Ophthalmol. 2018 Oct;66(10):1476-1477. doi: 10.4103/ijo.IJO_365_18.
Ocular chemical burns from accidental exposure to topical dermatological

medicinal agent.
Jinagal J(1), Gupta PC(1), Gupta G(1), Sahu KK(2), Ram J(1).
Author information:
(1)Advanced Eye Centre, Post Graduate Institute of Medical Education and
Research, Chandigarh, India.
(2)Department of Internal Medicine, St. Vincent Hospital, Worcester, 123 Summer
Street-01608, USA.
We report a case of accidental ocular chemical injury by self-medication with a

single application of a topical ayurvedic medication containing salicylic acid,
phenol, and tincture iodine, which is being used in developing countries for
treatment of various dermatological conditions.
DOI: 10.4103/ijo.IJO_365_18
PMCID: PMC6173047
409. Proc Natl Acad Sci U S A. 2016 May 17;113(20):E2861-70. doi:

10.1073/pnas.1520491113. Epub 2016 Apr 25.
Genetic background and epigenetic modifications in the core of the nucleus

accumbens predict addiction-like behavior in a rat model.
Flagel SB(1), Chaudhury S(2), Waselus M(2), Kelly R(3), Sewani S(3), Clinton
SM(4), Thompson RC(5), Watson SJ Jr(5), Akil H(1).
Author information:
(1)Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann
Arbor, MI 48109; Department of Psychiatry, University of Michigan, Ann Arbor, MI
48109; sflagel@umich.edu akil@umich.edu.
Arbor, MI 48109;
(3)Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109;
(4)Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL
35233.
Arbor, MI 48109; Department of Psychiatry, University of Michigan, Ann Arbor, MI
48109;
This study provides a demonstration in the rat of a clear genetic difference in

the propensity for addiction-related behaviors following prolonged cocaine
self-administration. It relies on the use of selectively bred high-responder
(bHR) and low-responder (bLR) rat lines that differ in several characteristics
associated with "temperament," including novelty-induced locomotion and
impulsivity. We show that bHR rats exhibit behaviors reminiscent of human
addiction, including persistent cocaine-seeking and increased reinstatement of
cocaine seeking. To uncover potential underlying mechanisms of this differential
vulnerability, we focused on the core of the nucleus accumbens and examined
expression and epigenetic regulation of two transcripts previously implicated in
bHR/bLR differences: fibroblast growth factor (FGF2) and the dopamine D2 receptor
(D2). Relative to bHRs, bLRs had lower FGF2 mRNA levels and increased association
of a repressive mark on histones (H3K9me3) at the FGF2 promoter. These
differences were apparent under basal conditions and persisted even following
prolonged cocaine self-administration. In contrast, bHRs had lower D2 mRNA under
basal conditions, with greater association of H3K9me3 at the D2 promoter and
these differences were no longer apparent following prolonged cocaine
self-administration. Correlational analyses indicate that the association of
H3K9me3 at D2 may be a critical substrate underlying the propensity to relapse.
These findings suggest that low D2 mRNA levels in the nucleus accumbens core,
likely mediated via epigenetic modifications, may render individuals more
susceptible to cocaine addiction. In contrast, low FGF2 levels, which appear
immutable even following prolonged cocaine exposure, may serve as a protective
factor.
DOI: 10.1073/pnas.1520491113
PMCID: PMC4878471
410. Clin Interv Aging. 2018 Apr 10;13:623-632. doi: 10.2147/CIA.S158501.

eCollection
2018.
Preferences and attitudes of older adults of Bialystok, Poland toward the use of
over-the-counter drugs.
Cybulski M(1), Cybulski L(2), Krajewska-Kulak E(1), Orzechowska M(1), Cwalina

U(3).
Author information:
(1)Department of Integrated Medical Care, Faculty of Health Sciences, Medical
University of Bialystok, Bialystok, Poland.
(2)National Security Student, Faculty of Social Sciences, University of Warmia
and Mazury in Olsztyn, Olsztyn, Poland.
(3)Department of Statistics and Medical Informatics, Faculty of Health Sciences,
Medical University of Bialystok, Bialystok, Poland.
Purpose: The aim of the study was to assess preferences and attitudes toward the
use of over-the-counter (OTC) drugs among residents of Bialystok aged 60 or
older.
Patients and methods: The study included 170 people, inhabitants of Bialystok
aged over 60: 85 students of the University of a Healthy Senior and the
University of Psychogeriatric Prophylaxis, and 85 students of the University of
the Third Age in Bialystok. The study made use of a diagnostic survey conducted
via a questionnaire prepared by the authors.
Results: The vast majority of respondents bought OTC drugs for own use. About
one-third of the respondents from each analyzed group bought OTC drugs less often
than once every 3 months. Over half of the respondents bought OTC drugs due to a
cold. A majority of the respondents were of the opinion that OTC drugs should be
sold only in pharmacies. Over 40% of seniors took 1 OTC drug regularly. Most
respondents also took vitamins and supplements. The main sources of information
on OTC drugs for the studied seniors were their doctor and pharmacist.
Respondents did not always consult the treatment method with a doctor or
pharmacist. Over half of the respondents familiarized themselves with the
contents of the OTC drug package leaflet. Over three-quarters of the respondents
were familiar with drug disposal methods; however, despite declarations of being
familiar with these principles, a significant percentage did not bring back
medication to a pharmacy or clinic, or threw the drugs into the trash.
Conclusion: Our study found that in our sample there were many OTC drug consumers
who did not always demonstrate responsible attitudes toward using this group of
drugs. Thus, older people should be educated on the possible adverse effects of
taking OTC drugs without consulting a doctor or pharmacist as well as basic drug
disposal principles. Furthermore, legislation should be introduced that will
limit the wide availability of OTC drugs, particularly to the elderly; and thus,
lower the costs of hospitalization and outpatient treatment of this age group.
Also, a wider-reaching study should be conducted. It should include a larger
group of elderly people as well as information on intake of prescribed
medications in order to be able to determine the frequency of drug consumption in
this population, as well as seniors' preferences and attitudes in this regard.
DOI: 10.2147/CIA.S158501
PMCID: PMC5901153

Socioeconomic determinants of out-of-pocket pharmaceutical expenditure among

middle-aged and elderly adults based on the China Health and Retirement
Longitudinal Survey.
Du J(1), Yang X(1), Chen M(1)(2), Wang Z(3)(2).
Author information:
(1)School of Health Policy and Management, Nanjing Medical University, Nanjing,
China.
(2)Creative Health Policy Research Group, Nanjing Medical University, Nanjing,
China.
(3)School of Health Policy and Management, Nanjing Medical University, Nanjing,
China wzh04@njmu.edu.cn.
OBJECTIVE: Out-of-pocket pharmaceutical expenditure (OOPPE) is a considerable

burden for middle-aged and elderly adults due to their high prevalence of
diseases, insufficient income and absence of medical insurance in China. The
objective of this study was to assess the determinants of OOPPE among Chinese
middle-aged and elderly adults.
METHODS: This is a cross-sectional study based on the China Health and Retirement
Longitudinal Survey conducted in 2015. The Andersen behavioural health model was
used to select the factors. Binary multivariable logistic and generalised linear
regressions were both applied to examine the determinants of OOPPE.
RESULTS: Of the respondents, 15.28%, 5.20% and 51.35% reported an OOPPE for
outpatient services, inpatient services and self-medication, respectively. The
OOPPE for outpatient services, inpatient services and self-medication was
US$6.66, US$17.93 and US$15.32, respectively. Increased age significantly
influenced the likelihood of OOPPE, and older people (aged >65 years) had lower
OOPPE for outpatient services. Having health insurance significantly reduced the
likelihood of OOPPE for outpatient and inpatient services but increased OOPPE for
self-medication. In general, compared with the low-income group, higher income
groups had a significantly lower likelihood of having an OOPPE, and when they did
the amounts were less. Generally, middle-aged and elderly people with poor
self-reported health status, limitation of daily activities, and critical or
chronic diseases had a significantly higher likelihood of having an OOPPE and at
a significantly higher amount.
CONCLUSION: Policy-making efforts should focus on reducing self-medication OOPPE
and alleviating its associated socioeconomic determinants to ease the economic
burden of diseases among middle-aged and elderly adults in China.

DOI: 10.1136/bmjopen-2018-024936
PMCID: PMC6678031
PMID: 31371285
412. Saudi Pharm J. 2018 Jan;26(1):7-13. doi: 10.1016/j.jsps.2017.11.006. Epub 2017

Nov 14.
Assessment of the association between drug disposal practices and drug use and
storage behaviors.
Akici A(1), Aydin V(1), Kiroglu A(2).
Author information:
(1)Department of Medical Pharmacology, Marmara University Faculty of Medicine,
Istanbul, Turkey.
(2)Turkcell Global Bilgi Inc., Istanbul, Turkey.
Objective: Keeping unnecessary drugs at home is a situation showing both causes

and consequences of irrational use of medicine. This study aimed to evaluate the
approaches of a company's employees regarding drug storage, use, and disposal.
Method: This online-based descriptive study was held in a multi-centered
private-sector company in a voluntary basis. The survey assessing participants'
drug handling and storage behaviors was answered by 1121 employees from across
eight provinces of Turkey in 2016. Main outcome measures were storage and
disposal of unused/unwanted drugs at home in a rational way.
Results: The percentage of participants who declared that they keep
unused/unwanted drugs at home was 28.0%. About one-third of participants disposed
their unused/unwanted drugs via the "garbage, sink, toilet, etc.". Participants
≥30 years old and living with <4 household members significantly tended to bring
their unused/unwanted drugs to the company's drug-box. Nearly half of all
participants (46.5%) stated a recent change in their disposal behavior. The vast
majority of participants (94.6%) who previously took drugs back to the company's
drug-box stated that they either had, or would, help their contacts adopt such
behaviors. These participants were also significantly less likely to dispose of
drugs inappropriately, practice self-medication, be unaware of expired drugs at
home, or fail to store drugs according to the labelling.
Conclusion: While our findings showed that a substantial number of participants
still had unused drugs at home and disposed of them inappropriately, it is
understood that they started to exhibit more favorable behaviors in recent years.
DOI: 10.1016/j.jsps.2017.11.006
PMCID: PMC5783817
PMID: 29379327
413. Subst Abuse Treat Prev Policy. 2018 Oct 22;13(1):37. doi:
10.1186/s13011-018-0174-1.
Pharmacological neuroenhancement and the ability to recover from stress - a

representative cross-sectional survey among the German population.
Bagusat C(1), Kunzler A(2)(3), Schlecht J(2), Franke AG(4), Chmitorz A(2)(3),
Lieb K(2)(3).
Author information:
(1)Department of Psychiatry and Psychotherapy, University Medical Center Mainz,
Untere Zahlbacher Str. 8, 55131, Mainz, Germany. bagusat@uni-mainz.de.
(2)Department of Psychiatry and Psychotherapy, University Medical Center Mainz,
Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
(3)German Resilience Center (DRZ) gGmbH, Untere Zahlbacher Str. 8, 55131, Mainz,
Germany.
(4)University of Applied Labour Studies, Bundesagentur für Arbeit, Seckenheimer
Landstr. 16, D-68163, Mannheim, Germany.
BACKGROUND: Pharmacological neuroenhancement (PNE) refers to the use of

psychoactive substances without doctor's prescription to enhance cognitive
performance or to improve mood. Although some studies have reported that drugs
for PNE are also being used to cope with stressful life situations, nothing is
known about the relationship of PNE and resilience, i.e. the ability to recover
from stress. This study aimed at investigating the relationship of PNE and
resilience in the first representative population sample.
METHODS: A cross-sectional survey in a representative sample of 1128 adults
(age ≥ 18 yrs.) living in Germany was conducted. The use of PNE and related
attitudes, perceptions and behaviours were assessed by structured interviews and
self-report questionnaires. Stepwise logistic regression with backward
elimination was conducted to identify potential risk factors for PNE use.
RESULTS: Lifetime prevalence for the use of stimulating prescription drugs
without medical indication was 4.3%, 10.2% for stimulating illicit drugs, 20.3%
for mood modulating prescription drugs, and 23.4% for cannabis. Coping with
stressful situations was more frequently reported as underlying motive for using
stimulant or mood modulating prescription drugs than stimulating illicit drugs or
cannabis. The individual perceived stress increased the risk of using stimulating
prescription drugs (OR: 2.86; 95% Cl: 1.49-5.46) and the individual ability to
recover from stress decreased the risk of using any substance for PNE and
especially mood modulating prescription drugs (OR: .62; 95% Cl: .47-.81).
CONCLUSIONS: The non-medical use of prescription drugs for PNE appears to be more
prevalent in subjects who are less resilient to stress. Tailored resilience
interventions that improve the ability to adapt to and recover from stressors may
prevent the use of prescription medication for PNE. Further research should
disentangle the association between psychological resilience and PNE as well as
examine the efficacy of resilience interventions in the prevention of PNE.
DOI: 10.1186/s13011-018-0174-1
PMCID: PMC6198480
Evaluation of exposure to effervescent drugs in a large health check-up

population in France: a cross-sectional study.
Perrin G(1)(2), Berdot S(1)(2)(3), Thomas F(4), Pannier B(4)(5), Danchin N(4)(6),
Durieux P(2)(7), Sabatier B(1)(2).
Author information:
(1)Department of Pharmacy, Georges-Pompidou European Hospital, Paris, France.
(2)INSERM UMR 1138 Team 22: Information Sciences to Support Personalized
Medicine, Cordelier Research Center, Paris, France.
(3)Department of Clinical Pharmacy, EA4123, Paris-Sud University,
Châtenay-Malabry, France.
(4)Centre d'Investigations Préventives et Cliniques, Paris, France.
(5)Department of Cardiology, Manhès Hospital, Fleury-Merogis, France.
(6)Department of Cardiology, Georges Pompidou European Hospital, Paris, France.
(7)Department of Biomedical Informatics and Public Health, Georges-Pompidou
European Hospital, Paris, France.
OBJECTIVES: The relationship between high dietary sodium intake and hypertension
is well established. Some drugs are associated with high-sodium content,
particularly effervescent tablets (ETs). Despite a possible cardiovascular risk
associated with the use of such drugs, observational data describing exposure to
ETs in ambulatory subjects are lacking.This study aims to estimate the prevalence
of exposure to ETs and to highlight factors associated with this exposure in a
large French health check-up population.
DESIGN: This was a cross-sectional study.
SETTING AND PARTICIPANTS: Participants were French individuals who underwent
medical check-ups at the Investigations Préventives et Cliniques centre between
April and June 2017.
RESULTS: In total, 1043 subjects were included in the study. The prevalence of
exposure to ETs in the last 30 days was 26.9% (95% CI 24.2% to 29.6%). Exposure
was frequent (ie, two ETs per week or more in the last 30 days) for 7.3% of
subjects. Self-medication was the major source of exposure (93.8%). Paracetamol,
aspirin, vitamins and betaine accounted for 95.3% of the ETs used. The factors
associated with this exposure by multivariate analysis were: male gender,
Overseas French origin, depression and body mass index ≥25 kg/m2. A diagnosis of
hypertension or treatment with diuretics were not protective factors against
exposure to ETs.
CONCLUSION: Exposure to ETs is frequent in the general population, particularly
through self-medication. Clinical conditions associated with low-salt
requirements were not associated with lower exposure to ETs, suggesting a lack of
awareness by practitioners and patients about this iatrogenic issue.

DOI: 10.1136/bmjopen-2018-022368
PMCID: PMC6067332
PMID: 30061444
415. J Pain Res. 2016 Nov 30;9:1143-1151. eCollection 2016.
Risks associated with borrowing and sharing of prescription analgesics among

patients observed by pain management physicians in Croatia: a qualitative study.
Markotic F(1), Puljak L(2).
Author information:
(1)Centre for Clinical Pharmacology, University Clinical Hospital Mostar, Mostar,
(2)Laboratory for Pain Research, University of Split School of Medicine, Split,
Croatia.
BACKGROUND: Understanding and improving patient safety is a key issue in

medicine. One of the potential threats to patient safety is the sharing of
medication among patients, which is a form of self-medication. This study
analyzed experiences and attitudes of pain management physicians (PMPs) about
sharing prescription analgesics among patients.
METHODS: This qualitative study was conducted by semi-structured interviews among
PMPs employed in Croatian pain clinics. The study involved two researchers and 15
PMPs.
RESULTS: Among PMPs, 80% have seen patients who share their prescription
analgesics with other patients for whom prescription is not intended. Most PMPs
consider prescription analgesics sharing a risky and negative behavior. Some of
them, however, found certain positive aspects associated to it, such as being a
benevolent behavior, helping patients to get medications when they need them, and
helping them cope with pain.
CONCLUSION: The majority of physicians specialized in pain management encountered
patients sharing prescription analgesics. Most of them considered this as risky
behavior with a number of potential consequences. It has been noted that this
problem is neglected and that physicians should inquire about medication sharing.
Direct-to-consumers advertising was perceived as a factor contributing to such
behavior. Patient education and more involvement of physicians in identifying
this behavior were cited as potential remedies for preventing sharing of
prescription analgesics.
DOI: 10.2147/JPR.S118945
PMCID: PMC5138048
PMID: 27942233
Conflict of interest statement: The authors report no conflicts of interest in

this work.
416. Am J Addict. 2015 Jun;24(4):323-8. doi: 10.1111/ajad.12183. Epub 2015 Apr 6.
No evidence for reduction of opioid-withdrawal symptoms by cannabis smoking

during a methadone dose taper.
Epstein DH(1), Preston KL.
Author information:
(1)Treatment Section, Clinical Pharmacology & Therapeutics Branch, Intramural
Research Branch of the National Institute on Drug Abuse, Baltimore, Maryland.
BACKGROUND AND OBJECTIVES: To support medication development with cannabinoids,

smoked cannabis has been said to alleviate symptoms of opioid withdrawal. We
evaluated that hypothesis.
METHODS: We analyzed data from the methadone-taper phase of a clinical trial we
had conducted. Participants were 116 outpatient heroin and cocaine users (of whom
46 were also cannabis users) who stayed for the 10-week taper. Main outcome
measures were weekly urine screens for cannabinoids, plus every-two-week
assessments of opioid-withdrawal symptoms.
RESULTS: Opioid-withdrawal scores did not differ overall between users and
nonusers of cannabis. In a lagged analysis in the 46 users, there was a slight
(not statistically significant) indication that weeks of higher opiate-withdrawal
symptoms preceded weeks of cannabis use (effect-size r = .20, 95% CI -.10 to .46,
p = .52). Even if this finding is taken to suggest self-medication with cannabis,
a lagged analysis in the other temporal direction showed no indication that
cannabis use predicted lower opiate-withdrawal symptoms the next week
(effect-size r = .01, 95% CI -.28 to .30, p = .69). These findings persisted in
sensitivity analyses controlling for each of 17 potential confounds.
DISCUSSION AND CONCLUSION: With our findings, the clinical evidence for smoked
cannabis as a reducer of opioid-withdrawal symptoms moves slightly further from
"inconclusive" or "mixed" and closer to negative, at least in the context of a
methadone dose taper like the one used here.
SCIENTIFIC SIGNIFICANCE: This finding may remove one rationale for medication
development using cannabinoids to treat opioid withdrawal, but leaves other
rationales intact.

DOI: 10.1111/ajad.12183
PMCID: PMC5576177
417. Saudi Pharm J. 2016 Sep;24(5):611-615. Epub 2015 Mar 21.
Active educational intervention as a tool to improve safe and appropriate use of

antibiotics.
Shehadeh MB(1), Suaifan GA(1), Hammad EA(2).
Author information:
(1)Department of Pharmaceutical Sciences, Faculty of Pharmacy, The University of
Jordan, Amman 11942 Jordan.
(2)Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The
University of Jordan, Amman 11942, Jordan.
Misconception about antibiotics use among the public has been widely outlined to
be a main reason for inappropriate use of antibiotics including failure to
complete treatment, skipping of doses, re-use of leftover medicines and overuse
of antibiotics. The study was devised to evaluate whether education might be a
potential strategy to promote safer use of antibiotics and reducing
self-medication. Two hundred seventy one adults were asked to complete two
questionnaires; a pre and posteducation. The questionnaires comprised of three
parts consisting of 17 statements assessing the knowledge on: appropriate use,
safe use and resistance of antibiotics. Knowledge score was estimated by
calculating the percentage of correct responses. The mean (SD) knowledge score
pre-education was 59.4% (20.3). However, posteducation the score was 65.9%
(17.9), p < 0.001(t-test). Knowledge scores were classified as poor, adequate and
good. Posteducation, participants within poor and adequate knowledge categories
were significantly shifted to the good category describing better knowledge,
McNemar-χ2 = 28.7, df = 3, p < 0.001. It is concluded that using tailored
education material targeting antibiotic need and use with a major aim of
improving the public knowledge about antibiotics can be an effective and feasible
strategy. This pilot study could be considered as the starting point for a wider
scale public educational intervention study and national antibiotic campaign.
However, the improvement in participant's knowledge might not reflect an actual
change in antibiotics-seeking behaviour or future retention of knowledge. Future
research should seek to assess the impact of education on participant's
behaviour.
DOI: 10.1016/j.jsps.2015.03.025
PMCID: PMC5059833
PMID: 27752235

10.1016/j.drugalcdep.2015.02.007.
Epub 2015 Feb 17.
Longitudinal analysis of pain and illicit drug use behaviors in outpatients on

methadone maintenance.
Dhingra L(1), Perlman DC(2), Masson C(3), Chen J(4), McKnight C(5), Jordan AE(5),
Wasser T(6), Portenoy RK(7), Cheatle MD(8).
Author information:
(1)MJHS Institute for Innovation in Palliative Care, 39 Broadway, 12th Floor, New
York, NY 10006, USA. Electronic address: LDhingra@mjhs.org.
(2)Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth
Israel, First Avenue at 16th Street, New York, NY 10003, USA; Department of
Medicine, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY
10003, USA; Center for Drug Use and HIV Research, New York University, 726
Broadway, New York, NY 10003, USA.
(3)Department of Psychiatry, University of California at San Francisco, 1001
Potrero Avenue, San Francisco, CA 94110, USA.
York, NY 10006, USA.
(5)Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth
Israel, First Avenue at 16th Street, New York, NY 10003, USA; Center for Drug Use
and HIV Research, New York University, 726 Broadway, New York, NY 10003, USA.
(6)Consult-Stat: Complete Statistical Services, 5754 Loyola Street, Macungie, PA
18062, USA.
York, NY 10006, USA; Department of Neurology, Albert Einstein College of
Medicine, Bronx, NY 10461, USA.
(8)Center for Studies of Addiction, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA 19104, USA; Reading Health System, West Reading,
PA 19611, USA.
BACKGROUND: Little is known about the experience of chronic pain and the
occurrence of illicit drug use behaviors in the population enrolled in methadone
maintenance treatment (MMT) programs.
METHODS: This is a secondary analysis of longitudinal data from two MMT samples
enrolled in a randomized controlled trial of hepatitis care coordination.
Patients completed pain, illicit drug use, and other questionnaires at baseline
and 3, 9, and 12 months later. Associations were sought over time between the
presence or absence of clinically significant pain (average daily pain ≥ 4 or
mean pain interference ≥ 4 during the past week) and current illicit drug use
(i.e., non-therapeutic opioid, cocaine or amphetamine use identified from
self-report or urine drug screening).
RESULTS: Of 404 patients providing complete data, within-patient variability in
pain and illicit drug use was high across the four assessment periods. While 263
denied pain at baseline, 118 (44.9%) later experienced clinically significant
pain during ≥ 1 follow-up assessments. Of 180 patients (44.6%) without evidence
of illicit drug use at baseline, only 109 (27.0%) had similar negative drug use
at all follow-up assessments. Across four assessment periods, there was no
significant association between pain group status and current illicit drug use.
CONCLUSIONS: This one-year longitudinal analysis did not identify a significant
association between pain and illicit drug use in MMT populations. This finding
conflicts with some earlier investigations and underscores the need for
additional studies to clarify the complex association between pain and substance
use disorders in patients in MMT program settings.
DOI: 10.1016/j.drugalcdep.2015.02.007
PMCID: PMC4391061
419. Addict Behav Rep. 2018 Jun 12;8:40-45. doi: 10.1016/j.abrep.2018.06.002.

eCollection 2018 Dec.
Examining co-patterns of depression and alcohol misuse in emerging adults

following university graduation.
Frohlich JR(1), Rapinda KK(1), O'Connor RM(2), Keough MT(1).
Author information:
(1)Department of Psychology, University of Manitoba, 190 Dysart Rd., Winnipeg, MB
R3T 2N2, Canada.
(2)Department of Psychology, Concordia University, 7141 Sherbrooke St. West,
Montreal, QC H4B 1R6, Canada.
Depression and alcohol use disorders are highly comorbid. Typically, alcohol use
peaks in emerging adulthood (e.g., during university), and many people also
develop depression at this time. Self-medication theory predicts that depressed
emerging adults drink to reduce negative emotions. While research shows that
depression predicts alcohol use and related problems in undergraduates, far less
is known about the continuity of this association after university. Most emerging
adults "mature out" of heavy drinking; however, some do not and go on to develop
an alcohol use disorder. Depressed emerging adults may continue to drink heavily
to cope with the stressful (e.g., remaining unemployed) transition out of
university. Accordingly, using parallel process latent class growth modelling, we
aimed to distinguish high- from low-risk groups of individuals based on joint
patterns of depression and alcohol misuse following university graduation.
Participants (N = 123) completed self-reports at three-month intervals for the
year post-graduation. Results supported four classes: class 1: low stable
depression and low decreasing alcohol misuse (n = 52), class 2: moderate stable
depression and moderate stable alcohol misuse (n = 35), class 3: high stable
depression and low stable alcohol misuse (n = 29), and class 4: high stable
depression and high stable alcohol misuse (n = 8). Our findings show that the
co-development of depression and alcohol misuse after university is not uniform.
Most emerging adults in our sample continued to struggle with significant
depressive symptoms after university, though only two classes continued to drink
at moderate (class 2) and high (class 4) risk levels.
DOI: 10.1016/j.abrep.2018.06.002
PMCID: PMC6039538
PMID: 30003136
420. Int J Drug Policy. 2018 May;55:249-255. doi: 10.1016/j.drugpo.2018.04.005.

Epub
2018 Apr 23.
Ice parties among young men who have sex with men in Thailand: Pleasures, secrecy
and risks.
Guadamuz TE(1), Boonmongkon P(2).
Author information:
(1)Department of Society and Health, Faculty of Social Sciences and Humanities,
Mahidol University, Nakorn Pathom, Thailand; Center for Health Policy Studies,
Faculty of Social Sciences and Humanities, Mahidol University, Nakorn Pathom,
Thailand. Electronic address: thomas.gua@mahidol.ac.th.
(2)Department of Society and Health, Faculty of Social Sciences and Humanities,
Mahidol University, Nakorn Pathom, Thailand; Center for Health Policy Studies,
Faculty of Social Sciences and Humanities, Mahidol University, Nakorn Pathom,
Thailand.
BACKGROUND: Crystal methamphetamine (ice) has become the substance of choice

among young men who have sex with men (YMSM) in urban Thailand. Yet, there is
scarce data on this phenomenon, partly due to the difficulty in accessing men who
will disclose and openly discuss the social contexts, meanings and risks
surrounding ice practice. We present an ethnography of ice parties, critically
discussing the in-depth social meanings of ice; the sexual socialities and the
secrecy surrounding its use; the transactions between older and younger men; and
the role of the Internet and mobile technology.
METHODS: Forty repeated narrative interviews (life stories), ten focus group
discussions, as well as systematic online and offline observations were conducted
over a three-year period. Purposive sampling was used to recruit study
participants in a variety of online and offline spaces and through working
closely with local Thai community-based organizations serving MSM. To be
eligible, participants had to be between 18 and 29 years, able to converse in
Thai, had used ice, and had anal sex with another man in the past 6 months. We
also strived for sample variability with respects to socio-demographic
characteristics (e.g., age, educational attainment and living situation). Data
analysis was conducted in Thai by two researchers using the constant comparative
method based on grounded theory.
RESULTS: On surface, participants described ice parties as exclusive, in trend,
luxurious, fun and pleasurable-a kind of modern camaraderie among beautiful men.
In reality, however, this group phenomenon was a social hierarchy containing
several important players with relational power to one another, to the ice itself
and to the physical space where ice was being consumed. These players included
ice suppliers, party hosts, party guests and "icetenders." The paper also
discusses the sociality of secrecy that surrounds ice parties as well as the
power relations between older relatively rich men who provide ice and the younger
men who crave for the chemical, pointing to the risks associated with engagement
at ice parties, including instances of rape, violence and unsafe sex. For some
participants, ice use was part of their "everyday life," or even believed to be a
"rites of passage." For others, it involved sexual silence in cases where they
were forced to have (unprotected) sex with certain persons or engage in high-risk
activities against their will.
CONCLUSIONS: Ice parties, where high-risk practices were common, power and agency
quickly became relational and negotiable. This paper illuminated the secret
sociality of ice so that public health efforts will be better equipped with
understanding and reaching out to young men who may be at heightened risk for
HIV, STI, violence and other health concerns. Ice parties can, for example, be
seen as opportunities for harm-reduction strategies whereby young men are not
judged for the activities they engage, but are instead respected and approached
in a contextualized, non-judgmental way. Finally, icetenders and party hosts may
be individuals where public health practitioners can target and include in the
development of novel harm-reduction programs.
DOI: 10.1016/j.drugpo.2018.04.005
PMCID: PMC5970987
421. Res Social Adm Pharm. 2018 Nov;14(11):979-988. doi:

10.1016/j.sapharm.2017.12.001. Epub 2017 Dec 13.
Interventions to enhance effective communication during over-the-counter

consultations in the community pharmacy setting: A systematic review.
Seubert LJ(1), Whitelaw K(2), Hattingh L(3), Watson MC(4), Clifford RM(5).
Author information:
(1)The University of Western Australia, Pharmacy M315, 35 Stirling Highway,
Crawley WA 6009, Australia. Electronic address: liza.seubert@uwa.edu.au.
Crawley WA 6009, Australia. Electronic address: kerry.whitelaw@uwa.edu.au.
(3)Curtin University, School of Pharmacy, Health Sciences, Kent Street, Bentley
WA 6102, Australia. Electronic address: l.hattingh@griffith.edu.au.
(4)University of Bath, 5W 3.33, Department of Pharmacy and Pharmacology,
Claverton Down, Bath England BA2 7AY, UK. Electronic address:
m.c.watson@bath.ac.uk.
Crawley WA 6009, Australia. Electronic address: rhonda.clifford@uwa.edu.au.
BACKGROUND: Easy access to effective over-the-counter (OTC) treatments allows

self-management of some conditions, however inappropriate or incorrect supply or
use of OTC medicines can cause harm. Pharmacy personnel should support consumers
in their health-seeking behaviour by utilising effective communication skills
underpinned by clinical knowledge.
OBJECTIVE: To identify interventions targeted towards improving communication
between consumers and pharmacy personnel during OTC consultations in the
community pharmacy setting.
METHODS: Systematic review and narrative analysis. Databases searched were
MEDLINE, EMBASE, Psycinfo, Cochrane Central Register and Cochrane Database of
Systematic Reviews for literature published between 2000 and 30 October 2014, as
well as reference lists of included articles. The search was re-run on 18 January
2016 and 25 September 2017 to maximise the currency. Two reviewers independently
screened retrieved articles for inclusion, assessed study quality and extracted
data. Full publications of intervention studies were included. Participants were
community pharmacy personnel and/or consumers involved in OTC consultations.
Interventions which aimed to improve communication during OTC consultations in
the community pharmacy setting were included if they involved a direct measurable
communication outcome. Studies reporting attitudes and measures not quantifiable
were excluded. The protocol was published on Prospero Database of Systematic
Reviews.
RESULTS: Of 4978 records identified, 11 studies met inclusion criteria.
Interventions evaluated were: face-to-face training sessions (n = 10); role-plays
(n = 9); a software decision making program (n = 1); and simulated patient (SP)
visits followed by immediate feedback (n = 1). Outcomes were measured using: SP
methodology (n = 10) and a survey (n = 1), with most (n = 10) reporting a level
of improvement in some communication behaviours.
CONCLUSION: Empirical evaluation of interventions using active learning
techniques such as face-to-face training with role-play can improve some
communication skills. However interventions that are not fully described limit
the ability for replication and/or generalisability. This review identified
interventions targeting pharmacy personnel. Future interventions to improve
communication should consider the consumer's role in OTC consultations.
Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.sapharm.2017.12.001
What Do Customers Demand from Drug Stores in Japan? Construct Validity and Factor
Structure of a Cross-Sectional Survey.
Minamida Y(1), Yoshida N(2), Nishimaki-Tomizu M(3), Hanada M(4), Kimura K(5),
Tsuboi H(6).
Author information:
(1)School of Pharmacy, Kanazawa University, Kanazawa 920-1192, Japan.
minamida.yuuki@stu.kanazawa-u.ac.jp.
(2)Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University,
Kanazawa 920-1192, Japan. naoko@p.kanazawa-u.ac.jp.
dmpc14@p.kanazawa-u.ac.jp.
dmpc12@p.kanazawa-u.ac.jp.
Kanazawa 920-1192, Japan. kimurak@p.kanazawa-u.ac.jp.
Kanazawa 920-1192, Japan. tsuboih@p.kanazawa-u.ac.jp.
Studies concerning patient demands are mainly conducted at hospitals and

pharmacies, whereas few surveys have been conducted on drug stores. The demand
for drug stores is estimated to be increasing with growing needs for
self-medication. Thus, conducting a customer survey at drug stores is thought to
be valuable. The aim of the current study was to clarify the structure of
customers' demands for drug stores. The survey was conducted on 190 customers of
19 drug stores in Japan. The questionnaire consisted of 24 items using a 9-point
Likert scale. The IBM SPSS Statistics version 23 (IBM Japan, Tokyo, Japan) and
Amos version 5 (IBM Japan, Tokyo, Japan) were utilized to perform factor
analysis. Gender did not influence the response to each question. Factor analysis
showed that the structure of customers' demands consisted of three factors: (1)
an explanation about medicine, (2) staff's manners, and (3) location of drug
stores. Because fit indices suggested a good fit, this three-factor solution was
adopted as the final factor structure. This study demonstrated the structure of
customers' demands for drug stores, with the potential for use in promotion of
self-medication.
DOI: 10.3390/pharmacy6030098
PMCID: PMC6164702
PMID: 30200579
423. J Clin Diagn Res. 2015 Nov;9(11):OC01-4. doi: 10.7860/JCDR/2015/15806.6729.

Epub
2015 Nov 1.
A Study Evaluating Adherence and Compliance of Anti-rheumatic Drugs in Women

Suffering from Rheumatoid Arthritis.
Sharma S(1), Roshi(2), Tandon VR(3), Mahajan A(4).
Author information:
(1)Associate Professor, Department of Obstetrics and Gynalcology, Government
Medical College , Jammu- J&K, India .
(2)Postgraduate Student, Department of Pharmacology, Government Medical College ,
Jammu- J&K, India .
(3)Assistant Professor, Department of Pharmacology, Government Medical College ,
Jammu- J&K, India .
(4)Professor and Head, Department of Medicine, Government Medical College ,
Jammu- J&K, India .
BACKGROUND: Treatment of Rheumatoid arthritis (RA) has always remained

challenging, complex and associated with high level of non adherence,
noncompliance in clinical practice.
AIM: To evaluate the satisfaction/adherence/compliance rates of most commonly
prescribed anti-rheumatic drugs among Indian women.
MATERIALS AND METHODS: A cross-sectional descriptive obser-vational study was
undertaken to evaluate the adherence/compliance rates of most commonly prescribed
anti-rheumatic drugs among women in a tertiary care teaching hospital in North
India. Hundred women on anti rheumatic treatment for rheumatoid arthritis
diagnosed by American College of Rheumatology (ACR) criteria were evaluated at
one point analysis for adherence/compliance/satisfaction.
RESULTS: Dissatisfaction rate with the anti rheumatic treatment was significantly
high p<0.0001 among 68% of the women. Non compliance/ non adherence rate was also
recorded very high among 52% and interrupted compliance rate was noticed among 6%
of the women suffering from RA. Switch over rate to other treatment or doctors
was also significantly (p<0.0001) very high among 66% of the women. Switch over
to alternative treatment, treatment under quacks and intermittent self medication
was recorded by 12%, 4% & 16% respectively. Among the self medication 12% of the
women took corticosteroids and 4% preferred taking intermittent NSAIDs.
CONCLUSION: Treatment compliance is not very good with anti-rheumatic drugs among
women patients of RA due to multi-factorial reasons.
DOI: 10.7860/JCDR/2015/15806.6729
PMCID: PMC4668446
PMID: 26676079
424. Addict Behav Rep. 2017 Aug 1;6:65-70. doi: 10.1016/j.abrep.2017.07.003.

The direct and indirect effect of loneliness on the development of adolescent

alcohol use in the United Kingdom.
McKay MT(1), Konowalczyk S(2), Andretta JR(3), Cole JC(1).
Author information:
(1)Department of Psychological Sciences, University of Liverpool, United Kingdom.
(2)University of Dortmund, Germany.
(3)Child Guidance Clinic, Superior Court of the District of Columbia, United
States.
Alcohol use among adolescents in the United Kingdom (UK) remains relatively high
compared to those in other European countries. The present study sought to
examine both the direct and indirect effect of loneliness on drinking behavior.
Participants were school children (mean age 13.5 years at Time 1) participating
in a Randomized Controlled Trial in the UK, who completed a battery of
questionnaires examining alcohol-use indicators, loneliness, self-efficacy and
sensation seeking at Time 1 and at +12 months. Loneliness at Time 1 had a
substantive, though largely indirect (i.e., via self-efficacy and sensation
seeking covariates), impact on alcohol-related harm at +12 months. Furthermore,
Loneliness interacted with gender in the prediction of context of alcohol use,
where being female and experiencing loneliness put an individual at a greater
risk of unsupervised drinking. Females experiencing loneliness were also 2.9
times as likely to have had a drink in the past 30 days, and around 2.5 times as
likely to have ever consumed a full drink, when compared to their male peers. The
current results indicate that loneliness is an important but complex factor in
adolescent drinking. There are important implications for the development of
interventions to prevent underage drinking, not least that it is not appropriate
to consider all underage drinkers as socially marginalised. However, for those
that are, the self-medication hypothesis is potentially relevant through
emotional self-efficacy.
DOI: 10.1016/j.abrep.2017.07.003
PMCID: PMC5800553
PMID: 29450238
425. Patient Prefer Adherence. 2015 Jan 22;9:161-72. doi: 10.2147/PPA.S74602.

eCollection 2015.
Concurrent use of amphetamine stimulants and antidepressants by undergraduate

students.
Vo K(1), Neafsey PJ(2), Lin CA(3).
Author information:
(1)University of Connecticut Health Center, Farmington, CT, USA.
(2)School of Nursing and Center for Health Information and Prevention, University
of Connecticut, Storrs, CT, USA.
(3)Department of Communication Sciences and Center for Health Information and
Prevention, University of Connecticut, Storrs, CT, USA.
Undergraduate students were recruited to participate in an online survey to

report their use of amphetamine stimulants and other drugs. Significant
differences were found between students reporting (n=79; 4.0%) and not reporting
(n=1,897; 96%) amphetamine-stimulant use in the past month - in terms of
race/ethnicity, class standing, residence, health symptoms, self-health report -
in addition to alcohol, tobacco, pain-reliever, and antidepressant use. Health
symptoms reported more often by stimulant users included depression, diarrhea,
difficulty sleeping, fatigue, dizziness, difficulty concentrating, and nicotine
craving. Health care providers of college students should query these patients
about symptoms that could be related to depression and amphetamine use. In
particular, they should provide education at the point of care around the risks
of amphetamine use in general and the specific risks in those students who have
symptoms of depression and/or are taking antidepressant medication. Prevention
programs should also target the risks of concurrent use of amphetamines,
antidepressants, and other drugs among college students.
DOI: 10.2147/PPA.S74602
PMCID: PMC4309786
PMID: 25653508

eCollection 2018.
DIY HIV prevention: Formative qualitative research with men who have sex with men
who source PrEP outside of clinical trials.
Paparini S(1), Nutland W(2), Rhodes T(2), Nguyen VK(1), Anderson J(3).
Author information:
(1)Department of Anthropology and Sociology of Development, Graduate Institute of
International and Development Studies, Geneva, Switzerland.
(2)Department of Social and Environmental Health Research, Faculty of Public
Health Policy, London School of Hygiene and Tropical Medicine, London, United
Kingdom.
(3)Homerton University Hospital NHS Foundation Trust, London, United Kingdom.
Pre-exposure prophylaxis (PrEP) with antiretroviral medication is an effective,

evidence-based option for HIV prevention. In England, issues of
cost-effectiveness and of responsibility for commissioning prevention services
have so far led National Health Service (NHS) England to decide not to commission
PrEP. Given the significant lag between the awareness of PrEP efficacy and the
opportunity to obtain PrEP through traditional health care routes, many gay and
other men who have sex with men (MSM) have turned to 'DIY PrEP', purchasing
generic formulations of PrEP for themselves on the internet or via other
alternative routes. However, there is very little research on DIY PrEP practices
and no qualitative study with DIY PrEP users in the UK. A formative qualitative
study was conducted in 2017 to inform the development of an intervention (PrEP
Club) to support DIY PrEP users and improve the safety and experience of this
prevention strategy. Focus groups were held with 20 MSM who are based in London
and are obtaining PrEP through means other than clinical trials, to explore their
accounts of sourcing and using PrEP and the experiential meanings of these. In
this article, we report findings from this first, formative study and present the
different practices involved in finding out about PrEP, buying it and
ascertaining legitimacy of sellers and products. We reflect on the uncertainties
participants described related to actually using PrEP, including deciding on drug
dosing and monitoring their health. Finally, we present the results of the
discussions participants had about the kind of support they had received, the
help they would have liked, and their views on proposed interventions to support
DIY PrEP users, such as PrEP Club.
PMCID: PMC6107262

interests exist. SP has received speaker honoraria from ViiV HealthCare. JA has
received speaker honoraria from Gilead Science, Merck Sharp Dohm, conference
attendance support and consultancy fees from Gilead Sciences. VKN has received
speaker honoraria from Gilead France. WN is the founder of PrEPster, a community
based organisations that has received grants from MAC Aids Fund, Elton John AIDS
Foundation, and Public Health England. WN has received personal travel grants
from AVAC and speaker honoraria from the Thai Red Cross. This does not alter the
authors’ adherence to PLOS ONE policies on sharing data and materials.
427. PeerJ. 2016 Nov 3;4:e2668. eCollection 2016.
Antibiotic misuse among children with diarrhea in China: results from a national
survey.
Li R(1), Xiao F(1), Zheng X(1), Yang H(1), Wang L(1), Yin D(1), Yin T(1), Xin
Q(1), Chen B(1).
Author information:
(1)Children Health and Development Department, Capital Institute of Paediatrics ,
Beijing , China.
BACKGROUND: Antibiotic resistance is one of the world's biggest public health

issues, and the situation in China is particularly grave. The objective of this
study is to investigate the antibiotics usage pattern among Chinese children and
provide further insight in developing strategies for promoting public health
education.
METHODS: This is a cross-sectional study, in the study, participants are from
53,665 guardians of children aged 0-6 years, who were recruited with multistage
stratified random cluster sampling in 2013/2014 from 46 community health centers
in 14 provinces across China Mainland. Children's guardians completed surveys on
their previous experience on using antibiotics in treating diarrhea of their
children without a prescription from any pediatrician. Odds ratios (ORs) and 95%
confidential intervals (CIs) for the association between antibiotic use and its
predictors were estimated using multilevel logistic regression models, with
antibiotic rational use group as a reference group.
RESULTS: The prevalence of antibiotic misuse among children with diarrhea in the
eastern, middle and western areas of China and associations between antibiotic
misuse and its predictors were studied. The average rate of antibiotic misuse is
35.12%. Multilevel logistic regression revealed that living in urban areas (OR =
0.79 (0.76, 0.83)), female children (OR = 0.92 (0.88, 0.96)), guardians having
higher education (OR = 0.60 (0.55, 0.66)), being raised by parents (OR = 0.90
(0.85, 0.94)), guardians having basic health knowledge (OR = 0.82 (0.79, 0.86))
are protective factors and children's age (1-3 years OR = 1.62 (1.54, 1.71)); 4-6
years OR = 1.90 (1.77, 2.03)) is a risk factor of antibiotic misuse among
children aged 0-6 years with diarrhea in China.
CONCLUSIONS: Our findings confirmed that there has been a high rate of antibiotic
misuse without a prescription in children with diarrhea in China, which requires
considerable attention. Suitable regulations and interventions are needed to
solve this problem.
DOI: 10.7717/peerj.2668
PMCID: PMC5101618
PMID: 27833822
Conflict of interest statement: The authors declare that they have no competing
interests.
428. Arq Neuropsiquiatr. 2018 Oct;76(10):663-667. doi: 10.1590/0004-282X20180109.
Botulinum toxin A (BT-A) versus low-level laser therapy (LLLT) in chronic

migraine treatment: a comparison.
Loeb LM(1), Amorim RP(1), Mazzacoratti MDGN(2), Scorza FA(1), Peres MFP(3).
Author information:
(1)Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento
de Neurologia/Neurocirurgia, São Paulo SP, Brasil.
(2)Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento
de Bioquímica, São Paulo SP, Brasil.
(3)Hospital Israelita Albert Einstein, São Paulo SP, Brasil.
OBJECTIVE: The aim of this work was to evaluate patients with chronic migraine
treated with botulinum toxin A (BT-A) and compare this with low level laser
therapy (LLLT), referencing: pain days, pain intensity, intake of
drugs/self-medication, anxiety and sleep disorders.
METHODS: Patients were randomized into two groups: BT-A group (n = 18) and LLLT
group (n = 18). Each patient kept three pain diaries: one before (baseline) (30
days), one during treatment (30 days) and one after the post-treatment phase (30
days). Repeated ANOVA plus the Bonferroni post-test, Student's t test, and
factorial analysis were applied, and p < 0.05 was accepted as significant.
RESULTS: Our data showed that both treatments were able to reduce headache days,
acute medication intake and decrease the intensity of pain. Anxiety was reduced
in the BT-A group, while sleep disturbance was reduced in the LLLT group.
CONCLUSION: Our data showed that both treatments can be used to treat chronic
migraine, without notable differences between them.
DOI: 10.1590/0004-282X20180109
429. Pediatrics. 2018 Feb;141(2). pii: e20163850. doi: 10.1542/peds.2016-3850. Epub

2018 Jan 17.
A Case of Cardiomyopathy Due to Premature Ductus Arteriosus Closure: The Flip

Side of Paracetamol.
Schierz IAM(1), Giuffrè M(2), Piro E(2), La Placa S(2), Corsello G(2).
Author information:
(1)Neonatal ICU, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone,"
Department of Sciences for Health Promotion and Mother and Child Care "Giuseppe
D'Alessandro," University of Palermo, Palermo, Italy inschier@tin.it.
(2)Neonatal ICU, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone,"
Department of Sciences for Health Promotion and Mother and Child Care "Giuseppe
D'Alessandro," University of Palermo, Palermo, Italy.
Paracetamol (acetaminophen or N-acetyl-p-aminophenol) is considered a safe

analgesic and antipyretic nonsteroidal antiinflammatory drug commonly used during
pediatric ages and during pregnancy. We report on a term neonate with closed
ductus arteriosus, severe cardiomyopathy, right ventricular dysfunction, and
functional stenosis of pulmonary arteries at birth after maternal self-medication
with paracetamol and consumption of polyphenol-rich foods in late pregnancy. This
drug, especially when associated with other vasoconstrictors (such as
polyphenols), interferes with prostaglandin metabolism, which seriously
accentuates the intrauterine ductus arteriosus constriction and leads to
pharmacologic adverse events. We suggest maternal educational programs to avoid
risky self-medications and provide training for the best diets.
Copyright © 2018 by the American Academy of Pediatrics.
DOI: 10.1542/peds.2016-3850
Conflict of interest statement: POTENTIAL CONFLICT OF INTEREST: The authors have

indicated they have no potential conflicts of interest to disclose.
430. Electron Physician. 2018 Feb 25;10(2):6310-6318. doi: 10.19082/6310.

eCollection
2018 Feb.
Effective factors on menstrual health among female students in Bam city: a

qualitative study.
Morowatisharifabad MA(1), Vaezi A(2), Mohammadinia N(3).
Author information:
(1)PhD of Health Education, Professor, Ageing Health Department, School of Public
Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
(2)PhD of Nursing, Assistant Professor, Nursing Department, School of Nursing &
Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
(3)PhD Student in Health Education and Health Promotion, International Campus,
Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Background: Menarche is an independent puberty event in a girl's life, and is

associated with physical growth, ability in marriage and fertility. Therefore,
poor menstrual health can be a major determinant of morbidity, as well as
physical, mental and social problems in this age group.
Objective: The aim of this study was to explore the effective factors on
menstrual health among female students in Bam city.
Methods: The qualitative study was conducted using content analysis approach in
2017. The participants were 32 individuals consisting of 13 students, 10 mothers
of the same students, 9 school associates and health educators of 5 secondary
schools in Bam city, who were selected based on an objective-oriented approach.
The sampling was done until data saturation. Data collection methods were
semi-structured and in-depth interview. Data analysis was performed using the
steps suggested by Graneheim and Landman.
Results: There were two categories (easy interaction and inappropriate adaptation
to changes in health behavior), 13 sub-categories and 52 initial codes. The
positive factors included easy access to sanitary pads, appropriate school
education, easy access to health and therapeutic services and school flexibility
on menstrual issues, while the negative factors included inadequate facilities
for sanitary pad disposal, lack of access to informed people about menstrual
issues, insufficient attention to menstrual problems, feeling ashamed, the high
cost of menstrual health, self-medication with traditional medicines, inadequate
self-directed education, lack of awareness and trust in health center staff, and
following family and teachers in menstrual problems.
Conclusion: Overall, this study indicated that economic, social, cultural and
educational factors affect menstrual health. Therefore, the identification of
each of these factors helps planners to apply the most appropriate methods and
strategies for menstrual health improvement.
DOI: 10.19082/6310
PMCID: PMC5878024
PMID: 29629053
Conflict of interest statement: Conflict of Interest: There is no conflict of

interest to be declared.
431. Int J Health Sci (Qassim). 2018 Jul-Aug;12(4):11-17.
Evaluation of the extent and reasons for increased non-prescription antibiotics

use in a University town, Nsukka Nigeria.
Badger-Emeka LI(1), Emeka PM(2), Okosi M(3).
Author information:
(1)Department of Biomedical Sciences, College of Medicine, King Faisal
University, Al- Hofuf, Kingdom of Saudi Arabia.
(2)Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King
Faisal University, Al-Hofuf, Kingdom of Saudi Arabia.
(3)Department of Microbiology, Faculty of Science, University of Nigeria Nsukka.
Nigeria.
Objectives: The use of non-prescribed antibiotics has become a public health

concern, and this behavior continues to thrive in many countries of the world
including Nigeria. Evidence from previous studies suggests that increased
antibiotic prescriptions and patients' past experiences are some of the factors
contributing to the use of non-prescribed antibiotics. The present investigation
was aimed at determining the factors driving this behavior and the extent of
usage among people living in a sub-urban Nigerian community.
Methods: A community-based, cross-sectional study was conducted in Nsukka,
South-East Nigeria using a semi-structured and self-administered questionnaire.
An estimated sample size of approximately 400 respondents, with ages ranging from
18 to 60 years participated in the study. A number of males were 233 and 197 were
females.
Results: Demographics showed that the majority of respondents were well educated.
The behavior appeared to be common regardless of gender, age, and educational
level. Results showed that more than 86% of the respondents use non-prescribed
antibiotics for treatment or prevention or both. A significant percentage uses it
to treat cold and cough. The most frequently used antibiotics where the
penicillins (58%) followed by quinolones (22%). Tetracycline, aminoglycosides,
and cephalosporin represented 20.75%, 14.75%, and 11% usage, respectively.
Conclusion: This study revealed a substantial use of over-the-counter
antibiotics, with this behavior cutting across gender, age and levels of
education. However, participants' knowledge and awareness of the hazards
associated with this behavior were lacking.
PMCID: PMC6040858
PMID: 30022898
432. BMJ Case Rep. 2015 Apr 29;2015. pii: bcr2014208945. doi: 10.1136/bcr-2014-
208945.
Life-threatening opioid toxicity from a fentanyl patch applied to eczematous

skin.
Doris MK(1), Sandilands EA(2).
Author information:
(1)NHS Lothian, Edinburgh, UK.
(2)National Poisons Information Service Edinburgh, NHS Lothian, Edinburgh, UK.
A 19-year-old man with a history of eczema was admitted to the emergency

department following collapsing at home. The paramedics found him unresponsive
with poor respiratory effort and a widespread erythematous rash. Anaphylaxis,
thought to be secondary to flucloxacillin he had recently been prescribed, was
diagnosed. Epinephrine, steroids and antihistamines were administered without
clinical improvement. On arrival to hospital, constricted pupils were noted
prompting the emergency physicians to consider opiate toxicity. Intravenous
naloxone brought about an immediate recovery. His father subsequently disclosed
that he had given his son one of his own fentanyl patches to alleviate the
distressing symptoms of eczema. Although the patient had removed the patch prior
to collapsing, he had suffered life-threatening opioid toxicity likely due to
enhanced opiate absorption through eczematous skin. This case highlights the
risks associated with fentanyl patches in patients with chronic skin conditions.
2015 BMJ Publishing Group Ltd.
DOI: 10.1136/bcr-2014-208945
PMCID: PMC4422925
433. Subst Abuse. 2015 May 24;9:39-46. doi: 10.4137/SART.S22233. eCollection 2015.
Emergency Department Visits Involving Misuse and Abuse of the Antipsychotic

Quetiapine: Results from the Drug Abuse Warning Network (DAWN).
Mattson ME(1), Albright VA(2), Yoon J(3), Council CL(2).
Author information:
(1)Substance Abuse and Mental Health Services Administration, Rockville, MD, USA.
(2)Research Triangle Institute, Chapel Hill, NC, USA.
(3)Health Resources and Services Administration, Rockville, MD, USA.
Case reports in medical literature suggest that the atypical antipsychotic
quetiapine, a medication not previously considered to have abuse potential, is
now being subject to misuse and abuse (MUA; ie, taken when not prescribed for
them or used in a way other than instructed by their health professional). Here
we present systematic, nationally representative data from the 2005 to 2011 Drug
Abuse Warning Network (DAWN) for prevalence of emergency department (ED) visits
among the U.S. general population involving quetiapine and related to MUA,
suicide attempts, and adverse reactions. Nationally, quetiapine-related ED visits
increased 90% between 2005 and 2011, from 35,581 ED visits to 67,497. DAWN data
indicate that when used without medical supervision for
recreational/self-medication purposes, quetiapine poses health risks for its
users, especially among polydrug users and women. These findings suggest that the
medical and public health communities should increase vigilance concerning this
drug and its potential for MUA.
DOI: 10.4137/SART.S22233
PMCID: PMC4444129
PMID: 26056465
Women's interpretation of and responses to potential gynaecological cancer

symptoms: a qualitative interview study.
Low EL(1), Whitaker KL(2), Simon AE(3), Sekhon M(3), Waller J(1).
Author information:
(1)Department of Epidemiology and Public Health, Health Behaviour Research
Centre, University College London (UCL), London, UK.
(2)School of Health Sciences, University of Surrey, Guildford, Surrey, UK.
(3)Centre for Health Services Research, City University, London, UK.
OBJECTIVE: To explore women's experiences of symptoms potentially indicative of

gynaecological cancer in a community-based sample without imposing a cancer
perspective.
DESIGN: A qualitative interview study with thematic analysis of transcripts.
PARTICIPANTS: 26 women aged ≥30 years, who had experienced a symptom that might
indicate gynaecological cancer in the past 3 months, were recruited using a
screening questionnaire distributed online and in community settings.
SETTING: London, UK.
RESULTS: Women attributed gynaecological symptoms to existing
illnesses/conditions or considered themselves to be predisposed to them, either
through their 'genes' or previous personal experience. Normalising symptoms by
attributing them to demographic characteristics (eg, age, sex) was common, as was
considering them a side effect of hormonal contraception. When women raised
cancer as a possible cause, they often dismissed it as unlikely. Responses to
symptoms included self-management (eg, self-medicating, making lifestyle
changes), adopting a 'lay system of care', or consulting a healthcare
professional. Triggers to help-seeking included persistent, painful or
debilitating symptoms, concern about symptom seriousness, and feeling that
help-seeking was legitimised. Barriers to help-seeking included lack of concern,
vague symptoms, unusual symptom location, competing time demands, previous
negative experiences with the healthcare system, and not wanting to be perceived
as a time-waster.
CONCLUSIONS: Attributions of symptoms potentially indicative of a gynaecological
cancer were varied, but most often involved women fitting symptoms into their
expectations of what was 'normal'. Normalising acted as a barrier to seeking help
from a healthcare professional, alongside competing time demands and negative
attitudes towards help-seeking. These barriers may lead to later diagnosis and
poorer cancer survival. Our findings could be used to inform the development of
interventions to encourage appropriate help-seeking.
DOI: 10.1136/bmjopen-2015-008082
PMCID: PMC4499727

eCollection 2015.
The relationship between bipolar disorder and cannabis use in daily life: an
experience sampling study.
Tyler E(1), Jones S(1), Black N(2), Carter LA(3), Barrowclough C(2).
Author information:
(1)The Spectrum Centre for Mental Health Research, Division of Health Research
Lancaster University, Lancaster, Lancashire, United Kingdom.
(2)School of Psychological Sciences, University of Manchester, Manchester, United
Kingdom.
(3)Health Methodology Research Group, School of Community Based Medicine,
University of Manchester, Manchester, United Kingdom.
Erratum in
PLoS One. 2015;10(3):e0123953.
OBJECTIVES: Although cannabis use is common in bipolar disorder and may

contribute to worse clinical outcomes, little is understood about the
relationship between this drug and bipolar disorder over the course of daily
life. The aim of study was to examine the effect of cannabis on affect and
bipolar symptoms in a group of individuals with bipolar disorder.
METHODS: Twenty-four participants with bipolar disorder type I or type II
completed diaries for 6 days using Experience Sampling Methodology to investigate
the temporal associations between cannabis, affect and bipolar disorder symptoms.
RESULTS: The results indicated that higher levels of positive affect increase the
odds of using cannabis (OR:1.25 ,CI:1.06-1.47, P=0.008). However, neither
negative affect, manic nor depressive symptoms predicted the use of cannabis.
Cannabis use was associated with subsequent increases in positive affect (β=0.35,
CI:0.20-0.51, P=0.000), manic symptoms (β=0.20,CI:0.05-0.34, P=0.009) and
depressive symptoms (β= 0.17,CI:0.04-0.29, P=0.008).
CONCLUSION: The findings indicate that cannabis use is associated with a number
of subsequent psychological effects. However there was no evidence that
individuals with BD were using cannabis to self-medicate minor fluctuations in
negative affect or bipolar disorder symptoms over the course of daily life. The
findings in relation to existing literature and clinical implications are
discussed.
PMCID: PMC4349825
436. J Subst Abuse Treat. 2015 Jun;53:33-8. doi: 10.1016/j.jsat.2014.12.005. Epub
2014
Dec 30.
The Relationship Between Drug Use, Drug-related Arrests, and Chronic Pain Among
Adults on Probation.
Reingle Gonzalez JM(1), Walters ST(2), Lerch J(3), Taxman FS(4).
Author information:
(1)The University of Texas School of Public Health, Department of Epidemiology,
Human Genetics and Environmental Sciences, Dallas Regional Campus, 6011 Harry
Hines Boulevard, V8.112, Dallas, TX 75390, USA. Electronic address:
Jennifer.reingle@utsouthwestern.edu.
(2)University of North Texas Health Science Center, School of Public Health, 3500
Camp Bowie Blvd., EAD 709, Fort Worth, TX 76107, USA. Electronic address:
Scott.Walters@unthsc.edu.
(3)George Mason University, Department of Criminology, Law and Society and Center
for Advancing Correctional Excellence (ACE!), 4087 University Drive, Suite 4100,
MSN 6D3, Fairfax, VA 22030, USA. Electronic address: jlerch@gmu.edu.
(4)George Mason University, Department of Criminology, Law and Society and Center
for Advancing Correctional Excellence (ACE!), 4087 University Drive, Suite 4100,
MSN 6D3, Fairfax, VA 22030, USA. Electronic address: ftaxman@gmu.edu.
The intersection between chronic health conditions, drug use, and treatment
seeking behavior among adults in the criminal justice system has been largely
understudied. This study examined whether chronic pain was associated with opiate
use, other illicit drug use, and drug-related arrests in a sample of
substance-using probationers. We expected that probationers with chronic
pain-related diagnoses would report more opiate use and drug-related arrests.
This study used baseline data from 250 adults on probation in Baltimore, Maryland
and Dallas, Texas who were participating in a larger clinical trial. Eighteen
percent of probationers in this sample reported suffering from chronic pain. In
bivariate analyses, probationers with chronic pain reported more drug-related
arrests (t=-1.81; p<0.05) than those without chronic pain. Multivariate analyses
support the hypothesis that probationers who reported chronic pain were
marginally more likely to use opiates (OR=2.37; 95% CI .89-1.05) and non-opiate
illicit drugs (OR=3.11; 95% CI 1.03-9.39) compared to offenders without chronic
pain. In summary, these findings suggest that adults under probation supervision
who suffer from chronic pain may be involved in criminal activity (specifically,
drug-related criminal activity) in an effort to self-medicate their physical
health condition(s). Screening probationers for chronic pain in the probation
setting and referring these adults to pain management treatment may be an
important step in advancing public safety.
DOI: 10.1016/j.jsat.2014.12.005
PMCID: PMC4414689
437. Inquiry. 2018 Jan-Dec;55:46958018793292. doi: 10.1177/0046958018793292.
Consumers' Perceptions About Pharmaceutical Care Provided by Community

Pharmacists in China in Relation to Over-the-Counter Drugs: A Qualitative Study.
Chen H(1), Ung COL(1), Chi P(1), Wu J(2), Tang D(3), Hu H(1).
Author information:
(1)1 University of Macau, China.
(2)2 University of Electronic Science and Technology of China, Chengdu, China.
(3)3 Beijing Jiaotong University, China.
While patient-centered care is highly anticipated nowadays, investigation of

consumers' perceptions and expectations about pharmacist's pharmaceutical care
when providing over-the-counter (OTC) drugs is sparse. This article aimed to
explore consumers' perceptions regarding the pharmaceutical care that community
pharmacists provide in relation to OTC drugs. Semistructured interviews were
conducted with consumers recruited (N = 97) in Yinchuan City, China. The 4 main
themes that emerged were expectations on pharmaceutical care, attitude toward
pharmacist's competence, experience of self-medication, and suggestions for
improving pharmaceutical care. Most participants had high expectations on
community pharmacists to recommend the right medicines, to advise them about the
effective use of drug, to advise them about the safe use of drug, and to
recommend economic drugs. However, their previous experiences at community
pharmacy were far from satisfaction reportedly, leading to a general distrust in
pharmacist's certification and qualification, knowledge, communication skills,
and attitude. As a result, the participants turned to self-medication based on
their personal experiences, their relatives' experiences, the information on drug
label, and the information distributed in the mass media. Realizing the need to
improve pharmaceutical care, the participants also made improvement suggestions
specific to community pharmacist, community pharmacy, and the government.
DOI: 10.1177/0046958018793292
PMCID: PMC6088464
438. Psychol Violence. 2016 Apr;6(2):271-279.
Longitudinal Change in Women's Sexual Victimization Experiences as a Function of

Alcohol Consumption and Sexual Victimization History: A Latent Transition
Analysis.
Bryan AE(1), Norris J(1), Abdallah DA(1), Stappenbeck CA(2), Morrison DM(3),
Davis KC(3), George WH(4), Danube CL(1), Zawacki T(5).
Author information:
(1)Alcohol and Drug Abuse Institute, University of Washington.
(2)Department of Psychiatry and Behavioral Sciences, University of Washington.
(3)School of Social Work, University of Washington.
(4)Department of Psychology, University of Washington.
(5)Department of Psychology, University of Texas at San Antonio.
OBJECTIVE: Women's alcohol consumption and vulnerability to sexual victimization

(SV) are linked, but findings regarding the nature and direction of the
association are mixed. Some studies have found support for the self-medication
hypothesis (i.e., victimized women drink more to alleviate SV-related distress);
others have supported routine activity theory (i.e., drinking increases SV
vulnerability). In this study, we aimed to clarify the interplay between women's
prior SV, typical drinking, and SV experiences prospectively over one year.
METHOD: Participants (N = 530) completed a baseline survey and weekly follow-up
surveys across Months 3, 6, 9, and 12.
RESULTS: Latent class analysis (LCA) suggested that women could be classified as
victimized or non-victimized at each assessment month; 28% of participants were
classified as victimized at one or more assessment months. Latent transition
analysis (LTA) revealed that childhood sexual abuse and adult SV history each
predicted greater likelihood of being victimized during the year. Typical
drinking during a given assessment month was associated with (1) greater
likelihood of victimized status at that assessment month and (2) greater
likelihood of having transitioned into (or remained in) the victimized status
since the previous assessment month. Furthermore, victimized status at a given
assessment month predicted a higher quantity of subsequent drinking.
CONCLUSION: These findings indicate a reciprocal relationship between typical
drinking and SV, supporting both the self-medication hypothesis and routine
activity theory, and suggesting that hazardous drinking levels may be one
important target for both SV vulnerability reduction and interventions for women
who have been sexually victimized.
DOI: 10.1037/a0039411
PMCID: PMC4873161
PMID: 27213101
439. Nutrients. 2014 Nov 26;6(12):5392-404. doi: 10.3390/nu6125392.
Inappropriate usage of dietary supplements in patients by miscommunication with

physicians in Japan.
Chiba T(1), Sato Y(2), Nakanishi T(3), Yokotani K(4), Suzuki S(5), Umegaki K(6).
Author information:
Shinjuku-ku, Tokyo 162-8636, Japan. tyschiba@nih.go.jp.
Shinjuku-ku, Tokyo 162-8636, Japan. satoyoko@nih.go.jp.
Shinjuku-ku, Tokyo 162-8636, Japan. nakanisi@nih.go.jp.
Shinjuku-ku, Tokyo 162-8636, Japan. yokotani-k@swu.ac.jp.
Shinjuku-ku, Tokyo 162-8636, Japan. sachina-s@nih.go.jp.
Shinjuku-ku, Tokyo 162-8636, Japan. umegaki@nih.go.jp.
Recently, people have used dietary supplements not only for nutritional
supplementation, but also for treatment of their diseases. However, use of
dietary supplements to treat diseases, especially with medications, may cause
health problems in patients. In this study, we investigated use of dietary
supplements in patients in Japan. This survey was conducted from January to
December 2012, and was completed by 2732 people, including 599 admitted patients,
1154 ambulatory patients, and 979 healthy subjects who attended a seminar about
dietary supplements. At the time of the questionnaire, 20.4% of admitted
patients, 39.1% of ambulatory patients, and 30.7% of healthy subjects were using
dietary supplements, which including vitamin/mineral supplements, herbal
extracts, its ingredients, or food for specified health uses. The primary purpose
for use in all groups was health maintenance, whereas 3.7% of healthy subjects,
10.0% of ambulatory patients, and 13.2% of admitted patients used dietary
supplements to treat diseases. In addition, 17.7% of admitted patients and 36.8%
of ambulatory patients were using dietary supplements concomitantly with their
medications. However, among both admitted patients and ambulatory patients,
almost 70% did not mention dietary supplement use to their physicians. Overall,
3.3% of all subjects realized adverse effects associated with dietary
supplements. Communication between patients and physicians is important to avoid
health problems associated with the use of dietary supplements.
DOI: 10.3390/nu6125392
PMCID: PMC4276974
440. Afr Health Sci. 2017 Dec;17(4):1178-1184. doi: 10.4314/ahs.v17i4.27.
Intestinal candidiasis and antibiotic usage in children: case study of Nsukka,

South Eastern Nigeria.
Ezeonu IM(1), Ntun NW(1), Ugwu KO(1).
Author information:
(1)Department of Microbiology, University of Nigeria, Nsukka.
Background: Overgrowth of candida results from factors that disrupt the

intestinal microbial balance, such as the use of antibiotics. Unregulated
antibiotic use and rampant practice of self-medication in Nigeria, is a cause for
concern.
Methods: A total of 314 stool specimens were collected from children <1 to 12
years of age in Nsukka, South Eastern Nigeria and screened for candida species
using standard methods. Questionnaires were used to collect relevant information
on the participants.
Results: Out of the 314 participants, 31.2% had candidiasis, indicated by growth
of ≥105 CFU/ml. Four different species of candida were identified. Candida
albicans had the highest prevalence (59.0%), while Candida krusei had the least
prevalence (6.0%). Of the 314 participants, 46.5% had diarrhoea, out of which
58.9% had intestinal candidiasis while only 14.3% of the non-diarrhoeic children
had candidiasis. Of 208 participants who had taken antibiotics within three weeks
of the study, 42.3% had candidiasis compared to 20.8% of those with no recent
history of antibiotic use.
Conclusion: The results of this study showed a high prevalence of intestinal
candidiasis among children in Nsukka. Strong associations were observed between
the presence of intestinal candidiasis and diarrhoea, age and use of antibiotics
(p<0.001).
DOI: 10.4314/ahs.v17i4.27
PMCID: PMC5870271
441. J Addict Med. 2015 Mar-Apr;9(2):155-6. doi: 10.1097/ADM.0000000000000098.
Possible addiction transference from cocaine insufflation to oral bupropion in

bipolar patient.
Costa C(1), Araujo A, Brasil M, Cruz M.
Author information:
(1)From the Institute of Psychiatry (CC, MC), the Federal University of Rio de
Janeiro, RJ, Brazil; and Clementino Fraga Filho Hospital (AA, MB), Federal
University of Rio de Janeiro, RJ, Brazil.
OBJECTIVE: Alert for the risk of oral bupropion addiction in patients with
cocaine dependence.
METHODS: Single-case study.
RESULTS: After a period of cocaine and alcohol abstinence, a 42-year-old patient
started taking oral bupropion to relieve the symptoms of cocaine craving. He
increased the bupropion dose up to 2250 mg/d without seizures.
CONCLUSION: This case highlights the possibility of oral bupropion addiction
after cocaine dependence. To our knowledge, it is the first case in the
literature and emphasizes the risk of bupropion's misuse. Therefore, physicians
should carefully examine the patient's profile before prescribing it, as well as
follow appropriate measures.
DOI: 10.1097/ADM.0000000000000098
PMCID: PMC4374723
442. Demogr Res. 2018;38. pii: 17. doi: 10.4054/DemRes.2018.38.17. Epub 2018 Jan
30.
Uninsured Migrants: Health Insurance Coverage and Access to Care Among Mexican
Return Migrants.
Wassink J(1).
Author information:
(1)University of North Carolina at Chapel Hill, Department of Sociology and
Carolina Population Center.
Background: Despite an expansive body of research on health and access to medical

care among Mexican immigrants in the United States, research on return migrants
focuses primarily on their labor market mobility and contributions to local
development.
Objective: Motivated by recent scholarship that documents poor mental and
physical health among Mexican return migrants, this study investigates return
migrants' health insurance coverage and access to medical care.
Methods: I use descriptive and multivariate techniques to analyze data from the
2009 and 2014 rounds of Mexico's National Survey of Demographic Dynamics (ENADID,
combined n=632,678).
Results: Analyses reveal a large and persistent gap between recent return
migrants and non-migrants, despite rising overall health coverage in Mexico.
Multivariate analyses suggest that unemployment among recent arrivals contributes
to their lack of insurance. Relative to non-migrants, recently returned migrants
rely disproportionately on private clinics, pharmacies, self-medication, or have
no regular source of care. Mediation analysis suggests that returnees' high rate
of uninsurance contributes to their inadequate access to care.
Conclusion: This study reveals limited access to medical care among the growing
population of Mexican return migrants, highlighting the need for targeted
policies to facilitate successful reintegration and ensure access to vital
resources such as health care.
DOI: 10.4054/DemRes.2018.38.17
PMCID: PMC5894520
PMID: 29657545
443. Ayu. 2015 Jan-Mar;36(1):69-72. doi: 10.4103/0974-8520.169015.
Ayurvedic management of life-threatening skin emergency erythroderma: A case

study.
Singh SK(1), Rajoria K(2).
Author information:
(1)Department of Panchakarma, National Institute of Ayurveda, Jaipur, India.
(2)Department of Panchakarma, S.S.S.B. Ayurvedic College and Hospital, Jaipur,
Rajasthan, India.
Erythroderma or generalized exfoliative dermatitis is a skin disorder that

requires attention equivalent to medical emergencies. It is more prevalent in
male population. It accounts for 35 cases/100,000 cases in dermatologic
outpatient departments. In erythroderma even with proper management there are
certain metabolic burdens and complications which make it more critical. The
primary aim, in this case, was to treat the patient with Ayurvedic management. A
18-year-old patient, suffering from erythroderma, was treated on the line of
Kapala Kushtha and Audumbera Kushtha. The patient had primarily suffered from
psoriasis for 8 years. Erythroderma was developed due to abrupt self-medication
with an unknown amount of intramuscular methylprednisolone several times in last
month. Rasamanikya-125 mg, Arogyavardhini Vati-1 g, Kaishora Guggulu-1 g,
Khadirarista-20 ml, and Panchatikta Ghrita-20 ml, all drugs twice a day with 3-4
times local application of Jatyadi Taila were administered. A decoction of
Jwarhara Kashaya was also administered in the dose of 40 ml twice a day. The
patient had relief from the acute phase after 20 days of treatment and complete
remission after 3 months of treatment. This case study demonstrates that
Ayurvedic management may be useful in erythroderma like acute and
life-threatening condition.
DOI: 10.4103/0974-8520.169015
PMCID: PMC4687243
PMID: 26730142
444. Front Psychiatry. 2018 Feb 13;9:38. doi: 10.3389/fpsyt.2018.00038. eCollection

2018.
Are Drinking Motives Universal? Characteristics of Motive Types in

Alcohol-Dependent Men from Two Diverse Populations.
Ertl V(1)(2), Preuße M(1)(2), Neuner F(1)(2).
Author information:
University, Bielefeld, Germany.
(2)vivo international, Konstanz, Germany.
Background and Aims: Since alcohol use disorders are among the most prevalent and
destructive mental disorders, it is critical to address factors contributing to
their development and maintenance. Drinking motives are relevant driving factors
for consumption. Identifying groups of drinkers with similar motivations may help
to specialize intervention components and make treatment more effective and
efficient. We aimed to identify and describe distinct motive types of drinkers in
dependent males from two diverse cultures (Uganda and Germany) and to explore
potential differences and similarities in addiction-related measures. Moreover,
we investigated specific links between motive types and childhood maltreatment,
traumatic experiences, and symptoms of comorbid psychopathologies.
Methods: To determine distinct drinking motive types, we conducted latent class
analyses concerning drinking motives (Drinking Motive Scale) in samples of
treatment-seeking alcohol-dependent men (N = 75). Subsequently we compared the
identified motive types concerning their alcohol consumption and alcohol-related
symptoms (Alcohol Use Disorders Identification Test), history of childhood
maltreatment (Childhood Trauma Questionnaire), trauma exposure (Violence, War and
Abduction Exposure Scale), psychopathology (Posttraumatic Stress Diagnostic
Scale, Depression-section of the Hopkins Symptom Checklist, and Brief Symptom
Inventory) and deficits in emotion regulation (Difficulties in Emotion Regulation
Scale).
Results: We found two congruent drinking motive types in both contexts.
Reward-oriented drinking motives like the generation of positive feelings and
enhancing performance were endorsed almost equally by both motive types, whereas
high relief motive endorsement characterized one group, but not the other. The
relief motive type drank to overcome aversive feelings, withdrawal, and daily
hassles and was characterized by higher adversity in general. Emotional
maltreatment in childhood and psychopathological symptoms were reported to a
significantly greater extent by relief drinkers (effect sizes of comparisons
ranging from r = 0.25 to r = 0.48). However, the motive types did not differ
significantly on alcohol consumption or alcohol-related symptoms and traumatic
experiences apart from childhood maltreatment.
Conclusion: The chronology of addiction development and patterns of drinking
motivation seem to be similar across cultures, i.e., that motive targeting
interventions might be applicable cross-culturally. Addressing comorbid
symptomatology should be a key treatment component for relief drinkers, whereas
finding alternatives for the creation of positive feelings and ways to counteract
boredom and inactivity should be a general treatment element.
DOI: 10.3389/fpsyt.2018.00038
PMCID: PMC5816937
PMID: 29487544
445. Ecol Evol. 2014 Oct;4(20):3960-7. doi: 10.1002/ece3.1252. Epub 2014 Sep 26.
Diversity of honey stores and their impact on pathogenic bacteria of the

honeybee, Apis mellifera.
Erler S(1), Denner A(1), Bobiş O(2), Forsgren E(3), Moritz RF(4).
Author information:
(1)Departamentul de Apicultură şi Sericicultură, Universitatea de Ştiinţe
Agricole şi Medicină Veterinară Calea Mănăştur 3-5, 400372, Cluj-Napoca, Romania
; Institut für Biologie, Molekulare Ökologie, Martin-Luther-Universität
Halle-Wittenberg Hoher Weg 4, 06099, Halle, Germany.
Agricole şi Medicină Veterinară Calea Mănăştur 3-5, 400372, Cluj-Napoca, Romania.
(3)Department of Ecology, Swedish University of Agricultural Sciences P.O. Box
7044, 75007, Uppsala, Sweden.
Agricole şi Medicină Veterinară Calea Mănăştur 3-5, 400372, Cluj-Napoca, Romania
; Institut für Biologie, Molekulare Ökologie, Martin-Luther-Universität
Halle-Wittenberg Hoher Weg 4, 06099, Halle, Germany ; Department of Zoology and
Entomology, University of Pretoria 0002, Pretoria, South Africa.
Honeybee colonies offer an excellent environment for microbial pathogen

development. The highest virulent, colony killing, bacterial agents are
Paenibacillus larvae causing American foulbrood (AFB), and European foulbrood
(EFB) associated bacteria. Besides the innate immune defense, honeybees evolved
behavioral defenses to combat infections. Foraging of antimicrobial plant
compounds plays a key role for this "social immunity" behavior. Secondary plant
metabolites in floral nectar are known for their antimicrobial effects. Yet,
these compounds are highly plant specific, and the effects on bee health will
depend on the floral origin of the honey produced. As worker bees not only feed
themselves, but also the larvae and other colony members, honey is a prime
candidate acting as self-medication agent in honeybee colonies to prevent or
decrease infections. Here, we test eight AFB and EFB bacterial strains and the
growth inhibitory activity of three honey types. Using a high-throughput cell
growth assay, we show that all honeys have high growth inhibitory activity and
the two monofloral honeys appeared to be strain specific. The specificity of the
monofloral honeys and the strong antimicrobial potential of the polyfloral honey
suggest that the diversity of honeys in the honey stores of a colony may be
highly adaptive for its "social immunity" against the highly diverse suite of
pathogens encountered in nature. This ecological diversity may therefore operate
similar to the well-known effects of host genetic variance in the arms race
between host and parasite.
DOI: 10.1002/ece3.1252
PMCID: PMC4242578
PMID: 25505523
446. Drug Alcohol Depend. 2015 Jul 1;152:272-6. doi:

10.1016/j.drugalcdep.2015.04.005.
Epub 2015 Apr 20.
Methamphetamine injecting is associated with phylogenetic clustering of hepatitis

C virus infection among street-involved youth in Vancouver, Canada.
Cunningham EB(1), Jacka B(2), DeBeck K(3), Applegate TL(2), Harrigan PR(4),
Krajden M(5), Marshall BD(6), Montaner J(7), Lima VD(7), Olmstead AD(5), Milloy
MJ(7), Wood E(7), Grebely J(2).
Author information:
(1)Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW
Australia, Sydney, NSW, Australia. Electronic address:
ecunningham@kirby.unsw.edu.au.
(2)Viral Hepatitis Clinical Research Program, The Kirby Institute, UNSW
Australia, Sydney, NSW, Australia.
(3)British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital,
Vancouver, BC, Canada; School of Public Policy, Simon Fraser University,
(5)BC Centre for Disease Control, Vancouver, BC, Canada.
(6)Department of Epidemiology, Brown University School of Public Health,
Providence, RI, United States.
Vancouver, BC, Canada; Division of AIDS, Department of Medicine, Faculty of
Medicine, University of British Columbia, Vancouver, BC, Canada.
BACKGROUND: Among prospective cohorts of people who inject drugs (PWID),

phylogenetic clustering of HCV infection has been observed. However, the majority
of studies have included older PWID, representing distant transmission events.
The aim of this study was to investigate phylogenetic clustering of HCV infection
among a cohort of street-involved youth.
METHODS: Data were derived from a prospective cohort of street-involved youth
aged 14-26 recruited between 2005 and 2012 in Vancouver, Canada (At Risk Youth
Study, ARYS). HCV RNA testing and sequencing (Core-E2) were performed on HCV
positive participants. Phylogenetic trees were inferred using maximum likelihood
methods and clusters were identified using ClusterPicker (Core-E2 without HVR1,
90% bootstrap threshold, 0.05 genetic distance threshold).
RESULTS: Among 945 individuals enrolled in ARYS, 16% (n=149, 100% recent
injectors) were HCV antibody positive at baseline interview (n=86) or
seroconverted during follow-up (n=63). Among HCV antibody positive participants
with available samples (n=131), 75% (n=98) had detectable HCV RNA and 66% (n=65,
mean age 23, 58% with recent methamphetamine injection, 31% female, 3% HIV+) had
available Core-E2 sequences. Of those with Core-E2 sequence, 14% (n=9) were in a
cluster (one cluster of three) or pair (two pairs), with all reporting recent
methamphetamine injection. Recent methamphetamine injection was associated with
membership in a cluster or pair (P=0.009).
CONCLUSION: In this study of street-involved youth with HCV infection and recent
injecting, 14% demonstrated phylogenetic clustering. Phylogenetic clustering was
associated with recent methamphetamine injection, suggesting that methamphetamine
drug injection may play an important role in networks of HCV transmission.
DOI: 10.1016/j.drugalcdep.2015.04.005
PMCID: PMC4461061
447. Eur J Dent. 2017 Oct-Dec;11(4):480-485. doi: 10.4103/ejd.ejd_142_17.
The prevalence of halitosis (oral malodor) and associated factors among dental
students and interns, Lahore, Pakistan.
Nazir MA(1), Almas K(1), Majeed MI(2).
Author information:
(1)Department of Preventive Dental Sciences, University of Dammam College of
Dentistry, Dammam, KSA.
(2)Department of Prosthetics, College of Dentistry, King Khalid University, Abha,
KSA.
Objective: To evaluate the prevalence of halitosis and the factors associated

with it among dental students and interns in Lahore, Pakistan.
Methods: A cross-sectional study design was chosen, and a sample of dental
students and interns was collected from seven dental colleges in Lahore,
Pakistan. A total of 833 participants were approached in person as convenient
sample population. A self-reported questionnaire was administered and informed
consent was obtained. The associations between oral malodor and different
variables of the study were explored using analytical statistics (Chi-square test
and logistic regression analysis). Statistical significance was determined using
a 95% confidence interval (CI).
Results: Six hundred and fifteen participants (aged 19-27 years) completed the
survey with a response rate of 73.8%. The prevalence of self-reported halitosis
was 75.1%. More female (51.4%) than male students (23.7%) reported oral malodor,
and most participants (61%) reported early morning halitosis. Thirteen percent of
respondents had examination for oral malodor by a dentist and 37.6% treated the
condition with self-medication. Binary logistic regression model showed that male
gender (odds ratio [OR] =0.44, CI = 0.22-0.87), daily use of dental floss (OR =
0.28, CI = 0.13-0.58), and drinking tea with mint (OR = 0.44, CI = 0.22-0.89)
were significantly associated with oral malodor. The participants with tongue
coating had higher odds (OR = 2.75, CI = 1.13-6.69) of having oral malodor than
those without tongue coating, and the association was statistically significant.
Conclusions: The study identified high prevalence of oral malodor among dental
students and interns. They should receive appropriate diagnosis and management of
the condition from dentist. The regular use of dental floss and removal of tongue
coating can significantly reduce halitosis.
DOI: 10.4103/ejd.ejd_142_17
PMCID: PMC5727733
PMID: 29279674
448. Ann Intensive Care. 2016 Dec;6(1):9. doi: 10.1186/s13613-016-0109-9. Epub 2016
Feb 2.
An observational study of adult admissions to a medical ICU due to adverse drug

events.
Jolivot PA(1)(2), Pichereau C(3), Hindlet P(1)(2)(4), Hejblum G(1), Bigé N(3),
Maury E(1)(3), Guidet B(1)(3), Fernandez C(5)(6)(7).
Author information:
(1)Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis
d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Equipe 6, 75012, Paris,
France.
(2)APHP, Hôpital Saint-Antoine, Service de Pharmacie, 75012, Paris, France.
(3)APHP, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75012, Paris,
France.
(4)Univ Paris-Sud, Faculté de Pharmacie, 92296, Châtenay-Malabry, France.
(5)Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis
d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Equipe 6, 75012, Paris,
France. christine.fernandez@aphp.fr.
(6)APHP, Hôpital Saint-Antoine, Service de Pharmacie, 75012, Paris, France.
christine.fernandez@aphp.fr.
(7)Univ Paris-Sud, Faculté de Pharmacie, 92296, Châtenay-Malabry, France.
christine.fernandez@aphp.fr.
BACKGROUND: The objectives of the study were to estimate the incidence of

intensive care unit (ICU) admissions due to adverse drug events (ADEs), to assess
preventability, severity and costs of the corresponding ADE and to determine the
leading causes of preventable ADEs.
METHODS: An observational study was conducted in a medical ICU of a teaching
hospital from February 2013 to February 2014.
RESULTS: A total of 743 consecutive admissions were included, and they involved
701 different patients. The included admissions were categorized into three
groups (admissions due to preventable ADE, admissions due to unpreventable ADE
and the control group). Among the 743 ICU admissions included during the study
period, 173 (23.3 %) were due to ADE, with 102 (13.7 %) related to preventable
ADE and 71 (9.6 %) to unpreventable ADE, yielding a preventability rate of ADE of
0.59 (102/173). Admissions due to unpreventable ADE concerned patients with more
comorbidities, a greater number of drugs and higher Simplified Acute Physiology
Score II than admissions due to preventable ADE and the control group admissions
(n = 570). Hospital mortality rates, corresponding costs and length of stay were
all similar in the preventable ADE and control groups, whereas they were always
significantly higher in the unpreventable ADE group. ICU mortality, length of
stay and the corresponding costs were similar in the three groups. Non-compliance
was the principal leading cause of preventable ADE (n = 31/102). The 102
preventable ADE-related admissions accounted for a total of 528 days of
hospitalization in the ICU, requiring a mean of 1.4 ICU beds per day over the
one-year period, with an associated total cost amounting to 747,651 €.
CONCLUSIONS: ADE was a major cause of admission in the studied ICU, and in 59 %
of the cases, ADEs were preventable. The reported burden of ICU admissions due to
ADE advocates for further investigations to explore how the rate of such
admissions could be decreased.
DOI: 10.1186/s13613-016-0109-9
PMCID: PMC4735088
PMID: 26830112
449. J Neurosci. 2015 Feb 4;35(5):1872-9. doi: 10.1523/JNEUROSCI.2777-14.2015.
Impaired neural response to negative prediction errors in cocaine addiction.
Parvaz MA(1), Konova AB(2), Proudfit GH(3), Dunning JP(4), Malaker P(1), Moeller
SJ(1), Maloney T(1), Alia-Klein N(1), Goldstein RZ(5).
Author information:
(1)Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount
Sinai, New York, New York 10029.
(2)Center for Neural Science, New York University, New York, New York 10003.
(3)Department of Psychology, Stony Brook University, Stony Brook, New York 11970,
and.
(4)Department of Psychology, Nevada State College, Henderson, Nevada 89002.
(5)Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount
Sinai, New York, New York 10029, rita.goldstein@mssm.edu.
Learning can be guided by unexpected success or failure, signaled via

dopaminergic positive reward prediction error (+RPE) and negative
reward-prediction error (-RPE) signals, respectively. Despite conflicting
empirical evidence, RPE signaling is thought to be impaired in drug addiction. To
resolve this outstanding question, we studied as a measure of RPE the feedback
negativity (FN) that is sensitive to both reward and the violation of
expectation. We examined FN in 25 healthy controls; 25 individuals with
cocaine-use disorder (CUD) who tested positive for cocaine on the study day
(CUD+), indicating cocaine use within the past 72 h; and in 25 individuals with
CUD who tested negative for cocaine (CUD-). EEG was acquired while the
participants performed a gambling task predicting whether they would win or lose
money on each trial given three known win probabilities (25, 50, or 75%). FN was
scored for the period in each trial when the actual outcome (win or loss) was
revealed. A significant interaction between prediction, outcome, and group
revealed that controls showed increased FN to unpredicted compared with predicted
wins (i.e., intact +RPE) and decreased FN to unpredicted compared with predicted
losses (i.e., intact -RPE). However, neither CUD subgroup showed FN modulation to
loss (i.e., impaired -RPE), and unlike CUD+ individuals, CUD- individuals also
did not show FN modulation to win (i.e., impaired +RPE). Thus, using FN, the
current study directly documents -RPE deficits in CUD individuals. The mechanisms
underlying -RPE signaling impairments in addiction may contribute to the
disadvantageous nature of excessive drug use, which can persist despite repeated
unfavorable life experiences (e.g., frequent incarcerations).
Copyright © 2015 the authors 0270-6474/15/351872-08$15.00/0.
DOI: 10.1523/JNEUROSCI.2777-14.2015
PMCID: PMC4315825
450. Cult Health Sex. 2015;17(1):92-103. doi: 10.1080/13691058.2014.950982. Epub

2014
Oct 1.
Cross-sex hormone use, functional health and mental well-being among transgender
men (Toms) and Transgender Women (Kathoeys) in Thailand.
Gooren LJ(1), Sungkaew T, Giltay EJ, Guadamuz TE.

Author information:
(1)a VU University Medical Center , Amsterdam , The Netherlands.
There exists limited understanding of cross-sex hormone use and mental well-being
among transgender women and, particularly, among transgender men. Moreover, most
studies of transgender people have taken place in the Global North and often in
the context of HIV. This exploratory study compared 60 transgender men (toms)
with 60 transgender women (kathoeys) regarding their use of cross-sex hormones,
mental well-being and acceptance by their family. Participants also completed a
dispositional optimism scale (the Life Orientation Test Revised), the Social
Functioning Questionnaire and the Short Form Health Survey 36 assessing their
profile of functional health and mental well-being. Cross-sex hormones were used
by 35% of toms and 73% of kathoeys and were largely unsupervised by
health-related personnel. There were no differences in functional health and
mental well-being among toms and kathoeys. However, toms currently using
cross-sex hormones scored on average poorer on bodily pain and mental health,
compared to non-users. Furthermore, compared to non-users, cross-sex hormone
users were about eight times and five times more likely to be associated with
poor parental acceptance among toms and kathoeys, respectively. This study was
the first to compare cross-sex hormone use, functional health and mental
well-being among transgender women and transgender men in Southeast Asia.
DOI: 10.1080/13691058.2014.950982
PMCID: PMC4227918
451. Hepat Mon. 2016 Mar 5;16(4):e32654. doi: 10.5812/hepatmon.32654. eCollection

2016
Apr.
Economic Burden of Hepatitis C Virus Infection in Different Stages of Disease: A

Report From Southern Iran.
Zare F(1), Fattahi MR(1), Sepehrimanesh M(1), Safarpour AR(1).
Author information:
(1)Gastroenterohepatology Research Center, Shiraz University of Medical Sciences,
Shiraz, IR Iran.
BACKGROUND: Hepatitis C virus (HCV) infection is a major blood-borne infection

which imposes high economic cost on the patients.
OBJECTIVES: The current study aimed to evaluate the total annual cost due to
chronic HCV related diseases imposed on each patient and their family in Southern
Iran.
PATIENTS AND METHODS: Economic burden of chronic hepatitis C-related liver
diseases (chronic hepatitis C, cirrhosis and hepatocellular carcinoma) were
examined. The current retrospective study evaluated 200 Iranian patients for
their socioeconomic status, utilization (direct and indirect costs) and treatment
costs and work days lost due to illness by a structured questionnaire in 2015.
Costs of hospital admissions were extracted from databases of Nemazee hospital,
Shiraz, Iran. The outpatient expenditure per patient was measured through the
rate of outpatient visits and average cost per visit reported by the patients;
while the inpatient costs were calculated through annual rate of hospital
admissions and average expenditure. Self-medication and direct non-medical costs
were also reported. The human capital approach was used to measure the work loss
cost.
RESULTS: The total annual cost per patient for chronic hepatitis C, cirrhosis and
hepatocellular carcinoma (HCC) based on purchasing power parity (PPP) were USD
1625.50, USD 6117.2, and USD 11047.2 in 2015, respectively.
CONCLUSIONS: Chronic hepatitis C-related liver diseases impose a substantial
economic burden on patients, families and the society. The current study provides
useful information on cost of treatment and work loss for different disease
states, which can be further used in cost-effectiveness evaluations.
DOI: 10.5812/hepatmon.32654
PMCID: PMC4887962
PMID: 27257424
452. BMC Res Notes. 2018 Sep 10;11(1):660. doi: 10.1186/s13104-018-3764-0.
Rational use of paracetamol among out-patients in a Bhutanese district hospital

bordering India: a cross-sectional study.
Dorji T(1)(2), Gyeltshen K(3), Pongpirul K(4)(5).
Author information:
(1)Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
dorji.thinleydr@gmail.com.
(2)Kidu Medical Unit, His Majesty's Peoples' Project, Thimphu, Bhutan.
dorji.thinleydr@gmail.com.
(3)Phuentsholing General Hospital, Phuentsholing, Bhutan.
(4)Holistic and Oriental Medicine Research Center, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand.
(5)Department of International Health, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA.
OBJECTIVE: Paracetamol or acetaminophen is a weak analgesic commonly used

worldwide and in Bhutan. It is available across all levels of Bhutan's health
care system and for purchase without prescription. Little is known, however,
about patterns of paracetamol use in Bhutan. This study aimed to assess what the
Bhutanese population knows about the indications for use of paracetamol, safe
use, and common patterns of usage (frequency, dosage). These questions were
studied among Bhutanese living in Phuentsholing, a large commercial town at
Bhutan-India border.
RESULTS: Among 441 participants, most (72.1%) reported having used paracetamol in
the past 1 year. The mean knowledge score was 57.6%; only 30 participants (6.8%)
had what was characterized as "good knowledge." Level of knowledge was positively
associated with level of education (p = 0.031). Less than half (41.3%) had a
"good attitude" towards use of paracetamol. In practice, few (4.8%) knew the
correct dose, including about one in ten who reported exceeding the recommended
therapeutic dose. Most knew about side effects (61.2%) and possible allergic
reactions (77.3%). Many participants (47.9%) acknowledged that the self-use of
paracetamol may not reduce the number of hospital visits.
DOI: 10.1186/s13104-018-3764-0
PMCID: PMC6131944
453. Exp Ther Med. 2019 Feb;17(2):1020-1023. doi: 10.3892/etm.2018.6983. Epub 2018
Nov
16.
Sea buckthorn extract in the treatment of psoriasis.
Boca AN(1), Ilies RF(2), Saccomanno J(2), Pop R(1), Vesa S(1), Tataru AD(3),
Buzoianu AD(1).
Author information:
(1)Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu
Hatieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania.
(2)Faculty of Medicine, 'Iuliu Hatieganu' University of Medicine and Pharmacy,
400012 Cluj-Napoca, Romania.
(3)Department of Dermatology, 'Iuliu Hatieganu' University of Medicine and
Pharmacy, 400000 Cluj-Napoca, Romania.
Psoriasis is one of the most common chronic dermatological conditions, with a

strong impact on patients' quality of life. Currently, psoriasis benefits from
conventional therapy with a high rate of adverse effects and an increase in
non-compliance and self-medication of patients. As such, there is a need to
pinpoint low-adverse effects and accessible remedies for this condition. Our
single-blind, placebo-controlled study assessed the effect of sea buckthorn
extract on psoriasis lesions in previously untreated patients. Our results showed
an improvement in Psoriasis Area Severity Index (PASI) scores and in Dermatology
Life Quality Index (DLQI) scores when compared to the baseline values, as well as
at the 4- and 8-week time marks for the lesions treated with sea buckthorn
extract. By contrast, the measurements for the placebo treated lesions showed no
alteration at the 4-week mark, and significant worsening at the end of the trial.
These findings provide a solid, optimistic base for the in-depth research of sea
buckthorn as an adjuvant or a component in psoriasis care protocols.
DOI: 10.3892/etm.2018.6983
PMCID: PMC6327666
PMID: 30679968
454. Front Pharmacol. 2018 Jul 17;9:725. doi: 10.3389/fphar.2018.00725. eCollection

2018.
Use of Psychotropic Medications and Illegal Drugs, and Related Consequences Among
French Pharmacy Students - SCEP Study: A Nationwide Cross-Sectional Study.
Balayssac D(1), Pereira B(2), Darfeuille M(3), Cuq P(4), Vernhet L(5), Collin
A(6), Vennat B(7), Authier N(8).
Author information:
(1)Inserm U1107, NEURO-DOL, Faculté de Pharmacie, Laboratoire de Toxicologie,
Université Clermont Auvergne, CHU Clermont-Ferrand, Délégation à la Recherche
Clinique et à l'Innovation, Clermont-Ferrand, France.
(2)CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation,
Clermont-Ferrand, France.
(3)Faculté de Pharmacie, Laboratoire de Toxicologie, Université Clermont
Auvergne, Clermont-Ferrand, France.
(4)Institut des Biomolécules Max Mousseron (IBMM), UMR 5247, CNRS, ENSCM, Faculté
de Pharmacie, Université de Montpellier, Montpellier, France.
(5)UMR Inserm 1085, Institut de Recherche sur la Santé, l'Environnement et le
Travail (IRSET), Université de Rennes 1, Rennes, France.
(6)Inserm U1107, NEURO-DOL, Faculté de Pharmacie, Laboratoire de Toxicologie,
Université Clermont Auvergne, Clermont-Ferrand, France.
(7)ACCePPT, Faculté de Pharmacie, Université Clermont Auvergne, Clermont-Ferrand,
France.
(8)Inserm U1107, NEURO-DOL, Université Clermont Auvergne, Faculté de Médecine,
CHU Clermont-Ferrand, Pharmacologie Médicale, Clermont-Ferrand, France.
Background: The use of psychotropic medications and illegal drugs is a worldwide

public health issue, leading to addiction, psychiatric and somatic disorders, and
death. Pharmacy students are more exposed to psychotropic medications than other
students (non-medical), which could lead to an overuse. The main objective of
this study was to assess the prevalence of psychotropic drug use (medications and
illegal drugs) by French pharmacy students, by carrying out a nationwide
cross-sectional study. The relation of these medications and illegal drug use
with several comorbidities and academic achievement was also assessed. Methods:
This online survey was performed by emails sent to all French pharmacy faculties
over a period of 66 days (March 16, 2016 to May 20, 2016). The survey assessed
the prevalence of uses of psychotropic medications and illegal drugs during the
last 3 months. These uses were compared to student characteristics (personal and
university) and comorbidities (anxiety, depression, stress, and fatigue).
Results: Of the 2,609 questionnaires received, 2,575 were completed and useable
for the analysis. Among French pharmacy students and during the 3 last months,
9.4% have used psychotropic medications, 21.5% illegal drugs and 3.3% both
psychotropic medications and illegal drugs. Psychotropic medications were used in
the cases of a medical prescription (49.0%), a self-medication (42.4%) or a
non-medical intent (26.3%). Stress scores of the last 7 days were higher for
psychotropic medication users compared to non-users and illegal drug users.
Proportions of anxiety and depression at the time of answer were higher for
psychotropic medication users than for non-users and illegal drug users. Fatigue
scores of the last 7 days were lower for illegal drug users compared to non-users
and self-medicated students. Annual average marks of the last year, attendance
and perception of study difficulty were lower for illegal drug users than for
non-users. Conclusion: French pharmacy students were less exposed to psychotropic
medications and illegal drugs than the general French population. However, in
comparison to other students in other countries, the use of psychotropic
medications seemed to be lower, but with a proportionally higher use of
anxiety/sedative medications and a lower use of opioid medications.
DOI: 10.3389/fphar.2018.00725
PMCID: PMC6056660
PMID: 30065649
455. Int J Hypertens. 2018 Apr 26;2018:8307591. doi: 10.1155/2018/8307591.

eCollection
2018.
Factors Influencing Compliance and Health Seeking Behaviour for Hypertension in

Mukono and Buikwe in Uganda: A Qualitative Study.
Musinguzi G(1)(2), Anthierens S(2), Nuwaha F(1), Van Geertruyden JP(3), Wanyenze
RK(1), Bastiaens H(2).
Author information:
(1)Department of Disease Control and Environmental Health, School of Public
Health, Makerere University, Kampala, Uganda.
(2)Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium.
(3)International Health, University of Antwerp, Antwerp, Belgium.
Background and Methods: Hypertension is a global public health challenge and a

leading risk factor for cardiovascular morbidity and mortality. Hypertension
control rates are low worldwide, and delay in seeking care is associated with
increased mortality.
Methods: In a qualitative study, known hypertensive patients were interviewed to
explore factors influencing compliance and health seeking behaviour (HSB). Data
was analyzed following a semantic thematic analysis approach.
Results: Patients sought various channels of care for their hypertension.
Self-medication and access to antihypertensive drugs with or without prescription
were common as well as use of herbal remedies. Regular monitoring of blood
pressure was not a common practice. Factors influencing HSB were related to
health systems and the patient socioeconomic and structural environment. The main
system issues were related to availability and attitudes of staff and shortage of
supplies and medicines. The patient factors were related to awareness, perceived
severity, perceived effectiveness of therapy, adverse effects, and perceived
fears of lifelong dependence on medicines. The patient socioeconomic status
played a role as did the marketing of traditional medicine.
Conclusion: Patients seek varied channels of care for their hypertension.
Strategies to address the multifactorial dimensions that affect HSB are needed to
improve hypertension control in this population.
DOI: 10.1155/2018/8307591
PMCID: PMC5944291
PMID: 29854433
456. Med Ultrason. 2014 Dec;16(4):372-6.
Ultrasound and MRI features of penile augmentation by "Jamaica Oil" injection. A

case series.
Francis J(1), Poh Choo Choo A(2), Wansaicheong Khin-Lin G(3).
Author information:
(1)Department of Diagnostic Radiology, Changi General Hospital, Singapore.
Joe_Francis@cgh.com.sg; joefrancis01@gmail.com.
(2)Department of Diagnostic Radiology, Changi General Hospital, Tan Tock Seng
Hospital, Singapore.
(3)Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.
Penile paraffinoma is a rare but well-known entity. There have been few studies
describing the ultrasound and MRI features of penile paraffinoma. In this case
series we describe the imaging findings of 4 patients who self-injected "Jamaica
oil" into their penises for the purpose of penile augmentation and discuss the
utility of US and MRI in the management of these patients.
457. Drugs (Abingdon Engl). 2015;22(3):208-216. Epub 2015 Apr 14.
Motivations for Prescription Drug Misuse among Young Adults: Considering Social
and Developmental Contexts.
LeClair A(1), Kelly BC(2), Pawson M(3), Wells BE(4), Parsons JT(5).
Author information:
(1)Institute for Health, Health Care Policy & Aging Research, Rutgers University.
(2)Purdue University ; Center for HIV Educational Studies & Training, CUNY.
(3)Center for HIV Educational Studies & Training, CUNY ; Graduate Center, CUNY.
(4)Center for HIV Educational Studies & Training, CUNY ; Hunter College, CUNY.
(5)Center for HIV Educational Studies & Training, CUNY ; Hunter College, CUNY ;
Graduate Center, CUNY.
AIMS: As part of a larger study on prescription drug misuse among young adults
active in urban nightlife scenes, we examined participants' motivations for
misuse. Prescription painkillers, stimulants and sedatives were the primary
substances of interest.
METHODS: Participants were recruited from nightlife venues in New York using
time-space sampling. Subjects completed a mixed-methods assessment at project
research offices. The data presented here are from a subsample of 70 qualitative
interviews conducted during the baseline assessment.
FINDINGS: We identified experimentation and a "work hard, play hard" ethos as key
motivations for misusing prescription drugs and argue that these motivations are
specific, though not necessarily unique, to the participants' social location as
young adults. These findings highlight the role of life stage and social context
in the misuse of prescription drugs.
CONCLUSION: Future studies of prescription drug misuse should pay attention to
the larger social contexts in which users are embedded and, therefore, make
decisions about how and why to misuse. Moving beyond the very broad concepts of
"recreation" and "self-medication" presently established in the research,
policies targeting young adults may want to tailor intervention efforts based on
motivations.
DOI: 10.3109/09687637.2015.1030355
PMCID: PMC4689195
PMID: 26709337
458. Eur J Psychotraumatol. 2018 Jul 17;9(1):1492835. doi:

10.1080/20008198.2018.1492835. eCollection 2018.
Childhood maltreatment trauma: a comparison between patients in treatment for

substance use disorders and patients in mental health treatment.
Rasmussen IS(1), Arefjord K(2), Winje D(2), Dovran A(2)(3).
Author information:
(1)Outpatient Department, Karmøy District Psychiatric Center, Kopervik, Norway.
(2)Faculty of Psychology, Department of Clinical Psychology, University of
Bergen, Bergen, Norway.
(3)The Stine Sofies Foundation and The Stine Sofie Centre, Grimstad, Norway.
Background: While previous research has found strong associations between

childhood maltreatment trauma and substance use disorders (SUDs), the role of
possible moderating effects of gender and mediating effects of psychopathology
and SUD is unclear. Objective: The objective of this study was to investigate
differences in self-reported childhood maltreatment trauma, general psychological
distress, and post-traumatic stress symptoms between 112 patients in treatment
for substance use disorders (SUD group) and 112 matched controls with mild to
moderate mental health disorders (comparison group). Methods: Childhood
maltreatment trauma was measured by the Childhood Trauma Questionnaire - Short
Form (CTQ-SF). General psychological distress was measured by the Symptom
Checklist-90 - Revised (SCL-90-R), and post-traumatic stress symptoms were
measured by the Impact of Event Scale - Revised (IES-R). Results: The SUD group
reported more severe childhood maltreatment trauma than the comparison group.
Females in the SUD group reported more severe and various forms of trauma
compared to males. The SUD group reported higher mean scores on the SCL-90-R, but
the proportions of people with caseness scores on the IES-R and the SCL-90-R were
similar in the two samples. The SUD group reported more avoidance symptoms than
the comparison group. Conclusion: This study adds further evidence to the
repeatedly found strong associations between childhood maltreatment trauma and
SUD, implying that the prevention of childhood maltreatment trauma may reduce the
occurrence of SUD. Furthermore, patients with SUD should be screened for
childhood maltreatment trauma, and the results should be applied in
trauma-informed as well as trauma-focused interventions aimed to help this
population. The association appears to be particularly strong for female
substance users.
Publisher: Antecedentes: Si bien investigaciones previas han encontrado fuertes

asociaciones entre el trauma por maltrato infantil y los trastornos por uso de
sustancias (SUD), no está claro el papel de los posibles efectos moderadores del
género y los efectos mediadores de la psicopatología y el SUD.Objetivo: El
objetivo de este estudio fue investigar las diferencias en el trauma de maltrato
infantil autoreportado, el estrés psicológico general y los síntomas de estrés
postraumático entre 112 pacientes en tratamiento por trastornos por consumo de
sustancias (grupo SUD) y 112 controles emparejados con trastornos de salud mental
leves a moderados (grupo de comparación).Métodos: el trauma por maltrato infantil
se midió mediante el Cuestionario de Traumas de la Infancia, versión abreviada
(CTQ-SF). El estrés psicológico general se midió mediante la Lista de Chequeo de
Síntomas Revisada (SCL-90-R), y los síntomas de estrés postraumático se midieron
mediante la Escala de Impacto de Eventos Revisada (IES-R).Resultados: El grupo
SUD reportó trauma de maltrato infantil más severo que el grupo de comparación.
Las mujeres en el grupo SUD reportaron formas más graves y diversas de trauma en
comparación con los hombres. El grupo SUD informó puntuaciones medias más altas
en el SCL-90-R, pero las proporciones de personas con puntajes de casos en el
IES-R y el SCL-90-R fueron similares en las dos muestras. El grupo SUD informó
más síntomas de evitación que el grupo de comparación.Conclusión: Este estudio
agrega evidencia adicional a las fuertes asociaciones encontradas repetidamente
entre el trauma por maltrato infantil y el SUD, lo que implica que la prevención
del trauma de maltrato infantil puede reducir la ocurrencia de trastornos por uso
de sustancias. Además, los pacientes con SUD deberían ser evaluados para detectar
traumas por maltrato infantil y los resultados deberían aplicarse en
intervenciones basadas en el trauma e intervenciones focalizadas en el trauma
dirigidas a ayudar a esta población. La asociación parece ser particularmente
fuerte para las mujeres usuarias de sustancias.Publisher:
背景：虽然以前的研究发现童年虐待创伤和物质滥用障碍（SUD）之间有强关联，但性别的调节效应和精神病理的
中介效应对 SUD 的作用尚不清楚。目的：本研究的目的是比较 11
2 例物质滥用障碍治疗组（SUD 组）和 112 例与其匹配控制的轻度至中度精神健康障碍患者（比较组）的自我报
告童年虐待创伤、一般心理困扰和创伤后应激症状的差异。方法：使
用《童年创伤问卷简表》（CTQ-SF）测量童年虐待创伤，《症状清单-90-修订版》（SCL-90-R）测量一般心理
困扰，并且使用《事件影响量表修订版》（IES-R
）来测量创伤后应激症状。结果：SUD 组比对照组报告更严重的儿童虐待创伤。与男性相比，SUD 组中的女性报
告了更严重和更多形式的创伤。
SUD 组报告 SCL-90-R 的平均得分较高，但 IES-R 和 SCL-90-R 的病例比例在两个样本中相似。
SUD 组报告比对照组更多的回避症状。结论：这项研究进一步证实了童年虐待创伤与 SUD 之间反复发现的强关联，
这意味着预防儿童虐待创伤可能会减少 SUD 的发生。并且，患有
SUD 的患者应该接受儿童虐待创伤的筛查，并将结果应用于创伤相关和创伤中心的干预措施，以更好帮助这些人
群。这种关联性似乎在女性物质滥用者中变现更强。.
DOI: 10.1080/20008198.2018.1492835
PMCID: PMC6052420
PMID: 30034641
459. Acta Biomed. 2019 Jan 23;90(1):83-91. doi: 10.23750/abm.v90i1.7572.
European university students of pharmacy: survey on the use of pharmaceutical

drugs.
Scuri S(1), Petrelli F, Tanzi E, Thi Thu CN, Grappasonni I.
Author information:
(1)University of Camerino. stefania.scuri@unicam.it.
BACKGROUND AND AIM: In recent years, self-medication is an increasing public
health issue, also among the European young people. Only 48% of people throughout
the world use prescribed medications, while the remainder admits that they
self-medicate with over the counter drugs or leftover prescribed drugs. Also, the
risk of antibiotic resistance, throughout the world, has doubled, due to the
recourse to these drugs when they are not called for, or to failure to follow
their instructions for use.
METHODS: A five-part questionnaire, translated into the national languages and
validated, was given to Pharmacy students in Italy, Spain, the Czech Republic and
Romania obtain anonymous information about their pharmaceutical drugs use.
RESULTS: Regarding the use of pharmaceutical drugs, students in Spain and Romania
indicated the highest percentages of use. In Italy and Romania, the pharmacist is
rarely consulted, while the advice of family members or friends is more
frequently requested. In all four countries the problem of taking antibiotics
without a medical prescription is significant, and 50% of Romanian students use
antibiotics to treat the flu. Another important result is that, in Spain, 38.4%
of the respondents admitted to using medicines with alcohol.
CONCLUSIONS: Considering that the drug information leaflet is not read by 50% of
young people interviewed, it would be important for public health entities to
instruct the population, especially younger age groups such as secondary school
students, about the importance of reading this information carefully. The use of
mass media in such a preventive medicine campaign could be effective.
DOI: 10.23750/abm.v90i1.7572
PMCID: PMC6502160
PMID: 30889159
460. Saudi Pharm J. 2015 Apr;23(2):138-42. doi: 10.1016/j.jsps.2014.06.007. Epub

2014
Jul 2.
Comparative evaluation of metered-dose inhaler technique demonstration among

community pharmacists in Al Qassim and Al-Ahsa region, Saudi-Arabia.
Adnan M(1), Karim S(2), Khan S(3), Al-Wabel NA(2).
Author information:
(1)Department of Clinical Pharmacy, College of Pharmacy and Dentistry, Buraidah
Private Colleges, Al Qassim, Saudi Arabia.
(2)Department of Pharmacology, College of Pharmacy and Dentistry, Buraidah
Private Colleges, Al Qassim, Saudi Arabia.
(3)Department of Pharmaceutical Chemistry, College of Pharmacy and Dentistry,
Buraidah Private Colleges, Al Qassim, Saudi Arabia.
TITLE: Comparative evaluation of metered-dose inhaler technique demonstration

among community pharmacists in Al Qassim and Al Ahsa regions, Saudi Arabia.
BACKGROUND: Patients rely on the information about use of proper inhaler
technique when dispensed by community pharmacists however; several studies have
shown that patients are unable to show correct inhalation technique. The aim of
this study is to assess the ability of community pharmacists in Al Qassim region
to demonstrate proper inhalation technique of metered dose inhaler and compare
the baseline outcomes with a similar study at Al-Ahsa region.
METHOD: We approach 96 pharmacies in Al Qassim region as mock patient
(Investigator). The investigator asks the Pharmacist to guide him about proper
inhalation technique of metered dose inhaler. Investigator completes a
standardized and validated checklist of 8 steps of inhaler device use immediately
after leaving the pharmacy. Baseline data were compared between the two study
groups et al. Ahsa and Al-Qassim for variables for effectiveness of pharmacist
handling of patient queries.
RESULT: A total number of 96 community pharmacies were approached in five cities
of the Al Qassim province in Saudi Arabia This study has found that majority
(93.7%) of community pharmacists failed to demonstrate proper inhalation
technique of pMDI inhaler.
CONCLUSION: The pharmacists demonstrated particularly poor skills involving steps
for coordination of the actuation process with the mechanics of inhalation with
MDI. The errors detected in this simple assessment session, if translated to
patient self-medication errors, are potentially significant.
DOI: 10.1016/j.jsps.2014.06.007
PMCID: PMC4421000
PMID: 25972732
461. Pain Manag. 2019 Jul 1;9(4):379-387. doi: 10.2217/pmt-2018-0092. Epub 2019 Apr
2.
Frequency, nature and management of patient-reported severe acute pain episodes

in the over-the-counter setting: results of an online survey.
Hersch C(1), Denis C(1), Sugár D(1).
Author information:
(1)Reckitt Benckiser Healthcare International Ltd, 103-105 Bath Road, Slough,
Berkshire, SL1 3UH, UK.
Aim: Understand the frequency, nature and over-the-counter (OTC) self-management

of patient-reported severe acute pain occasions. Patients & methods: A
consumer-based survey of adults experiencing acute pain in Australia, Russia and
the UK. Participants recorded pain type, frequency and intensity plus action
taken to address pain. Results: A total of 2994 participants completed the
survey; 1366 provided ≥1 diary entry (total 6527 pain occasions). Of these, 744
(11%) were reported as severe, and 72% were treated with OTC medication.
Participants were somewhat satisfied/very satisfied with the action taken for 87%
of pain occasions overall, and for 83% of severe pain episodes; however,
participants with severe pain were somewhat/very dissatisfied with treatment in
9% of cases. Conclusion: Acute pain episodes described as 'severe' are not
uncommon in the self-management setting; most can be managed successfully with
self-medication. Individuals seeking strong OTC pain relief should be supported
to consider self-management strategies first, before considering prescription
medication.
DOI: 10.2217/pmt-2018-0092
PMID: 30938229
462. BMC Health Serv Res. 2018 Dec 3;18(1):915. doi: 10.1186/s12913-018-3753-y.
"You could lose when you misuse" - factors affecting over-the-counter sale of
antibiotics in community pharmacies in Saudi Arabia: a qualitative study.
Alhomoud F(1), Almahasnah R(2), Alhomoud FK(2).
Author information:
Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. f.k.alhomoud@gmail.com.
Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
BACKGROUND: The sale of antibiotics without a prescription poses a global public
health concern. Antibiotics dispensed without a prescription are largely
recognised as a cause of antibiotic misuse and overuse which may result in
antibiotic resistance, recurrent infection, increased cost and adverse effects of
treatment. There have been no qualitative studies to explore the reasons for
over-the-counter (OTC) sale of antibiotics, despite the fact that
non-prescription sale of antibiotics are increasing in Saudi Arabia.
METHODS: Qualitative interviews were conducted with community pharmacists living
in the Eastern Province of Saudi Arabia using face-to-face, open-ended questions.
Interviews were audio-recorded and transcribed verbatim. The interview
transcripts were analysed using thematic analysis and NVivo 10 software.
RESULTS: All participants declared that antibiotics were frequently sold without
a medical prescription on an OTC basis. The main reasons for OTC sale of
antibiotics were found to be related to the ease of access to community
pharmacies compared to other healthcare services, expertise and knowledge of
pharmacists and patients' trust, misconceptions and inappropriate practices of
the public towards antibiotic use, customer pressure, pharmacists' need to ensure
business survival and weak regulatory enforcement mechanism. These are presented
in more detail below by using illustrative quotes from participants' transcripts.
CONCLUSIONS: The non-prescribed sale of antibiotics is still a common practice in
Saudi Arabia, despite being a problem. The results of this study highlight the
need to design interventions to promote rational use of antibiotics.
DOI: 10.1186/s12913-018-3753-y
PMCID: PMC6276151
463. Schizophr Res Cogn. 2015 Jan 28;2(1):26-32. doi: 10.1016/j.scog.2014.12.001.

eCollection 2015 Mar.
Smoking in schizophrenia: cognitive impact of nicotine and relationship to

smoking motivators.
Beck AK(1)(2), Baker AL(2)(3), Todd J(1)(2).
Author information:
(1)School of Psychology, University of Newcastle, Callaghan, 2280, NSW,
Australia.
(2)Schizophrenia Research Institute, 405 Liverpool St, Darlinghurst, 2010, NSW,
Australia.
(3)School of Medicine & Public Health, University of Newcastle, Callaghan, 2280,
NSW, Australia.
Smoking prevalence in schizophrenia is significantly elevated relative to other

clinical and to non-clinical groups. The cognitive self-medication hypothesis
attributes this to the beneficial effects of nicotine on illness-related
cognitive deficits. Significant effects of nicotine have been observed on visual
spatial working memory (VSWM), sustained attention (Continuous Performance Test -
Identical Pairs; CPT-IP) and prepulse inhibition (PPI). It remains unclear
whether these neurophysiological and neurocognitive effects of nicotine influence
self-reported smoking motivation. To explore the relationship between nicotine
effects on cognition and self-reported smoking motivation in schizophrenia and
non-psychiatric control smokers, the impact of smoking abstinence and
reinstatement was examined across three cognitive indices (VSWM, CPT-IP, PPI) and
compared to self-reported smoking motivation (Modified Reasons for Smoking Scale
revised to include 'cognitive motivators'). Cognitive function was assessed after
'typical' smoking and overnight abstinence. Schizophrenia smokers (but not
controls) demonstrated significantly less error on the VSWM task in the smoking
relative to abstinent condition. Control (but not schizophrenia) smokers, showed
evidence of CPT-IP improvement in the smoking relative to abstinent condition.
The overall profile of smoking motivation was comparable between groups. However,
significant relationships between subjective and objective indices of smoking
related cognitive change were observed for controls. Differential effects of
nicotine on cognition have been hypothesised to influence the pattern and
persistence of smoking in schizophrenia. These preliminary findings indicate that
evidence for such effects is apparent even in small samples - particularly for
VSWM. This is the first study to show that neurocognitive effects of smoking may
influence self-reported smoking motivation.
DOI: 10.1016/j.scog.2014.12.001
PMCID: PMC5779288
PMID: 29379758
464. Indian J Med Res. 2019 Feb;149(2):180-184. doi: 10.4103/ijmr.IJMR_147_18.
Policy document on antimicrobial stewardship practices in India.
Walia K(1), Ohri VC(1), Madhumathi J(1), Ramasubramanian V(2).
Author information:
(1)Division of Epidemiology & Communicable Diseases, Indian Council of Medical
Research, New Delhi, India.
(2)Department of Infectious Diseases, Apollo Hospitals, Chennai, India.
Antimicrobial resistance (AMR) in India has become a great threat because of high
rate of infectious diseases. One of the key contributing factors is high
antibiotic use due to poor prescription practices, self-medication,
over-the-counter sale of drugs and lack of awareness. Antimicrobial stewardship
programme (AMSP) have been proved to be successful in restraining sale and use of
antibiotics to a large extent in many countries. An AMSP programme for a hospital
is imperative for rational and evidence-based antimicrobial therapy. The ultimate
aim is to improve patient outcomes, reduce emergence of bacterial resistance and
ensure longevity of the existing antimicrobials. The primary goal of AMSP is to
encourage cautious use of available antibiotics by training the healthcare
workers and creating awareness. This article describes the strategies and
recommendations for formulation of AMSP policy for India.
DOI: 10.4103/ijmr.IJMR_147_18
PMCID: PMC6563731
PMID: 31219081
465. J Clin Psychopharmacol. 2014 Oct;34(5):595-601. doi:

10.1097/JCP.0000000000000193.
Multivitamin and protein supplement use is associated with positive mood states
and health behaviors in US Military and Coast Guard personnel.
Austin KG(1), McGraw SM, Lieberman HR.
Author information:
(1)From the *US Army Research Institute of Environmental Medicine, Natick, MA;
and †Oak Ridge Institute for Science and Education, Belcamp, MD.
Approximately 60% of Armed Forces personnel regularly consume dietary supplements
(DSs). We investigated the association of mood and health behaviors with multiple
classes of DSs in military and Coast Guard personnel (N = 5536). Participants
completed a survey of DS use and the Quick Mood Scale to assess mood domains of
wakeful-drowsiness, relaxed-anxious, cheerful-depressed, friendly-aggression,
clearheaded-confused, and well coordinated-clumsy. Supplements were categorized
as multivitamin/minerals (MVM), individual vitamin/minerals, protein/amino acid
supplements (PS), combination products (C), herbals (H), purported steroid
analogs, (S) and other (O). One-way analyses of covariance assessed associations
of DSs and perceived health behavior with mood controlling for age. Logistic
regression determined associations between DS use and health behavior. Users of
MVM and PS reported feeling significantly (P < 0.05) more awake, relaxed,
cheerful, clearheaded, and coordinated. Participants using PS and S reported
feeling less friendly (more aggressive, P < 0.02). Users of MVM and PS were more
likely to report their general health, eating habits, and fitness level as
excellent/good (P < 0.05). Participants reporting health behaviors as
excellent/good were more (P < 0.01) awake, relaxed, cheerful, friendly,
clearheaded, and coordinated. As no known biological mechanisms can explain such
diverse effects of MVM and PS use on multiple mood states, health, eating habits,
and fitness, we hypothesize these associations are not causal, and DS intake does
not alter these parameters per se. Preexisting differences in mood and other
health-related behaviors and outcomes between users versus nonusers of DSs could
be a confounding factor in studies of DSs.
DOI: 10.1097/JCP.0000000000000193
PMCID: PMC4165472
466. Ecol Evol. 2019 May 15;9(11):6722-6737. doi: 10.1002/ece3.4989. eCollection

2019
Jun.
Pollinator parasites and the evolution of floral traits.
Fouks B(1), Wagoner KM(1).
Author information:
(1)Department of Biology University of North Carolina at Greensboro Greensboro
North Carolina.
The main selective force driving floral evolution and diversity is

plant-pollinator interactions. Pollinators use floral signals and indirect cues
to assess flower reward, and the ensuing flower choice has major implications for
plant fitness. While many pollinator behaviors have been described, the impact of
parasites on pollinator foraging decisions and plant-pollinator interactions have
been largely overlooked. Growing evidence of the transmission of parasites
through the shared-use of flowers by pollinators demonstrate the importance of
behavioral immunity (altered behaviors that enhance parasite resistance) to
pollinator health. During foraging bouts, pollinators can protect themselves
against parasites through self-medication, disease avoidance, and grooming.
Recent studies have documented immune behaviors in foraging pollinators, as well
as the impacts of such behaviors on flower visitation. Because pollinator
parasites can affect flower choice and pollen dispersal, they may ultimately
impact flower fitness. Here, we discuss how pollinator immune behaviors and
floral traits may affect the presence and transmission of pollinator parasites,
as well as how pollinator parasites, through these immune behaviors, can impact
plant-pollinator interactions. We further discuss how pollinator immune behaviors
can impact plant fitness, and how floral traits may adapt to optimize plant
fitness in response to pollinator parasites. We propose future research
directions to assess the role of pollinator parasites in plant-pollinator
interactions and evolution, and we propose better integration of the role of
pollinator parasites into research related to pollinator optimal foraging theory,
floral diversity and agricultural practices.
DOI: 10.1002/ece3.4989
PMCID: PMC6580263
PMID: 31236255
Conflict of interest statement: None declared.
467. Rev Salud Publica (Bogota). 2017 Jan-Feb;19(1):45-51. doi:

10.15446/rsap.v19n1.55933.
Proportion of fever attributable to malaria in Colombia: Potential indicators for

monitoring progress towards malaria elimination.
Valero-Bernal MV(1), Tanner M(2), Muñoz-Navarro S(3), Valero-Bernal JF(4).
Author information:
(1)Ph. D. Epidemiology and Dr. Public Health. Faculty of Medicine, Universidad
Nacional de Colombia, Bogotá, Colombia. mvvalerober@unal.edu.co.
(2)MD. Ph. D. Epidemiology. Dhc. Director-Emeritus, Swiss Tropical and Public
Health Institute, University of Basel. President, Academia of Sciences. Basel,
Switzerland. Marcel.tanner@unibas.ch.
(3)Biostatistician. Ph. D. Biostatistics. Director, School of Public Health.
Faculty of Medicine, Universidad de La Frontera. Temuco, Chile.
sergio.munoz.n@ufrontera.cl.
(4)MD. Anesthesiologist. Surgery Department Anesthesiology Unit, Faculty of
Medicine, Universidad Nacional de Colombia. Bogotá, Colombia.
jfvalerob@unal.edu.co.
OBJECTIVE: Identify and characterize indicators to assess progress in terms of

control and monitoring of malaria in endemic areas of Colombia and compare
malaria elimination findings with those of countries in the same region.
METHODS: Cross-sectional surveys were carried out in 2011 and 2014 in malaria
endemic areas in Colombia, Pacific and Caribbean regions. A socio-demographic and
a clinical questionnaire were applied to each participant; likewise, written and
informed consents were obtained. Capillary blood samples were taken and examined
through microscopic tests and rapid diagnostic test. A narrative systematic
review was conducted to correlate malaria elimination in Colombia and in
countries of the Amazon Region.
RESULTS: The sample consisted of 548 participants from the departments of Córdoba
and Nariño, Colombia. The proportion of positive malaria cases was 3 % (17/548),
in which the prevalence of malaria mixed infections was 47 % (8/17). Regarding
fever, temperature over 38.0o C, its prevalence was 2.7 % (15/548). Only two
febrile patients tested positive for the disease. Prevalence of asymptomatic
malaria cases among all positive cases was 88 %.
CONCLUSION : Asymptomatic malaria cases, mixed infections and self-medication are
the challenges that malaria control and elimination programs face. It is
important to note that studies on subclinical malaria in the region are scarce.
Endemic areas with dense populations and experiencing an increase in immigration
levels are more vulnerable to malaria reemergence. Imported malaria cases impact
the basic reproduction rate (Ro). Funding resources availability has impact on
the sustainability of public health actions and the elimination of malaria in
South America.
DOI: 10.15446/rsap.v19n1.55933
PMID: 30137154
468. Springerplus. 2015 Nov 26;4:737. doi: 10.1186/s40064-015-1549-7. eCollection

2015.
Key information providers, channels, and characteristics of Japanese consumers'

informed choices of over-the-counter medications.
Hayashi M(1), Masuda S(1), Kimura H(1).
Author information:
(1)Pharmaco-Business Innovation Laboratory, Graduate School of Pharmaceutical
Sciences, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033
Japan.
People need reliable information regarding over-the-counter medications (OTCs),

so that they can independently make appropriate informed choices. The study aimed
to identify the information providers and channels that have an impact on the
purchase of OTCs, and to demonstrate the information needs of OTC purchasers,
using these providers and channels, from the viewpoint of information
characteristics such as specialty, objectivity, concreteness, comprehensiveness,
individuality, and availability, focusing on the efficacy of OTCs and related
safety information. A questionnaire survey of randomly sampled adults aged ≥20
was conducted at the Japan Drugstore Show 2012, hosted by the Japan Association
of Chain Drug Stores. In this questionnaire, information was particularly limited
to the efficacy and safety of OTCs. Multivariate logistic regression analysis was
performed on data from 1743 respondents (1625 purchasers and 118 non-purchasers
of OTCs) who obtained information on OTCs in their daily lives, to demonstrate
the associations between the use of information providers and channels (predictor
variables) and the purchase of OTCs (outcome variable), as well as between
information characteristics valued by purchasers (predictor variables) and their
use of these information providers or channels (outcome variables). Both the use
of pharmacists as information providers and consultation at pharmacies as an
information channel were positively associated with the purchase of OTCs (odds
ratio [OR], 3.74; 95 % confidence interval [CI], 2.46-5.68; P < 0.001 and OR,
4.55; 95 % CI 2.92-7.11, P < 0.001, respectively), whereas both the use of family
or friends using OTCs as information providers and family or friends as
information channels were negatively associated with the purchase of OTCs (OR,
0.60; 95 % CI 0.40-0.90; P = 0.014 and OR, 0.55; 95 % CI 0.36-0.82; P = 0.004,
respectively). OTC purchasers who valued individuality of information were more
likely to use pharmacists (OR 2.00; 95 % CI 1.61-2.48; P < 0.001) and
consultation at pharmacies (OR 1.98; 95 % CI 1.61-2.43; P < .001). In conclusion,
individualized information provided by pharmacists on the efficacy and safety of
OTCs during consultation at pharmacies can play the most important role in the
informed choices of OTC purchasers.
DOI: 10.1186/s40064-015-1549-7
PMCID: PMC4661161
PMID: 26640749
469. J Stud Alcohol Drugs. 2015 Sep;76(5):781-9.
Coping Expectancies, Not Enhancement Expectancies, Mediate Trauma Experience

Effects on Problem Alcohol Use: A Prospective Study From Early Childhood to
Adolescence.
Jester JM(1), Steinberg DB(1), Heitzeg MM(1), Zucker RA(1).
Author information:
(1)Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.
OBJECTIVE: The relationship between experiencing trauma and increased alcohol

consumption has been well established. Exposure to childhood trauma has been
linked to both early onset of drinking and problematic substance use. However,
the mechanisms underlying this relationship remain unclear. The results of early
work suggested that drinking to relieve negative affect (i.e., drinking to cope)
was driving this connection. However, the findings of more recent work suggest
that drinking might be used to enhance positive affect as a way of addressing the
aftereffects of early trauma. The current study looked at these two drinking
expectancies as indirect pathways between the experience in early childhood of
living in a home with parental violence and peak alcohol use in emerging
adulthood.
METHOD: Participants were 1,064 children and their parents involved in a
longitudinal community study of children at high risk for the development of
alcoholism and a community contrast group of those at lower risk. Baseline
assessment was at age 3-5 years, self-reports of internalizing behavior and
drinking expectancies were obtained at age 12-14, and drinking measures were
assessed at age 18-20.
RESULTS: Results indicated that coping expectancy was a mediator of the
relationship between early childhood trauma and later peak alcohol use, whereas
enhancement expectancy was not.
CONCLUSIONS: Children living in homes with parental violence were more likely to
develop ineffective coping strategies, such as using alcohol to decrease negative
affect. These results support the self-medication theory. They also demonstrate
the long-term effects of early life experience on drinking behavior in early
adulthood.
DOI: 10.15288/jsad.2015.76.781
PMCID: PMC4714828
470. J Anxiety Disord. 2015 Jan;29:52-60. doi: 10.1016/j.janxdis.2014.11.003. Epub

2014 Nov 24.
A prospective investigation of emotion dysregulation as a moderator of the

relation between posttraumatic stress symptoms and substance use severity.
Tull MT(1), Bardeen JR(2), DiLillo D(3), Messman-Moore T(4), Gratz KL(5).
Author information:
(1)Department of Psychiatry and Human Behavior, University of Mississippi Medical
Center, Jackson, MS, USA. Electronic address: mtull@umc.edu.
(2)Department of Psychology, Auburn University, Auburn, AL, USA.
(3)Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA.
(4)Department of Psychology, Miami University, Oxford, OH, USA.
(5)Department of Psychiatry and Human Behavior, University of Mississippi Medical
Center, Jackson, MS, USA.
Despite strong evidence for an association between the experience of

posttraumatic stress (PTS) symptoms and substance use, little is known about the
particular individuals most at-risk for problematic substance use in response to
PTS symptoms. Consequently, the goal of this study was to conduct a prospective
investigation of the moderating role of emotion dysregulation (assessed through
self-report and behavioral measures) in the relation between PTS symptoms and
substance use 8-months later within a sample of 106 young adult women. No main
effect of PTS symptoms on substance use was found. Instead, PTS symptoms were
only associated with later substance use in the context of heightened emotion
dysregulation. Results provide support for emotion dysregulation as a key factor
that may increase risk for substance use among women experiencing PTS symptoms
and highlight a target for future interventions aimed at reducing risk for the
development of maladaptive behaviors stemming from PTS symptoms.
DOI: 10.1016/j.janxdis.2014.11.003
PMCID: PMC4749400
471. J Family Med Prim Care. 2015 Apr-Jun;4(2):226-31. doi: 10.4103/2249-

4863.154655.
Mothers' understanding of childhood malaria and practices in rural communities of

Ise-Orun, Nigeria: implications for malaria control.
Orimadegun AE(1), Ilesanmi KS(1).
Author information:
(1)Institute of Child Health, College of Medicine, University of Ibadan, Ibadan,
Nigeria.
INTRODUCTION: Regular evaluations of communities' understanding of

malaria-related practices are essential for control of the disease in endemic
areas. This study was aimed at investigating the perceptions, prevention and
treatments practices for childhood malaria by mothers in rural communities.
MATERIALS AND METHODS: We conducted a community-based cross-sectional study at
rural communities of Ise-Orun local Government area, Nigeria. We randomly sampled
422 mothers of children less than 5 years and administered a validated
questionnaire to assess their perceptions and practices relating to childhood
malaria. We used a 10-point scale to assess perception and classified it as good
(≥5) or poor (<5). Predictive factors for poor perceptions were identified using
RESULTS: Approximately 51% of the mothers had poor perception and 14.2% ascribed
malaria illness to mosquito bite only. Majority (85.8%) of the mothers practiced
malaria preventive measures, including: Insecticide treated nets (70.0%),
chemoprophylaxis (20.1%) and environmental sanitation (44.8%). Of the 200 mothers
whose children had malaria fever within the 3 months prior to the study visits,
home treatment was adopted by 87.5%. Local herbal remedies were combined with
orthodox medicine in the treatments of malaria for 91.5% of the children. The
main reasons for not seeking medical treatment at existing formal health
facilities were "high cost", "challenges of access to facilities" and "mothers'
preference for herbal remedies". Lack of formal education was the only
independent predictor of poor malaria perceptions among mothers (OR = 1.91, 95%
CI = 1.18, 3.12).
CONCLUSIONS: Considerable misconceptions about malaria exist among mothers in the
rural communities. The implications for malaria control in holoendemic areas are
highlighted.
DOI: 10.4103/2249-4863.154655
PMCID: PMC4408706
PMID: 25949972
472. Patient Prefer Adherence. 2015 Aug 24;9:1219-24. doi: 10.2147/PPA.S89258.
eCollection 2015.
Adolescent reproductive health challenges among schoolgirls in southeast Nigeria:

role of knowledge of menstrual pattern and contraceptive adherence.
Ajah LO(1), Onubogu ES(1), Anozie OB(1), Lawani LO(1), Iyoke CA(2), Onwe EO(3),
Ajah MI(4).
Author information:
(1)Department of Obstetrics and Gynaecology, Federal Teaching Hospital,
Abakaliki, Nigeria.
(2)Department of Obstetrics and Gynaecology, University of Nigeria Teaching
Hospital, Ituku-Ozalla, Nigeria.
(3)Department of Paediatrics, Abakaliki, Nigeria.
(4)Well Women Centre, Federal Teaching Hospital, Abakaliki, Nigeria.
BACKGROUND: Reproductive health services in the form of adolescent health and

contraceptive services are fundamental in the prevention of a high incidence of
teenage pregnancy. The purpose of this study was to determine the age at
menarche, menstrual pattern, and awareness of and use of modern contraception
among secondary school girls in Abakaliki, Nigeria.
SUBJECTS AND MATERIALS: This was a cross-sectional study in which
self-administered questionnaires were completed by 482 adolescent girls at two
girls' secondary schools between August and September 2012.
RESULTS: The mean age at menarche was 13.13±1.37 years. The mean menstrual cycle
length was 27.8±3.14 days, and the mean duration of menstrual flow was 4.8±1.14
days. Thirty-seven (7.7%) respondents were ignorant of their cycle length, while
29 (6.0%) had irregular cycles. Premenstrual syndrome and dysmenorrhea were major
menstrual issues, which resulted in 69 (14.3%) and 59 (12.2%) of respondents
resorting to self-medication and absenteeism from school, respectively. Mothers
were the main source of their daughters' adolescent education, while friends and
mass media were the main source of contraceptive information. Though there was a
high level (75.7%) of awareness of contraceptive information among the girls,
usage (8.9%) was poor. Only eight (18.6%) of the 43 respondents who had ever used
modern contraception were adherent to modern contraceptives. Students who were
more than 15 years old, attained menarche at 13 years or less, and whose families
were of low socioeconomic classes were more likely to be sexually active.
CONCLUSION: The declining age at menarche, menstrual challenges, and poor
reproductive health status of adolescent girls in this study have made menstrual
issues and contraceptive adherence critical aspects of adolescent health care,
especially when appropriate sources of reproductive health information were not
fully harnessed. Therefore, there is an urgent need to establish
adolescent-friendly clinics and include sexuality education in the curriculum of
schools in this environment.
DOI: 10.2147/PPA.S89258
PMCID: PMC4556251
PMID: 26346663
A Theory Based Intervention to Enhance Information Exchange during

Over-The-Counter Consultations in Community Pharmacy: A Feasibility Study.
Seubert LJ(1), Kerry W(2), Laetitia H(3)(4), Watson MC(5), Clifford RM(6).
Author information:
(1)Division of Pharmacy, The University of Western Australia, M315, 35 Stirling
Highway, Crawley WA 6009, Australia. liza.seubert@uwa.edu.au.
Highway, Crawley WA 6009, Australia. kerry.whitelaw@uwa.edu.au.
(3)School of Pharmacy and Pharmacology, Griffith University, Gold Coast Campus,
Queensland 4222, Australia. l.hattingh@griffith.edu.au.
(4)Gold Coast Health, Griffith University, Gold Coast, Queensland 4215,
Australia. l.hattingh@griffith.edu.au.
(5)Watson Research and Training Ltd., Aberdeen AB15 8FL, Scotland.
magswatsonbusiness@gmail.com.
Highway, Crawley WA 6009, Australia. rhonda.clifford@uwa.edu.au.
Background: Management of minor ailments through self-care and self-medication

brings both benefits and risks that can be mitigated if consumers and pharmacy
personnel engage in information exchange during over-the-counter (OTC)
consultations. Objective: Explore the feasibility of interventions using
situational cues to promote information exchange between pharmacy personnel and
consumers, during OTC consultations. Methods: Intervention tools were developed
prior to conducting the study, in two community pharmacies in Perth, Western
Australia. The situational cues included two posters and individual position
badges. Data were collected from audio-recording OTC consultations, consumer
questionnaires and interviews, and pharmacy personnel interviews. Results: Space
required for posters and for researchers conducting interviews was challenging in
the retail environment. Pharmacy personnel perceived that the badges positively
impacted -consumers' ability to identify the position of personnel they engaged
with. Data collection methods were deemed practical and acceptable. Conclusions:
The proposed interventions and evaluation methods were feasible. The use of
posters and badges as situational cues to address the barriers to information
exchange during OTC consultations was found to be practical, in a community
pharmacy setting. There is potential to use situational cues to address other
barriers identified to information exchange, to add to the effectiveness of the
intervention. With growing emphasis on self-care and self-medication, effective
interventions are necessary to promote information exchange to enhance
appropriate management in community pharmacies.
DOI: 10.3390/pharmacy7020073
PMCID: PMC6630978
PMID: 31226837
474. Ann Afr Med. 2014 Oct-Dec;13(4):184-8. doi: 10.4103/1596-3519.142289.
Eye health seeking habits and barriers to accessing curative services among blind
beggars in an urban community in Northern Nigeria.
Balarabe AH(1), Hassan R, Fatai OO.
Author information:
(1)Department of Ophthalmology, Federal Medical Centre, Birnin-Kebbi, Nigeria.
OBJECTIVE: The aim of the following study was to determine the types of
intervention sought by the blind street beggars and assess the barriers to
accessing available eye care services.
METHODS: This cross-sectional study was conducted among consenting blind street
beggars in Sokoto, Nigeria between May and June, 2009. A semi-structured
interview was conducted to probe issues on historical antecedents of the
blindness and the eye heath seeking behavior including the use of traditional eye
medications. Assessment of barriers to accessing curative services among the
blind persons was explored. Questions were asked and the individual responses
were recorded in the questionnaire under the appropriate sections.
RESULTS: Two hundred and two of 216 (94.7%) of the examined subjects were found
to be blind and included in the analysis. The principal cause of blindness was
corneal opacity. Overall 82% of the blindness was due to avoidable causes with
majority irreversibly blind. Only 38 subjects (18.8%) sought for intervention in
hospitals, others resorted to self-medication (42.1%), medicine store (31.2%) and
traditional facility (7.9%). Those that accessed treatment at a hospital did so
mainly at a primary health center (50.0%) and General Hospitals (34.2%). The
barriers to accessing treatment at the hospital were mainly due to "not taken to
any hospital" by the parents/relatives (50.3%) and "services not available"
(25.2%).
CONCLUSION: Most respondents resorted to ocular self-medication particularly
traditional eye medicines. We advocate for a provision of affordable, accessible
and qualitative eye care services with a strong health education component on
avoidable causes of blindness.
DOI: 10.4103/1596-3519.142289

The provision of advice by pharmacy staff in eastern Indonesian community

pharmacies.
Brata C(1), Schneider CR(2), Marjadi B(3), Clifford RM(4).
Author information:
(1)Centre of Medicine Information and Pharmaceutical Care, University of
Surabaya, Surabaya (Indonesia). cecilia.brata@gmail.com.
(2)Faculty of Pharmacy, University of Sydney. Sydney, NSW (Australia).
carl.schneider@sydney.edu.au.
(3)School of Medicine, University of Western Sydney. Sydney, NSW (Australia).
B.Marjadi@westernsydney.edu.au.
(4)School of Medicine and Pharmacology, University of Western Australia. Perth,
WA (Australia). rhonda.clifford@uwa.edu.au.
Background: Indonesian community pharmacies hold a strategic position from which

to promote the rational use of medicines by providing appropriate advice for
patients requesting self-medication. To date, published studies related to the
provision of advice in Indonesian community pharmacies are limited and have been
conducted only in more developed western Indonesia. No studies have been
undertaken in eastern Indonesia, which is less developed than and culturally
different from the western region.
Objectives: This paper aims to: (1) describe the types and amount of advice
provided by pharmacy staff for three scenarios in a patient simulation study and
for two scenarios in pharmacy staff interviews; and (2) ascertain the frequency
of appropriate advice given in response to the scenarios.
Methods: A patient simulation study was conducted at community pharmacies in an
eastern Indonesian provincial capital. Four weeks after completing a patient
simulation study, structured interviews with pharmacy staff were conducted. Two
cough scenarios and one diarrhoea scenario were developed for the patient
simulation study. Meanwhile, two scenarios (an ACE inhibitor-induced cough and a
common cough and cold) were developed for pharmacy staff interviews. The types
and amount of advice provided by pharmacy staff were recorded on paper and
assessed for its appropriateness. The determination of appropriate advice was
based on the literature and by consensus of two Indonesian experts.
Results: In patient simulation, the most common type of advice provided in all
scenarios was product recommendations. In interviews, medical referrals and
recommending cough and cold medicine were the most common types of advice
provided for ACE inhibitor-induced cough and common cough and cold scenarios
respectively. Appropriate advice was provided in less than 0.5% in the patient
simulation study, but two-third of participants in the interviews responded to
the scenarios appropriately.
Conclusions: Pharmacy staff did not provide appropriate advice in practice,
although they may have adequate knowledge. A contributing factor was insufficient
information gathered in patient encounters. Optimising information-gathering
practice by pharmacy staff is needed.
DOI: 10.18549/PharmPract.2019.2.1452
PMCID: PMC6594425
PMID: 31275500
Conflict of interest statement: CONFLICT OF INTEREST The authors declare that

they have no competing interests.
476. BMC Complement Altern Med. 2019 Aug 2;19(1):196. doi: 10.1186/s12906-019-2602-
9.
Herbal supplements in the print media: communicating benefits and risks.
Peacock M(1), Badea M(2), Bruno F(3), Timotijevic L(4), Laccisaglia M(3),
Hodgkins C(4), Raats M(4), Egan B(4).
Author information:
(1)Food, Consumer Behaviour and Health Research Centre, School of Psychology,
Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH,
UK. m.peacock@surrey.ac.uk.
(2)Department of Fundamental, Prophylactic and Clinical Specialties, Faculty of
Medicine, Transylvania University of Brasov, Bdul Eroilor Nr 29, 500039, Brasov,
Romania.
(3)Centre of Studies in Drug Communication, Department of Pharmacological and
Biomolecular Sciences, Pharmaceutical Sciences, University Of Milan, Via
Balzaretti 9, 20133, Milan, MI, Italy.
(4)Food, Consumer Behaviour and Health Research Centre, School of Psychology,
Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH,
UK.
BACKGROUND: The rise in use of food supplements based on botanical ingredients

(herbal supplements) is depicted as part of a trend empowering consumers to
manage their day-to-day health needs, which presupposes access to clear and
accurate information to make effective choices. Evidence regarding herbal
supplement efficacy is extremely variable so recent regulations eliminating
unsubstantiated claims about potential effects leave producers able to provide
very little information about their products. Medical practitioners are rarely
educated about herbal supplements and most users learn about them via
word-of-mouth, allowing dangerous misconceptions to thrive, chief among them the
assumption that natural products are inherently safe. Print media is prolific
among the information channels still able to freely discuss herbal supplements.
METHOD: This study thematically analyses how 76 newspaper/magazine articles from
the UK, Romania and Italy portray the potential risks and benefits of herbal
supplements.
RESULTS: Most articles referenced both risks and benefits and were factually
accurate but often lacked context and impartiality. More telling was how the
risks and benefits were framed in service of a chosen narrative, the paucity of
authoritative information allowing journalists leeway to recontextualise herbal
supplements in ways that serviced the goals and values of their specific
publications and readerships.
CONCLUSION: Providing sufficient information to empower consumers should not be
the responsibility of print media, instead an accessible source of objective
information is required.
DOI: 10.1186/s12906-019-2602-9
PMCID: PMC6679444
PMID: 31375101
477. BMC Pulm Med. 2019 Jun 17;19(1):107. doi: 10.1186/s12890-019-0869-8.
"Characteristics of patients admitted to emergency department for asthma attack:

a real-LIFE study".
Losappio L(1), Heffler E(2)(3), Carpentiere R(4), Fornero M(1), Cannito CD(4),
Guerrera F(5), Puggioni F(2)(3), Monti R(6), Nicola S(6), Rolla G(6), Brussino
L(7).
Author information:
(1)Allergy and Immunology Department, Niguarda Ca Granda Hospital, Milan, Italy.
(2)Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital,
Rozzano, Italy.
(3)Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
(4)Emergency Department, "Dimiccoli" Hospital, Barletta, Italy.
(5)Department of Surgical Science, University of Torino, Torino, Italy.
(6)Allergy and Clinical Immunology Unit, Department of Medical Science,
University of Torino and AO Ordine Mauriziano Umberto I, Torino, Italy.
(7)Allergy and Clinical Immunology Unit, Department of Medical Science,
University of Torino and AO Ordine Mauriziano Umberto I, Torino, Italy.
luisa.brussino@unito.it.
BACKGROUND: Asthma is a chronic disease affecting 30 million people in Europe

under 45y. Poor control of Asthma is the main cause of emergency-department (ED)
access, becoming the strongest determinant of the economic burden of asthma
management.
OBJECTIVE: To examine the characteristics of adult patients admitted to ED for
acute asthma attack, focusing on previous diagnosis of asthma (DA) and current
therapy.
METHODS: During a one-year period, a structured questionnaire, assessing asthma
diagnosis and management, was administered to all patients admitted for asthma
attack, to the ED of a South-Italy town. Only patients with subsequently
confirmed asthma were enrolled. The data on oxygen saturation (Sat.O2), heart and
respiratory-rate, severity code ED-admission, hospitalization or discharge, had
been obtained.
RESULTS: Two hundred one patients (mean 50.3ys), were enrolled. One hundred
eighteen had a DA, made 17.5 ± 5.88 years before, and 35.6% had a
specialist-examination in the last year. 53.3% of DA-patients used a
self-medication before ED access with short-acting-beta-2-agonist and
oral-corticosteroids, although none had a written-asthma-action-plan (WAAP).
Almost all DA-patients were on regular therapy: inhaled-corticosteroids (ICS) in
61%, associated with LABA in 85%. 16.7% of DA-patients had previous DA-access.
The overall hospitalization-rate was 39%, higher in DA compared to unknown
asthmatic patients (UA)(p = 0.017). Significant risk factors for hospitalization
were Sat-O2 ≤ 94% breathing ambient air (OR9.91, p < 0.001),
inability-to-complete a sentence (OR9.42,p < 0.001) and the age
(OR1.02,p = 0.049).
CONCLUSION: Despite the asthma guidelines-recommendation, up to 40% of patients
received the asthma diagnosis in ED, only 61% of DA-patients were taking ICS. It
is disappointing that DA-patients did not have a WAAP, which could explain the
poor patient-self-medication at ED admission.
DOI: 10.1186/s12890-019-0869-8
PMCID: PMC6580601
PMID: 31208388
478. Fertil Res Pract. 2018 Apr 13;4:2. doi: 10.1186/s40738-018-0047-3. eCollection
2018.
Pyosalpinges after hysterosalpingography in a patient with lower genital tract

infection and managed by laparoscopic surgery in a resource low tertiary hospital
case report and literature review.
Egbe TO(1), Kobenge FM(2), Arlette MMJ(3), Belley-Priso E(4).
Author information:
(1)1Faculty of Health Sciences, University of Buea and Department of Obstetrics
and Gynecology, Douala General Hospital, P.O. Box 63, Buea, Cameroon.
(2)Department of Obstetrics and Gynecology, Douala General Hospital, Douala,
Cameroon.
(3)Department of Anesthesiology and Reanimation, Douala General Hospital, Douala,
Cameroon.
(4)Faculty of Medicine and Biomedical Sciences, University of Yaounde 1 and
Department of Obstetrics and Gynecology, Douala General Hospital, Douala,
Cameroon.
Background: Pyosalpinges (a complication of pelvic inflammatory disease) is

infection of the fallopian tubes and the morbidity associated with it has major
health implications. We are reporting a case of pyosalpinges diagnosed after
hysterosalpingography and managed by laparoscopic surgery at the Douala General
Hospital, Cameroon.
Case presentation: A 29-year-old single woman, an assistant nurse of the Douala
tribe in Cameroon. She is G1P0010 and came to our attention because of secondary
infertility of three years duration. She has a history consistent with four
lifetime sexual partners, self-medication for chlamydia trachomatis infection and
induced abortion by dilatation and aspiration. Furthermore, she is HIV positive
and had an ultrasound scan suggestive of bilateral hydrosalpinges. After a
hysterosalpingography examination she developed painless muco-purulent vaginal
discharge and bilateral adnexal tenderness on bimanual examination suggestive of
pyosalpinges. Vaginal and cervical cultures isolated Ureaplasma urealyticum and
Gardnerella vaginalis sensitive to ofloxacin and metronidazole, respectively.At
laparoscopy, bilateral pyosalpinges, pelvic adhesions and peri-hepatic adhesions
were found. Bilateral salpingectomy with adhesiolysis including lysis of
perihepatic adhesions and peritoneal toileting was done. She was discharged from
hospital 72 h later and her hospital stay was uneventful. She was counseled for
in-vitro fertilization and to register in the national HIV treatment programme.
Her husband was prescribed ofloxacin empirically.
Conclusion: Antimicrobial prophylaxis should be given to patients prior to HSG,
especially those with a history of chlamydia or evidence of hydrosalpinges. There
should also be universal STI testing in high risk and HIV positive patients or
the danger for suboptimal antibiotic usage in areas where self-medication is
common.In resource-low tertiary hospitals where computed tomography or magnetic
resonance imaging is not readily available and/or affordable, clinical
examination and pelvic ultrasound remains the key diagnostic tool. Surgical
treatment is the best option for pyosalpinges and when plausible, laparoscopic
surgery is the treatment of choice. Laparotomy is the mainstay in most hospitals
in Cameroon. The parent of the patient did not consent to histo-pathologic
examination.
DOI: 10.1186/s40738-018-0047-3
PMCID: PMC5898046
PMID: 29686882
Conflict of interest statement: Authorization was obtained from the Director

General of the Douala General Hospital and consent was obtained from the patient
to report the case.Written informed consent was obtained from the patient for
publication of this case report and any accompanying images. A copy of the
written consent is available for review by the editor-in-chief of this
journal.The authors declare that they have no competing interests.Springer Nature
remains neutral with regard to jurisdictional claims in published maps and
479. Glob J Health Sci. 2014 Oct 27;7(1):296-314. doi: 10.5539/gjhs.v7n1p296.
Treatment-seeking behaviour and social health insurance in Africa: the case of

Ghana under the National Health Insurance Scheme.
Fenny AP(1), Asante FA, Enemark U, Hansen KS.
Author information:
(1)Aarhus University. amafenny@yahoo.co.uk.
Health insurance is attracting more and more attention as a means for improving
health care utilization and protecting households against impoverishment from
out-of-pocket expenditures. Currently about 52 percent of the resources for
financing health care services come from out of pocket sources or user fees in
Africa. Therefore, Ghana serves as in interesting case study as it has
successfully expanded coverage of the National Health Insurance Scheme (NHIS).
The study aims to establish the treatment-seeking behaviour of households in
Ghana under the NHI policy. The study relies on household data collected from
three districts in Ghana covering the 3 ecological zones namely the coastal,
forest and savannah.Out of the 1013 who sought care in the previous 4 weeks, 60%
were insured and 71% of them sought care from a formal health facility. The
results from the multinomial logit estimations show that health insurance and
travel time to health facility are significant determinants of health care
demand. Overall, compared to the uninsured, the insured are more likely to choose
formal health facilities than informal care including self-medication when ill.
We discuss the implications of these results as the concept of the NHIS grows
widely in Ghana and serves as a good model for other African countries.
DOI: 10.5539/gjhs.v7n1p296
PMCID: PMC4796516
480. J Infect Public Health. 2019 Mar - Apr;12(2):159-166. doi:

10.1016/j.jiph.2018.09.002. Epub 2018 Sep 21.
Public knowledge and behaviours relating to antibiotic use in Gulf Cooperation

Council countries: A systematic review.
Almohammed RA(1), Bird EL(2).

Author information:
(1)Riyadh, Saudi Arabia. Electronic address: Rima.almohammed@gmail.com.
(2)Department of Health and Social Sciences, Faculty of Health & Applied
Sciences, University of the West of England, Bristol, United Kingdom.
The aim of this review was to assess public knowledge and behaviours in relation
to antibiotic use in GCC countries. A systematic review was performed using
MEDLINE, EMBASE and other relevant databases. Cross-sectional studies published
from January 2000 to June 2017 relating to public knowledge and behaviours
towards antibiotic use were included. Overall nine studies met the inclusion
criteria for this systematic review. Nearly half of general public respondents in
the GCC region reported a lack of knowledge about antibiotic use and showed
negative attitudes towards antibiotic utilisation. Penicillin was the most
frequently misused antibiotic, particularly for self-medication. Most respondents
declared that they obtained information on antibiotics from pharmacists.
Pharmacies were the major source of antibiotics used for self-medication. A
multi-disciplinary approach must be put in place to educate the public on
appropriate antibiotic use, to improve policies regarding the rational
prescription of antimicrobials and to increase regulation enforcement.
DOI: 10.1016/j.jiph.2018.09.002
481. Front Vet Sci. 2019 Mar 15;6:72. doi: 10.3389/fvets.2019.00072. eCollection
2019.
Spontaneous Intake and Long-Term Effects of Essential Oils After a Negative

Postnatal Experience in Chicks.
Guilloteau LA(1), Collin A(1), Koch A(1), Leterrier C(2).
Author information:
(1)BOA, INRA, Université de Tours, Nouzilly, France.
(2)PRC, CNRS, IFCE, INRA, Université de Tours, Nouzilly, France.
The postnatal period is critical for broiler chicks as they are exposed to
potentially stressful environmental changes in the hatchery and during
transportation to the rearing houses. The ability of broiler chicks to
spontaneously drink essential oils (EO) to mitigate the effects of a negative
postnatal experience was tested. Chicks were placed in the rearing facility
either immediately (C group), or after a 24 h-delay period (D group) to mimic a
delay in transportation possible under commercial conditions. In experiment 1,
each group had access to either water only or to water and one EO (cardamom,
marjoram, or verbena) from D1 to D13. Verbena EO intake was higher in the D group
than in the C group from D1 to D6 and cardamom EO intake was lower in the D group
than in the C group from D6 to D13. In experiment 2, half of the groups had
access to water only and the other half had both water and the three EO
simultaneously. Chicks from D and C groups chose the EO similarly except for
cardamom EO with a lower intake being observed in the D than in the C group from
D6 to D12. The delayed placement of the D group reduced chicken growth until 34
days of age and temporarily increased the feed conversion ratio, but did not
affect their welfare or the prevalence of health disorders. The EO intake did not
mitigate the growth reduction in D group chicks, but did mitigate the reduced
Pectoralis major muscle yield. In conclusion, chicks were able to make
spontaneous choices regarding EO intake according to their postnatal experience
when EO were presented individually, but not when presented simultaneously as in
our experimental design. The EO intake only partially mitigated the decrease in
chicken performance after the negative postnatal experience.
DOI: 10.3389/fvets.2019.00072
PMCID: PMC6428774
PMID: 30931317
482. Open J Psychiatry Allied Sci. 2019 Jul-Dec;10(2):139-145. doi:

10.5958/2394-2061.2019.00030.2. Epub 2019 Feb 25.
Study of sociodemographic correlates, anxiety, and depression among opioid

dependents admitted in treatment centres in Sikkim, India.
Sharma B(1), Bhandari SS(1), Dutta S(2), Soohinda G(3).
Author information:
(1)Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim
Manipal University, Gangtok, Sikkim, India.
(2)Department of Psychiatry and Head of the Department, Sikkim Manipal Institute
of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India.
(3)Department of Psychiatry, Department, Sikkim Manipal Institute of Medical
Sciences, Sikkim Manipal University, Gangtok, Sikkim, India.
Background: People with opioid use disorder have significant anxiety and
depression which can be because of neuroplastic changes due to use of opioid or
because of use as a self-medication to relieve depression and anxiety. During the
last one decade, opioid use has reached an alarming proportion in Sikkim, India;
but, any research related to anxiety and depression among opioid users has not
been done.
Aims: To assess for depression and anxiety disorders among the opioid dependence
syndrome (ODS) participants and its severity, and to find the association with
the sociodemographic characteristics.
Method: One hundred participants from three different drug detoxification and
rehabilitation centres who were diagnosed with ODS as per the ICD-10, Diagnostic
Criteria for Research were assessed cross-sectionally with the Addiction Severity
Index to find out the substances abused and psychiatric morbidity. Anxiety,
depression, and mania were graded with the Hamilton rating scales for anxiety and
depression, and the Young Mania Rating Scale.
Results: Mean age of participants was 29.6 (±6.24) years. Ninety six per cent
were males. Most of the participants were using multiple opioid preparations.
Thirty four per cent were using dextropropoxyphene containing pain killer
followed by six per cent using codeine containing cough syrup. Eighty two per
cent had depression; however, only 13% were found to have severe depression.
Fifty six per cent had anxiety and six per cent were found to have mania. Most of
the participants with ODS were single, attended at least secondary education,
from urban locality, and were from high socioeconomic status.
Conclusion: anxiety and depression are highly prevalent among ODS people.
Treatment should not be limited to management of ODS but also the comorbid
psychiatric illness.
DOI: 10.5958/2394-2061.2019.00030.2
PMCID: PMC6602083
PMID: 31263773
483. Front Psychiatry. 2019 Jun 14;10:421. doi: 10.3389/fpsyt.2019.00421.

eCollection
2019.
Frustration Tolerance and Personality Traits in Patients With Substance Use

Disorders.
Ramirez-Castillo D(1)(2)(3), Garcia-Roda C(1)(2), Guell F(1), Fernandez-Montalvo

J(3), Bernacer J(1), Morón I(4).
Author information:
(1)Mind-Brain Group, Institute for Culture and Society, University of Navarra,
Pamplona, Spain.
(2)Faculty of Education and Psychology, University of Navarra, Pamplona, Spain.
(3)Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
(4)Department of Psychobiology and Research Center for Mind, Brain, and Behavior
(CIMCYC), University of Granada, Granada, Spain.
Previous research has suggested the prevalence of certain personality traits,

some of which are related to a disorganized attachment, in substance abuse
disorders. Further, frustration tolerance (FT) has been proposed as an important
factor in addiction, both at the inception-following the "self-medication"
hypothesis-and regarding treatment compliance. In turn, an inadequate response to
frustrating events has been also associated with a disrupted attachment. Our goal
is to explore the mediational role of FT in the relationship between personality
traits and two different treatments for substance addiction: therapeutic
community (TC) and ambulatory treatment (AT). Eighty-four subjects with substance
abuse disorder were recruited in total (22 female), including 46 volunteers (13
female) in TC and 38 (9 female) in AT. They were assessed with Rosenzweig's test
for FT and the Millon Clinical Multiaxial Inventory-III (MCMI-III) test to
evaluate personality factors. By comparing with a control sample (335 volunteers,
268 female), we found that FT was lower in patients. Between therapeutic groups,
FT was significantly lower in TC. Depressive, antisocial, sadistic, negativistic,
schizotypal, borderline, paranoid, anxiety, dysthymia, alcohol use, drug use,
posttraumatic stress disorder (PTSD), thought disorder, and delusional disorder
traits were suggestive of pathology in the clinical samples and were
significantly different between control, AT, and TC groups. Further, anxiety and
PTSD traits were higher in TC than in AT. A mediational analysis revealed that
the effect of anxiety and PTSD scales on therapeutic group was partially mediated
by FT. In conclusion, FT and its interplay with personality traits commonly
related to disorganized attachment (anxiety and PTSD) might be important factors
to consider within therapeutic programs for persons with substance addiction.
DOI: 10.3389/fpsyt.2019.00421
PMCID: PMC6588127
PMID: 31258496
484. BMC Public Health. 2019 Jul 22;19(1):971. doi: 10.1186/s12889-019-7300-5.
What is in the drug packet?: access and use of non-prescribed poly-pharmaceutical

packs (Yaa Chud) in the community in Thailand.
Sunpuwan M(1), Punpuing S(2), Jaruruengpaisan W(1), Kinsman J(3)(4), Wertheim

H(5)(6)(7).
Author information:
(1)Institute for Population and Social Research, Mahidol University, Salaya,
Nakhon Pathom, Thailand.
(2)Institute for Population and Social Research, Mahidol University, Salaya,
Nakhon Pathom, Thailand. sureeporn.pun@mahidol.ac.th.
(3)Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
(4)Department of Public Health Sciences, Global Health (IHCAR), Karolinska
Institutet, Stockholm, Sweden.
(5)Oxford University Clinical Research Unit, Hanoi, Vietnam.
(6)The Nuffield Department of Medicine, University of Oxford, Oxford, UK.
(7)Department of Clinical Microbiology and the Radboud Center for Infectious
Diseases, Radboudumc, Nijmegen, Netherlands.
BACKGROUND: 'Yaa Chud' is a non-prescribed poly-pharmaceutical pack containing

several types of drugs, including antibiotics and steroids, which can be
purchased over the counter in Thailand for self-medication. Although it is
illegal, it is still available at some community outlets. This study aimed to
understand access to and use of Yaa Chud at the community level in order to raise
awareness on its usage and to provide policy recommendations to address the
problem.
METHODS: This study employed qualitative methods, including in-depth interviews
with 18 drug suppliers and 16 community members, and six focus group discussions.
It included inventories from 17 drug suppliers. Data were collected in selected
communities of the Kanchanaburi Demographic Surveillance System, located in the
western region of Thailand.Thematic analysis was based upon the Health Services
Utilization Model and conducted using the Open Code qualitative software program.
RESULTS: Overcrowding, long waiting times, and a perceived unwelcoming
environment at public health-care service outlets were identified as factors that
drive people into the private sector, where loose regulation of drug laws
facilitates access and use of Yaa Chud. Migrants and older people were most
likely to seek and use Yaa Chud, especially for mild illness. Availability, easy
access through a user's network, low cost, and perceived effectiveness were
identified as factors that enable access and use of Yaa Chud.
CONCLUSIONS: Though illegal in Thailand, Yaa Chud is likely to remain available
for self-medication by community members, due to the persisting demand by the
elderly and migrant workers. There is an urgent need to replace these mixed
medications with better choices. Safer Yaa Chud may be a preferred, first-line
health-care option, which could help reduce congestion in the formal health-care
setting. At the same time, enforcement of regulatory compliance needs to be
continued in order to stop the supply of unsafe Yaa Chud.
DOI: 10.1186/s12889-019-7300-5
PMCID: PMC6647088
PMID: 31331304
485. Front Pharmacol. 2019 Mar 5;10:129. doi: 10.3389/fphar.2019.00129. eCollection

2019.
Corrigendum: The Economic Impact of a Switch From Prescription-Only to

Non-prescription Drugs in Italy.
Otto MH(1)(2), Pillarella C(3), Jommi C(1)(4).
Author information:
(1)Centre for Research on Health and Social Care Management (CERGAS) SDA Bocconi
School of Management, Milan, Italy.
(2)Department of Social and Political Sciences, Bocconi University, Milan, Italy.
(3)Federchimica Assosalute, Milan, Italy.
(4)Department of Pharmaceutical Sciences, Università del Piemonte Orientale,
Novara, Italy.
Erratum for
Front Pharmacol. 2018 Oct 17;9:1069.
[This corrects the article DOI: 10.3389/fphar.2018.01069.].
DOI: 10.3389/fphar.2019.00129
PMCID: PMC6412142
PMID: 30890931
486. Toxins (Basel). 2019 Apr 22;11(4). pii: E234. doi: 10.3390/toxins11040234.
Antiparasitic Properties of Cantharidin and the Blister Beetle Berberomeloe

majalis (Coleoptera: Meloidae).
Whitman DW(1), Andrés MF(2), Martínez-Díaz RA(3), Ibáñez-Escribano A(4), Olmeda

AS(5), González-Coloma A(6).
Author information:
(1)School of Biological Sciences, Illinois State University, Normal, IL 61790,
USA. dwwhitm@ilstu.edu.
(2)Instituto de Ciencias Agrarias, CSIC, Serrano 115-dpdo, 28006 Madrid, Spain.
mafay@ica.csic.es.
(3)Facultad de Medicina, Universidad Autónoma de Madrid (UAM), Arzobispo Morcillo
S/N, 28029 Madrid, Spain. rafael.martinez@uam.es.
(4)Facultad de Farmacia, Universidad Complutense de Madrid (UCM), CEI Campus
Moncloa, 28040 Madrid, Spain. alexandraibanez@ucm.es.
(5)Facultad de Veterinaria, Universidad Complutense (UCM), 28040 Madrid, Spain.
angeles@ucm.es.
(6)Instituto de Ciencias Agrarias, CSIC, Serrano 115-dpdo, 28006 Madrid, Spain.
azu@ica.csic.es.
Cantharidin (CTD) is a toxic monoterpene produced by blister beetles (Fam.

Meloidae) as a chemical defense against predators. Although CTD is highly
poisonous to many predator species, some have evolved the ability to feed on
poisonous Meloidae, or otherwise beneficially use blister beetles. Great
Bustards, Otis tarda, eat CTD-containing Berberomeloe majalis blister beetles,
and it has been hypothesized that beetle consumption by these birds reduces
parasite load (a case of self-medication). We examined this hypothesis by testing
diverse organisms against CTD and extracts of B. majalis hemolymph and bodies.
Our results show that all three preparations (CTD and extracts of B. majalis)
were toxic to a protozoan (Trichomonas vaginalis), a nematode (Meloidogyne
javanica), two insects (Myzus persicae and Rhopalosiphum padi) and a tick
(Hyalomma lusitanicum). This not only supports the anti-parasitic hypothesis for
beetle consumption, but suggests potential new roles for CTD, under certain
conditions.
DOI: 10.3390/toxins11040234
PMCID: PMC6521026
PMID: 31013660
487. PLoS One. 2019 Apr 29;14(4):e0216115. doi: 10.1371/journal.pone.0216115.

eCollection 2019.
Evaluation of antibiotic dispensing practice in community pharmacies in Jordan: A

Haddadin RN(1), Alsous M(2), Wazaify M(3), Tahaineh L(4).

Author information:
(1)Pharmaceutics and Pharmaceutical Technology Department, School of Pharmacy,
The University of Jordan, Amman, Jordan.
(2)Department of Pharmacy Practice, School of Pharmacy, Yarmouk University,
Irbid, Jordan.
(3)Clinical Pharmacy Department, School of Pharmacy, The University of Jordan,
Amman, Jordan.
(4)Clinical Pharmacy Department, Faculty of Pharmacy, Jordan University of
Science and Technology, Irbid, Jordan.
It is well known that the emergence of antibiotic resistance is linked to the

misuse and overuse of antibiotics. Misuse includes self-medication and the
inappropriate use of antibiotics because of improper dosage or improper duration
than recommended. This study investigated three patterns of dispensing
antibiotics in a sample of community pharmacies in Jordan. This included
dispensing antibiotics by prescription or over-the-counter either by direct
request or upon a pharmacist's recommendation. The antibiotics dispensed were
evaluated in terms of indication, appropriateness of dose, and duration of
treatment based on the empirical treatment suggested by selected references:
Lexicomp (2017) and UptoDate (2017) and the manufacturer's recommendations. Of
the 457 antibiotics dispensed, almost one third were without prescription. Of the
antibiotics dispensed with prescription or without prescription, 31.5% and 24.6%
respectively were appropriate dosage and duration (p = 0.002). In the three
patterns of dispensing, beta lactam antibiotics were the most commonly dispensed.
In addition, it was noticed that there was a tendency to prescribe or dispense
higher generations of antibiotics to cases that could have been treated with
lower generation or safer antibiotics. Furthermore, 12.2% of the antibiotics were
dispensed to treat infections that are not indicated for them. In conclusion, a
significant proportion of antibiotics are dispensed without prescription in
Jordan. Moreover, a considerable proportion of prescribed antibiotics were
inappropriate for the conditions concerned. This indicates the importance of
enforcing the Jordanian regulations prohibiting the dispensing of nonprescription
antibiotics and the implementation of continuous education to physicians and
pharmacists to increase awareness about the emergence of antibiotic resistance.
PMCID: PMC6488076
PMID: 31034528

interests exist.
10.3390/ijerph16030335.
The Misconception of Antibiotic Equal to an Anti-Inflammatory Drug Promoting

Antibiotic Misuse among Chinese University Students.
Wang W(1), Wang X(2), Hu YJ(3), Wu D(4), Lu J(5), Xu Y(6), Sun C(7), Zhou X(8).
Author information:
(1)Institute for Social Medicine and Family Medicine, School of Medicine,
Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, China.
weiyiwang@zju.edu.cn.
ellen_wang@zju.edu.cn.
(3)School of Public Health, The University of Hong Kong, 7 Sassoon Road, Pokfulam
10000, Hong Kong. jesshu17@hku.hk.
(4)The University of North Carolina at Chapel Hill Project-China, 2 Lujing Road,
Guangzhou, 510095, China. denisewd@163.com.
jingjinglu@zju.edu.cn.
seanxuzju@zju.edu.cn.
sunchenhui@zju.edu.cn.
zhouxudong@zju.edu.cn.
Massive misuse of antibiotics is one of the most important reasons for

antimicrobial resistance (AMR). Misconceptions of antibiotics contribute to
antibiotic misuse behaviors. This study aims to examine whether university
students hold the misconception that Antibiotic is a Xiaoyanyao (literally means
anti-inflammatory drug in Chinese), and association between this misconception
and antibiotic misuse behaviors. A cross-sectional study was conducted among
university students using the cluster random sampling method in six universities
of six regions in China (one university per region). The Chi-square test was used
to assess the relationship between the misconception and antibiotic misuse
behaviors. Logistic regression was conducted to identify the risk factors for
antibiotic misuse behaviors. 11,192 of university students completed the entire
questionnaire. There were 3882 (34.7%) students who were considered to have the
misconception. Female students were more likely to have the misconception
compared with males (36.7% vs. 32.6%, P < 0.001). Those students with a
background of social science/humanities were more likely to have the
misconception compared with those from science and medicine (44.1% vs. 30.3% vs.
20.1%, P < 0.001). Students came from rural areas compared with those from urban
areas (37.5% vs. 32.5%, P < 0.001) were more likely to have the misconception.
Students who had the misconception were 1.51 (95% CI 1.21⁻1.89, P < 0.001) times,
1.34 (95% CI 1.21⁻1.48, P < 0.001) times, and 1.36 (95% CI 1.24⁻1.50, P < 0.001)
times more likely to report self-medication, request to obtain antibiotics, and
take antibiotics prophylactically than those who did not have this misconception,
respectively. The high proportion of university students' misconception on
Antibiotic is a Xiaoyanyao is worth more attention. Effective health education
and interventions need to be promoted among university students and the whole
population.
DOI: 10.3390/ijerph16030335
PMCID: PMC6388115
489. Int J Gen Med. 2019 Jun 28;12:235-246. doi: 10.2147/IJGM.S200641. eCollection
2019.
University students' knowledge, attitudes, and practice regarding antibiotic use

and associated factors: a cross-sectional study in the United Arab Emirates.
Jairoun A(1), Hassan N(1), Ali A(1), Jairoun O(2), Shahwan M(1), Hassali M(3).
Author information:
(1)College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE.
(2)College of Dentistry, Ajman University, Ajman, UAE.
Sciences, Universiti Sains Malaysia, Penang, Malaysia.
Purpose: Antibiotic resistance is one of the world's most fatal health crises.
Medical students are the antibiotic prescribers of tomorrow, so better
understanding of their knowledge, attitudes, and practice (KAP) pertaining to
antibiotic use is crucial. Objectives: This study aimed to assess the KAP of
antibiotics and associated factors among university students in the United Arab
Emirates (UAE). Methods: This was a descriptive cross-sectional study conducted
among a random sample of undergraduate students from Ajman University in the UAE.
A self-administered pretested questionnaire was used to collect data on students'
demographics and their KAP regarding antibiotic use. Data were analysed using
STATA version 14.2. P<0.05 was considered statistically significant. Results:
This study showed that university students have a high rate of antibiotic
self-medication. The average KAP score was 56% (95% CI 55%-57%). Statistical
modeling showed that major, study year, age, and sex were strong determinants of
KAP regarding antibiotic use. Conclusion: There is a need to develop an effective
and comprehensive antibiotic-stewardship program as part of undergraduate
education. Moreover, reinforcing antibiotic-use policies, involving pharmacies,
drug supply, distribution, and sale, are also urgently needed.
DOI: 10.2147/IJGM.S200641
PMCID: PMC6607982
PMID: 31388309

this work.
490. Am J Pharm Educ. 2019 Jun;83(5):6745. doi: 10.5688/ajpe6745.
Promoting Patient Care Through Communication Training in a Pre-clerkship Pharmacy

Education Course in Japan.
Epp DA(1)(2), Kubota T(3), Yoshida M(4), Kishimoto J(5), Kobayashi D(2), Shimazoe
T(2).
Author information:
(1)Center for Advancing Pharmaceutical Education, Daiichi University of Pharmacy,
Fukuoka, Japan.
(2)Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan.
(3)Center of Pharmaceutical Care for Community Health, Daiichi University of
Pharmacy, Fukuoka, Japan.
(4)Faculty of Medicine, International University for Health and Welfare, Narita,
Japan.
(5)Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
Objective. The purpose of this study was to teach communication skills for
patient care to pre-clerkship students and observe changes in student
perspectives towards communication from pre- to post-training. Methods. Two
cohorts of fourth-year pharmacy students completed an eight-week pre-clerkship
training course designed to improve their communication skills. The course
involved class discussions and in-class research of medications, practicing
communication skills, learning to give science-based responses, and developing an
awareness of patient education for lifestyle, self-medication, quality of life,
and medication adherence. A comparison of students' pre- and post-training
responses to a questionnaire were used to assess changes in students' ability and
confidence in communicating with patients. An exploratory factor analysis was
used to analyze and compare the data results. Results. Students' mean
post-training scores for perceived ability to make small talk and confidence to
communicate with patients increased compared to pre-training scores. Based on the
results of the exploratory factor analysis, the greatest increase in students'
scores was in the area of patient education skills. Conclusion. The pre-clerkship
communication training improved student understanding of the pharmacy
communication skills needed to conduct effective patient education and
pharmacist-patient interaction beyond dispensing, affirming the theory that
specialized communication training before students' begin a clerkship may be
essential.
DOI: 10.5688/ajpe6745
PMCID: PMC6630866
PMID: 31333251
491. Infect Drug Resist. 2019 Mar 26;12:687-699. doi: 10.2147/IDR.S189114.

eCollection
2019.
What drives inappropriate use of antibiotics? A mixed methods study from

Bahawalpur, Pakistan.
Atif M(1), Asghar S(1), Mushtaq I(2), Malik I(1), Amin A(1), Babar ZU(3), Scahill
S(4).
Author information:
(1)Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur,
Pakistan, pharmacist_atif@yahoo.com.
(2)Department of Education, The Islamia University of Bahawalpur, Bahawalpur,
Pakistan.
(3)Department of Pharmacy, University of Huddersfield, Huddersfield, UK.
(4)School of Management, Massey Business School, Massey University, Auckland, New
Zealand.
Purpose: This study investigates the knowledge, attitudes and practices of the
general public regarding the use of antibiotics in community pharmacy, in
Pakistan.
Methods: This is a mixed method study where data were collected through a
validated questionnaire and semi-structured interviews. Convenience sampling
techniques were used to recruit participants from the general public of
Bahawalpur, Pakistan who visited pharmacies to purchase antibiotics between 1
June 2018 and 31 July 2018. Descriptive statistics and regression analyses were
used to tabulate the results of quantitative data while inductive thematic
analysis was used to identify themes and draw conclusions from the qualitative
data.
Results: Over 60% of the 400 survey participants (n=246; 61.5%) had a moderate
level of antibiotic knowledge; however, attitudes regarding antibiotics use were
poor in half the sample (n=201; 50.3%). More than half (n=226; 56.6%) of the
respondents stated that antibiotics could cure all types of infections. Just
under one third (n=129; 32.3%) of respondents obtained the appropriate dosage
regimen while the majority did not complete the course (n=369; 92.3%); stopping
when they felt better. Inductive thematic analysis yielded four themes, 10
subthemes and 27 categories. Two subthemes were related to knowledge, one to
attitude, three to practices and four subthemes were related to suggestions to
improve the healthcare system. Inappropriate antibiotic practices included: lack
of consultation with healthcare professionals, purchase of antibiotics without
prescription or refilling of previous prescription, use of home supply of
antibiotics, sharing of antibiotics with others, improper dosage regimens and
early cessation of antibiotic therapy.
Conclusion: Level of education, low health literacy, high consultation fees of
private practitioners, inadequate health facilities in government hospitals and
patient overload, busy schedules of people, poor healthcare infrastructure in
rural areas and unrestricted supply of antibiotics were key factors associated
with inappropriate use of antibiotics in Pakistan.
DOI: 10.2147/IDR.S189114
PMCID: PMC6440533
PMID: 30988635

interest in this work
492. BMC Health Serv Res. 2019 Jun 20;19(1):404. doi: 10.1186/s12913-019-4219-6.
Analysing the landscape for prescription to non-prescription reclassification

(switch) in Germany: an interview study of committee members and stakeholders.
Gauld NJ(1).
Author information:
(1)School of Pharmacy, The University of Auckland, Park Rd, Grafton, Auckland,
New Zealand. n.gauld@auckland.ac.nz.
BACKGROUND: Non-prescription medicines are increasingly used in Germany, aided by

prescription-to-non-prescription reclassification (or switch). This study aimed
to examine the barriers and enablers to reclassification of medicines in Germany
and provide recommendations for change.
METHODS: Face-to-face conversational interviews with purposively selected key
informants in Germany were conducted in 2017 by a researcher informed in the
area. Interviews were transcribed, coded in NVIVO and systematically analysed
using a framework approach.
RESULTS: Twenty-four interviews were conducted with 32 participants including
members of the committee considering reclassifications, and representatives from
government, industry, health insurance, academia, and pharmacy, medical, and
patients' organisations. A range of enablers and barriers emerged that influence
reclassification including effects on the committee and process, or the desire
of pharmaceutical companies to pursue reclassifications. Enabling market factors
included the large population and a culture of self-medication. Enabling health
system factors include the pharmacy-only category. Some pharmacy factors appeared
enabling (e.g. a positive experience after reclassifying emergency contraception)
while others appeared to hinder reclassification (e.g. insufficient pharmacy
practice research). Some medical factors were enabling (e.g. reported waiting
times) and others limited reclassification (e.g. opposition to some
reclassifications). Some committee and government openness to reclassification
and self-medication reportedly enabled reclassification, while conservatism was
considered a barrier, particularly for classifications with special conditions
for supply such as initial doctor diagnosis or other complexities. Some
improvements to the committee constitution and considerations were recommended.
Some participants found the reclassification process after the committee
recommendation opaque, with opportunity for delays and political interference.
Industry factors included both enablers such as capability in reclassification,
and barriers, such as a perceived low market potential of some reclassifications,
and doubt that some candidates would be approved. A need for more data emerged
strongly, both pre-reclassification in applications, and post-reclassification.
Many participants saw merit with reclassification in non-traditional areas such
as hypertension, diabetes and oral contraception.
CONCLUSIONS: Many factors influence reclassification in Germany. Recommended
improvements included aspects of the process and committee consideration, and
more data collection. Sufficient market exclusivity linked to data collection
could aid the generation of evidence to aid committee considerations and
encourage more applications of high quality.
DOI: 10.1186/s12913-019-4219-6
PMCID: PMC6587299
493. Medicina (Kaunas). 2019 Jun 3;55(6). pii: E238. doi: 10.3390/medicina55060238.
Time from Symptom Onset to Diagnosis and Treatment among Haematological

Malignancies: Influencing Factors and Associated Negative Outcomes.
Dapkevičiūtė A(1)(2), Šapoka V(3), Martynova E(4), Pečeliūnas V(5)(6).
Author information:
(1)Haematology, Oncology and Transfusion Medicine Centre, Vilnius University
Hospital Santaros Klinikos, Santariškių 2, LT-08661 Vilnius, Lithuania.
austeja.dapkeviciute@santa.lt.
(2)Institute of Clinical Medicine, Vilnius University, Santariškių 2, LT-08661
Vilnius, Lithuania. austeja.dapkeviciute@santa.lt.
Vilnius, Lithuania. virginijus.sapoka@santa.lt.
(4)Quantitative Psychology Program, University of Virginia, 485 McCormick Road
Charlottesville, VA 22903, USA. em6gg@virginia.edu.
(5)Haematology, Oncology and Transfusion Medicine Centre, Vilnius University
Hospital Santaros Klinikos, Santariškių 2, LT-08661 Vilnius, Lithuania.
valdas.peceliunas@santa.lt.
Vilnius, Lithuania. valdas.peceliunas@santa.lt.
Background and objectives: Diagnostic delay causes unfavorable outcomes among

cancer patients. It has been widely analyzed in solid tumors. However, data
regarding hematological malignancies diagnostic delay are scarce. We aimed to
evaluate diagnostic intervals, their influencing factors, and the negative effect
on clinical outcomes among multiple myeloma and lymphoma patients. Materials and
methods: One hundred patients diagnosed with multiple myeloma (n = 53) or
lymphoma (n = 47) (ICD codes-C90, C81-C84) were asked to participate during their
scheduled hematology consultations. Interval durations and the majority of
influencing factors were assessed based on a face-to-face questionnaire. Data of
disease characteristics were collected from medical records. Results: The median
interval from symptom onset to registration for medical consultation was 30
(0-730) days, from registration to consultation 2 (0-30) days, from first
consultation to diagnosis 73 (6-1779) days, and from diagnosis to treatment 5
(0-97) days. Overall time to diagnosis median was 151 (23-1800) days. Factors
significantly prolonging diagnostic intervals in multivariate linear regression
were living in big cities (p = 0.008), anxiety and depression (p = 0.002),
self-medication (p = 0.019), and more specialists seen before diagnosis (p =
0.022). Longer diagnostic intervals resulted in higher incidences of multiple
myeloma complications (p = 0.024) and more advanced Durie-Salmon stage (p =
0.049), but not ISS stage and Ann-Arbor staging systems for lymphomas.
Conclusion: Median overall diagnostic delay was nearly 5 months, indicating that
there is room for improvement. The most important factors causing delays were
living in big cities, anxiety and depression, self-medication, and more
specialists seen before diagnosis. Diagnostic delay may have a negative influence
on clinical outcomes for multiple myeloma patients.
DOI: 10.3390/medicina55060238
PMCID: PMC6631661
PMID: 31163661
494. BMJ Open. 2019 Apr 11;9(4):e024856. doi: 10.1136/bmjopen-2018-024856.
Cross-sectional study of the use of antimicrobials following common infections by

rural residents in Anhui, China.
Chai J(1)(2), Coope C(3)(4), Cheng J(1)(2), Oliver I(3)(4), Kessel A(5), Hu Z(1),
Wang D(2).
Author information:
(1)School of Public Health, Anhui Medical University, Hefei, China.
(2)School of Health Services Management, Anhui Medical University, Hefei, China.
(3)NIHR Health Protection Research Unit in Evaluation of Interventions, Bristol
Medical School, University of Bristol, Bristol, UK.
(4)National Infection Service, Public Health England, Bristol, UK.
(5)Faculty of Public Health and Policy, London School of Hygiene & Tropical
OBJECTIVE: To describe help seeking behaviour from a medical doctor and

antimicrobial use for common infections among rural residents of Anhui province,
China.
DESIGN: A cross-sectional retrospective household survey.
SETTING: 12 administrative villages from rural Anhui, China.
PARTICIPANTS: 2760 rural residents selected through cluster-randomised sampling
using an interviewer administered questionnaire.
METHOD: Logistic regression models were used to estimate associations between
exposures (health insurance and antimicrobial-related knowledge), adjusted for
confounders (sex, age and education), and help-seeking behaviour from a medical
doctor and antimicrobial use following common infections, including acute
respiratory tract infections (ARTIs), gastrointestinal tract infections (GTIs)
and urinary tract infections (UTIs).
RESULTS: In total 2611 (94.6%) rural residents completed the questionnaire. Help
seeking from a medical doctor was highest for ARTIs (59.4%) followed by GTIs
(42.1%), and UTIs (27.8%). Around two-thirds (82.3% for ARTIs, 87.0% for GTIs and
66.0% for UTIs) of respondents sought help within 3 days following symptom onset
and over three quarters (88% for ARTIs, 98% for GTIs and 77% for UTIs) reported
complete recovery within 7 days. Of the help-seeking respondents, 94.5% with ARTI
symptoms recalled being prescribed either oral or intravenous antimicrobials
(GTIs 81.7% and UTIs 70.4%). Use of antimicrobials bought from medicine shops
without prescriptions ranged from 8.8% for GTIs to 17.2% for ARTIs; while use of
antimicrobials leftover from previous illnesses or given by a relative ranged
from 7.6% for UTIs to 13.4% for ARTIs. Multivariate logistic regression analysis
revealed that respondents with a higher antimicrobial-related knowledge score and
lack of insurance were associated with lower levels of help-seeking for ARTIs;
while respondents with a higher antimicrobial-related knowledge score were less
likely to be prescribed either oral or intravenous antimicrobials.
CONCLUSIONS: Excessive antimicrobial use in the studied primary care settings is
still prevalent.

DOI: 10.1136/bmjopen-2018-024856
PMCID: PMC6500192
PMID: 30975670
495. Infect Drug Resist. 2019 Jun 28;12:1815-1825. doi: 10.2147/IDR.S200996.

eCollection 2019.
Antibiotic resistance: a hospital-based multicenter study in Tabuk city, Kingdom

of Saudi Arabia.
Yagoub U(1), Al Qahtani B(2), Hariri IA(3), Al Zahrani A(4), Siddique K(1).
Author information:
(1)Research Department, Academic Affairs, King Salman Armed Forces Hospital
Northwestern Region, Tabuk 71411, Saudi Arabia.
(2)Department of Academic Affairs, King Salman Armed Forces Hospital Northwestern
Region, Tabuk 71411, Saudi Arabia.
(3)Department of Family Medicine, King Salman Armed Forces Hospital Northwestern
Region, Tabuk 71411, Saudi Arabia.
(4)Department of Surgery, King Salman Armed Forces Hospital Northwestern Region,
Tabuk 71411, Saudi Arabia.
Background: During the 21st century, antimicrobial resistance (AMR) has emerged
as one of the greatest public health challenges worldwide. In the coming 20
years, health care systems may be unable to treat bacterial diseases efficiently
due to this phenomenon. Objective: To determine the level of knowledge regarding
AMR among patients attending two hospitals in Tabuk city in northeast Kingdom of
Saudi Arabia (KSA). Materials and Methods: This cross-sectional study was
conducted at King Salman Armed Forces Hospital and King Khalid Armed Forces
Hospital in Tabuk city. The study participants were selected from different
outpatient departments using a simple random sampling technique. Data collection
was performed using a self-reported questionnaire. All of the questions were
closed-ended to facilitate study participation and were translated into Arabic.
The data were entered into SPSS version 22 for Windows, cleaned and managed
before analysis. Results: Our results showed that 26.85% of the respondents had
knowledge regarding antibiotic resistance. Knowledge regarding the use of
antibiotics for treating bacterial infection was good among participants (60%),
but responses related to viral infection indicated confusion (23.06%), and
misconceptions were observed. Several factors were significantly associated with
knowledge regarding AMR among participants: 1) the use of antibiotics in the last
year (OR: 2.102, CI: 0.654-6.754); 2) the discontinued use of antibiotics when
feeling better (OR: 8.285, CI: 3.918-17.523); 3) giving antibiotics to friends or
family members to treat the same illness ([False]: OR: 108.96, CI: 29.98-395.93)
and 4) asking doctors to prescribe antibiotics that had been previously
administered for the same symptoms (OR: 9.314, CI: 3.684-23.550). Conclusion: Our
results revealed a very high unawareness of AMR and its contributing factors
among the study participants. Thus, health education and awareness are highly and
urgently recommended to address AMR in the Tabuk area.
DOI: 10.2147/IDR.S200996
PMCID: PMC6605762
PMID: 31303774
Conflict of interest statement: The authors have no conflicts of interests to

declare in this work.
496. Front Neurol. 2019 Jun 18;10:634. doi: 10.3389/fneur.2019.00634. eCollection
2019.
No Free Lunch With Herbal Preparations: Lessons From a Case of Parkinsonism and
Depression Due to Herbal Medicine Containing Reserpine.
Rijntjes M(1), Meyer PT(2).
Author information:
(1)Department of Neurology and Neurophysiology, Medical Center, Faculty of
Medicine, University of Freiburg, Freiburg, Germany.
(2)Department of Nuclear Medicine, Medical Center, Faculty of Medicine,
University of Freiburg, Freiburg, Germany.
The increasing use of herbal medicines calls for a heightened awareness of their
potential side-effects. This especially pertains to western countries, where
patients tend to use herbal medicine as self-medication, often alongside regular
prescriptions, and physicians have less experience with their application. Here
we report a case in which Parkinsonism, depression, and an atypical finding
detected by dopamine transporter single-photon emission computed tomography were
all belatedly recognized as side-effects of herbal medicine. This only occurred
because one of its active ingredients, reserpine, has been extensively studied.
For most other herbal medicines, however, knowledge about side-effects remains
scarce or unavailable. Therefore, we suggest that physicians, when taking a
medication history, should actively ask for the use of any herbal preparations.
DOI: 10.3389/fneur.2019.00634
PMCID: PMC6591315
PMID: 31275227
497. Medicine (Baltimore). 2019 Apr;98(15):e15214. doi:

10.1097/MD.0000000000015214.
Benzbromarone as a possible cause of acute kidney injury in patients with

urolithiasis: Two case reports.
Ye X(1)(2)(3), Wu J(4), Tang K(3), Li W(5), Xiong C(6), Zhuo L(5).
Author information:
(1)Department of Pharmacy, Zhejiang Provincial People's Hospital.
(2)Department of Pharmacy, People's Hospital of Hangzhou Medical College,
Hangzhou.
(3)Department of Pharmacy, China-Japan Friendship Hospital, Beijing.
(4)Laboratory Medicine, The First People's Hospital of Yancheng City, Yancheng,
Jiangsu.
(5)Department of Nephrology, China-Japan Friendship Hospital, Beijing.
(6)College of Pharmacy, Jiangsu Vocational College of Medicine, Yancheng,
Jiangsu, China.
RATIONALE: Reports of acute kidney injury (AKI) associated with benzbromarone use
in patients with hyperuricemia (HUA) are rare so far.
PATIENT CONCERNS: We describe 2 unique clinical patterns in which benzbromarone
was a possible cause of AKI following self-medication for HUA. In case 1, a
45-year-old man developed AKI after taking 100 mg of benzbromarone. His serum
creatinine (Scr) increased to 2.3 mg/dL on day 2 after benzbromarone
administration. Ultrasound showed multiple small stones in both kidneys, and the
24-hour urine uric acid level was 3128 mg. In case 2, a 17-year-old male student
presented with AKI after self-administration of 50 mg of benzbromarone. His Scr
increased to 6.8 mg/dL on day 3 after benzbromarone administration. Ultrasound
showed multiple stones in the left kidney.
DIAGNOSIS: Both patients underwent renal biopsy, with findings of acute tubular
interstitial nephropathy in case 1 and acute tubular damage in case 2.
Drug-induced AKI was considered.
INTERVENTIONS: Both cases were treated supportively with intravenous hydration
only. In both patients, the Scr level recovered within 0.5 months and renal
function was normal 3 months after discharge.
LESSONS: Oral benzbromarone is widely used in Asian counties to treat HUA and the
adverse effects are mostly mild. However, clinicians should be alert for
benzbromarone-induced AKI. Moreover, uricosuric drugs should only be used after
exclusion of urolithiasis and other contraindications.
DOI: 10.1097/MD.0000000000015214
PMCID: PMC6485891
498. JMIR Res Protoc. 2019 Aug 9;8(8):e13973. doi: 10.2196/13973.
Evaluation of a Collaborative Protocolized Approach by Community Pharmacists and

General Medical Practitioners for an Australian Minor Ailments Scheme: Protocol
for a Cluster Randomized Controlled Trial.
Dineen-Griffin S(1), Garcia-Cardenas V(1), Rogers K(1), Williams K(1), Benrimoj

SI(2).
Author information:
(1)Graduate School of Health, University of Technology Sydney, Ultimo, Australia.
(2)Emeritus Professor, The University of Sydney, Camperdown, Australia.
BACKGROUND: Internationally, governments have been investing in supporting

pharmacists to take on an expanded role to support self-care for health system
efficiency. There is consistent evidence that minor ailment schemes (MASs)
promote efficiencies within the health care system. The cost savings and health
outcomes demonstrated in the United Kingdom and Canada open up new opportunities
for pharmacists to effect sustainable changes through MAS delivery in Australia.
OBJECTIVE: This trial aims to evaluate the clinical, economic, and humanistic
impact of an Australian Minor Ailments Service (AMAS) compared with usual
pharmacy care in a cluster randomized controlled trial (cRCT) in Western Sydney,
Australia.
METHODS: The cRCT design has an intervention group and a control group, comparing
individuals receiving a structured intervention (AMAS) with those receiving usual
care for specific health ailments. Participants will be community pharmacies,
general practices, and patients located in Western Sydney Primary Health Network
(WSPHN) region. A total of 30 community pharmacies will be randomly assigned to
either intervention or control group. Each will recruit 24 patients, aged 18
years or older, presenting to the pharmacy in person with a symptom-based or
product-based request for one of the following ailments: reflux, cough, common
cold, headache (tension or migraine), primary dysmenorrhea, or low back pain.
Intervention pharmacists will deliver protocolized care to patients using
clinical treatment pathways with agreed referral points and collaborative systems
boosting clinician-pharmacist communication. Patients recruited in control
pharmacies will receive usual care. The coprimary outcomes are rates of
appropriate recommendation of nonprescription medicines and rates of appropriate
medical referral. Secondary outcomes include self-reported symptom resolution,
health services resource utilization, and EuroQoL Visual Analogue Scale.
Differences in primary outcomes between groups will be analyzed at the individual
patient level accounting for correlation within clusters with generalized
estimating equations. The economic impact of the model will be evaluated by
cost-utility and cost-effectiveness analysis compared with usual care.
RESULTS: The study began in July 2018. Thirty community pharmacies were
recruited. Pharmacists from the 15 intervention pharmacies were trained. A total
of 27 general practices consented. Pharmacy patient recruitment began in August
2018 and was completed on March 31, 2019.
CONCLUSIONS: This study may demonstrate the efficacy of a protocolized
intervention to manage minor ailments in the community and will assess the
clinical, economic, and humanistic impact of this intervention in Australian
pharmacy practice. Pharmacists supporting patient self-care and appropriate
self-medication may contribute to greater efficiency of health care resources and
integration of self-care in the health system. The proposed model and developed
educational content may form the basis of a national MAS service in Australia,
using a robust framework for management and referral for common ailments.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR)
ACTRN12618000286246; http://www.anzctr.org.au/ACTRN12618000286246.aspx.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13973.
©Sarah Dineen-Griffin, Victoria Garcia-Cardenas, Kris Rogers, Kylie Williams,

Shalom Isaac Benrimoj. Originally published in JMIR Research Protocols
(http://www.researchprotocols.org), 09.08.2019.
DOI: 10.2196/13973
PMCID: PMC6709938
PMID: 31400107
Indigenous and non-Indigenous people experiencing homelessness and mental illness

in two Canadian cities: A retrospective analysis and implications for culturally
informed action.
Bingham B(1), Moniruzzaman A(1), Patterson M(1), Distasio J(2), Sareen J(3),
O'Neil J(1), Somers JM(1).
Author information:
(1)Faculty of Health Sciences, Simon Fraser University, Burnaby, British
Columbia, Canada.
(2)Geography, University of Winnipeg, Winnipeg, Manitoba, Canada.
(3)Psychology and Community Health Sciences, University of Manitoba, Winnipeg,
Manitoba, Canada.
OBJECTIVES: Indigenous people in Canada are not only over-represented among the
homeless population but their pathways to homelessness may differ from those of
non-Indigenous people. This study investigated the history and current status of
Indigenous and non-Indigenous people experiencing homelessness and mental
illness. We hypothesised that compared with non-Indigenous people, those who are
Indigenous would demonstrate histories of displacement earlier in life, higher
rates of trauma and self-medication with alcohol and other substances.
DESIGN AND SETTING: Retrospective data were collected from a sample recruited
through referral from diverse social and health agencies in Winnipeg and
Vancouver.
PARTICIPANTS: Eligibility included being 19 years or older, current mental
disorder and homelessness.
MEASURES: Data were collected via interviews, using questionnaires, on
sociodemographics (eg, age, ethnicity, education), mental illness, substance use,
physical health, service use and quality of life. Univariate and multivariable
models were used to model the association between Indigenous ethnicity and
dependent variables.
RESULTS: A total of 1010 people met the inclusion criteria, of whom 439
self-identified as Indigenous. In adjusted models, Indigenous ethnicity was
independently associated with being homeless at a younger age, having a lifetime
duration of homelessness longer than 3 years, post-traumatic stress disorder,
less severe mental disorder, alcohol dependence, more severe substance use in the
past month and infectious disease. Indigenous participants were also nearly twice
as likely as others (47% vs 25%) to have children younger than 18 years.
CONCLUSIONS: Among Canadians who are homeless and mentally ill, those who are
Indigenous have distinct histories and current needs that are consistent with the
legacy of colonisation. Responses to Indigenous homelessness must be developed
within the context of reconciliation between Indigenous and non-Indigenous
Canadians, addressing trauma, substance use and family separations.
TRIAL REGISTRATION NUMBER: ISRCTN42520374, ISRCTN57595077, ISRCTN66721740.

DOI: 10.1136/bmjopen-2018-024748
PMCID: PMC6500294
PMID: 30962229
500. BMC Public Health. 2019 May 6;19(1):518. doi: 10.1186/s12889-019-6878-y.
Knowledge, attitude and practice of antibiotic use among university students: a

cross sectional study in UAE.
Jairoun A(1), Hassan N(2), Ali A(2), Jairoun O(3), Shahwan M(2).
Author information:
Dr_ammar_91_@hotmail.com.
(3)College of Dentistry, Ajman University, Ajman, UAE.
BACKGROUND: Antibiotic resistance became a marker of irrational and overuse of

these medicines in many countries. This study aims to evaluate the knowledge,
attitude and practice (KAP) of medical students (MS) and non-medical students
(NS) towards antibiotic use in the United Arabs Emirates (UAE).
METHOD: A descriptive cross-sectional study was conducted amongst 1200 MS and NS
from Ajman University in UAE. A self-administered questionnaire was used to
assess the knowledge, attitude and practice of antibiotic use. The later was
composed into knowledge, attitude and practice of antibiotic use. Descriptive
analysis was used to analyse the qualitative variables while quantitative
variables were summarised using mean ± Standard Deviation (±SD). A Chi-square
test was used to compare differences in the proportions of qualitative variables.
Unpaired student's t-test was used to test the average differences in
quantitative variables across medical and non-medical students. A p < 0.05 was
considered statistically significant.
RESULTS: One thousand two hundred students (MS: 600 and NS: 600) were considered
valid for analysis. On average, participants scored higher in attitude score
followed by knowledge and practice scores. The average attitude score was 76%
(95% CI: [75, 78%]) compared to 59% for knowledge (95% CI: [58, 60%]) and 45%
(95% CI: [44, 47%]) for practice. The results suggest that overall, medical
students scored remarkably better than non-medical students on KAP of antibiotic
use, respectively (p = 0.0001), (p = 0.000) and (p = 0.002).
CONCLUSION: The students' knowledge, attitude and practice regarding antibiotic
use, which drive the practice of self-medication, reflect a gap in medical
curricula in UAE institutes and medical colleges.
DOI: 10.1186/s12889-019-6878-y
PMCID: PMC6501289
501. Sci Rep. 2019 Jul 5;9(1):9788. doi: 10.1038/s41598-019-46078-y.
Antibiotic drug-resistance as a complex system driven by socio-economic growth

and antibiotic misuse.
Malik B(1), Bhattacharyya S(2).
Author information:
(1)Disease Modelling Lab, Department of Mathematics, School of Natural Sciences,
Shiv Nadar University, Gautan Buddha Nagar, India. bm650@snu.edu.in.
(2)Disease Modelling Lab, Department of Mathematics, School of Natural Sciences,
Shiv Nadar University, Gautan Buddha Nagar, India. samit.b@snu.edu.in.
Overwhelming antibiotic use poses a serious challenge today to the public-health

policymakers worldwide. Many empirical studies pointed out this ever-increasing
antibiotic consumption as primary driver of the community-acquired antibiotic
drug-resistance, especially in the middle- and lower-income countries. The
association is well documented across spatio-temporal gradients in many parts of
the world, but there is rarely any study that emphasizes the mechanism of the
association, which is important for combating drug-resistance. Formulating a
mathematical model of emergence and transmission of drug-resistance, we in this
paper, present how amalgamating three components: socio-economic growth,
population ecology of infectious disease, and antibiotic misuse can instinctively
incite proliferation of resistance in the society. We show that combined impact
of economy, infections, and self-medication yield synergistic interactions
through feedbacks on each other, presenting the emergence of drug-resistance as a
self-reinforcing cycle in the population. Analysis of our model not only
determines the threshold of antibiotic use beyond which the emergence of
resistance may occur, but also characterizes how fast it develops depending on
economic growth, and lack of education and awareness of the population. Our model
illustrates that proper and timely government aid in population health can break
the self-reinforcing process and reduce the burden of drug-resistance in the
community.
DOI: 10.1038/s41598-019-46078-y
PMCID: PMC6611849
PMID: 31278344
502. BJU Int. 2016 Feb;117(2):363-72. doi: 10.1111/bju.13218. Epub 2015 Jul 30.
Rates of self-reported 'burnout' and causative factors amongst urologists in

Ireland and the UK: a comparative cross-sectional study.
O'Kelly F(1), Manecksha RP(1), Quinlan DM(2), Reid A(3), Joyce A(4), O'Flynn
K(4), Speakman M(4), Thornhill JA(2).
Author information:
(1)Department of Urological Surgery, Tallaght Hospital, Dublin, Ireland.
(2)Irish Society of Urology, Dublin, Ireland.
(3)Department of Occupational Health, Tallaght Hospital, Dublin, Ireland.
(4)The British Association of Urological Surgeons, London, UK.
OBJECTIVES: To determine the incidence of 'burnout' among UK and Irish urological

consultants and non-consultant hospital doctors (NCHDs). The second objective was
to identify possible causative factors and to investigate the impact of various
vocational stressors that urologists face in their day-to-day work and to
establish whether these correlate with burnout. The third objective was to
develop a new questionnaire to complement the Maslach Burnout Inventory (MBI),
more specific to urologists as distinct from other surgical/medical specialties,
and to use this in addition to the MBI to determine if there is a requirement to
develop effective preventative measures for stress in the work place, and develop
targeted remedial measures when individuals are affected by burnout.
SUBJECTS AND METHODS: A joint collaboration was carried out between the Irish
Society of Urology (ISU) and the British Association of Urological Surgeons
(BAUS). Anonymous voluntary questionnaires were sent to all current registered
members of both governing bodies. The questionnaire comprised two parts: the
first part encompassed sociodemographic data collection and identifying potential
risk factors for burnout, and the second used the MBI to objectively assess for
workplace burnout. To evaluate differences in burnout, 2 × 2 contingency tables
and Fischer's exact probability tests were used.
RESULTS: In all, 575 urologists responded to the online survey out of a total of
1380 invites, yielding a 42% response rate. All respondents were aged <75 years
(median age 45 years), with men representing 87.5% of respondents. In all, 75% of
respondents worked in England, followed by the Republic of Ireland (9%), Scotland
(8%), Northern Ireland (4%), and Wales (3%). In all, 79% of respondents were
consultants, with 13% representing training posts, and 40% of respondents held a
professorship/clinical lead position. Respondents' countries of origin included
England, Scotland, Ireland, India, Wales, Malaysia, Pakistan and Sri Lanka.
Overall, the mean emotion exhaustion (EE) score was 23.5, representing a moderate
level of EE. The mean depersonalisation (DP) score was 8.2, representing a
moderate level of DP. The mean personal achievement (PA) score was 17.1,
representing high levels of PA. In all, 86 respondents (15%) reported
self-medication with non-prescription drugs or alcohol to combat signs and
symptoms of burnout, while 46 (8%) sought professional help for symptoms of
burnout. In all, 460 respondents (80%) felt that burnout should be evaluated
amongst members of the ISU/BAUS, and 345 (60%) would avail of counselling if
provided.
CONCLUSIONS: This is the first study to address the issue of burnout across two
separate health systems in the UK and Ireland. This study has shown previously
undescribed high levels of burnout characterised by EE and DP, with associated
significant levels of self-medication amongst a male-predominant cohort. Burnout
was attributed to non-surgical administrative/institutional factors, with most
respondents reporting support for staff evaluation and the provision of
counselling services. This pilot study lends itself to the creation of risk
stratification for urologists, and an opportunity to provide educational
resources, training/development programmes, and collegial and administrative
support pathways.
© 2015 The Authors BJU International published by John Wiley & Sons Ltd on behalf
of BJU International.
DOI: 10.1111/bju.13218
503. J Rural Med. 2018 May;13(1):64-71. doi: 10.2185/jrm.2959. Epub 2018 May 29.
Prevalence of hypertension and hypertension control rates among elderly adults
during the cold season in rural Northeast China: a cross-sectional study.
Kawazoe N(1)(2), Zhang X(3), Chiang C(1), Liu H(4), Li J(3), Hirakawa Y(1),
Aoyama A(1).
Author information:
(1)Department of Public Health and Health Systems, Nagoya University School of
Medicine, Japan.
(2)Department of Economics, Nagoya University of Commerce and Business, Japan.
(3)Department of Social Medicine and Health Service Management, Jilin University
School of Public Health, China.
(4)Department of Epidemiology and Biostatistics, Jilin University School of
Public Health, China.
Objective: The burden of noncommunicable diseases (NCDs) is increasing in China,

together with economic development and social changes. The prevalence of risk
factors for NCDs, such as overweight/obesity, hypertension, diabetes, and
dyslipidemia, is reported to be high even among poor residents of rural areas. We
aimed to investigate the prevalence of hypertension among elderly adults in rural
Northeast China and the proportion with controlled hypertension among those on
antihypertensive medication (hypertension control rate). We also aimed to examine
the association of hypertension control with health facilities that provide
treatment. Methods: We conducted a community-based cross-sectional study in six
rural villages of Northeast China from February to early March, 2012. We
interviewed 1593 adults aged 50-69 years and measured their blood pressure. We
examined the differences in mean blood pressure between participants who obtained
antihypertensive medication from village clinics and those who obtained
medication from other sources, using analysis of covariance adjusted for several
covariates. Results: The prevalence of hypertension among participants was as
high as 63.3%, but the hypertension control rate was only 8.4%. Most villagers
(98.1%) were not registered in the chronic disease treatment scheme of the public
rural health insurance. The mean systolic blood pressure, adjusted for the
covariates, of participants who obtained antihypertensive medication from village
clinics was significantly lower than that of participants who obtained medication
from township hospitals (by 16.5 mmHg) or from private pharmacies (by 7.3 mmHg).
Conclusion: The prevalence of hypertension was high and the hypertension control
rate low among elderly villagers during the cold season. As treatment at village
clinics, which villagers can access during the cold season seems to be more
effective than self-medication or treatment at distant hospitals, improving the
quality of treatment in village clinics is urgently needed.
DOI: 10.2185/jrm.2959
PMCID: PMC5981021
PMID: 29875899
504. Front Public Health. 2017 May 26;5:115. doi: 10.3389/fpubh.2017.00115.

eCollection 2017.
Use of Non-Prescription Remedies by Ghanaian Human Immunodeficiency

Virus-Positive Persons on Antiretroviral Therapy.
Laar AK(1), Kwara A(2), Nortey PA(3), Ankomah AK(1), Okyerefo MPK(4), Lartey
MY(5).
Author information:
(1)Department of Population, Family, and Reproductive Health, School of Public
Health, University of Ghana, Accra, Ghana.
(2)Department of Medicine, Warren Alpert Medical School of Brown University,
Providence, RI, United States.
(3)Department of Epidemiology and Disease Control, School of Public Health,
University of Ghana, Accra, Ghana.
(4)Department of Sociology, University of Ghana, Accra, Ghana.
(5)Department of Medicine, University of Ghana School of Medicine and Dentistry,
University of Ghana, Accra, Ghana.
BACKGROUND: Inappropriate use of non-prescription remedies by persons living with

human immunodeficiency virus (PLHIV) may result in adverse events or potentiate
non-adherence to prescribed medications. This study investigated the use of
non-prescription remedies among PLHIV receiving antiretroviral therapy (ART) from
four treatment centers in southern Ghana.
METHODS: A mixed method design using quantitative and qualitative methods was
used. This article focuses on the quantitative survey of 540 respondents.
Univariate analysis was used to generate descriptive tabulations of key
variables. Bivariate analysis and logistic regression modeling, respectively,
produced unadjusted and adjusted associations between background attributes of
PLHIV and the use of non-prescription remedies. A p-value of < 0.05 was
considered statistically significant. All analyses were performed using IBM SPSS
Statistics for Windows, Version 20.0.
RESULTS: One out of three respondents reported the use of non-prescription
remedies at least once within 3 months of the survey. Most of these were locally
made and included "Angel natural bitters, concoctions from the Christian prayer
centers, garlic, and mahogany syrups." These remedies were used concomitantly
with antiretroviral medications (ARVs)-46% or administered with ARVs but at
different times during the day (43%). Some of the remedies were reportedly
prescribed by health workers, or self-initiated during periods of ARVs shortage.
Others took them based on their perception of their efficacy. Bivariate level
analysis identified ART clinic site, place of residence, and ARV adherence
monitoring to be significantly associated with the use of non-prescription
remedies (p < 0.05). Multiple logistic regression analysis controlling for
covariates confirmed the location of ART clinic as the only predictor of the use
of non-prescription remedies. Compared to clients at the large urban teaching
hospital (Korle-Bu Fevers Unit ART center), those at the district level (Atua ART
center) were ninefold more likely to use non-prescription remedies [adjusted odds
ratio (AOR) = 8.84; 95% confidence interval (CI) 2.83-33.72]. Those from a
district level mission hospital (St. Martin's ART center) were threefold as
likely to use these remedies (AOR = 2.610; 95% CI 1.074-9.120).
CONCLUSION: The use of non-prescription remedies by PLHIV on ART is common in
southern Ghana. Usage is mostly self-initiated because of perceived efficacy of
remedy, and was more common among clients attending rural ART clinics.
DOI: 10.3389/fpubh.2017.00115
PMCID: PMC5445137
PMID: 28603710
505. NPJ Prim Care Respir Med. 2014 Sep 18;24:14062. doi: 10.1038/npjpcrm.2014.62.
Patients' experience of identifying and managing exacerbations in COPD: a

qualitative study.
Williams V(1), Hardinge M(2), Ryan S(1), Farmer A(1).
Author information:
Oxford, UK.
(2)Oxford Centre of Respiratory Medicine, Oxford University Hospitals NHS Trust,
Churchill Hospital, Oxford, UK.
BACKGROUND: Effective self-management in chronic obstructive pulmonary disease

(COPD) is crucial to reduce hospital admissions and improve outcomes for
patients. This includes early detection and treatment of exacerbations by
patients themselves.
AIMS: To explore patients' current understanding and experience of managing and
identifying COPD exacerbations at home.
METHODS: A qualitative, interview-based study was carried out in patients' homes.
Interviews were audio-recorded, transcribed and analysed using a grounded theory
approach. Forty-four patients (17 women, 27 men; age range 55-85 years), with
moderate-to-very-severe COPD, were recruited to the interview study from primary
and secondary care settings in Oxford, UK, during 2012-2013.
RESULTS: Patients identified exacerbations on the basis of measurable, 'visible'
symptoms, such as cough and sputum and 'invisible' symptoms, such as chest
sensations and bodily knowledge. Most patients seemed to use a combination of
these approaches when identifying exacerbations, according to the symptoms that
had the most impact on their well-being. Patients used additional self-management
strategies during an exacerbation, such as self-medication (antibiotics and
steroids) and monitored their recovery. Contact with health-care professionals
usually occurred when patients felt no longer able to manage themselves.
CONCLUSIONS: Patients use both assessment of objective biomarkers, which are
aligned with medical knowledge, and subjective symptoms based on their
experience, to identify and manage exacerbations of COPD. Health-care
professionals and clinicians should acknowledge this 'expert patient' knowledge
and integrate this into patients' care plans to facilitate early recognition and
treatment of exacerbations.
DOI: 10.1038/npjpcrm.2014.62
PMCID: PMC4498166
506. Niger Med J. 2017 Jul-Aug;58(4):143-148. doi: 10.4103/nmj.NMJ_47_17.
Dysmenorrhea and Its Effects on School Absenteeism and School Activities among
Adolescents in Selected Secondary Schools in Ibadan, Nigeria.
Femi-Agboola DM(1), Sekoni OO(2), Goodman OO(3).
Author information:
(1)MH Healthcare Ltd, Alegbe Close, Maryland, Lagos, Nigeria.
(2)Department of Community Medicine, College of Medicine, University of Ibadan,
Ibadan, Nigeria.
(3)Department of Community Health and Primary Health Care, Lagos State University
College of Medicine, Lagos, Nigeria.
Background: Menstruation can be associated with dysmenorrhea that may affect

daily activities. This study aimed to determine the prevalence of dysmenorrhea,
effects on school activities, and associated school absenteeism among secondary
school girls in Ibadan, Nigeria.
Materials and Methods: This cross-sectional study was among 460 students from all
girls' only secondary schools in Ibadan, Nigeria, using a cluster sampling
method. Data were collected using questionnaires and focus group discussions. The
severity of dysmenorrhea was categorized as mild, moderate, and severe. Data
collected were analyzed using descriptive statistics and Chi-square tests
performed to determine significant associations. Level of statistical
significance was set at 5%.
Results: Prevalence of dysmenorrhea and school absenteeism was 73% and 13.1%,
with the severity of dysmenorrhea being 37.5%, 43.8%, and 18.8% for mild,
moderate, and severe dysmenorrhea. Other school activities affected were as
follows: class concentration, class participation, social, and sports activities
(17.6%, 12.2%, 10.9%, and 4.6%). Main sources of medication for pain relief were
family (15.8%) and self (13.7%). Age and duration of menstruation predicted
dysmenorrhea (odds ratio [OR] =3.5, confidence interval [CI] = 1.2-9.7, P =
0.019), (OR = 1.7, CI = 1.1-2.6, P = 0.022), whereas severe dysmenorrhea
predicted school absenteeism (OR = 4.2, CI = 1.7-9.9, P = 0.001). Respondents
opined that analgesic drugs should be available in school to prevent school
absenteeism.
Conclusion: Prevalence of dysmenorrhea was high and severe dysmenorrhea played a
role in school absenteeism. Health education should be provided to address the
dangers of self-medication while drugs for pain relief should be available in
schools.
DOI: 10.4103/nmj.NMJ_47_17
PMCID: PMC6496977
PMID: 31057207
507. Einstein (Sao Paulo). 2017 Oct-Dec;15(4):428-434. doi:

10.1590/S1679-45082017AO3972.
Self-perceived quality of health and satisfaction by elderly seen by the Family

Health Strategy team.
Rigo L(1), Garbin RR(2), Rodrigues JLSA(3), Menezes-Júnior LR(4), Paranhos LR(5),
Barelli C(2).
Author information:
(1)Faculdade IMED de Passo Fundo, Passo Fundo, RS, Brazil.
(2)Universidade de Passo Fundo, Passo Fundo, Brazil.
(3)Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil.
(4)Prefeitura Municipal de Itabaiana, Itabaiana, SE, Brazil.
(5)Universidade Federal de Sergipe, Lagarto, SE, Brazil.
OBJECTIVE: To verify the profile of elderly followed up by Family Health Strategy

teams and the influence of self-reported chronic diseases on demographic
variables, describing self-perception and satisfaction with quality of health.
METHODS: This is a cross-sectional population- based study carried out with 301
elderly residents in two areas of a city in southern Brazil. Data were collected
through a questionnaire based on the Health, Well-Being, and Aging Study adapted
by researchers, and a playful scale to assess satisfaction with health. For the
statistical analysis, the χ2 test was used (p<0.05).
RESULTS: Regarding cognitive assessment, the majority was classified as
independent (86.4%), not requiring caregiver assistance to answer the
questionnaire. The population was predominantly female (55.8%), White (64.8%),
married (51.2%), and catholic (82.1%). A total of 47.5% considered their current
health status as regular. Regarding satisfaction with health, 72.4% were happy,
even reporting having at least one chronic health problem (58.5%).
CONCLUSION: The presence of chronic diseases was reported by most respondents,
and the practice of self-medication is significantly more frequent among the
aged. Nevertheless, the degree of satisfaction with their health status was
predominantly positive, both related to the previous year and compared to others
of the same age.
DOI: 10.1590/S1679-45082017AO3972
PMCID: PMC5875155
508. Front Public Health. 2019 Jul 9;7:193. doi: 10.3389/fpubh.2019.00193.

eCollection
2019.
A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and

Gastrointestinal Health.
Wiss DA(1).
Author information:
(1)Fielding School of Public Health, University of California, Los Angeles, Los
Angeles, CA, United States.
The opioid crisis has reached epidemic proportions in the United States with
rising overdose death rates. Identifying the underlying factors that contribute
to addiction vulnerability may lead to more effective prevention strategies.
Supply side environmental factors are a major contributing component.
Psychosocial factors such as stress, trauma, and adverse childhood experiences
have been linked to emotional pain leading to self-medication. Genetic and
epigenetic factors associated with brain reward pathways and impulsivity are
known predictors of addiction vulnerability. This review attempts to present a
biopsychosocial approach that connects various social and biological theories
related to the addiction crisis. The emerging role of nutrition therapy with an
emphasis on gastrointestinal health in the treatment of opioid use disorder is
presented. The biopsychosocial model integrates concepts from several
disciplines, emphasizing multicausality rather than a reductionist approach.
Potential solutions at multiple levels are presented, considering individual as
well as population health. This single cohesive framework is based on the
interdependency of the entire system, identifying risk and protective factors
that may influence substance-seeking behavior. Nutrition should be included as
one facet of a multidisciplinary approach toward improved recovery outcomes.
Cross-disciplinary collaborative efforts, new ideas, and fiscal resources will be
critical to address the epidemic.
DOI: 10.3389/fpubh.2019.00193
PMCID: PMC6629782
PMID: 31338359
509. Hippokratia. 2017 Jan-Mar;21(1):13-18.
Prevalence of illicit drug use among medical students in Northern Greece and
association with smoking and alcohol use.
Papazisis G(1), Tsakiridis I(2), Koulas I(1), Siafis S(1), Dagklis T(2), Kouvelas
D(1).
Author information:
(1)Department of Clinical Pharmacology, Faculty of Medicine, Aristotle University
of Thessaloniki, Greece.
(2)3 Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle
University of Thessaloniki, Greece.
AIM: The aim of this study was to estimate the prevalence of illicit drug use
among medical students in Northern Greece, to identify the motivations for
cannabis use and also to investigate the possible associations with smoking and
alcohol misuse.
METHODS: A sample of undergraduate students completed an anonymous,
self-administered, web-based survey assessing lifetime and past-year illicit
substance use. To further evaluate the motivation to use, the responders were
classified into three subtypes (self-medication, recreational, and mixed). The
CAGE questionnaire and a question assessing binge drinking were also used.
Illicit substance use was correlated with age, gender, study year, CAGE and binge
drinking.
RESULTS: Five hundred and ninety-one undergraduate medical students completed the
survey. The lifetime prevalence of illicit drug use was 24.7 %, while the most
used drug was cannabis (22.2 %). The past-month prevalence of cannabis use was
8.1 %. Experimentation was the predominant reported motivation for its use, and
the recreational subtype was the most prevalent. Binge drinking behavior was
reported by 22.7 % of the sample, and the CAGE screening test was positive for
6.4 % of the students. Most students (80.4 %) characterized themselves as
non-smokers. In the multivariate analysis, lifetime use of illicit drugs was
significantly correlated with smoking and binge drinking. No associations were
found with gender, age, study year or CAGE.
CONCLUSION: Smoking and binge drinking were found to be risk factors for illicit
drug use, whereas no association was found with gender, age, study year and CAGE.
HIPPOKRATIA 2017, 21(1): 13-18.
PMCID: PMC5997020
PMID: 29904251
510. Trop Dis Travel Med Vaccines. 2016 Jun 1;2:8. doi: 10.1186/s40794-016-0024-y.
eCollection 2016.
Knowledge, attitudes, and practices regarding dengue infection among public

sector healthcare providers in Machala, Ecuador.
Handel AS(1), Ayala EB(2)(3), Borbor-Cordova MJ(4), Fessler AG(5), Finkelstein

JL(5), Espinoza RXR(3), Ryan SJ(6)(7)(8), Stewart-Ibarra AM(7).
Author information:
(1)Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY
USA.
(2)Universidad Técnica de Machala, Machala, Ecuador.
(3)Ministerio de Salud Publica, Machala, El Oro Ecuador.
(4)Facultad de Ingenieria Maritima, Ciencias Oceanicas y Recursos Naturales,
Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Guayas Ecuador.
(5)Division of Nutritional Sciences, Cornell University, Ithaca, NY USA.
(6)Department of Geography, University of Florida, Gainesville, FL USA.
(7)Emerging Pathogens Institute, University of Florida, Gainesvillee, fl USA.
(8)Center for Global Health and Translational Science, State University of New
York Upstate Medical University, Syracuse, NY USA.
BACKGROUND: Dengue fever is a rapidly emerging infection throughout the tropics

and subtropics with extensive public health burden. Adequate training of
healthcare providers is crucial to reducing infection incidence through patient
education and collaboration with public health authorities. We examined how
public sector healthcare providers in a dengue-endemic region of Ecuador view and
manage dengue infections, with a focus on the 2009 World Health Organization
(WHO) Dengue Guidelines.
METHODS: A 37-item questionnaire of dengue knowledge, attitudes, and practices
was developed and administered to dengue healthcare providers in Machala,
Ecuador. Survey focus areas included: "Demographics," "Infection and Prevention
of Dengue," "Dengue Diagnosis and the WHO Dengue Guide," "Laboratory Testing,"
"Treatment of Dengue," and "Opinions Regarding Dengue."
RESULTS: A total of 76 healthcare providers participated in this study, of which
82 % were medical doctors and 14 % were nurses. Fifty-eight percent of healthcare
professionals practiced in ambulatory clinics and 34 % worked in a hospital.
Eighty-nine percent of respondents were familiar with the 2009 WHO Dengue
Guidelines, and, within that group, 97 % reported that the WHO Dengue Guide was
helpful in dengue diagnosis and clinical management. Knowledge gaps identified
included Aedes aegypti mosquito feeding habits and dengue epidemiology.
Individuals with greater dengue-related knowledge were more likely to consider
dengue a major health problem. Only 22 % of respondents correctly reported that
patients with comorbidities and dengue without warning signs require hospital
admission, and 25 % of providers reported never admitting patients with dengue to
the hospital. Twenty percent of providers reported rarely (≤25 % of cases)
obtaining laboratory confirmation of dengue infection. Providers reported patient
presumptive self-medication as an ongoing problem. Thirty-one percent of
healthcare providers reported inadequate access to resources needed to diagnose
and treat dengue.
CONCLUSION: Participants demonstrated a high level of knowledge of dengue
symptoms and treatment, but additional training regarding prevention, diagnosis,
and admission criteria is needed. Interventions should not only focus on
increasing knowledge, but also encourage review of the WHO Dengue Guidelines,
avoidance of presumptive self-medication, and recognition of dengue as a major
health problem. This study provided an assessment tool that effectively captured
healthcare providers' knowledge and identified critical gaps in practice.
DOI: 10.1186/s40794-016-0024-y
PMCID: PMC5531027
PMID: 28883952
511. Neurosci Biobehav Rev. 2015 Nov;58:168-85. doi:

10.1016/j.neubiorev.2015.06.004.
Epub 2015 Jun 6.
Negative affective states and cognitive impairments in nicotine dependence.
Hall FS(1), Der-Avakian A(2), Gould TJ(3), Markou A(2), Shoaib M(4), Young JW(5).
Author information:
(1)Department of Pharmacology and Experimental Therapeutics, College of Pharmacy
and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USA. Electronic
address: frank.hall@utoledo.edu.
(2)Department of Psychiatry, University of California San Diego, La Jolla, CA,
USA.
(3)Department of Psychology, Temple University, Philadelphia, PA, USA.
(4)Institute of Neuroscience, Newcastle University, Newcastle, UK.
USA; Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
Smokers have substantial individual differences in quit success in response to

current treatments for nicotine dependence. This observation may suggest that
different underlying motivations for continued tobacco use across individuals and
nicotine cessation may require different treatments in different individuals.
Although most animal models of nicotine dependence emphasize the positive
reinforcing effects of nicotine as the major motivational force behind nicotine
use, smokers generally report that other consequences of nicotine use, including
the ability of nicotine to alleviate negative affective states or cognitive
impairments, as reasons for continued smoking. These states could result from
nicotine withdrawal, but also may be associated with premorbid differences in
affective and/or cognitive function. Effects of nicotine on cognition and affect
may alleviate these impairments regardless of their premorbid or postmorbid
origin (e.g., before or after the development of nicotine dependence). The
ability of nicotine to alleviate these symptoms would thus negatively reinforce
behavior, and thus maintain subsequent nicotine use, contributing to the
initiation of smoking, the progression to dependence and relapse during quit
attempts. The human and animal studies reviewed here support the idea that
self-medication for pre-morbid and withdrawal-induced impairments may be more
important factors in nicotine addiction and relapse than has been previously
appreciated in preclinical research into nicotine dependence. Given the diverse
beneficial effects of nicotine under these conditions, individuals might smoke
for quite different reasons. This review suggests that inter-individual
differences in the diverse effects of nicotine associated with self-medication
and negative reinforcement are an important consideration in studies attempting
to understand the causes of nicotine addiction, as well as in the development of
effective, individualized nicotine cessation treatments.
DOI: 10.1016/j.neubiorev.2015.06.004
PMCID: PMC4670824

eCollection 2014.
Genetic variants and early cigarette smoking and nicotine dependence phenotypes
in adolescents.
O'Loughlin J(1), Sylvestre MP(2), Labbe A(3), Low NC(4), Roy-Gagnon MH(5), Dugas
EN(6), Karp I(7), Engert JC(8).
Author information:
(1)Centre de recherche CHUM, Montreal, Quebec, Canada; Department of Social and
Preventive Medicine, University of Montreal, Montreal, Quebec, Canada; Institut
national de santé publique du Québec, Montreal, Quebec, Canada.
Preventive Medicine, University of Montreal, Montreal, Quebec, Canada.
(3)Department of Epidemiology, McGill University, Montreal, Quebec, Canada.
(4)Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
(5)Department of Epidemiology and Community Medicine, Faculty of Medicine,
University of Ottawa, Ottawa, Ontario, Canada.
(6)Centre de recherche CHUM, Montreal, Quebec, Canada.
Preventive Medicine, University of Montreal, Montreal, Quebec, Canada; Department
of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry,
University of Western Ontario, London, Ontario, Canada.
(8)Departments of Medicine and Human Genetics, McGill University, Montreal,
Quebec, Canada; Research Institute of the McGill University Health Center,
Montreal, Quebec, Canada.
BACKGROUND: While the heritability of cigarette smoking and nicotine dependence

(ND) is well-documented, the contribution of specific genetic variants to
specific phenotypes has not been closely examined. The objectives of this study
were to test the associations between 321 tagging single-nucleotide polymorphisms
(SNPs) that capture common genetic variation in 24 genes, and early smoking and
ND phenotypes in novice adolescent smokers, and to assess if genetic predictors
differ across these phenotypes.
METHODS: In a prospective study of 1294 adolescents aged 12-13 years recruited
from ten Montreal-area secondary schools, 544 participants who had smoked at
least once during the 7-8 year follow-up provided DNA. 321 single-nucleotide
polymorphisms (SNPs) in 24 candidate genes were tested for an association with
number of cigarettes smoked in the past 3 months, and with five ND phenotypes (a
modified version of the Fagerstrom Tolerance Questionnaire, the ICD-10 and three
clusters of ND symptoms representing withdrawal symptoms, use of nicotine for
self-medication, and a general ND/craving symptom indicator).
RESULTS: The pattern of SNP-gene associations differed across phenotypes. Sixteen
SNPs in seven genes (ANKK1, CHRNA7, DDC, DRD2, COMT, OPRM1, SLC6A3 (also known as
DAT1)) were associated with at least one phenotype with a p-value <0.01 using
linear mixed models. After permutation and FDR adjustment, none of the
associations remained statistically significant, although the p-values for the
association between rs557748 in OPRM1 and the ND/craving and self-medication
phenotypes were both 0.076.
CONCLUSIONS: Because the genetic predictors differ, specific cigarette smoking
and ND phenotypes should be distinguished in genetic studies in adolescents.
Fifteen of the 16 top-ranked SNPs identified in this study were from loci
involved in dopaminergic pathways (ANKK1/DRD2, DDC, COMT, OPRM1, and SLC6A3).
IMPACT: Dopaminergic pathways may be salient during early smoking and the
development of ND.
PMCID: PMC4278712
513. J Public Health Afr. 2018 Dec 31;9(3):772. doi: 10.4081/jphia.2018.772.

eCollection 2018 Dec 21.
The role of health insurance in the coverage of oral health care in Senegal.
Diop M(1), Kanouté A(2), Diouf M(1), Ndiaye AD(1), Lo CMM(1), Faye D(1), Cissé
D(1).
Author information:
(1)Department of Public Health Faculty of Medicine.
(2)Department of Odontology, Faculty of Medicine, Pharmacy and
Odonto-Stomatology, University Cheikh Anta Diop of Dakar, Senegal.
Oral diseases costs are among the most expensive health care benefits. In
Senegal, households contribute up to 37.6% of the national health spending
through direct payments. The aim of this work was to study the role of health
insurance in the coverage of oral health care in Senegal. The study was based on
health insurance agents and policyholders. The study reveals that oral health
care coverage through health insurance still does not meet requirements for
treatment of oral infections. In financial terms, oral health care costs health
insurance too much. As a result, carriers cover them partially. On top of that,
the majority of the population's lack of knowledge about mutual, because they
have a little background on oral health care, the latter weighs heavily on health
insurance leading to the use of self-medication, traditional medicine and
handicraft prosthetists. The analysis reveals an unequal access to oral health
care through the health insurance system. To bring under control the expenditure
for oral health care, carriers and dental surgeons must work together to raise
the populations' awareness on community solidarity.
DOI: 10.4081/jphia.2018.772
PMCID: PMC6379686
PMID: 30854174
Conflict of interest statement: Conflict of interest: the authors declare no

potential conflict of interests.
514. Genet Mol Res. 2014 Nov 27;13(4):9861-6. doi: 10.4238/2014.November.27.13.
Nuclear and mitochondrial genome instability induced by senna (Cassia

angustifolia Vahl.) aqueous extract in Saccharomyces cerevisiae strains.
Silva CR(1), Caldeira-de-Araújo A(1), Leitão AC(2), Pádula M(2).
Author information:
(1)Laboratório de Radio e Fotobiologia, Departamento de Biofísica e Biometria,
IBRAG, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
(2)Laboratório de Radiobiologia Molecular, Universidade Federal do Rio de
Janeiro, Rio de Janeiro, RJ, Brasil.
Cassia angustifolia Vahl. (senna) is commonly used in self-medication and is

frequently used to treat intestine constipation. A previous study involving
bacteria and plasmid DNA suggested the possible toxicity of the aqueous extract
of senna (SAE). The aim of this study was to extend the knowledge concerning SAE
genotoxicity mechanisms because of its widespread use and its risks to human
health. We investigated the impact of SAE on nuclear DNA and on the stability of
mitochondrial DNA in Saccharomyces cerevisiae (wt, ogg1, msh6, and ogg1msh6)
strains, monitoring the formation of petite mutants. Our results demonstrated
that SAE specifically increased Can(R) mutagenesis only in the msh6 mutant,
supporting the view that SAE can induce misincorporation errors in DNA. We
observed a significant increase in the frequency of petite colonies in all
studied strains. Our data indicate that SAE has genotoxic activity towards both
mitochondrial and nuclear DNA.
DOI: 10.4238/2014.November.27.13
515. BMC Fam Pract. 2015 Jul 29;16:91. doi: 10.1186/s12875-015-0300-3.
Self-care behavior when suffering from the common cold and health-related quality
of life in individuals attending an annual checkup in Japan: a cross-sectional
study.
Shaku F(1), Tsutsumi M(2), Miyazawa A(3), Takagi H(4), Maeno T(5).
Author information:
(1)Department of Internal Medicine, Division of Respiratory Medicine, Nihon
University, 30-1 Oyaguchikamimachi, Itabashiku, Tokyo, 173-8610, Japan.
shaku-gi@umin.ac.jp.
(2)Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
madoka@md.tsukuba.ac.jp.
(3)Graduate School of Comprehensive Human Sciences, University of Tsukuba,
Tsukuba, Japan. tulip_with_freesia@yahoo.co.jp.
(4)Yamato clinic, Sakuragawa, Japan. rjmhw904@ybb.ne.jp.
(5)Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
maenote@md.tsukuba.ac.jp.
BACKGROUND: The World Health Organization and several governments encourage
medical self-care (including self-medication) for minor illnesses. Accordingly,
the factors that influence self-care have received research attention, with
socioeconomic status identified as one such predictor. Although studies have
examined the relationship between socioeconomic status and quality of life (QOL)
in patients suffering from respiratory allergies or chronic illnesses, the
relationship between QOL and self-care behavior for the common cold, the most
common illness seen in primary care, has not been examined. Therefore, we
investigated the relationship between QOL and self-care behavior in individuals
suffering from the common cold.
METHODS: We distributed questionnaires to 499 people who attended an annual
public health checkup in Kasama city, Japan. Valid questionnaires were received
from 398 participants (mean age = 59.0, SD = 15.8, range = 24-87 years; 61.4 %
women). The materials included a question relating to typical actions taken when
treating a common cold (self-care or visiting a health clinic), demographics, and
the Short Form-8™ (SF-8™)-an 8-item survey that assesses health-related quality
of life (HRQOL). The association of care action and HRQOL were investigated using
Mann-Whitney U tests with a significance level of p < 0.05.
RESULTS: The mean scores for the Physical Functioning, Role-Physical, Bodily
Pain, Social Functioning, Role-Emotional, and Physical Component Summary score of
the SF-8™ were significantly higher among the self-care group than the group that
preferred visiting a clinic.
CONCLUSIONS: HRQOL among individuals who engage in self-care when treating the
common cold was observed to be significantly higher than among individuals who
preferred to attend a health clinic. It is unclear whether self-care behavior
affects QOL, or whether QOL affects self-care behavior; however, this finding
highlights the importance of the relationship between QOL and self-care behavior.
Additional studies should be conducted in order to investigate the direction of
causality between self-care behaviors and QOL further.
DOI: 10.1186/s12875-015-0300-3
PMCID: PMC4518653

2018
Jan 31.
Pregabalin dispensing patterns in Amman-Jordan: An observational study from

community pharmacies.
Al-Husseini A(1), Abu-Farha R(2), Wazaify M(1), Van Hout MC(3).
Author information:
(1)Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The
University of Jordan (UJ), Amman, Jordan.
(2)Department of Clinical Pharmacy and Therpeutics, Faculty of Pharmacy, Applied
Science Private University, Amman, Jordan.
(3)Public Health Institute, Liverpool John Moore's University, United Kingdom.
Objectives: Pregabalin is currently approved for the treatment of epilepsy,

generalized anxiety disorder, neuropathic pain and fibromyalgia. Rising attention
to the abuse liability of pregabalin causing addictive behaviors is partially
based on case reports and published literature of pregabalin used in dosages that
override the approved therapeutic range. This study was conducted to provide
background data regarding the abuse/misuse of pregabalin from community pharmacy
in Jordan.
Methods: A prospective cross-sectional observational study design was used, which
was conducted at different community pharmacies in Amman-Jordan. During the study
period (November 2016-January 2017), a total 77 requests for pregabalin were
observed from 14 pharmacies. A structured interview was conducted with all
customers to gather information regarding their demographic and their request of
pregabalin.
Results: A total of 77 pregabalin requests form 77 customers in a community
pharmacy setting were observed in this study. Spinal disc herniation was the most
common complaint for which the customer asked for the medication (n = 27, 35.1%).
Self-medication was the most frequent method of requesting pregabalin (n = 44,
57.1%), while a total of 33 customers (42.9%) asked for the product using a
prescription. During the observation period the number of customers suspected of
abusing pregabalin for non-medical reason was 35 (45.5%). A total of 33 out of
the 35 suspected customers (94.3%) asked for the product without a prescription,
and 19/35 weren't sold due to suspicion of abuse (54.3%).
Conclusion: The study underscores the need for regulatory efforts to manage
pregabalin abuse, through the addition of pregabalin containing products to the
controlled drug list which can't be purchased without a prescription. Also,
pharmacists and customers must be educated at a community pharmacy level
regarding potential hazards of pregabalin abuse.
DOI: 10.1016/j.jsps.2018.01.012
PMCID: PMC5856951
PMID: 29556121

4863.220030.
Morbidity pattern and health-seeking behavior of elderly in urban slums: A

cross-sectional study in Assam, India.
Barua K(1), Borah M(1), Deka C(1), Kakati R(1).
Author information:
(1)Department of Community Medicine, Jorhat Medical College, Jorhat, Assam,
India.
Background: Elderly population in India is increasing fast which indicates a

growing share of population with more special needs for health and support.
Understanding the morbidities and health-seeking behavior of elderly is essential
for strengthening geriatric health-care services delivery.
Objectives: The objective of this study was to study the morbidity profile of
elderly in urban slum areas and assess their health-seeking behavior.
Methodology: A cross-sectional study was conducted in urban slums of Jorhat
district of Assam, among 125 elderly selected by simple random sampling.
Statistical Analysis Used: The statistical analysis was performed by Chi-square
and proportions.
Results: The most common morbidity found was arthritis (70.4%) followed by visual
impairment (58%). Majority (83.7%) were seeking treatment for their health
problems. Among those elderly who did not seek treatment, the most common reasons
given were "lack of money" (81.2%) and "not feeling necessary to go to doctor as
conditions were age related" (62.5%).
Conclusions: More than two-third of slum-dwelling elderly in the present study
were suffering from chronic morbidities; a few could not afford proper health
care due to lack of money and self-medication practices were prevalent among
some. This stresses the need to provide suitable health facilities and affordable
health care to the elderly in slum areas to ensure their active aging. Living
arrangement of the elderly was found to have significantly influenced their
health-seeking behavior. Strategic implementation of policies focusing on the
problems and beliefs of slum-dwelling elderly which prevent them from seeking
healthcare is the need of the hour.
DOI: 10.4103/2249-4863.220030
PMCID: PMC5749084
PMID: 29302545

eCollection 2015.
"Carrying Ibuprofen in the Bag": Priority Health Concerns of Latin American

Migrants in Spain- A Participatory Qualitative Study.
Roura M(1), Bisoffi F(1), Navaza B(1), Pool R(2).
Author information:
(1)ISGlobal, Barcelona Centre for International Health Research (CRESIB) Hospital
Clínic, Universitat de Barcelona, Barcelona, Spain.
(2)Centre for Social Science and Global Health University of Amsterdam,
Amsterdam, The Netherlands.
BACKGROUND: An estimated 2.7 million Latin Americans reside in Europe, mostly in

Spain. Part of a broader project aimed at developing a research agenda on the
health status and determinants of this population, this qualitative study engaged
Latin American migrants in the identification of research priorities.
METHODS: We conducted 30 group discussions between November 2012-March 2013 with
84 participants purposively selected for maximum diversity in Madrid and
Barcelona (Spain). We facilitated sequences of task-oriented visual activities to
explore their views on priority health concerns. We tape-recorded and transcribed
discussions and developed a coding frame based on socio-ecological frameworks,
which we applied to all the data using NVIVO-10. A final round of eight group
discussions allowed us to triangulate and enrich interpretations by including
participants' insights.
FINDINGS: The cumulative toll of daily stresses was the major health concern
perceived by a population that conceptualised ill-health as a constellation of
symptoms rather than as specific diseases. Work-related factors, legislative
frameworks regulating citizenship entitlements and feeling ethnically
discriminated were major sources of psycho-social strain. Except for sexually
transmitted infections, participants rarely referred to communicable diseases as
a concern. The perception that clinicians systematically prescribed painkillers
discouraged health seeking and fostered self-medication. Participants felt that
the medicalised, chemicalised, sexually liberal and accelerated culture of the
host society damaged their own, and the local populations' health.
CONCLUSION: Health systems bear a disproportionate responsibility in addressing
health problems rooted in other sectors. Occupational and migration policies
should be recognised explicitly as health policies. The mismatch between
researchers' emphasis on communicable infections and the health concerns of Latin
American migrants highlights the need for greater interaction between different
forms of knowledge. In this process, the biomedical culture of reliance on
pharmacological solutions should not remain unquestioned.
PMCID: PMC4552793
519. Caspian J Intern Med. 2018 Winter;9(1):87-91. doi: 10.22088/cjim.9.1.87.
Stimulant use in medical students and residents requires more careful attention.
Fallah G(1), Moudi S(2)(3), Hamidia A(4)(3), Bijani A(5).
Author information:
(1)1.Student Research Committee, Babol University of Medical Sciences, Babol,
Iran.
(2)2.Cancer Research Center, Health Research Institute, Babol University of
Medical Sciences, Babol, Iran.
(3)Department of Psychiary, Babol University of Medical Sciences, Babol, Iran.
(4)Social Determinants of Health Research Center, Health Research Institute,
Babol University of Medical Sciences, Babol, Iran.
(5)Non-Communicable Pediatric Diseases Research Center, Health Research
Institute, Babol University of Medical Sciences, Babol, Iran.
Background: Stimulant pharmaceuticals are abused among academic students to

elevate mood, improve studying, intellectual capacity, memory and concentration,
and increase wakefulness. This study was designed to evaluate the current
situation of stimulant use among medical students and residents of Babol
University of Medical Sciences.
Methods: This cross-sectional study was conducted among 560 medical students and
clinical residents of Babol University of Medical Sciences during the academic
year 2014-2015. A self-administered questionnaire was used for data collection.
Results: Four hundred and forty-four (79.3%) students filled out the
questionnaires. 49 (11%) individuals reported amphetamine and methylphenidate
(ritalin) use. The mean age of the stimulant drug users was 24.6±4.8 years. The
main initiator factor was to improve concentration (29 persons; 59.2%). There
were significant statistical correlations between stimulant drugs abuse and male
gender, living in dormitor in residence and internship and past medical history
of psychiatric disorders (depression, attention deficit hyperactivity disorder
and substance abuse) (p<0.05).16 (32%) students started the drug use on their
friends' advice; 15 (30%) due to self-medication and 12 (24%) persons with
physician´s prescription.
Conclusions: Because of significant prevalence of stimulant use, regulatory
governmental policies and also planning to improve essential life skills,
awareness about the side effects and complications of these drugs, screening of
at-risk college students and early identification of the abusers are suggested.
DOI: 10.22088/cjim.9.1.87
PMCID: PMC5771366
PMID: 29387325
Conflict of interest statement: The authors declare that there are no conflicts
of interest.
520. Int J Pediatr Adolesc Med. 2017 Sep;4(3):108-111. doi:

10.1016/j.ijpam.2017.04.002. Epub 2017 Jun 23.
Consumption of antibiotics by children in Greece: a cross-sectional study.
Maltezou HC(1), Dedoukou X(1), Asimaki H(2), Kontou I(2), Ioannidou L(2),
Mitromara K(2), Theodoridou K(2), Katerelos P(1), Theodoridou M(2).
Author information:
(1)Department for Interventions in Health-Care Facilities, Hellenic Center for
Disease Control and Prevention, Athens, Greece.
(2)First Department of Pediatrics, University of Athens, "Aghia Sophia"
Children's Hospital, Athens, Greece.
Background: Greece is among the European countries with the highest consumption
of antibiotics.
Objectives: To study the rates and characteristics of consumption of antibiotics
in the community by children in Greece.
Methods: Questionnaire-based study of parents of hospitalized children.
Results: A total of 549 children were studied; 247 (45%) received at least one
course of antibiotics the previous year (mean number of antibiotic courses the
past year: 1.9), including 427 (91.8%) following examination by a pediatrician, 6
(1.3%) following phone consultation, 2 (0.4%) following suggestion by a
pharmacist and 2 (0.4%) as self-medication. Prevalent reasons for antibiotic
consumption were acute otitis media (AOM) (27.3%), pharyngotonsillitiss (25.4%),
and bronchitis (17.8%). Amoxicillin-clavulanate was the prevalent antibiotic for
pharyngotonsillitis, urinary tract infection (UTI) and skin infection (30.5%,
35.7% and 36.4% of cases, respectively), amoxicillin for AOM and pneumonia (32.3%
and 36.4% of cases, respectively), and clarithromycin for bronchitis (27.7%). We
found 84.3%, 81.9%, 64.3%, 63.7%, and 50% of parents reporting treatment
consisted with the national guidelines for AOM, pneumonia, UTI, skin infection,
and pharyngotonsillitis, respectively. In the multivariate analysis, an age of
1-5 years and asthma were significantly associated with a higher probability for
antibiotic consumption.
Conclusions: Antibiotic consumption of children in Greece is mainly driven by
pediatricians. Continuing medical education is expected to further improve
antibiotic prescription practices by pediatricians.
DOI: 10.1016/j.ijpam.2017.04.002
PMCID: PMC6372488
PMID: 30805511
521. Biol Pharm Bull. 2017;40(10):1654-1660. doi: 10.1248/bpb.b17-00118.
Inhibitory Effects of Gastrointestinal Drugs on CYP Activities in Human Liver

Microsomes.
Iwase M(1), Nishimura Y(1), Kurata N(2), Namba H(1), Hirai T(1), Kiuchi Y(1).
Author information:
(1)Department of Pharmacology, Showa University School of Medicine.
(2)Faculty of Arts and Sciences at Fujiyoshida, Showa University.
OTC drugs have an important role in self-medication. However, the pharmacokinetic

properties of some OTC drugs have not been fully investigated and reports
concerning their drug interactions are insufficient. Several gastrointestinal
drugs are available as OTC drugs. Because of their pharmacological properties,
these drugs are often used concomitantly with other drugs. Therefore, it is
important to predict the possible drug interactions among these drugs. In the
current study, we investigated the inhibitory effects of five gastrointestinal
drugs, namely loperamide, oxethazaine, papaverine, pirenzepine, and trimebutine,
on CYP activities in human liver microsomes. Furthermore, we calculated the ratio
of the intrinsic clearance of each CYP substrate in the presence or absence of
the gastrointestinal drugs. The possibility of drug interactions in vivo was
predicted by cut-off criteria. CYP3A4 activity was markedly inhibited by
trimebutine, papaverine, and oxethazaine. Their inhibitory properties were
competitive and the Ki values were 6.56, 12.8, and 3.08 µM, respectively.
Alternative R values of CYP3A4 exceeded the cut-off level. These results
suggested that drug interactions mediated by CYP3A4 may occur during treatment
with these gastrointestinal drugs, necessitating the confirmation of the clinical
significance of these drug interactions to prevent unexpected adverse effects.
DOI: 10.1248/bpb.b17-00118
522. Srp Arh Celok Lek. 2015 Mar-Apr;143(3-4):134-40.
The correlation between pain perception among patients with six different
orthodontic archwires and the degree of dental crowding.
Marković E, Fercec J, Šćepan I, Glišić B, Nedeljković N, Juloski J, RudolF R.
INTRODUCTION: Forces generated in orthodontic treatment with fixed appliances

create tension and compression zones in the periodontal ligament resulting in a
painful experience for patients. In the first phase of orthodontic treatment,
when leveling of teeth is needed, nickel-titanium (NiTi) archwires can be
completely engaged in brackets, even in the cases of extreme crowding, exerting
small forces. There is a great individual variation in the pain perception
related to the application of orthodontic forces.
OBJECTIVE: The aim of this study was to investigate the pain perception among
patients with dental crowding after insertion of six different NiTi orthodontic
archwires as a part of fixed appliances in the first stage of orthodontic
treatment.
METHODS: The study was conducted on a sample of 189 orthodontic patients
receiving one of six different either superelastic or heat activated NiTi
archwires, in the first phase of orthodontic treatment. Pain perception was
evaluated in groups of patients with different degree of crowding. The modified
McGill Pain Questionnaire with Visual Analogue Scale was used to evaluate the
quality and intensity of pain. Statistical analysis was performed using simple
descriptive statistics, and Pearson's chi-square test with statistical
significance of p<0.05.
RESULTS: Majority of patients reported pain as discomfort or pressure of moderate
intensity caused by chewing or biting, started within 12 hours, carried on for
3-4 days, and decreased over time without self-medication.
CONCLUSION: No correlation was found between pain perception among patients with
different types of NiTi archwires and the degree of crowdinq.
523. BMC Med. 2015 May 6;13:106. doi: 10.1186/s12916-015-0314-7.
Smartphone apps for calculating insulin dose: a systematic assessment.
Huckvale K(1), Adomaviciute S(2), Prieto JT(3), Leow MK(4)(5)(6), Car J(7)(8).
Author information:
(1)Global eHealth Unit, Imperial College London, Reynolds Building, St Dunstans
Road, London, W6 8RP, UK. c.huckvale@imperial.ac.uk.
Road, London, W6 8RP, UK. samanta.adomaviciute@gmail.com.
(3)CRG, École polytechnique, Palaiseau, France.
jose-tomas.prieto@polytechnique.edu.
(4)Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore.
melvin.leow@sics.a-star.edu.org.
(5)Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore,
Singapore. melvin.leow@sics.a-star.edu.org.
(6)Singapore Institute for Clinical Studies, A*STAR, Singapore, Singapore.
melvin.leow@sics.a-star.edu.org.
Road, London, W6 8RP, UK. josip.car@imperial.ac.uk.
(8)Health Services and Outcomes Research Programme, LKC Medicine, Imperial
College - Nanyang Technological University, Singapore, Singapore.
josip.car@imperial.ac.uk.
Comment in
BMC Med. 2015;13:205.
BACKGROUND: Medical apps are widely available, increasingly used by patients and
clinicians, and are being actively promoted for use in routine care. However,
there is little systematic evidence exploring possible risks associated with apps
intended for patient use. Because self-medication errors are a recognized source
of avoidable harm, apps that affect medication use, such as dose calculators,
deserve particular scrutiny. We explored the accuracy and clinical suitability of
apps for calculating medication doses, focusing on insulin calculators for
patients with diabetes as a representative use for a prevalent long-term
condition.
METHODS: We performed a systematic assessment of all English-language
rapid/short-acting insulin dose calculators available for iOS and Android.
RESULTS: Searches identified 46 calculators that performed simple mathematical
operations using planned carbohydrate intake and measured blood glucose. While
59% (n = 27/46) of apps included a clinical disclaimer, only 30% (n = 14/46)
documented the calculation formula. 91% (n = 42/46) lacked numeric input
validation, 59% (n = 27/46) allowed calculation when one or more values were
missing, 48% (n = 22/46) used ambiguous terminology, 9% (n = 4/46) did not use
adequate numeric precision and 4% (n = 2/46) did not store parameters faithfully.
67% (n = 31/46) of apps carried a risk of inappropriate output dose
recommendation that either violated basic clinical assumptions (48%, n = 22/46)
or did not match a stated formula (14%, n = 3/21) or correctly update in response
to changing user inputs (37%, n = 17/46). Only one app, for iOS, was issue-free
according to our criteria. No significant differences were observed in issue
prevalence by payment model or platform.
CONCLUSIONS: The majority of insulin dose calculator apps provide no protection
against, and may actively contribute to, incorrect or inappropriate dose
recommendations that put current users at risk of both catastrophic overdose and
more subtle harms resulting from suboptimal glucose control. Healthcare
professionals should exercise substantial caution in recommending unregulated
dose calculators to patients and address app safety as part of self-management
education. The prevalence of errors attributable to incorrect interpretation of
medical principles underlines the importance of clinical input during app design.
Systemic issues affecting the safety and suitability of higher-risk apps may
require coordinated surveillance and action at national and international levels
involving regulators, health agencies and app stores.
DOI: 10.1186/s12916-015-0314-7
PMCID: PMC4433091
524. BMC Public Health. 2017 Sep 21;17(1):732. doi: 10.1186/s12889-017-4770-1.
Medicine use practices in management of symptoms of acute upper respiratory tract

infections in children (≤12 years) in Kampala city, Uganda.
Ocan M(1), Aono M(2), Bukirwa C(2), Luyinda E(2), Ochwo C(2), Nsambu E(2),
Namugonza S(2), Makoba J(3), Kandaruku E(2), Muyende H(2), Nakawunde A(2).
Author information:
Makerere University, P.O. Box 7072, Kampala, Uganda. ocanmoses@gmail.com.
(2)Department of Medicine, College of Health Sciences, Makerere University, P.O.
Box 7072, Kampala, Uganda.
(3)Department of Pharmacy, College of Health Sciences, Makerere University, P. O.
Box, 7072, Kampala, Uganda.
BACKGROUND: Medicines are commonly accessed and used for management of illness in
children without a prescription. This potentially increases the risk of unwanted
treatment outcomes. We investigated medicine use practices in management of
symptoms of acute upper respiratory tract infections among children (≤12 years)
in households in Nakawa division, Kampala city.
METHODS: This was a cross-sectional study conducted among 390 randomly selected
children. Data on use of medicines in children (≤12 years) during recent episode
of acute upper respiratory tract infection was collected from their care takers
using an interviewer administered questionnaire. A recall period of two weeks
(14 days) was used in during data collection.
RESULTS: The prevalence of giving children non-prescription antimicrobial
medicines was 44.8% (38.3-52.2). The most common disease symptoms that the
children reportedly had included flu, 84.9% (331/390), cough, 83.1% (324/390),
and undefined fever, 69.7% (272/390). Medicines commonly given to children
included, paracetamol 53.1% (207/390), Coartem 29.7% (116/390), cough linctus
20.8% (81/390), amoxicillin 18.9% (74/390), Co-trimoxazole 18.5% (72/390), and
diphenhydramine 15.4% (60/390). The major sources of medicines given to the
children was hospital/clinic, 57.26% (223/390). Most of the children, 81% were
given more than one medicine at a time. The majority, 62.3% (243/390) of the care
takers who gave the children medicine during the recent illness were not aware of
any medicine (s) that should not be given to children. The predictors of
non-prescription use of antimicrobial medicines in managing symptoms of acute
upper respiratory tract infections in children included, medicines obtained from
drug shop (PR: 1.45, CI: 1.14-1.85), medicines at home (PR: 1.8, CI: 0.83-1.198)
and type of medicine (antimalarial) (PR: 2.8, CI: 1.17-6.68).
CONCLUSION: Children are commonly given multiple medicines during episodes of
acute upper respiratory tract infections with most antimicrobial agents accessed
and used without a prescription in Kampala city, Uganda.
DOI: 10.1186/s12889-017-4770-1
PMCID: PMC5609015
525. Innov Clin Neurosci. 2019 Mar 1;16(3-4):16-18.
The Pathophysiology of Marijuana-induced Encephalopathy and Possible Epilepsy

after Ingestion in Children: A Case Series.
Carvalho A(1)(2), Evans-Gilbert T(1)(2).
Author information:
(1)Drs. Carvalho and Evans-Gilbert are with the Department of Pediatrics at the
Cornwall Regional Hospital in Montego Bay, Jamaica.
(2)Dr. Evans-Gilbert is also with the University of the West Indies, Western
Campus, in Montego Bay, Jamaica.
Background: Ingestion of marijuana in children presents primarily with

encephalopathy and potentially, in severe cases, seizures. There is a growing
body of evidence supporting the benefit of medical marijuana as an anticonvulsant
treatment for intractable seizures. However, there are limited data regarding its
proconvulsant effects after ingestion. In this case series, we review the
pathophysiology of marijuana encephalopathy and potential seizures after
ingestion of marijuana in infants and young children. Case presentation: We
summarized the cases of six children who were admitted to the hospital with
neurological symptoms and a positive urine test for tetrahydrocannabinol (THC)
between 2016 and 2018. The primary symptom was excessive drowsiness, with two
children progressing to an unarousable state. Two cases presented after ingesting
a marijuana confectionery, and the caregivers in four cases were unaware that
marijuana exposure was responsible for the clinical presentation. All cases
resolved without sequelae and were investigated by social services. In one case,
a 6-year-old child with developmental delay and a previous episode of seizures
presented with recurrent seizures and evidence of marijuana exposure. Marijuana
was considered a probable cause due its proconvulsant effects, but a subsequent
seizure episode with a negative urine THC ruled this out. Conclusion: Physicians
should consider the possibility of ingestion of marijuana in infants and young
children who present with symptoms of unexplained drowsiness. Marijuana products
have the potential to provoke seizures and affect the developing brain of a
child. Self-medication with marijuana products should be dissuaded, particularly
in households with young children.
PMCID: PMC6538397
PMID: 31214478
Conflict of interest statement: FUNDING:No funding was provided. DISCLOSURES:The

authors have no conflicts of interest relevant to the content of this article.
526. Indian J Sex Transm Dis AIDS. 2017 Jan-Jun;38(1):54-59. doi:

10.4103/0253-7184.203436.
Clinico-epidemiological profile of patients attending Suraksha Clinic of tertiary

care hospital of North India.
Banger HS(1), Sethi A(1), Malhotra S(2), Malhotra SK(1), Kaur T(1).
Author information:
(1)Department of Skin and STD, Government Medical College, Amritsar, Punjab,
India.
(2)Department of Microbiology, Government Medical College, Amritsar, Punjab,
India.
BACKGROUND: Sexually transmitted infections (STIs) are a global health problem.

Trends of STIs vary from place to place depending on various epidemiological
factors prevailing in that respective geographic area.
AIMS AND OBJECTIVES: The present study was conducted to find the pattern and
prevalence of different STIs out of total STI clinic attendees, to identify any
change in the trend of STIs, various epidemiological factors, and behavior of
individual diseases.
MATERIALS AND METHODS: Case records of the patients, attending the STI clinic
(Suraksha Clinic) attached with Department of Dermatology, Venereology, and
Leprosy of a tertiary care medical college and hospital of North India from April
2007 to March 2014, were analyzed. All the patients were thoroughly examined and
investigated.
RESULTS: This study included a total of 5468 STI clinic attendees out of which
3908 were diagnosed to have STIs. Most of the patients were male, married, and in
the third decade of their lives. In our study, the highest number of patients had
herpes genitalis, i.e., 850 patients (21.75%) followed by 415 patients (10.61%)
having genital warts. Molluscum contagiosum was present in 239 patients (6.11%),
106 patients (2.71%) had urethral discharge whereas 81 patients (2.07%) diagnosed
to have syphilis. Viral infections accounted for 38.48% of cases. Human
immunodeficiency virus (HIV) positivity was seen in 414 patients (10.59%) of
total STI cases.
CONCLUSION: The trend of STIs is changing from bacterial to viral diseases. This
is because of the widespread use of antibacterial, self-medication, and treatment
through national program. STIs enhance the susceptibility of an individual to
acquire or transmit HIV through sexual contact.
DOI: 10.4103/0253-7184.203436
PMCID: PMC5389216
PMID: 28442804
527. J Clin Med. 2019 May 10;8(5). pii: E652. doi: 10.3390/jcm8050652.
Hepatobiliary Events in Migraine Therapy with Herbs-The Case of Petadolex, A

Petasites Hybridus Extract.
Anderson N(1), Borlak J(2).
Author information:
(1)Hannover Medical School, Centre for Pharmacology and Toxicology,
Carl-Neuberg-Str. 1, 30625 Hannover, Germany. nora.anderson@web.de.
(2)Hannover Medical School, Centre for Pharmacology and Toxicology,
Carl-Neuberg-Str. 1, 30625 Hannover, Germany. borlak.juergen@mh-hannover.de.
Petadolex®, a defined butterbur extract has clinically proven efficacy against

migraine attacks. However, spontaneous reports indicate cases of herbal induced
liver injury (HILI). While most HILI patients presented mild serum biochemistry
changes (<3 ULN, dose range 50 to 225 mg/day; treatment duration 4-730 days) nine
developed severe HILI (average time-to-onset 103 days, ALT-range 3-153; AST
2-104-fold ULN). HILI cases resolved after medication withdrawal though two
patients required liver transplantation. Liver biopsies revealed an inconsistent
injury pattern, i.e. necrosis, macrovesicular steatosis, inflammation,
cholestasis, and bile duct proliferation. Causality assessment rated 3 cases
likely, 13 possible, 8 unlikely and 24 as unclassifiable/unclassified. Note, 22
patients reported hepatotoxic co-medications especially during periods of pain. A
no-observable-adverse-effect-level at 15-fold of the maximal clinical dose (3
mg/kg/day MCD) was established for rats. At >45 and 90-fold MCD bile duct
hyperplasia was observed but could not be confirmed in an explorative minipig
study at 218-fold MCD. Human hepatocyte studies at 49-fold Cmax serum petasins
(=active ingredient) and therapeutic Ibuprofen, Paracetamol and Naratriptan
concentrations evidenced liver transaminase and CYP-monooxygenase changes.
Collectively, Petadolex® HILI cases are rare, idiosyncratic and frequently
confounded by co-medications. A physician-supervised self-medication plan with
herbs and pain relief medication is needed to minimize risk for HILI.
DOI: 10.3390/jcm8050652
PMCID: PMC6572430
PMID: 31083451
Conflict of interest statement: Several mechanistic safety studies were performed

at the Fraunhofer Institute of Toxicology and Experimental Medicine, Germany and
were funded by the manufacturer of Petadolex, Weber & Weber GmbH & Co. KG,
Germany in 2008–2010. J.B. served as a scientific advisor to Weber & Weber and
received a consultancy fee. The sponsor had no role in the design, execution,
interpretation or writing of the study.
Mapping patients' experiences from initial symptoms to gout diagnosis: a

qualitative exploration.
Liddle J(1), Roddy E(1), Mallen CD(1), Hider SL(1), Prinjha S(2), Ziebland S(2),
Richardson JC(1).
Author information:
(1)Research Institute for Primary Care and Health Sciences, Keele University,
Keele, UK.
(2)Nuffield Department of Primary Care Health Sciences, Oxford University,
Oxford, UK.
OBJECTIVE: To explore patients' experiences from initial symptoms to receiving a

diagnosis of gout.
DESIGN: Data from in-depth semistructured interviews were used to construct
themes to describe key features of patients' experiences of gout diagnosis.
PARTICIPANTS AND SETTING: A maximum variation sample of 43 UK patients with gout
(29 men; 14 women; age range 32-87 years) were recruited from general practices,
rheumatology clinics, gout support groups and through online advertising.
RESULTS: Severe joint pain, combined with no obvious signs of physical trauma or
knowledge of injury, caused confusion for patients attempting to interpret their
symptoms. Reasons for delayed consultation included self-diagnosis and/or
self-medication, reluctance to seek medical attention, and financial/work
pressures. Factors potentially contributing to delayed diagnosis after
consultation included reported misdiagnosis, attacks in joints other than the
first metatarsophalangeal joint, and female gender. The limitations in using
serum uric acid (SUA) levels for diagnostic purposes were not always communicated
effectively to patients, and led to uncertainty and lack of confidence in the
accuracy of the diagnosis. Resistance to the diagnosis occurred in response to
patients' beliefs about the causes of gout and characteristics of the people
likely to be affected. Diagnosis prompted actions, such as changes in diet, and
evidence was found of self-monitoring of SUA levels.
CONCLUSIONS: This study is the first to report data specifically about patients'
pathways to initial consultation and subsequent experiences of gout diagnosis. A
more targeted approach to information provision at diagnosis would improve
patients' experiences.
DOI: 10.1136/bmjopen-2015-008323
PMCID: PMC4577947
529. Harm Reduct J. 2018 Jul 5;15(1):35. doi: 10.1186/s12954-018-0241-y.
Pain as a risk factor for substance use: a qualitative study of people who use
drugs in British Columbia, Canada.
Voon P(1)(2), Greer AM(2)(3), Amlani A(3), Newman C(3), Burmeister C(3), Buxton
JA(4)(5).
Author information:
(1)British Columbia Centre on Substance Use, 400 - 1045 Howe Street, Vancouver,
BC, V6Z 2A9, Canada.
(2)School of Population and Public Health, Faculty of Medicine, University of
British Columbia, 2206 East Mall, Vancouver, BC, V6Z 1Z3, Canada.
(3)British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver,
BC, V5Z 4R4, Canada.
(4)School of Population and Public Health, Faculty of Medicine, University of
British Columbia, 2206 East Mall, Vancouver, BC, V6Z 1Z3, Canada.
jane.buxton@bccdc.ca.
(5)British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver,
BC, V5Z 4R4, Canada. jane.buxton@bccdc.ca.
BACKGROUND: People who use drugs have a significantly higher prevalence of

chronic non-cancer pain compared to the general population, yet little is known
about how various policy, economic, physical, and social environments may serve
as risk or protective factors in the context of concurrent pain and substance
use. Therefore, this study sought to explore perspectives, risks, and harms
associated with pain among people who use drugs.
METHODS: Thirteen focus group interviews were held across British Columbia,
Canada, from July to September 2015. In total, 83 people who had lived experience
with substance use participated in the study. Using an interpretive description
approach, themes were conceptualized according to the Rhodes' Risk Environment
and patient-centered care frameworks.
RESULTS: Participants described how their experiences with inadequately managed
pain in various policy, economic, physical, and social environments reinforced
marginalization, such as restrictive policies, economic vulnerability, lack of
access to socio-physical support systems, stigma from health professionals, and
denial of pain medication leading to risky self-medication. Principles of
patient-centered care were often not upheld, from a lack of recognition of
patients as experts in understanding their unique pain needs and experiences, to
an absence of shared power and decision-making, which often resulted in distrust
of the patient-provider relationship.
CONCLUSIONS: Various risk environments and non-patient-centered interactions may
contribute to an array of health and social harms in the context of inadequately
managed pain among people who use drugs.
DOI: 10.1186/s12954-018-0241-y
PMCID: PMC6034304
530. Addict Biol. 2014 Nov;19(6):1020-31. doi: 10.1111/adb.12082. Epub 2013 Aug 6.
Nicotine is more addictive, not more cognitively therapeutic in a

neurodevelopmental model of schizophrenia produced by neonatal ventral
hippocampal lesions.
Berg SA(1), Sentir AM, Cooley BS, Engleman EA, Chambers RA.
Author information:
(1)Laboratory for Translational Neuroscience of Dual Diagnosis and Development,
Institute of Psychiatric Research and Training Program in Addiction Psychiatry,
Indiana University Department of Psychiatry, Indianapolis, IN, USA.
Nicotine dependence is the leading cause of death in the United States. However,
research on high rates of nicotine use in mental illness has primarily explained
this co-morbidity as reflecting nicotine's therapeutic benefits, especially for
cognitive symptoms, equating smoking with 'self-medication'. We used a leading
neurodevelopmental model of mental illness in rats to prospectively test the
alternative possibility that nicotine dependence pervades mental illness because
nicotine is simply more addictive in mentally ill brains that involve
developmental hippocampal dysfunction. Neonatal ventral hippocampal lesions
(NVHL) have previously been demonstrated to produce post-adolescent-onset,
pharmacological, neurobiological and cognitive-deficit features of schizophrenia.
Here, we show that NVHLs increase adult nicotine self-administration,
potentiating acquisition-intake, total nicotine consumed and drug seeking.
Behavioral sensitization to nicotine in adolescence prior to self-administration
is not accentuated by NVHLs in contrast to increased nicotine self-administration
and behavioral sensitization documented in adult NVHL rats, suggesting
periadolescent neurodevelopmental onset of nicotine addiction vulnerability in
the NVHL model. Delivering a nicotine regimen approximating the exposure used in
the sensitization and self-administration experiments (i.e. as a treatment) to
adult rats did not specifically reverse NVHL-induced
cortical-hippocampal-dependent cognitive deficits and actually worsened cognitive
efficiency after nicotine treatment stopped, generating deficits that resemble
those due to NVHLs. These findings represent the first prospective evidence
demonstrating a causal link between disease processes in schizophrenia and
nicotine addiction. Developmental cortical-temporal limbic dysfunction in mental
illness may thus amplify nicotine's reinforcing effects and addiction risk and
severity, even while producing cognitive deficits that are not specifically or
substantially reversible with nicotine.
© 2013 The Authors. Addiction Biology published by John Wiley & Sons Ltd on
behalf of Society for the Study of Addiction.
DOI: 10.1111/adb.12082
PMCID: PMC3916969
531. Asthma Res Pract. 2015 Jun 4;1:4. eCollection 2015.
The patient with rhinitis in the pharmacy. A cross-sectional study in real life.
Lombardi C(1), Musicco E(1), Rastrelli F(2), Bettoncelli G(3), Passalacqua G(4),
Canonica GW(4).
Author information:
(1)Unit of Allergy-Clinical Immunology & Respiratory Diseases - Department of
Medicine & Geriatrics, Poliambulanza Hospital Institute, Brescia, Italy.
(2)President of the Order of Pharmacists of Brescia, Brescia, Italy.
(3)General Practitioner, Brescia, National Responsible for the Pulmonology Area
of the Italian Society of General Practitioners (SIMMG), Brescia, Italy.
(4)Allergy & Respiratory Diseases, Department of Internal Medicine, University of
Genoa, Genoa, Italy.
BACKGROUND: In the practical management of allergic rhinitis (AR), pharmacists

are usually the first-line contact, also because some medications are available
as over the counter. Therefore, pharmacists may represent an important resource,
in mediating the interaction between patients and physicians. We evaluated the
clinical/demographic characteristics of patients with respiratory allergies who
consulted their pharmacists as first-line contact. A patient-oriented
questionnaire was developed by a scientific committee including pharmacists, GPs,
allergists, pulmonologists and ENT specialists.
METHODS: The questionnaire consisted of items covering the general aspects of AR.
Allergic Rhinitis and its Impact on Asthma guidelines were assumed as reference
for diagnosis and therapy. The questionnaire was distributed to pharmacies, and
pharmacists were asked to deliver the questionnaire to all patients referring for
nasal symptoms.
RESULTS: 30 pharmacies were involved during the pollen season 2011, and 410
patients (55 % male) participated. The most frequent complaints were 20 rhinitis
(49 %) and conjunctivitis (29 %), followed by lower respiratory symptoms (cough
and/or dyspnea). Isolated conjunctival symptoms were present in only 22 % of
patients. Among patients with lower respiratory symptoms, cough was the most
frequent, variously associated with upper respiratory symptoms or overt dyspnea.
Dyspnea alone was present in 16 % of patients. 39 % of patients had no
physician-based diagnosis. Oral antihistamines were the most used
self-medication, followed by intranasal decongestants. 30 % of respondents had
used alternative medicines.
CONCLUSION: According to these data, AR is still considered a trivial disease,
frequently self-managed, with over the counter medications, not in line with
guidelines. A physician-based diagnosis is present in about 60 % of patients.
DOI: 10.1186/s40733-015-0002-6
PMCID: PMC4970378
PMID: 27965758
532. J Pain. 2015 Sep;16(9):887-94. doi: 10.1016/j.jpain.2015.06.003. Epub 2015 Jun

21.
Pain Among High-Risk Patients on Methadone Maintenance Treatment.
Voon P(1), Hayashi K(2), Milloy MJ(3), Nguyen P(2), Wood E(3), Montaner J(3),
Kerr T(4).
Author information:
Vancouver, BC, Canada; School of Population and Public Health, Faculty of
Medicine, University of British Columbia, Vancouver, BC, Canada.
Vancouver, BC, Canada; Department of Medicine, University of British Columbia,
St. Paul's Hospital, Vancouver, BC, Canada.
Vancouver, BC, Canada; Department of Medicine, University of British Columbia,
St. Paul's Hospital, Vancouver, BC, Canada. Electronic address:
uhri-tk@cfenet.ubc.ca.
The complexity of treating concurrent pain and opioid dependence among many
methadone-maintained individuals presents a major challenge in many clinical
settings. Furthermore, recent expert guidelines have called for increased
research on the safety of methadone in the context of chronic pain. This study
explores the prevalence and correlates of pain among a prospective cohort of
people who use illicit drugs in Vancouver, British Columbia, Canada, who reported
enrollment in methadone maintenance treatment (MMT) between 2011 and 2014. Among
the 823 participants eligible for this analysis, 338 (40.9%) reported moderate
pain and 91 (11.1%) reported extreme pain at the first study visit. In
multivariable, generalized, linear mixed model analyses, higher pain severity was
positively and independently associated with self-managing pain (adjusted odds
ratio [AOR] 2.15, 95% confidence interval [CI] 1.77-2.60), patient perception of
methadone dose being too low (AOR 1.82, 95% CI 1.41-2.34), older age (AOR 1.31,
95% CI 1.13-1.51), having a physical disability (AOR 4.59, 95% CI 3.73-5.64),
having ever been diagnosed with a mental illness (AOR 1.44, 95% CI 1.13-1.84),
white ethnicity (AOR 1.42, 95% CI 1.10-1.83), and marijuana use (AOR 1.25, 95% CI
1.02-1.52). These findings suggest several areas for clinical intervention,
particularly related to patient education and alternative analgesic approaches
for MMT patients experiencing pain. Perspective: To better understand the
complexity of concurrent pain and opioid dependency among individuals on
methadone maintenance treatment, this article describes the prevalence and
correlates of higher pain severity among methadone-maintained people who use
illicit drugs. Patients on methadone with comorbid pain may benefit from
education and alternative analgesic approaches.
Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights
reserved.
DOI: 10.1016/j.jpain.2015.06.003
PMCID: PMC4556532
533. J Infect Public Health. 2018 Mar - Apr;11(2):165-170. doi:

10.1016/j.jiph.2017.06.004. Epub 2017 Jun 28.
Morbidity and mortality amongst Indian Hajj pilgrims: A 3-year experience of

Indian Hajj medical mission in mass-gathering medicine.
Khan ID(1), Khan SA(2), Asima B(3), Hussaini SB(4), Zakiuddin M(5), Faisal FA(6).
Author information:
(1)Clinical Microbiology and Infectious Diseases, Army College of Medical
Sciences and Base Hospital, New Delhi 110010, India. Electronic address:
titan_afmc@yahoo.com.
(2)Army College of Medical Sciences and Base Hospital, New Delhi 110010, India.
(3)Nuclear Medicine, Army Hospital Research and Referral, New Delhi, India.
(4)Madurai Medical College, Madurai 625020, India.
(5)Provincial Medical Services, Karnataka, India.
(6)MH, Roorkee, India.
The Hajj, a mass-gathering of over 3.5-million pilgrims, faces challenges to

global health-security, housing, food, water, transportation, communication,
sanitation, crowd-control and security. The Indian Medical Mission extended
health-security to approximately 140,000 pilgrims, through outreach medical
teams, primary-care clinics, tent-clinics, secondary-care hospitals and
evacuation capabilities. Data on medical attendance, bed-occupancy,
investigations, referrals, medication usage and deaths was compared. Outpatient
attendance was 374,475 in static-clinics, 5135 in tent-clinics and 13,473 through
task-forces. 585 (62.90%) in-patients were hospitalized amongst 930
secondary-care referrals. Secondary-care bed-days were 2106 with average
bed-occupancy being 77.78%. 495 patients were institutionalized in tertiary-care
Saudi-Arabian hospitals. Infectious diseases were most commonly (53.26%)
encountered due to overwhelming respiratory-infections, followed by trauma
(24.40%). Analgesics (66.38/100 patients) and antibacterials (48.34/100 patients)
were frequently prescribed. Crude mortality amongst Indian pilgrims was
11.99/10,000. Risk-factors associated with high morbidity were old-age and
pre-existing comorbidities. Overwhelming surge of patients facilitates
transmission of communicable infections and leads to stress induced physical,
mental and compassion fatigue amongst healthcare personnel. Respiratory
infections are highly prevalent and easily transmissible during Hajj leading to
significant morbidity, increased burden to existing health facilities,
overwhelming costs on health systems and globalization of multiresistant
pathogens. Diabetic patients should avoid heat exposure and use protective
footwear during Hajj rituals. Mass-gathering medicine at Hajj can be optimized by
improving patient knowledge on performing Hajj at a younger age, medicine
compliance, avoiding self-medication, self-monitoring of hypertension, blood
glucose, and preventive health measures; screening of pre-existing comorbidities;
and resource augmentation with telemedicine networks and decision-support
systems.
DOI: 10.1016/j.jiph.2017.06.004
534. Pak J Med Sci. 2016 Nov-Dec;32(6):1557-1561. doi: 10.12669/pjms.326.10788.
Knowledge, Attitude and Practice of mothers on acute respiratory infection in

children under five years.
Bham SQ(1), Saeed F(2), Shah MA(3).
Author information:
(1)Dr. Shireen Qasim Bham, DCH, FCPS. Department of Pediatrics, Liaquat College
of Medicine & Dentistry and Darul Sehat Hospital, Karachi, Pakistan.
(2)Dr. Farhan Saeed, DCH, FCPS. Department of Pediatrics, Liaquat College of
Medicine & Dentistry and Darul Sehat Hospital, Karachi, Pakistan.
(3)Dr. Manzar Alam Shah, MPH. Department of Community Medicine, Liaquat College
of Medicine & Dentistry and Darul Sehat Hospital, Karachi, Pakistan.
OBJECTIVE: To assess Knowledge, Attitude and Practices of mothers on ARI (Acute

Respiratory Tract Infection) in children less than five years of age.
METHODS: This cross-sectional survey was conducted in the Department of
Pediatrics, Darul Sehat hospital from 1st December 2014 to 28th February 2015.
Mothers(n=335) who were local residents, had at least one child below the age of
five years and coming to the hospital for any medical problem along with
accompanying women were included. Foreign mothers and/or those having difficulty
in perceiving questions were excluded. Language used in the Questionnaire was
English which was translated to Urdu for better understanding. Questionnaire was
interviewer administered. Researchers and two house physicians took part in
questioning the mothers.
RESULTS: Total 335 children were studied. Out of 335 children 228(68%) had ARI.
Mean age of the children was 20 months ±17 SD while mean Birth weight was 2.7 kg
± 1.8 SD. The most common symptom perceived was cough (n=303, 40%), mostly
worsening during winter season (n=255,87%), commonest aggravating factor was dust
(n=174,81%), most common complication was Pneumonia (n=135, 83%), and most
mothers opted for medical practitioner (n=268,89%) for treatment. Self-medication
was practiced by 192(58%) and paracetamol was frequently used medication
(n=117,42%).
CONCLUSION: The study reveals good knowledge of mothers on ARI symptoms,
worsening environmental conditions, aggravating factors and complications. Their
attitude towards ARI was appropriate with early consultation with qualified
medical practitioner. Better literacy rate, has a positive influence on the
Knowledge, Attitude and Practices of mothers.
DOI: 10.12669/pjms.326.10788
PMCID: PMC5216320
PMID: 28083064
Conflict of interest statement: Declaration of interest: The authors declare no
conflict of interest with regard to research, authorship and publication of the
study.
535. J Headache Pain. 2018 Feb 1;19(1):10. doi: 10.1186/s10194-018-0839-1.
Poor medical care for people with migraine in Europe - evidence from the
Eurolight study.
Katsarava Z(1), Mania M(2), Lampl C(3), Herberhold J(4), Steiner TJ(5)(6).
Author information:
(1)Evangelical Hospital Unna, University of Duisburg-Essen, Essen, Germany.
Zaza.katsarava@gmail.com.
(2)Aversi Hospital, Tbilisi, Georgia.
(3)Headache Medical Center, Department of Neurogeriatric Medicine and
Remobilisation, Hospital of the Sisters of Charity, Linz, Austria.
(4)Medical Faculty, Stradins University, Riga, Latvia.
(5)Department of Neuromedicine and Movement Science, Faculty of Medicine and
Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim,
Norway.
(6)Division of Brain Sciences, Imperial College London, London, UK.
BACKGROUND: Migraine is prevalent everywhere, and disabling. It is also

neglected: consequently, it is under-diagnosed and undertreated. We analysed data
from the Eurolight study on consultations and utilization of migraine-specific
medications as indicators of adequacy of medical care in Europe.
METHODS: Eurolight was a cross-sectional questionnaire-based survey in 10
European countries. Sampling was population-based in six (Germany, Italy,
Lithuania, Luxembourg, Netherlands, Spain) and from consecutive patients
attending general practitioners (GPs) for any reason in three (Austria, France,
UK). Additional samples in Netherlands and Spain, and the only sample from
Ireland, were recruited by lay headache organisations. We recorded migraine
prevalence and frequency, and utilization of medical services and medications
(acute and preventative).
RESULTS: Among 9247 participants (mean age 43.9 ± 13.9 years, M/F ratio 1:1.4),
3466 (37.6%) were diagnosed with migraine (definite or probable). Of these, 1175
(33.8%) reported frequent migraine (> 5 days/month) and might clearly expect
benefit from, and therefore had need of, preventative medication. In
population-based samples, minorities of participants with migraine had seen a GP
(9.5-18.0%) or specialist (3.1-15.0%), and smaller minorities received adequate
treatment: triptans 3.4-11.0%, with Spain outlying at 22.4%; preventative
medication (1.6-6.4% of those eligible, with Spain again outlying at 13.7%).
Proportions were greater in GP-based samples (13.6-24.5% using triptans, 4.4-9.1%
on preventative medication) and among those from lay organisations (46.2-68.2%
and 16.0-41.7%). Participants with migraine who had consulted specialists
(3.1-33.8%) were receiving the best care by these indicators; those treated by
GPs (9.5-29.6%) fared less well, and those dependent on self-medication
(48.0-84.2%) were, apparently, inadequately treated.
CONCLUSION: In wealthy European countries, too few people with migraine consult
physicians, with proportionately too many of these seeing specialists, and
migraine-specific medications are used inadequately even among those who do.
These findings represent yet another call for action in Europe to improve care
for people with headache. Education of both health-care providers and the public
should be central to this action.
DOI: 10.1186/s10194-018-0839-1
PMCID: PMC5794675
536. World J Gastroenterol. 2016 Feb 7;22(5):1877-83. doi: 10.3748/wjg.v22.i5.1877.
Italian survey on non-steroidal anti-inflammatory drugs and gastrointestinal

bleeding in children.
Cardile S(1), Martinelli M(1), Barabino A(1), Gandullia P(1), Oliva S(1), Di
Nardo G(1), Dall'Oglio L(1), Rea F(1), de'Angelis GL(1), Bizzarri B(1), Guariso
G(1), Masci E(1), Staiano A(1), Miele E(1), Romano C(1).
Author information:
(1)Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit,
Department of Pediatrics, University of Messina, 98100 Messina, Italy.
AIM: To investigate gastrointestinal complications associated with non-steroidal

anti-inflammatory drug (NSAIDs) use in children.
METHODS: A retrospective, multicenter study was conducted between January 2005
and January 2013, with the participation of 8 Italian pediatric gastroenterology
centers. We collected all the cases of patients who refer to emergency room for
suspected gastrointestinal bleeding following NSAIDs consumption, and underwent
endoscopic evaluation. Previous medical history, associated risk factors,
symptoms and signs at presentation, diagnostic procedures, severity of bleeding
and management of gastrointestinal bleeding were collected. In addition, data
regarding type of drug used, indication, dose, duration of treatment and
prescriber (physician or self-medication) were examined.
RESULTS: Fifty-one patients, including 34 males, were enrolled (median age: 7.8
years). Ibuprofen was the most used NSAID [35/51 patients (68.6%)]. Pain was the
most frequent indication for NSAIDs use [29/51 patients (56.9%)]. Seven patients
had positive family history of Helicobacter pylori (H. pylori) infection or
peptic ulcer, and 12 had associated comorbidities. Twenty-four (47%) out of 51
patients used medication inappropriately. Hematemesis was the most frequent
symptom (33.3%). Upper gastrointestinal endoscopy revealed gastric lesions in
32/51 (62%) patients, duodenal lesions in 17 (33%) and esophageal lesions in 8
(15%). In 10/51 (19.6%) patients, a diagnosis of H. pylori gastritis was made.
Forty-eight (94%) patients underwent medical therapy, with spontaneous bleeding
resolution, while in 3/51 (6%) patients, an endoscopic hemostasis was needed.
CONCLUSION: The data collected in this study confirms that adverse events with
the involvement of the gastrointestinal tract secondary to NSAID use are also
common in children.
DOI: 10.3748/wjg.v22.i5.1877
PMCID: PMC4724619
537. Braz J Infect Dis. 2017 Mar - Apr;21(2):133-139. doi:

10.1016/j.bjid.2016.11.008.
Epub 2016 Dec 21.
Factors associated with pain in individuals infected by human T-cell lymphotropic

virus type 1 (HTLV-1).
Santos DN(1), Santos KO(2), Paixão AB(2), Andrade RC(3), Costa DT(4), S-Martin
DL(5), Sá KN(6), Baptista AF(7).
Author information:
(1)Universidade Federal da Bahia, Programa de Pós-graduação em Medicina e Saúde,
Salvador, BA, Brazil; Universidade Federal da Bahia, Laboratório de
Eletroestimulação Funcional, Salvador, BA, Brazil; Universidade Federal da Bahia,
Hospital Professor Edgard Santos, Serviço de Imunologia, Salvador, BA, Brazil.
(2)Universidade Federal da Bahia, Laboratório de Eletroestimulação Funcional,
Salvador, BA, Brazil.
(3)Universidade Federal da Bahia, Hospital Professor Edgard Santos, Serviço de
Imunologia, Salvador, BA, Brazil.
(4)Universidade Federal da Bahia, Hospital Professor Edgard Santos, Serviço de
Imunologia, Salvador, BA, Brazil; Universidade Estadual do Sudoeste da Bahia,
Vitoria da Conquista, BA, Brazil.
Salvador, BA, Brazil; Universidade Federal da Bahia, Faculdade de Medicina da
Bahia, Salvador, BA, Brazil.
Salvador, BA, Brazil; Escola Bahiana de Medicina e Saúde Pública, Pós graduação e
pesquisa, Salvador, BA, Brazil.
(7)Universidade Federal da Bahia, Programa de Pós-graduação em Medicina e Saúde,
Salvador, BA, Brazil; Universidade Federal da Bahia, Laboratório de
Eletroestimulação Funcional, Salvador, BA, Brazil; Escola Bahiana de Medicina e
Saúde Pública, Pós graduação e pesquisa, Salvador, BA, Brazil. Electronic
address: afbaptista@ufba.br.
INTRODUCTION: Despite the high prevalence of chronic pain in individuals infected

with HTLV-1, predictive and protective factors for its development are still
unclear.
OBJECTIVE: To identify factors associated with chronic pain in individuals with
HTLV-1.
METHODS: This cross-sectional study was conducted in a reference center for
treatment of patients infected with HTLV-1 in Salvador, Bahia, Brazil. The study
included individuals infected with HTLV-1, over 18 years, and excluded those with
difficulty to respond the pain protocol. Data on sociodemographic, health
behavior, and clinical characteristics were collected in a standardized way. The
prevalence ratio (PR) of pain is described, as well as the factors independently
associated with the presence of pain, which were assessed by multiple logistic
regression.
RESULTS: A total of 142 individuals were included in the study, mostly female
(62.7%), aged 20-64 years (73.2%), married (61.3%), with less than eight years of
education (54.2%), and with a steady income (79.6%). Multivariate analysis showed
that being symptomatic for HTLV-1 - sensory manifestations, erectile dysfunction,
overactive bladder, and/or HAM/TSP (PR=1.21, 95% CI: 1.05 to 1.38),
self-medication (PR=1.29, 95% CI: 1.08-1.53), physiotherapy (PR=1.15, 95% CI:
1.02-1.28), and depression (PR=1.14, 95% CI: 1.01-1.29) were associated with an
increased likelihood of presenting pain. On the other hand, physical activity
(PR=0.79, 95% CI: 0.67-0.93) and religious practice (PR=0.83, 95% CI: 0.72-0.95)
were associated with a decreased likelihood of having pain.
CONCLUSION: The use of self-medication, physiotherapy and the presence of
depression are independently associated with neurological symptoms in HTLV-1
infected patients. Religious practice and physical activity are both protective
for the development of pain.
Copyright © 2016 Sociedade Brasileira de Infectologia. Published by Elsevier

Editora Ltda. All rights reserved.
DOI: 10.1016/j.bjid.2016.11.008

Perceptions in the community about the use of antibiotics without a prescription:
Exploring ideas behind this practice.
Aponte-González J(1), González-Acuña A(2), Lopez J(3), Brown P(4),

Eslava-Schmalbach J(5).
Author information:
(1)Pharmacy Department, School of Sciences, Universidad Nacional de Colombia.
Bogotá (Colombia). jaaponteg@unal.edu.co.
Bogotá (Colombia). anagonzalezac@unal.edu.co.
Bogotá (Colombia). jjlopezg@unal.edu.co.
(4)Director Public Health and Health Sciences Research Institute, University of
California. Merced, CA (United States). pbrown3@ucmerced.edu.
(5)Hospital Universitario Nacional de Colombia; & Clinical Research Institute,
Faculty of Medicine, Universidad Nacional de Colombia. Bogotá (Colombia).
jheslavas@unal.edu.co.
Objective: The use of antibiotics without prescription is common in Colombia as

well as in other developing countries. The objective of this study is to explore
the attitudes and motivations associated with the use of antibiotics without
prescription.
Methods: Focus group sessions were held with residents of Bogotá. Different
socioeconomic groups were approached to identify possible differences of opinion.
A semi-structured interview guide was used to guide the discussion, with thematic
analysis used to identify central themes.
Results: In total, 21 people, aged between 25 and 50 years participated in four
focus groups. The results suggest that the use of antibiotics without
prescription is common practice. The main reasons included barriers to access to
prescribed medications due to limited health insurance. Even those with adequate
access to health insurance report being willing to use a treatment without a
prescription if they have confidence in its effectiveness. The relationship with
the physician is important, but pharmacy storekeepers are also highly trusted.
While some participants understood that antibiotics can cure infections but cause
serious adverse events, several misconceptions about antibiotics therapy were
identified. These included a lack of knowledge of resistance transmissibility
among communities.
Conclusions: The results have implications for interventions aimed at reducing
inappropriate use of antibiotics, highlighting i) how lack of access to timely
care creates an incentive to self-prescribe, ii) the key role that pharmacy
storekeepers play in the Colombian healthcare system and the need to include them
in interventions, and iii) the misconceptions about inappropriate use of
medications that need to be addressed by educational programs. These findings
provide insights to other countries where antibiotics misuse is also a problem.
DOI: 10.18549/PharmPract.2019.1.1394
PMCID: PMC6463418
PMID: 31015877
Conflict of interest statement: CONFLICT OF INTEREST The authors state that they
do not present any conflict of interests in the present investigation.
539. Pan Afr Med J. 2017 Mar 29;26:177. doi: 10.11604/pamj.2017.26.177.11519.

eCollection 2017.
Paediatric otogenic tetanus: an evidence of poor immunization in Nigeria.

Ogunkeyede SA(1), Daniel A(1), Ogundoyin O(1).
Author information:
(1)Department of Otorhinolaryngology, College of Medicine, University of Ibadan,
Ibadan and University College Hospital, Ibadan Nigeria.
Suppurative otitis media is a common childhood infection that predisposes to

otogenic tetanus. Tetanus is a vaccine preventable disease that is associated
with high cost of care and mortality. This study highlights reasons for otogenic
tetanus in Nigerian children and way of reducing the menace. This is a 5-year
retrospective review of all patients managed for otogenic tetanus in at the
Department of Otorhinolaryngology, University College Hospital, Ibadan. The data
collected include demographic, clinical presentations, tetanus immunisation
history, and duration of hospital admission, and management- outcome. There were
23 patients comprising of 13(56.5 %) males and 10 (43.5%) females, male to female
ratio was 1.3:1. The age ranged between 11 months and12 years (mean age 3.4 years
± 2.1). All the patients presented with discharging ear, trismus and spasms. The
onset of symptoms prior hospital presentation ranged between 2 - 11 days (mean
3.0 days ± 1.3). Only 12(52.1%) patients had complete childhood tetanus
immunisation, 6(26.1) % had no tetanus immunisation and no other childhood
immunisation, while 5(21.7%) had partial tetanus immunisation. The discharging
ears were managed by self-medication and other harmful health practices. The
hospital admission ranged from 20 days - 41days (average of 23days) and there
were 3(13.0 %) death. Tetanus immunization was not received because of; non-
availability of the vaccine at health centers, lack of health facility in
communities, fear of complications from immunization, poor awareness of the
immunization programme. Tetanus, an immunisable disease, is still a major problem
in Nigeria.
DOI: 10.11604/pamj.2017.26.177.11519
PMCID: PMC5483367
Conflict of interest statement: The authors declare no competing interests.
540. J Infect Public Health. 2017 Nov - Dec;10(6):755-760. doi:

10.1016/j.jiph.2016.11.011. Epub 2017 Feb 13.
Socio-economic factors, cultural values, national personality and antibiotics

use: A cross-cultural study among European countries.
Gaygısız Ü(1), Lajunen T(2), Gaygısız E(3).
Author information:
(1)Intensive Care Unit, Department of Anesthesiology and Intensive Care, Erzurum
Regional Training and Research Hospital, Erzurum, Turkey.
(2)Department of Psychology, Norwegian University of Science and Technology
(NTNU), Trondheim, Norway. Electronic address: timo.lajunen@svt.ntnu.no.
(3)Department of Economics, Middle East Technical University, Ankara, Turkey.
There are considerable cross-national differences in public attitudes towards

antibiotics use, use of prescribed antibiotics, and self-medication with
antibiotics even within Europe. This study was aimed at investigating the
relationships between socio-economic factors, cultural values, national
personality characteristics and the antibiotic use in Europe. Data included
scores from 27 European countries (14 countries for personality analysis).
Correlations between socio-economic variables (Gross National Income per capita,
governance quality, life expectancy, mean years of schooling, number of
physicians), Hofstede's cultural value dimensions (power distance, individualism,
masculinity, uncertainty avoidance, long-term orientation, indulgence), national
personality characteristic (extraversion, neuroticism, social desirability) and
antibiotic use were calculated and three regression models were constructed.
Governance quality (r=-.51), mean years of schooling (r=-.61), power distance
(r=.59), masculinity (r=.53), and neuroticism (r=.73) correlated with antibiotic
use. The highest amount of variance in antibiotic use was accounted by the
cultural values (65%) followed by socio-economic factors (63%) and personality
factors (55%). Results show that socio-economic factors, cultural values and
national personality characteristics explain cross-national differences in
antibiotic use in Europe. In particular, governance quality, uncertainty
avoidance, masculinity and neuroticism were important factors explaining
antibiotics use. The findings underline the importance of socio-economic and
cultural context in health care and in planning public health interventions.
DOI: 10.1016/j.jiph.2016.11.011
541. Tuberc Res Treat. 2019 Feb 3;2019:4840561. doi: 10.1155/2019/4840561.

eCollection
2019.
Patient Health Seeking and Diagnostic Delay in Extrapulmonary Tuberculosis: A

Hospital Based Study from Central India.
Purohit MR(1)(2)(3)(4), Purohit R(5), Mustafa T(4)(6).
Author information:
(1)Department of Pathology, R.D. Gardi Medical College, Ujjain, India.
(2)Central Clinical Laboratory, Ujjain Charitable Trust Hospital and Research
Centre, Ujjain, India.
(3)Division of Global Health, Department of Public Health Sciences, Karolinska
(4)Centre for International Health, Department of Global Public Health and
Primary Care, University of Bergen, Norway.
(5)Intern, R.D. Gardi Medical College, Ujjain, India.
(6)Department of Thoracic Medicine, Haukeland University Hospital, Bergen,
Norway.
Objective: We aimed to investigate the awareness, health care seeking behavior,

and diagnostic delay in extrapulmonary tuberculosis (EPTB) in a
resource-constrained setting from Central India.
Setting and Method: Questionnaire based interview of 1220 EPTB patients ≥14 years
of age was conducted between July 2004 and August 2012 at Ujjain charitable
Hospital, Ujjain, India.
Results: Only 15% of patients had ever heard about EPTB and 2-4% knew about its
prevention or treatment. Only 12% patients first sought medical advice while 49%
patients practiced self-medication, 28% consulted traditional healers and 11%
drug store/pharmacy. The median patient delay was 8 weeks (4.6-21.4 weeks).
Majority (78%) of patients visited ≥3 health centers. Thirty-eight percent
patients first visited any government health facility. Majority (97%) who first
visited district and primary public health center were referred to private sector
for investigations and 82% patients changed the consultation to private doctor
after initial visit to public hospital. The median health system delay was 7
weeks (0.6-16.4 weeks).
Conclusion: Patients had very poor awareness of EPTB. Patients were referred from
public to private sector in search of diagnostic facilities. Improvement of
public awareness about EPTB and better public-private partnership may contribute
towards reduction in diagnostic delay.
DOI: 10.1155/2019/4840561
PMCID: PMC6378024
PMID: 30854235
542. Open Neurol J. 2017 Dec 22;11:84-91. doi: 10.2174/1874205X01711010084.

eCollection 2017.
Omega-3 Hastens and Omega-6 Delays the Progression of Neuropathology in a Murine

Model of Familial ALS.
Boumil EF(1)(2), Vohnoutka RB(1)(2), Liu Y(2), Lee S(1), Shea TB(1).
Author information:
(1)Laboratory for Neuroscience, University of Massachusetts Lowell, Lowell, MA
01854, USA.
(2)Department of Biomedical and Nutritional Sciences, University of Massachusetts
Lowell, Lowell, MA 01854, USA.
Background: Amyotrophic lateral sclerosis (ALS) is a progressive disease of motor

neurons that has no cure or effective treatment. Any approach that could sustain
minor motor function during terminal stages would improve quality of life.
Objective: We examined the impact of omega-3 (Ω-3) and Ω-6, on motor neuron
function in mice expressing mutant human superoxide dismutase-1 (SOD-1), which
dominantly confers familial ALS and induces a similar sequence of motor neuron
decline and eventual death when expressed in mice.
Method: Mice received standard diets supplemented with equivalent amounts of Ω-3
and Ω-6 or a 10x increase in Ω-6 with no change in Ω-3 commencing at 4 weeks of
age. Motor function and biochemical/histological parameters were assayed by
standard methodologies.
Results: Supplementation with equivalent Ω-3 and Ω-6 hastened motor neuron
pathology and death, while 10x Ω-6 with no change in Ω-3 significantly delayed
motor neuron pathology, including preservation of minor motor neuron function
during the terminal stage.
Conclusion: In the absence of a cure or treatment, affected individuals may
resort to popular nutritional supplements such as Ω-3 as a form of
"self-medication". However, our findings and those of other laboratories indicate
that such an approach could be harmful. Our findings suggest that a critical
balance of Ω-6 and Ω-3 may temporarily preserve motor neuron function during the
terminal stages of ALS, which could provide a substantial improvement in quality
of life for affected individuals and their caregivers.
DOI: 10.2174/1874205X01711010084
PMCID: PMC5748836
PMID: 29387280
543. Int J Environ Res Public Health. 2016 Dec 22;14(1). pii: E7. doi:
10.3390/ijerph14010007.
Motivations and Limitations Associated with Vaping among People with Mental
Illness: A Qualitative Analysis of Reddit Discussions.
Sharma R(1), Wigginton B(2), Meurk C(3)(4), Ford P(5), Gartner CE(6).
Author information:
(1)School of Public Health, The University of Queensland, Herston, QLD 4006,
Australia. r.ratika@uq.edu.au.
Australia. b.wigginton@uq.edu.au.
Australia. c.meurk@uq.edu.au.
(4)Policy and Epidemiology Group, Queensland Centre for Mental Health Research,
Locked Bag 500, Archerfield, QLD 4018, Australia. c.meurk@uq.edu.au.
(5)School of Dentistry, The University of Queensland, Herston, QLD 4006,
Australia. p.ford1@uq.edu.au.
Australia. c.gartner@uq.edu.au.
This study aims to understand the nature and significance of online lay
discussions about e-cigarettes and mental illness. We systematically searched the
website Reddit.com using keywords related to e-cigarettes and mental illness. We
coded relevant posts into themes under the framework of motivations for and
limitations of vaping for people with mental illness. The thematic analysis
included 3263 comments from 133 discussion threads. Six themes were classified as
motivations to vape for people with mental illness: Self-medication; Quitting
smoking; Freedom and control; Hobby; Social connectedness; and Motivation from
caregivers and online communities. The limitations of vaping included:
Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug
interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and
Cost. People with mental illness; and their carers; use online discussion boards
like Reddit to discuss the benefits and limitations of e-cigarettes for people
with mental illness. Both positive and negative views exist. Media platforms like
Reddit may shape the opinions of stakeholders and generate lay expertise about
contentious health topics such as e-cigarettes. These findings have implications
for policy and practice concerning assisting smokers with mental illness to
reduce their health risk through switching to e-cigarettes.
DOI: 10.3390/ijerph14010007
PMCID: PMC5295258

eCollection 2016.
Stretching the Boundaries: Tanzanian Pharmacy Workers' Views and Experiences of

Providing STI Services for Men Who Have Sex with Men.
Larsson M(1), Odberg Pettersson K(1), Kashiha J(2), Ross MW(3), Agardh A(1).
Author information:
(1)Division of Social Medicine and Global Health, Department of Clinical Sciences
Malmö, Lund University, Malmö, Sweden.
(2)Community Health Education Services & Advocacy (CHESA), Dar es Salaam,
Tanzania.
(3)Programme in Human Sexuality, Department of Family Medicine and Community
Health, Medical School, University of Minnesota, Minneapolis, Minnesota, United
States of America.
OBJECTIVE: To explore the views and experiences of providing assistance and

treatment of sexually transmitted infections to same-sex practicing male clients
among service providers at pharmacies and drugstores in Dar es Salaam, Tanzania.
Previous research suggests that sexually transmitted infections are an increasing
concern for this population. Due to stigma and discrimination, men who have sex
with men face limited access to treatment, which might contribute to increased
self-medication. However, limited research has been conducted on the role of the
pharmaceutical service provider with regards to this population in sub-Saharan
Africa.
METHOD: In January 2016, 16 service providers at private pharmacies and
drugstores with previous experience of providing services to this population were
purposively selected for open-ended face-to-face interviews. The analysis was
guided by the grounded theory approach.
RESULTS: The process that emerged was labelled "Stretching Boundaries for
Pharmaceutical Responsibilities". This reflected informants' perceptions of
themselves as being involved in a transition from having limited engagement in
the care of same-sex practicing male clients to becoming regular
service-providers to this group. Findings further revealed that the emotional
commitment they developed for clients through this process led to a transgression
of provider-client boundaries, which undermined objective decision-making when
clients lacked prescription. Financial interests also emerged as an underlying
motivation for providing incomplete or inaccurate drug dosages.
CONCLUSIONS: Further studies are required to better address incentives related to
unregulated sale of drugs. Inter-professional networks between pharmacy and
healthcare workers could support the development of targeted treatment for men
who have sex with men and other key populations.
PMCID: PMC5094583

interests exist.
545. Adicciones. 2016 Jun 14;29(1):6-12. doi: 10.20882/adicciones.724.
Tobacco and cognitive performance in schizophrenia patients: the design of the

COGNICO study.
[Article in English, Spanish; Abstract available in Spanish from the publisher]
Al-Halabí S(1), Fernández-Artamendi S, Díaz-Mesa EM, García-Álvarez L, Flórez G,

Martínez-Santamaría E, Arrojo M, Saiz PA, García-Portilla MP, Bobes J.
Author information:
(1)Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Área de
Psiquiatría, Universidad de Oviedo.. alsusana@uniovi.es.
People with schizophrenia constitute a substantial part of the people who still
smoke. Regarding cognitive performance, the self-medication hypothesis states
that patients smoke to improve their cognitive deficits based on the stimulating
effects of nicotine. The aim of this paper is to describe in detail the
methodology used in the COGNICO study. A quasi-experimental, observational,
prospective, multicenter study with follow-ups over 18 months was conducted in
three cities in northern Spain (Oviedo, Ourense and Santiago de Compostela). A
total of 81 outpatient smokers with schizophrenia were recruited with a mean age
43.35 years (SD = 8.83), 72.8% of them male. They were assigned to 3 groups: a)
control group (smokers); b) patients who quit smoking using nicotine patches; c)
patients who quit smoking with Varenicline. The MATRICS neuropsychological
battery was applied as a primary measure. In addition, a comprehensive assessment
of patients was performed, including the number of cigarettes per day, physical
and psychological dependence on nicotine and CO expired. Clinical evaluation
(PANSS, HDRS, CGI, C-SSRS), anthropometric measurements and vital signs
assessment was also performed. The aim is to identify the relationship between
the pattern of tobacco use and cognitive performance by comparing scores on the
neuropsychological battery MATRICS during the follow-up periods (3, 6, 12 and
18months). The importance of this study lies in addressing a topical issue often
ignored by clinicians: the unacceptably high rates of tobacco use in patients
with severe mental disorders.
Publisher: Las personas con esquizofrenia constituyen una parte sustancial de las
personas que todavía fuman. La hipótesis de la automedicación en relación al
rendimiento cognitivo mantiene que los pacientes fuman para mejorar su déficit
cognitivo basándose en los efectos estimulantes de la nicotina. El objetivo de
este artículo es describir la metodología del estudio COGNICO. Estudio
cuasiexperimental, observacional, prospectivo, multicéntrico y con seguimiento a
3, 6, 12 y 18 meses. Fue llevado a cabo en tres ciudades del norte de España
(Oviedo, Ourense y Santiago de Compostela). Se reclutaron 81pacientes con
esquizofrenia fumadores (edad media de 43,35 años (DT=8,83). 72,8% varones). Se
asignaron a 3 grupos: a) control: pacientes fumadores; b) pacientes que dejan de
fumar mediante parches de nicotina; c) pacientes que dejan de fumar mediante
vareniclina. Como medida primaria se aplicó la batería neuropsicológica MATRICS.
Además, se llevó a cabo una evaluación comprehensiva de los pacientes, que
incluía el número de cigarrillos por día, la dependencia física y psicológica a
la nicotina y el CO expirado. También se realizó una evaluación clínica general
(PANSS, HDRS, ICG, C-SSRS) así como un seguimiento de las medidas antropométricas
y los signos vitales. Se pretende identificar la relación entre el patrón de
consumo de tabaco y el rendimiento cognitivo mediante la comparación de las
puntuaciones en la batería neuropsicológica MATRICS durante los períodos de
seguimiento.
DOI: 10.20882/adicciones.724
546. Compr Psychiatry. 2015 Oct;62:209-17. doi: 10.1016/j.comppsych.2015.07.013.

Epub
2015 Jul 26.
Discrepancies between clinical needs and helpseeking behaviors in co-occurring

posttraumatic stress and alcohol use disorders.
Müller M(1), Rodgers S(2), Rössler W(3), Castelao E(4), Preisig M(4),
Ajdacic-Gross V(2), Vandeleur C(4).
Author information:
Hospital of Psychiatry, Zurich, Switzerland. Electronic address:
mario.mueller@dgsp.uzh.ch.
Hospital of Psychiatry, Zurich, Switzerland.
Hospital of Psychiatry, Zurich, Switzerland; Collegium Helveticum, University of
Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland; Institute
of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao
Paulo, Brazil.
(4)Department of Psychiatry, University Hospital of Lausanne, Lausanne,
Switzerland.
OBJECTIVE: The aim of the study was to compare subjects dually diagnosed with
posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) to those with
only one or none of these conditions regarding helpseeking needs and behaviors.
METHOD: Data from a large community sample (N=3694) were used to assess the
associations among lifetime PTSD and AUD, other psychiatric disorders, clinical
characteristics and lifetime helpseeking behaviors derived from a semi-structured
interview.
RESULTS: Comorbid individuals had more severe clinical profiles and were more
impaired than individuals with either PTSD or AUD alone or those with no/other
psychiatric conditions. However, they did not differ in overall helpseeking
behavior from any other group. Those with comorbid PTSD/AUD were even less likely
than the other groups to seek help for depression and anxiety disorders through
specific treatment facilities or the use of prescribed psychotropic drugs.
CONCLUSIONS: Despite a greater need for treatment the comorbid group did not seek
more help than the others. Their lower use of prescribed drugs supports the
self-medication hypothesis, suggesting that those individuals relieve their
symptoms through higher alcohol use instead. Our findings underline the need for
health care facilities to encourage helpseeking behavior in the aftermath of
stressful life events.
DOI: 10.1016/j.comppsych.2015.07.013
547. J Ophthalmic Inflamm Infect. 2017 Dec;7(1):13. doi: 10.1186/s12348-017-0130-7.

Epub 2017 May 23.
Anterior segment optical coherence tomography and retained vegetal intraocular

foreign body masquerading as chronic anterior uveitis.
Mahmoud A(1), Messaoud R(1), Abid F(1), Ksiaa I(2), Bouzayene M(1), Khairallah
M(3).
Author information:
(1)Department of Ophthalmology, Taher Sfar University Hospital, Faculty of
Medicine, University of Monastir, Monastir, Tunisia.
(2)Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty
of Medicine, University of Monastir, 5019, Monastir, Tunisia.
(3)Department of Ophthalmology, Fattouma Bourguiba University Hospital, Faculty
of Medicine, University of Monastir, 5019, Monastir, Tunisia.
moncef.khairallah@rns.tn.
BACKGROUND: The purpose of this single case report was to report the use of
anterior segment optical coherence tomography for the diagnosis and management of
a retained vegetal intraocular foreign body.
RESULTS: A 23-year-old otherwise healthy male presented with a progressive vision
loss in the right eye (RE). He reported a mild ocular trauma with a tree leaf
1 year ago followed by recurrent episodes of redness and pain in the RE that
partially resolved after a self-medication with topical steroids. Visual acuity
of the RE was limited to light perception. Slit-lamp examination of the RE showed
an iris granuloma with overlying exudate and associated anterior chamber
inflammatory reaction. Film X-rays, contact B-scan ultrasonography, and CT scan
showed no abnormalities. Anterior segment optical coherence tomography revealed
an enclaved iris foreign body. The foreign body was removed after a short course
of local antibio-corticosteroid therapy. This was followed 2 months later by
cataract surgery with intraocular lens implantation, with subsequent improvement
of visual acuity to 20/40.
CONCLUSIONS: A missed intraocular foreign body can lead to sight-threatening
complications. Anterior segment optical coherence tomography may be useful for
detecting non-clinically evident intraocular foreign body involving the anterior
segment masquerading as chronic anterior uveitis.
DOI: 10.1186/s12348-017-0130-7
PMCID: PMC5442073
PMID: 28536985
548. ChemMedChem. 2014 Dec;9(12):2791-7. doi: 10.1002/cmdc.201402285. Epub 2014 Sep

10.
Comparative cytotoxicity of artemisinin and cisplatin and their interactions with

chlorogenic acids in MCF7 breast cancer cells.
Suberu JO(1), Romero-Canelón I, Sullivan N, Lapkin AA, Barker GC.
Author information:
(1)Chemical Engineering and Biotechnology, University of Cambridge, CB2 3RA (UK).
In parts of Africa and Asia, self-medication with a hot water infusion of

Artemisia annua (Artemisia tea) is a common practice for a number of ailments
including malaria and cancer. In our earlier work, such an extract showed better
potency than artemisinin alone against both chloroquine-sensitive and -resistant
parasites. In this study, in vitro tests of the infusion in MCF7 cells showed
high IC50 values (>200 μM). The combination of artemisinin and 3-caffeoylquinic
acid (3CA), two major components in the extract, was strongly antagonistic and
gave a near total loss of cytotoxicity for artemisinin. We observed that the
interaction of 3CAs with another cytotoxic compound, cisplatin, showed
potentiation of activity by 2.5-fold. The chelation of cellular iron by 3CA is
hypothesized as a possible explanation for the loss of artemisinin activity.
© 2014 The Authors. Published by Wiley-VCH Verlag GmbH & Co. KGaA. This is an
open access article under the terms of the Creative Commons Attribution License,
which permits use, distribution and reproduction in any medium, provided the
original work is properly cited.
DOI: 10.1002/cmdc.201402285
PMCID: PMC4506560

eCollection 2019.
A cross-sectional study on the prevalence of antibiotic use prior to laboratory

tests at two Ghanaian hospitals.
Donkor GY(1), Dontoh E(1), Owusu-Ofori A(2).
Author information:
(1)Department of Medical Laboratory Technology, Kwame Nkrumah University of
Science and Technology, Kumasi, Ghana.
(2)Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah
University of Science and Technology, Kumasi, Ghana.
There has been a significant rise in global antibiotic use in recent years.
Development of resistance has been linked to easy accessibility, lack of
regulation of sale, increased tendency to self-medicate and the lack of public
knowledge. The increase in antibiotic misuse, including self-medication, has not
been well documented in developing countries. Antibiotic use prior to visiting
health facilities has been found to be prevalent in developing countries. It has
been identified by some studies to increase the likelihood of missed diagnoses
and influence the outcome of bacteriological tests. This study is aimed at
determining the prevalence of prior antibiotic use through a cross-sectional
survey of patients undergoing laboratory tests at two health facilities in Ghana.
Face-to-face questionnaires were used to interview 261 individuals chosen by
random sampling of patients visiting the bacteriology laboratory of the hospitals
within a two-month period. The questionnaire investigated participant demographic
characteristics, knowledge about antibiotics and the nature of antibiotic use.
Antibiotic property detection bioassay was performed on patient's urine sample
using a disk diffusion method to accurately determine antibiotic use within 72
hours. Culture results were used as an index to evaluate the effect of prior
antibiotic use on bacteriological tests. Out of a 261 participants enrolled,
19.9% (95% CI, 14.9-24.9) acknowledged using antibiotics prior to their visit to
the laboratory during the study period. On the contrary, 31.4% (95% CI,
25.7-37.5) of participants' urine samples were positive for antimicrobial
activity. Participants within the age ranges of 20-30, 31-40 and 41-50 years had
significantly lower odds of urine antimicrobial activity. Participants who had
urine antimicrobial activity were more likely to have no growth on their culture
plates than participants who had no urine antimicrobial activity [OR
2.39(1.37-4.18), p = 0.002]. The most commonly used antibiotics were the
penicillins, fluoroquinolones and metronidazole. Although, majority of the
participant (54.8%) had knowledge of antibiotics, most of them had inadequate
information on their proper use. The commonest indications for antibiotic use
were aches and pains (30.3%), diarrhoea (43.3%) and urinary tract infections
(28.0%). Prior antibiotic use was found to increase the likelihood of obtaining a
culture negative result and can affect the outcome of bacteriological tests.
PMCID: PMC6333348
PMID: 30645626

interests exist.

eCollection 2016.
Health Care Seeking Behavior in Southwest Ethiopia.
Begashaw B(1), Tessema F(2), Gesesew HA(2)(3).
Author information:
(1)Department of Public Health, Mizan Tepi University, Mizan Teferi, SNNPR,
Ethiopia.
(2)Department of Epidemiology, Jimma University, Jimma, Oromiya, Ethiopia.
(3)Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences,
Flinders University, Adelaide, South Australia, Australia.
BACKGROUND: Rural and urban populations have disparate socio-demographic and

economic characteristics, which have an influence on equity and their health
seeking behavior. We examined and compared the health care seeking behavior for
perceived morbidity between urban and rural households in Southwest Ethiopia.
METHODS: Analytic cross-sectional study was conducted among urban and rural
households living in Esera district of Southwest Ethiopia. A random sample of 388
head of households (126 urban and 262 rural) were selected. A pretested and
structured questionnaire was used for data collection with face-to-face
interview. In addition to descriptive methods, binary logistic regression was
used to identify factors associated with health seeking behavior at p value of
less than 0.05.
RESULTS: Of the sample household heads, 377 (97.2%) (119 urban and 258 rural)
were successfully interviewed. Among these, 58.4% (95% CI, 53.3-63.3%) of the
households sought care from modern health care that was lower among rural (48.1%)
than urban (80.7%) households. The prevalence of self-treatment was 35.3% in
urban and 46.1% in rural households. Among the factors considered for modern
health care utilization, higher monthly income (AOR, 5.6; 95% CI, 2.04-15.4),
perceived severity of disease (AOR, 2.5; 95% CI, 1.1-5.8), acute duration of
disease (AOR, 8.9; 95% CI, 2.4-33.3) and short distance from health facilities
(AOR, 3; 95% CI, 1.2-8.4) among rural and being married (AOR, 11.3; 95% CI,
1.2-110.2) and perceived severity of disease (AOR, 6.6; 95% CI, 1.1-10.9) among
urban households showed statistically significant association.
CONCLUSIONS: The general health seeking behavior of households on perceived
morbidity was satisfactory but lower in rural compared to urban households.
Self-medication was also widely practiced in the study area. The findings signal
the need to work more on accessibility and promotion of healthcare seeking
behavior especially among rural households.
PMCID: PMC5023186

interests exist.
551. Patient Prefer Adherence. 2018 May 10;12:793-802. doi: 10.2147/PPA.S153312.

eCollection 2018.
Association of health literacy and medication self-efficacy with medication

adherence and diabetes control.
Huang YM(1), Shiyanbola OO(1), Smith PD(2).
Author information:
(1)Division of Social and Administrative Sciences, School of Pharmacy, University
of Wisconsin-Madison, Madison, WI, USA.
(2)Department of Family Medicine and Community Health, University of
Wisconsin-Madison, Madison, WI, USA.
Introduction: The exact pathway linking health literacy, self-efficacy,

medication adherence, and glycemic control for type 2 diabetes remains unclear.
Understanding the relationship between patient factors, medication adherence, and
lower glycated hemoglobin (HbA1c) may help patients better manage their disease.
This study examined the association of health literacy and medication
self-efficacy with self-reported diabetes medication adherence, and the
association of health literacy, medication self-efficacy, and self-reported
diabetes medication adherence with HbA1c of patients with type 2 diabetes.
Methods: This cross-sectional study utilized a face-to-face questionnaire at two
family medicine clinics in a Midwestern state among 174 patients; subjects
enrolled were at least 20 years old with diagnosed type 2 diabetes, prescribed at
least one oral diabetes medicine, and understood English. Questionnaires were
administered to assess the participants': health literacy, using the Newest Vital
Sign six-item questionnaire (NVS); self-efficacy for medication use, using the
13-item Self-Efficacy for Appropriate Medication Use Scale; and self-report
medication adherence, using the eight-item Morisky Medication Adherence Scale.
HbA1c values were obtained from participants' electronic medical records.
Multiple linear regressions were used to explore the association of health
literacy and medication self-efficacy with both medication adherence and HbA1c
level after controlling for all other covariates.
Results: Self-reported health status (β = 0.17, p = 0.015) and medication
self-efficacy (β = 0.53, p < 0.001) were positively associated with diabetes
medication adherence. Health literacy was neither associated with diabetes
medication adherence (β = -0.04, p = 0.586) nor HbA1c (β = -0.06, p = 0.542).
Lower diabetes medication adherence (β = -0.26, p = 0.008) and higher number of
prescribed medications (β = 0.28, p = 0.009) were correlated with higher HbA1c.
Conclusion: Health literacy, as measured by the NVS, does not correlate with
medication adherence or glycemic control among patients with type 2 diabetes.
Interventions to improve patients' self-efficacy of medication use may improve
diabetes medication adherence.
DOI: 10.2147/PPA.S153312
PMCID: PMC5953319
PMID: 29785094

552. J Int Soc Prev Community Dent. 2016 Nov-Dec;6(6):549-553. doi:

10.4103/2231-0762.195519.
Pain and distress induced by elastomeric and spring separators in patients

undergoing orthodontic treatment.
Al-Balbeesi HO(1), Bin Huraib SM(1), AlNahas NW(2), AlKawari HM(1), Abu-Amara
AB(3), Vellappally S(4), Anil S(5).
Author information:
(1)Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King
Saud University, Riyadh, Saudi Arabia.
(2)Department of Periodontics and Community Dentistry, College of Dentistry, King
Saud University, Riyadh, Saudi Arabia.
(3)College of Medicine, Al Imam Mohammed Bin Saud Islamic University, Riyadh,
Saudi Arabia.
(4)Department of Dental Health, College of Applied Medical Sciences, King Saud
University, Riyadh, Saudi Arabia.
(5)Department of Preventive Dental Sciences, College of Dentistry, Prince Sattam
Bin Abdulaziz University, Al Kharj, Saudi Arabia.
AIMS AND OBJECTIVES: The objective of the present investigation is to evaluate

patients' pain perception and discomfort, the duration of pain and the level of
self-medication over time during tooth separation, and the effectiveness of
elastomeric and spring types of orthodontic separators in Saudi population.
MATERIALS AND METHODS: The study group consisted of 30 female adolescent patients
who had elastomeric/spring separators as part of their orthodontic treatment. A
self-administrated questionnaire comprising 16 multiple choice questions and
another with visual analog scale were used to record the patient's pain
perceptions at 4 hours, 24 hours, 3 days, 5 days, and 7 days from the time of
insertion. The level of pain and discomfort during these time periods were
assessed by a visual analog scale. After a separation period of 7 days, the
amount of separation was measured with a leaf gauge. Type and frequency of
analgesic consumption was also recorded. The Statistical Package for the Social
Sciences (SPSS) version 20 (IBM SPSS -Chicago, IL: SPSS Inc.,) was used for
statistical analysis.
RESULTS: The data showed significant increase in the level of pain at 4 hours, 24
hours, and 3 days from separator placement. The elastomeric separators produced
significantly more separation than the spring separators and also caused maximum
pain during the first 3 days after insertion. However, there was no significant
difference between the score of pain between two separators at all time
intervals.
CONCLUSION: Both elastomeric and spring separators showed comparative levels of
pain and discomfort during the early phase of separation. Elastomeric separators
were found to be more effective in tooth separation than spring separators.
However, further studies are necessary to substantiate this preliminary
observation.
DOI: 10.4103/2231-0762.195519
PMCID: PMC5184389
PMID: 28032047

eCollection 2019.
Malaria care-seeking behaviour among HIV-infected patients receiving

antiretroviral treatment in South-Eastern Nigeria: A cross-sectional study.
Chukwuocha UM(1), Iwuoha GN(1), Nwakwuo GC(2), Egbe PK(1), Ezeihekaibe CD(3),
Ekiyor CP(1)(2), Dozie INS(1), Burrowes S(3).
Author information:
(1)Department of Public Health, Federal University of Technology, Owerri,
Nigeria.
(2)RAHI Medical Outreach, Port Harcourt, Nigeria.
(3)College of Education and Health Sciences, Touro University, California, United
States of America.
This study assesses malaria prevention and treatment behaviour among people
living with HIV/AIDS (PLWHA) in Owerri, South Eastern Nigeria. Although Nigeria
bears one of the world's largest burdens of both malaria and HIV, there is almost
no research studying how co-infected patients manage their care. We
systematically sampled 398 PLWHA receiving care at Imo State Specialist Hospital
and the Federal Medical Centre in Owerri to complete a structured, pre-tested
questionnaire on malaria care-seeking behaviour. Descriptive statistics were
reported and chi-square tests and multivariate logistic regressions were also
used. The majority of HIV-infected patients (78.9%) reported having had an
episode of suspected malaria quarterly or more often. There was a large variation
in care-seeking patterns: on suspicion of malaria, 29.1% of participants engaged
in self-medication; 39.2% went to drug shops, and only 22.6% visited HIV/AIDS
care centres. Almost 40% waited more than 24 hours before initiating treatment.
Most (60.3%), reported taking recommended artemisinin-based combination
treatments (ACT) but a significant minority took only paracetamol (25.6%) or
herbal remedies (3.5%). Most (80%) finished their chosen course of treatment; and
completion of treatment was significantly associated with the frequency of
suspected malaria occurrence (p = 0.03). Most (62.8%) did not take anti-malaria
medication while taking antiretroviral treatment (ART) and almost all (87.6%)
reported taking an ACT regimen that could potentially interact with Nigeria's
first-line ART regimen. Our findings suggest the need to pay more attention to
malaria prevention and control as a crucial element in HIV/AIDS management in
this part of Nigeria and other areas where malaria and HIV/AIDS are co-endemic.
Also, more research on ART-ACT interactions, better outreach to community-level
drug shops and other private sector stakeholders, and clearer guidelines for
clinicians and patients on preventing and managing co-infection may be needed.
This will require improved collaboration between programmes for both diseases.
PMCID: PMC6508638
PMID: 31071091

interests exist.
554. Malar J. 2018 Oct 10;17(1):354. doi: 10.1186/s12936-018-2504-1.
Home treatment and use of informal market of pharmaceutical drugs for the
management of paediatric malaria in Cotonou, Benin.
Apetoh E(1)(2), Tilly M(3), Baxerres C(3)(4), Le Hesran JY(3).
Author information:
(1)Institut de recherche pour le développement, Unité mixte de recherche 216:
Mères et enfants face aux infections tropicales, Université Paris-Descartes, 4
Avenue de l'Observatoire, 75006, Paris, France. eapetoh@gmail.com.
(2)Ecole doctorale Pierre Louis de santé publique, ED 393 Epidémiologie et
Sciences de l'Information Biomédicale, Paris, France. eapetoh@gmail.com.
(3)Institut de recherche pour le développement, Unité mixte de recherche 216:
Mères et enfants face aux infections tropicales, Université Paris-Descartes, 4
Avenue de l'Observatoire, 75006, Paris, France.
(4)Centre Norbert Elias EHESS-Campus Marseille La Vieille Charité, 2 Rue de la
Charité, 13002, Marseille, France.
BACKGROUND: Malaria is the main cause of hospital admissions in Benin and a

leading cause of death in childhood. Beside consultations, various studies have
underlined the management of the disease through home treatment. The medicines
used can be purchased in informal market of pharmaceutical drugs (IMPD) without
prescription or any involvement of healthcare professional. Pharmaceutical drugs
are sold by informal private vendors, who operate at any time in the immediate
environment of the patients. The present study was conducted in Cotonou to study
the health-seeking behaviour of caregivers to treat malaria in children under
12 years old. Factors associated with malaria home treatment and drugs purchase
in IMPD were studied.
METHODS: A cross-sectional study was carried out among 340 children's caregivers
who were interviewed about their socio-demographic characteristics and their
care-seeking behaviour during the most recent episode of malaria in their
children under 12. Medicines used and purchase place were also collected.
Multivariate logistic regression model was used to determine factors associated
with malaria home treatment and drug purchase in IMPD.
RESULTS: Beyond all the 340 caregivers, 116 (34%) consulted healthcare
professional, 224 (66%) home treat the children, among whom 207 (61%) gave
pharmaceutical drugs and 17 (5%) gave traditional remedies to children. Malaria
home treatment was associated with family size, health insurance (OR = 0.396, 95%
CI 0.169-0.928), and wealth quintiles where home treatment was less used by the
richest (OR = 0.199, 95% CI 0.0676-0.522) compared to those in the poorest
quintile. The caregivers age group 30-39 years was associated to the use of IMPD
(OR = 0.383, 95% CI 0.152-0.964), the most economically wealthy people were less
likely to use IMPD (wealth quintile richest: OR = 0.239, 95% CI 0.064-0.887;
wealth quintile fourth OR = 0.271, 95% CI 0.100-0.735) compared to those in the
poorest quintile. All caregivers who benefited from health insurance did not use
IMPD.
CONCLUSION: This study highlights the link between worse economic conditions and
accessibility to medical care as one of the main factors of malaria home
treatment and drug purchase in IMPD, even if those two phenomena need to be
understood apart.
DOI: 10.1186/s12936-018-2504-1
PMCID: PMC6180418

Assessment of attitudes and practices of young Malaysian adults about antibiotics

use: a cross-sectional study.
Hassali MA(1), Arief M(2), Saleem F(3), Khan MU(4), Ahmad A(5), Mariam W(6),
Bheemavarapu H(7), Syed IA(8).
Author information:
Sciences, Universiti Sains Malaysia. Penang (Malaysia). azmihassali@gmail.com.
University. Kuala Lumpur (Malaysia). mohammad.arief786@gmail.com.
(3)Department of Pharmacy Practice, Faculty of Pharmacy & Health Sciences,
University of Balochistan. Quetta (Pakistan). fahaduob@gmail.com.
(4)Faculty of pharmacy, University of Sydney, Sydney, NSW (Australia).
umair104@yahoo.com.
University. Kuala Lumpur (Malaysia). akrampharma67@gmail.com.
(6)Department of Community Medicine, Maulana Azad Medical College. New Delhi
(India). warishamariam@gmail.com.
(7)Department of Pharmaceutical Analysis, Talla Padmavati College of Pharmacy.
Warangal (India). hariikabhimavarapu@gmail.com.
(8)Department of Pharmacy, Ibn Sina College of pharmacy. Jeddah (Saudi Arabia).
iizharahmedsyed@gmail.com.
OBJECTIVE: The present study was aimed to evaluate the practices and attitudes of
young Malaysian adults towards the use of antibiotics, and to determine the
socioeconomic factors associated with the antibiotic use.
METHODS: A survey was carried in Cheras community by approaching a conveniently
selected sample of 480 participants. A pre-tested questionnaire was used for data
collection.
RESULT: Of 480 participants approached, 400 agreed to participate in this study,
giving a response rate of 83.3%. The study results showed that 42.75% of the
participants exhibited poor attitudes towards antibiotic usage. Chinese race and
high income were significantly associated with the positive attitudes towards
antibiotic usage. It is shown that the practice of the participants towards
antibiotics was relatively poor. The majority of participants agreed that they do
not consult a doctor for minor illnesses (64%). The main reason for not
consulting a doctor was the high fees of consultation (34.25%) and the
inconvenience of visit (29.25%). However, a large proportion of respondents
(77.5%) agreed that there is a need to enhance antibiotic education among public.
CONCLUSION: The study results identified some crucial gaps in the attitudes and
practices of Cheras community about the use of antibiotics. Thus, improving the
public knowledge and changing their attitude towards antibiotic use along with
proper interventions to regulate the ease of their availability would play a
significant role for the effective use of antibiotics in the community.
DOI: 10.18549/PharmPract.2017.02.929
PMCID: PMC5499350
PMID: 28690695
Conflict of interest statement: CONFLICT OF INTEREST None declared.
556. Malays J Pathol. 2017 Apr;39(1):69-72.
Rate of active Helicobacter pylori infection among symptomatic patients of

Pakistan.
Rasheed F(1), Yameen A, Ahmad T, Bilal R.
Author information:
(1)Oncology and Radiotherapy Institute, Nuclear Medicine, Islamabad, Pakistan.
frohpl@gmail.com.
Only few epidemiological studies have examined the rate of active H. pylori
infection in the symptomatic population in Pakistan. This retrospective study
presents the laboratory data collected during the past 13 years (2002 to 2015)
from 2315 symptomatic patients referred to the BreathMAT Lab, Nuclear Medicine,
Oncology and Radiotherapy Institute, Islamabad for the diagnosis of active H.
pylori infection using the 13C Urea Breath Test. Rate of infection and its
association with gender and age were evaluated. The overall rate of active H.
pylori infection was 49.5% and there was no association of this rate of infection
with gender. An increase in rate of infection was observed with increasing age
with significant difference (p < 0.05). The patients that tested negative for
this infection might be having symptoms due to stress and indiscriminate use of
non-steroidal antiinflammatory drugs (NSAIDs) in this community. The fact that
half of the symptomatic patients were negative needs to be highlighted and
further suggests that symptomatic patients should be tested by the 13C UBT before
prescribing antibiotic treatment for H. pylori eradication. In addition, there is
a need to educate this community about the harmful and side effects of self
medication and overuse of NSAIDs.
557. Int J Nurs Sci. 2018 Sep 21;5(4):352-356. doi: 10.1016/j.ijnss.2018.09.009.

eCollection 2018 Oct 10.
Correlation of long-term medication behaviour self-efficacy with social support

and medication knowledge of kidney transplant recipients.
Du C(1), Wu S(1), Liu H(1), Hu Y(1), Li J(1).
Author information:
(1)School of Nursing, Beijing University of Chinese Medicine (BUCM), Beijing,
China.
Aim: This study aimed to explore the correlation of long-term medication

behaviour self-efficacy with social support and medication knowledge of kidney
transplant recipients.
Methods: A convenient sample of kidney transplant recipients in a general
hospital in Guangzhou was recruited from November 2016 to January 2017.
Self-reported survey data were provided by the kidney transplant recipients using
long-term medication behaviour self-efficacy scale (LTMBSES), perceived social
support scale (PSSS) and scale for patient-perceived medication knowledge in
medication usage. Descriptive statistics and Spearman's correlation analysis were
used for data analysis.
Results: A total of 195 kidney transplant recipients (132 men and 63 women) were
recruited for this study. The mean scores of all LTMBSES dimensions, namely
personal attitudes, environmental and task-related and behavioural factors, were
32.49 ± 4.34, 60.90 ± 7.56 and 32.32 ± 4.40, respectively. The mean scores of
three PSSS dimensions, namely, family, friends and significant others, were
24.91 ± 3.42, 22.71 ± 4.66 and 22.15 ± 4.26, correspondingly. The mean scores of
two five-item knowledge subscale dimensions, namely, general and interaction
knowledge, were 9.56 ± 1.07 and 13.02 ± 2.67, respectively. Spearman's
correlation analysis showed that social support (r s = 0.232, P < 0.01) and
medication knowledge (r s = 0.352, P < 0.01) were positively associated with
long-term medication self-efficacy in the kidney transplant recipients.
Conclusion: The levels of long-term medication self-efficacy, perceived social
support and medication knowledge of the kidney transplant recipients were high.
Social support and medication knowledge were correlated with self-efficacy.
DOI: 10.1016/j.ijnss.2018.09.009
PMCID: PMC6626269
PMID: 31406847
558. Patient Prefer Adherence. 2018 Jul 20;12:1279-1287. doi: 10.2147/PPA.S165749.

eCollection 2018.
Self-efficacy for medication management: a systematic review of instruments.
Lamarche L(1), Tejpal A(1), Mangin D(1).
Author information:
(1)Department of Family Medicine, McMaster University, Hamilton, ON, Canada,
lamarche@mcmaster.ca.
Background: Medication self-efficacy is a potentially important construct in

research around optimal use of prescription medications. A number of medication
self-efficacy measures are available; however, there is no systematic review of
existing instruments and cataloguing of their theoretical underpinnings or
psychometric properties, strengths, and weaknesses. The aim of the study was to
identify instruments that measure self-efficacy for medication management. The
study also aimed to examine the quality, theoretical grounding, and psychometric
evaluation of existing measures of self-efficacy for medication management. The
study was a systematic review.
Methods: Data were extracted from PubMed, OVID, and MEDLINE using a predefined
search strategy. Citations were included if they reported the development and/or
psychometric evaluation of an instrument to measure self-efficacy for medication
management and were in English. Abstracts were screened for studies potentially
meeting eligibility criteria. Full articles of these studies were then reviewed
in depth. The review was carried out independently by two members of the research
team.
Results: The search identified 158 citations of which 12 were included after
screening. Full review identified 3 articles fitting inclusion criteria for the
review. Generally, development was theoretically grounded and included patients
and experts in the field. Psychometric testing showed evidence of internal
consistency (2/3 instruments) and test-retest reliability (1/3 instruments). All
instruments showed some validity; however, assessment of all forms of validity
for each instrument was lacking.
Conclusion: Although our analysis would recommend the use of the Self-Efficacy
for Appropriate Medication Use Scale because of the current evidence of validity
and reliability, more psychometric evaluation is required, particularly in terms
of responsiveness to change as self-efficacy is a malleable patient-level factor.
Three measures of self-efficacy for medication management were identified.
Overall, some evidence of reliability and/or validity was demonstrated for all
instruments; however, other forms of validity were not tested (ie, responsiveness
to change). Use of a well-validated measure of self-efficacy medication
management is essential in order to understand relationships between medication
self-efficacy and other patient-reported outcomes such as patient-centeredness,
patient enablement, and burden of treatment, an important area of research that
is currently lacking.
DOI: 10.2147/PPA.S165749
PMCID: PMC6056165
PMID: 30050290

559. Heart Lung. 2015 Jul-Aug;44(4):276-81. doi: 10.1016/j.hrtlng.2015.03.006. Epub

2015 May 13.
Type D personality, self-efficacy, and medication adherence in patients with

heart failure-A mediation analysis.
Wu JR(1), Song EK(2), Moser DK(3).
Author information:
(1)University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill,
NC 27599, USA. Electronic address: jiarongw@email.unc.edu.
(2)University of Ulsan, College of Medicine, Department of Nursing, Ulsan, South
Korea.
(3)University of Kentucky, College of Nursing, Lexington, KY 40536, USA.
BACKGROUND: Type D personality is associated with medication non-adherence. Both

Type D personality and non-adherence are predictors of poor outcomes.
Self-efficacy, which is modifiable, is also associated with medication adherence.
OBJECTIVES: To determine the relationships among Type D personality,
self-efficacy, and medication adherence in 84 heart failure patients.
METHODS: Self-efficacy, Type D personality, medication adherence, demographic and
clinical data were collected. Hierarchical linear regression was used.
RESULTS: Type D patients were more likely to have lower self-efficacy (p = .023)
and medication non-adherence (p = .027) than non-Type D patients. Low
self-efficacy was associated with medication non-adherence (p < .001). Type D
personality didn't predict medication adherence after entering self-efficacy in
the model (p = .422), demonstrating mediation.
CONCLUSIONS: Self-efficacy mediates the relationship between Type D personality
and medication adherence. Developing and applying interventions to enhance
self-efficacy may help to sever the link between Type D personality and poor
outcomes.
DOI: 10.1016/j.hrtlng.2015.03.006
PMCID: PMC4470745
560. BMJ Open. 2019 Jun 5;9(6):e027687. doi: 10.1136/bmjopen-2018-027687.
How far do we still need to go? A survey on knowledge, attitudes, practice

related to antimicrobial stewardship regulations among Chinese doctors in 2012
and 2016.
Xia R(1), Hu X(#)(2), Willcox M(#)(2), Li X(3), Li Y(4), Wang J(5), Li X(1),
Moore M(2), Liu J(1), Fei Y(1).
Author information:
(1)Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese
Medicine, Beijing, China.
(2)Primary Care and Population Sciences, University of Southampton, Southampton,
UK.
(3)Department of International Liaison, World Federation of Chinese Medicine
Societies, Beijing, China.
(4)Department of endocrinology, South of Guang'anmen Hospital, China Academy of
Chinese Medical Sciences, Beijing, China.
(5)Department of Neurology, The Affiliated Hospital of Changchun University of
Chinese Medicine, Changchun, China.
OBJECTIVES: To explore doctors' knowledge, willingness, concerns and the

countermeasures to the most stringent antimicrobial stewardship regulations of
China which implemented in August 2012.
DESIGN: Cross-sectional survey. A pretested 32-point structured questionnaire was
distributed to doctors by sending a web link via the mobile phone application
WeChat through snowball sampling methods and email groups of medical academic
societies.
SETTING: China.
PARTICIPANTS: Doctors.
PRIMARY AND SECONDARY OUTCOME MEASURES: The questionnaire inquired about the
doctors' experiences, knowledge, willingness, concerns and the countermeasures to
the stewardship policies.
RESULTS: Total of persons in the groups was 19 791, among them 1194 submitted the
answers, within them, 807 were doctors. Doctors had a mean age of 39.0 years. The
majority (78.9% in 2012, 89.1% in 2016) reported that they were willing or very
willing to accept the regulations. Almost all respondents (93.2%) felt the
stewardship regulations had the potential to adversely affect the prognosis of
patients who would have been prescribed antimicrobials before they were
implemented, and >65% (65.7% in 2012, 66.9% in 2016) of doctors were often or
always concerned about the prognosis of these patients. In 2012, 32% of doctors
prescribed restricted antimicrobials or suggested patient self-medication with
restricted antimicrobials to address doctors' concerns, and this number decreased
to 22.6% in 2016. Although compulsory antimicrobial stewardship training was
frequent, less than half of respondents (46.8%) responded correctly to all three
knowledge questions.
CONCLUSION: Antimicrobial stewardship regulations had some positive effect on
rational antimicrobial use. Willingness and practice of doctors towards the
regulations improved from 2012 to 2016. Knowledge about rational antimicrobial
use was still lacking. Doctors found ways of accessing restricted antibiotics to
address their concerns about the prognosis of patients, which undermined the
implementation of the stewardship regulations.

DOI: 10.1136/bmjopen-2018-027687
PMCID: PMC6561603
PMID: 31171552
561. Community Ment Health J. 2015 Oct;51(7):833-40. doi: 10.1007/s10597-015-9894-

0.
Epub 2015 May 29.
Interactive Effect of Child Maltreatment and Substance Use on Depressed Mood

Among Adolescents Presenting to Community-Based Substance Use Treatment.
Gomez J(1), Becker S(2)(3), O'Brien K(4), Spirito A(2).
Author information:
(1)Department of Psychiatry and Human Behavior, Alpert Medical School of Brown
University, Box G-BH, Providence, RI, 02912, USA. Judelysse_gomez@brown.edu.
(2)Department of Psychiatry and Human Behavior, Alpert Medical School of Brown
University, Box G-BH, Providence, RI, 02912, USA.
(3)Department of Behavioral and Social Sciences, Center for Alcohol and Addiction
Studies, Brown University, Box G-S121-5, Providence, RI, 02912, USA.
(4)Simmons School of Social Work, Boston Children's Hospital, Harvard Medical
School, 300 The Fenway, Boston, MA, 02115, USA.
Adolescents referred to community behavioral health centers (CBHC) for substance

use (SU) problems report high rates of child maltreatment. Although SU and
maltreatment are independent risk factors for adolescent depression, few studies
have examined their interactive effects. This study examined the interactive
effects of SU (alcohol and marijuana) and exposure to different types of trauma
on depressed mood among 74 adolescents referred to a CBHC for SU. Hierarchical
regressions controlling for sex and common adolescent comorbidities showed that
sexual abuse had a stronger relationship with depressed mood than other types of
maltreatment. Although SU was not independently related to depressed mood,
consistent with the self-medication hypothesis, increased SU was associated with
lower levels of depressed mood among adolescents with greater exposure to sexual
abuse. Results suggest that teens presenting to CBHCs for SU should be assessed
for multiple forms of maltreatment and for depressed mood.
DOI: 10.1007/s10597-015-9894-0
PMCID: PMC4565743
562. Rev Bras Epidemiol. 2019 Feb 4;21Suppl 02(Suppl 02):e180006. doi:
10.1590/1980-549720180006.supl.2.
Survival of the elderly and exposition to polypharmacy in the city of São Paulo,
Brazil: SABE Study.

publisher]
Romano-Lieber NS(1), Corona LP(2), Marques LFG(1), Secoli SR(3).
Author information:
(1)Departamento de Prática de Saúde Pública, Faculdade de Saúde Pública,
(2)Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São
Paulo - São Paulo (SP), Brasil.
(3)Departamento de Enfermagem Médico-Cirúrgica, Escola de Enfermagem,
INTRODUCTION: The use of polypharmacy may be due to the concomitant presence of

chronic conditions, medical care by several doctors simultaneously and
self-medication. Combined with the vulnerability of the elderly to the effects of
drugs due to pharmacokinetic and pharmacodynamic changes, polypharmacy makes this
population more susceptible to adverse outcomes. In Brazil, studies show that
polypharmacy is a common problem among elderly people. However, few information
is available on the association between polypharmacy and mortality.
OBJECTIVE: It was assessed the survival of the elderly from São Paulo city
exposed to the use of polypharmacy (five or more medications).
METHODS: That was a population-based cohort, the Health, Well-Being and Aging
Study (SABE Study), conducted from 2006 to 2010. The sample was composed of 1,258
individuals aged 60 years or more. The Kaplan-Meier method and Cox proportional
risks model were used to examine the association between polypharmacy and
mortality.
RESULTS: The probability of survival after five years of the users of
polypharmacy at baseline was 77.2%, while among the non-users was 85.5%.
Polypharmacy remained as a risk factor for death even after adjustment in other
conditions associated with mortality, such as age, gender, income, chronic
diseases and hospitalization.
CONCLUSION: The results point polypharmacy as an indicator of mortality in
elderly people. The use of multiple medications by the elderly should be
carefully assessed to avoid or minimize the damage to this population.
Publisher: O uso de polifarmácia pode ser resultante da presença concomitante de

condições crônicas, atendimento por diversos médicos e automedicação. Combinada
com a vulnerabilidade de idosos aos efeitos dos medicamentos devido a alterações
farmacocinéticas e farmacodinâmicas, a polifarmácia torna essa população mais
suscetível a desfechos adversos. No Brasil, estudos mostram que a polifarmácia é
um problema frequente entre idosos, mas faltam informações sobre sua associação
com mortalidade.Avaliar a sobrevida de idosos do município de São Paulo expostos
ao uso de polifarmácia (cinco ou mais medicamentos).Trata-se de uma coorte de
base populacional, o Estudo Saúde, Bem-Estar e Envelhecimento (Sabe), da qual se
pesquisou o seguimento de 2006 a 2010. A amostra foi composta por 1.258
indivíduos com 60 anos ou mais. O método de Kaplan-Meier e o modelo de riscos
proporcionais de Cox foram usados para examinar a associação entre mortalidade e
polifarmácia.A probabilidade de sobrevida após cinco anos dos indivíduos usuários
de polifarmácia na linha de base foi de 77,2%, enquanto nos não usuários foi de
85,5%. Apolifarmácia permaneceu como fator de risco para óbito mesmo após ajuste
de demais condições associadas à mortalidade, como idade, sexo, renda, doenças
crônicas e internação hospitalar.Os resultados apontam para a polifarmácia como
um preditor de mortalidade para pessoas idosas. O uso de múltiplos medicamentos
por idosos deve ser cuidadosamente avaliado para evitar ou minimizar danos a essa
população.
DOI: 10.1590/1980-549720180006.supl.2
563. Medicines (Basel). 2017 Dec 12;4(4). pii: E90. doi: 10.3390/medicines4040090.
The Lipid Lowering and Cardioprotective Effects of Vernonia calvoana Ethanol

Extract in Acetaminophen-Treated Rats.
Egbung GE(1), Atangwho IJ(2), Odey OD(3), Ndiodimma VN(4).
Author information:
(1)Department of Biochemistry, University of Calabar, P.M.B 1115, Calabar 540
Nigeria. eneji.egbung@unical.edu.ng.
Nigeria. dratangwho@gmail.com.
Nigeria. diianer12@yahoo.com.
Nigeria. ndiodimmavictor@gmail.com.
Background: Paracetamol overdose/abuse as a result of self-medication is a common

occurrence amongst people living in low/middle income countries. The present
study was designed to investigate the hypolipidemic and cardioprotective
potentials of Vernonia calvoana (VC) ethanol extract in acetaminophen
(paracetamol)-treated rats. Methods: Thirty-five Wistar rats weighing 100-150 g
were randomly assigned into five groups of seven rats each. Groups 2-5 received
high doses of paracetamol to induce liver damage, while group 1 was used as
normal control. Afterwards, they were allowed to receive varying doses of VC
(group 3 and 4) or vitamin E (group 5), whilst groups 1 and 2 were left
untreated. The treatment period lasted for twenty one days after which sera were
harvested and assayed for serum lipid indices using standard methods. Results:
Groups 3 to 5 treated animals indicated significant decrease (p < 0.001) in low
density lipoprotein cholesterol (LDL-c), total cholesterol (TC) and
triacylglycerol (TG) levels relative to the normal and acetaminophen-treated
controls, the atherogenic index showed a significant decrease (p < 0.001) in all
treated groups compared with normal and acetaminophen-treated controls. However,
the VC- and vitamin E-treated groups showed significant (p < 0.001) increase in
high density lipoprotein cholesterol (HDL-C) relative to the controls.
Conclusions: Data from our study suggest that ethanol leaf extract of VC
possesses probable hypolipidemic and cardioprotective effects.
DOI: 10.3390/medicines4040090
PMCID: PMC5750614
PMID: 29231843
564. PLoS Negl Trop Dis. 2016 Jul 18;10(7):e0004852. doi:

10.1371/journal.pntd.0004852. eCollection 2016 Jul.
Preparing towards Preventing and Containing an Ebola Virus Disease Outbreak: What
Socio-cultural Practices May Affect Containment Efforts in Ghana?
Adongo PB(1), Tabong PT(1), Asampong E(1), Ansong J(2), Robalo M(2), Adanu RM(3).
Author information:
(1)Department of Social and Behavioural Sciences, School of Public Health,
University of Ghana, Legon, Accra, Ghana.
(2)World Health Organization Country Office for Ghana, Accra, Ghana.
(3)Department of Population, Family and Reproductive Health, School of Public
Health, University of Ghana, Legon, Accra, Ghana.
BACKGROUND: Ebola Virus Disease (EVD) is a condition with high fatality. Though
the disease is deadly, taking precautions to reduce contact with infected people
and their secretions can prevent cross- infection. In the 2014 EVD outbreak,
socio-cultural factors were identified to be responsible for the spread of the
disease in the three most affected countries in West Africa. In this light, we
undertook this study to identify socio-cultural factors that may influence the
prevention and containment of EVD in Ghana and ways to address such practices.
METHODS: We conducted a descriptive qualitative study in five regions in Ghana.
Twenty-five focus group discussions (5 in each region) with community members (4
in each region) and nurses (1 in each region) were conducted. In addition, forty
(40) in-depth interviews were conducted with various stakeholders and opinion
leaders; eight in each region. All interviews were recorded using a digital voice
recorder and transcribed. With the aid of Nvivo 10 for windows, we analyzed the
data using framework analysis.
RESULTS: We found that socio-cultural practices, such as care of the body of dead
and burial practices, widowhood rites and anointing children with water used to
rinse the dead, were common. These practices require individuals coming into
direct contact with either the dead or items used to take care of the dead.
Social norms also require frequent handshakes in all social gatherings such as
funeral, and religious congregations. We also found that self-medication (using
herbs and orthodox medications) was a common practice. People use both biomedical
and non-orthodox health outlets either simultaneously or in sequence in times of
ill-health.
CONCLUSION: The study concludes that high risk socio-cultural practices were
common among Ghanaians and generally perceived as indispensable. These high risk
practices may hinder containment efforts in the event of an outbreak. Community
leaders should be engaged in any social mobilization to modify these practices as
part of preparation efforts.
DOI: 10.1371/journal.pntd.0004852
PMCID: PMC4948768
565. Front Behav Neurosci. 2017 Aug 8;11:145. doi: 10.3389/fnbeh.2017.00145.

eCollection 2017.
Effect of Levodopa on Reward and Impulsivity in a Rat Model of Parkinson's

Disease.
Carvalho MM(1)(2), Campos FL(1)(2), Marques M(1)(2), Soares-Cunha C(1)(2), Kokras

N(3)(4), Dalla C(3), Leite-Almeida H(1)(2), Sousa N(1)(2), Salgado AJ(1)(2).
Author information:
(1)Life and Health Sciences Research Institute (ICVS), School of Health Sciences,
University of Minho, Campus de GualtarBraga, Portugal.
(2)ICVS/3B's, PT Government Associate LaboratoryGuimarães, Portugal.
(3)Department of Pharmacology, Medical School, National and Kapodistrian
University of AthensAthens, Greece.
(4)First Department of Psychiatry, Medical School, National and Kapodistrian
University of AthensAthens, Greece.
The use of dopamine replacement therapies (DRT) in the treatment of Parkinson's

disease (PD) can lead to the development of dopamine dysregulation syndrome (DDS)
and impulse control disorders (ICD), behavioral disturbances characterized by
compulsive DRT self-medication and development of impulsive behaviors. However,
the mechanisms behind these disturbances are poorly understood. In animal models
of PD, the assessment of the rewarding properties of levodopa (LD), one of the
most common drugs used in PD, has produced conflicting results, and its ability
to promote increased impulsivity is still understudied. Moreover, it is unclear
whether acute and chronic LD therapy differently affects reward and impulsivity.
In this study we aimed at assessing, in an animal model of PD with bilateral
mesostriatal and mesocorticolimbic degeneration, the behavioral effects of LD
therapy regarding reward and impulsivity. Animals with either sham or
6-hydroxydopamine (6-OHDA)-induced bilateral lesions in the substantia nigra pars
compacta (SNc) and ventral tegmental area (VTA) were exposed to acute and chronic
LD treatment. We used the conditioned place preference (CPP) paradigm to evaluate
the rewarding effects of LD, whereas impulsive behavior was measured with the
variable delay-to-signal (VDS) task. Correlation analyses between behavioral
measurements of reward or impulsivity and lesion extent in SNc/VTA were performed
to pinpoint possible anatomical links of LD-induced behavioral changes. We show
that LD, particularly when administered chronically, caused the development of
impulsive-like behaviors in 6-OHDA-lesioned animals in the VDS. However, neither
acute or chronic LD administration had rewarding effects in 6-OHDA-lesioned
animals in the CPP. Our results show that in a bilateral rat model of PD, LD
leads to the development of impulsive behaviors, strengthening the association
between DRT and DDS/ICD in PD.
DOI: 10.3389/fnbeh.2017.00145
PMCID: PMC5550717
PMID: 28848409
566. Reprod Health. 2016 Jun 8;13 Suppl 1:36. doi: 10.1186/s12978-016-0136-x.
Community's perceptions of pre-eclampsia and eclampsia in Sindh Pakistan: a

qualitative study.
Khowaja AR(1)(2), Qureshi RN(3), Sheikh S(1), Zaidi S(1), Salam R(1), Sawchuck
D(2), Vidler M(2), von Dadelszen P(2), Bhutta Z(1).
Author information:
(1)Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
(2)Department of Obstetrics and Gynecology, Child and Family Research Institute,
University of British Columbia, Vancouver, Canada.
(3)Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
rahat.qureshi@aku.edu.
BACKGROUND: Maternal mortality is of global public health concern and >99 % of

maternal deaths occur in less developed countries. The common causes of direct
maternal death are hemorrhage, sepsis and pre-eclampsia/eclampsia. In Pakistan,
pre-eclampsia/eclampsia deaths represents one-third of maternal deaths reported
at the tertiary care hospital settings. This study explored community
perceptions, and traditional management practices about pre-eclampsia/eclampsia.
METHODS: A qualitative study was conducted in Sindh Province of Pakistan from
February to July 2012. Twenty-six focus groups were conducted, 19 with women of
reproductive age/mothers-in-law (N = 173); and 7 with husbands/fathers-in-law
(N = 65). The data were transcribed verbatim in Sindhi and Urdu, then analyzed
for emerging themes and sub-themes using NVivo version 10 software.
RESULTS: Pre-eclampsia in pregnancy was not recognized as a disease and there was
no name in the local languages to describe this. Women however, knew about high
blood pressure and were aware they can develop it during pregnancy. It was widely
believed that stress and weakness caused high blood pressure in pregnancy and it
caused symptoms of headache. The perception of high blood pressure was not based
on measurement but on symptoms. Self-medication was often used for headaches
associated with high blood pressure. They were also awareness that severely high
blood pressure could result in death.
CONCLUSIONS: Community-based participatory health education strategies are
recommended to dispel myths and misperceptions regarding pre-eclampsia and
eclampsia. The educational initiatives should include information on the
presentation, progression of illness, danger signs associated with pregnancy, and
appropriate treatment.
DOI: 10.1186/s12978-016-0136-x
PMCID: PMC4943481
567. J Clin Hypertens (Greenwich). 2016 May;18(5):408-14. doi: 10.1111/jch.12781.
Epub
2016 Jan 20.
Prevalence and Determinants of Chronic Kidney Disease Among Hypertensive

Cameroonians According to Three Common Estimators of the Glomerular Filtration
Rate.
Kaze FF(1)(2), Kengne AP(3), Magatsing CT(4), Halle MP(5), Yiagnigni E(6), Ngu
KB(2).
Author information:
(1)Department of Medicine and Specialties, Faculty of Medicine and Biomedical
Sciences, The University of Yaoundé 1, Yaoundé, Cameroon.
(2)Department of Internal Medicine, The Yaoundé University Teaching Hospital,
Yaoundé, Cameroon.
(3)South African Medical Research Council, University of Cape Town, Cape Town,
South Africa.
(4)Higher Institute of Health Sciences, Bangangté, Cameroon.
(5)Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical
Sciences, The University of Douala, Douala, Cameroon.
(6)Department of Internal Medicine, Yaoundé Central Hospital, Yaoundé, Cameroon.
Comment in
J Clin Hypertens (Greenwich). 2016 May;18(5):405-7.
Hypertension is a risk factor for renal diseases, which, in turn, are precursors
of hypertension. The authors assessed the prevalence and determinants of chronic
kidney disease (CKD) among 336 hypertensive adult Cameroonians (mean age,
60.9±11.3 years; 63.4% women) at Yaoundé. Any participant with an estimated
glomerular filtration rate <60 mL/min/1.73 m(2) regardless of the equation used
(Cockcroft-Gault [CG], Modification of Diet in Renal Disease [MDRD], and Chronic
Kidney Disease Epidemiology Collaboration [CKD-EPI]) and/or dipstick proteinuria
was reviewed 3 months later. Participants presented a high prevalence of diabetes
(18.5%), dyslipidemia (17.6%), gout/hyperuricemia (10.7%), overweight/obesity
(68.8%), self-medication (37.5%), and alcohol consumption (33.3%). Hypertension
was uncontrolled in 265 patients (78.9%). The prevalence of CKD was 49.7%, 50.0%,
and 52.1% according to MDRD, CKD-EPI, and CG equations, respectively. Advanced
age, adiposity, and severity of hypertension were determinants of CKD. Nearly
half of the hypertensive patients had CKD regardless of the estimators used,
predicted by well-known risk factors.
©2016 Wiley Periodicals, Inc.
DOI: 10.1111/jch.12781
568. Psychol Addict Behav. 2014 Dec;28(4):1013-25. doi: 10.1037/a0037257. Epub 2014
Aug 18.
An experience sampling study of PTSD and alcohol-related problems.
Gaher RM(1), Simons JS(1), Hahn AM(1), Hofman NL(1), Hansen J(1), Buchkoski J(2).
Author information:
(1)Department of Psychology, University of South Dakota.
(2)Sioux Falls Veterans Administration Health Care System.
Posttraumatic stress disorder (PTSD) represents a debilitating psychiatric

condition that is affecting the lives of many returning veterans. PTSD and
alcohol use and dependence are highly comorbid. The purpose of this study was to
understand the functional mechanisms between PTSD and alcohol use and problems.
Specifically, the role of negative urgency and emotional intelligence were
investigated as vulnerability and resiliency factors, respectively. This study
utilized experience sampling to test associations between PTSD symptoms and
alcohol use and related problems in a sample of 90 OIF/OEF veterans. Participants
completed 8 brief questionnaires daily for 2 weeks on palmtop computers.
Elevations in PTSD symptoms during the day were associated with subsequent
increases in alcohol use and associated problems that night. PTSD symptoms were
associated with greater problems above and beyond the effect of drinking level at
both the within- and between- person level. Emotional intelligence was associated
with lower negative urgency, fewer PTSD symptoms, and less alcohol use and
associated problems. The effects of emotional intelligence were primarily
indirect via negative urgency and the effects of negative urgency on alcohol use
and problems were indirect via its positive association with PTSD symptoms.
Hypothesized cross-level effects of emotional intelligence and negative urgency
were not supported. The findings suggest a functional association between PTSD
symptoms and alcohol consumption. The association between PTSD symptoms and
alcohol consumption is consistent with a self-medication model. However, the
significant associations between PTSD symptoms and alcohol problems, after
controlling for use level, suggest a broader role of dysregulation.
DOI: 10.1037/a0037257
PMCID: PMC4274209
569. WHO South East Asia J Public Health. 2018 Sep;7(2):73-78. doi:
10.4103/2224-3151.239417.
Addressing the threat of antibiotic resistance in Thailand: monitoring population

knowledge and awareness.
Tangcharoensathien V(1), Sommanustweechai A(1), Chanvatik S(1), Kosiyaporn H(1),

Tisocki K(2).
Author information:
(1)International Health Policy Program, Ministry of Public Health, Nonthaburi,
Thailand.
(2)World Health Organization Regional Office for South-East Asia, New Delhi,
India.
The 2015 Global action plan on antimicrobial resistance (GAP-AMR) highlights the
key importance of improving awareness and understanding of antimicrobial
resistance among consumers. While low levels of awareness are not exclusive to
consumers in low- and middle-income countries, the challenges to improving
understanding are compounded in these settings, by factors such as higher rates
of antibiotic self-medication and availability through informal suppliers. In
2016, Thailand set an ambitious target to increase, by 2021, public knowledge of
antibiotic resistance and awareness of appropriate use of antibiotic by 20%. This
involved first establishing baseline data by incorporating a module on antibiotic
awareness into the 2017 national Health and Welfare Survey conducted by the
National Statistical Office. The benefit of this approach is that the data from
the antibiotic module are collected in parallel with data on socioeconomic,
demographic and geospatial parameters that can inform targeted public
communications. The module was developed by review of existing tools that have
been used to measure public awareness of antibiotics, namely those of the
Eurobarometer project of the European Union and a questionnaire developed by the
World Health Organization. The Thai module was constructed in such a way that
results could be benchmarked against those of the other survey tools, to allow
international comparison. The Thai experience showed that close collaboration
between the relevant national authorities allowed smooth integration of a module
on antibiotic awareness into the national household survey. To date, evidence
from the module has informed the content and strategy of public communications on
antibiotic use and misuse. Work is under way to select the most robust indicators
to use in monitoring progress. The other Member States of the World Health
Organization South-East Asia Region can benefit from Thailand's experiences in
improvement of monitoring population knowledge and awareness.
DOI: 10.4103/2224-3151.239417
Conflict of interest statement: None declared
570. Am J Mens Health. 2018 Sep;12(5):1463-1472. doi: 10.1177/1557988318768596.

Epub
2018 Apr 16.
Prostate Cancer Screening Perception, Beliefs, and Practices Among Men in

Bamenda, Cameroon.
Kaninjing E(1), Lopez I(2), Nguyen J(1), Odedina F(1), Young ME(3).
Author information:
(1)1 Department of Pharmacotherapy and Translational Research, College of
Pharmacy, University of Florida, Orlando, FL, USA.
(2)2 Institute of Public Health, Florida A&M University, Tallahassee, FL, USA.
(3)3 Department of Occupational Therapy, College of Public Health and Health
Professions, University of Florida, Gainesville, FL, USA.
Prostate Cancer (CaP) is the most commonly diagnosed cancer among Cameroonian
men. Due to inadequate infrastructure, record keeping, and resources, little is
known about its true burden on the population. There are rural/urban disparities
with regards to awareness, screening, treatment, and survivorship. Furthermore,
use of traditional medicine and homeopathic remedies is widespread, and some men
delay seeking conventional medical treatment until advanced stages of CaP. This
study examined the perceptions, beliefs, and practices of men in Cameroon
regarding late stage CaP diagnoses; identified factors that influence screening
decision; and ascertained how men decided between traditional or conventional
medicine for CaP diagnosis and treatment. Semistructured focus groups were used
to collect data from men in Bamenda, Cameroon. Qualitative data analysis was used
to analyze transcripts for emerging themes and constructs using a
socio-ecological framework. Twenty-five men participated in the study, with an
average age of 59. Most of the participants had never received a prostate
screening recommendation. Socioeconomic status, local beliefs, knowledge levels,
awareness of CaP and screening methods, and stigma were prominent themes. A
significant number of Cameroonian men receive late stage CaP diagnosis due to
lack of awareness, attitudes, cultural beliefs, self-medication, and economic
limitation. To effectively address these contributing factors to late stage CaP
diagnosis, a contextually based health education program is warranted and should
be tailored to fill knowledge gaps about the disease, dispel misconceptions, and
focus on reducing barriers to utilization of health services.
DOI: 10.1177/1557988318768596
PMCID: PMC6142138
571. PLoS Negl Trop Dis. 2017 Nov 20;11(11):e0006100. doi:

10.1371/journal.pntd.0006100. eCollection 2017 Nov.
Poverty and health among CDC plantation labourers in Cameroon: Perceptions,

challenges and coping strategies.
Makoge V(1)(2), Vaandrager L(1), Maat H(3), Koelen M(1).
Author information:
(1)Health and Society (HSO) group, Wageningen University and Research,
Wageningen, The Netherlands.
(2)Institute for Medical Research and Medicinal Plant studies (IMPM), Yaoundé,
Cameroon.
(3)Knowledge Technology and Innovation (KTI) group, Hollandseweg 1, Wageningen
University and Research, Wageningen, The Netherlands.
Creating better access to good quality healthcare for the poor is a major
challenge to development. In this study, we examined inter-linkages between
poverty and disease, referred to as poverty-related diseases (PRDs), by
investigating how Cameroon Development Corporation (CDC) camp dwellers respond to
diseases that adversely affect their health and wellbeing. Living in plantation
camps is associated with poverty, overcrowding, poor sanitation and the rapid
spread of diseases. In a survey of 237 CDC camp dwellers in Cameroon, we used the
health belief model to understand the drivers (perceived threats, benefits and
cues for treatment seeking) of reported responses. Using logistic regression
analysis, we looked for trends in people's response to malaria. We calculated the
odds ratio of factors shown to have an influence on people's health, such as
food, water, sanitation challenges and seeking formal healthcare for malaria.
Malaria (40.3%), cholera (20.8%) and diarrhoea (17.7%) were the major PRDs
perceived by camp dwellers. We found a strong link between what respondents
perceived as PRDS and hygiene conditions. Poverty for our respondents was more
about living in poor hygiene conditions than lack of money. Respondents perceived
health challenges as stemming from their immediate living environment. Moreover,
people employed self-medication and other informal health practices to seek
healthcare. Interestingly, even though respondents reported using formal
healthcare services as a general response to illness (84%), almost 90% stated
that, in the case of malaria, they would use informal healthcare services. Our
study recommends that efforts to curb the devastating effects of PRDs should have
a strong focus on perceptions (i.e. include diseases that people living in
conditions of poverty perceive as PRDs) and on hygiene practices, emphasising how
they can be improved. By providing insights into the inter-linkages between
poverty and disease, our study offers relevant guidance for potentially
successful health promotion interventions.
PMCID: PMC5714393
572. Emerg Infect Dis. 2016 May;22(5):903-6. doi: 10.3201/eid2205.151957.
Malaria Hyperendemicity and Risk for Artemisinin Resistance among Illegal Gold
Miners, French Guiana.
Pommier de Santi V, Djossou F, Barthes N, Bogreau H, Hyvert G, Nguyen C, Pelleau
S, Legrand E, Musset L, Nacher M, Briolant S.
To assess the prevalence of malaria among illegal gold miners in the French
Guiana rainforest, we screened 205 miners during May-June 2014. Malaria
prevalence was 48.3%; 48.5% of cases were asymptomatic. Patients reported
self-medication with artemisinin-based combination therapy. Risk for emergence
and spread of artemisinin resistance among gold miners in the rainforest is high.
DOI: 10.3201/eid2205.151957
PMCID: PMC4861531
573. Philos Trans R Soc Lond B Biol Sci. 2015 May 26;370(1669). pii: 20140115. doi:
10.1098/rstb.2014.0115.
The sociality-health-fitness nexus: synthesis, conclusions and future directions.
Nunn CL(1), Craft ME(2), Gillespie TR(3), Schaller M(4), Kappeler PM(5).
Author information:
(1)Department of Evolutionary Anthropology, Duke University, Box 90383, Durham,
NC 27708, USA Duke Global Health Institute, Duke University, 310 Trent Drive,
Durham, NC 27710, USA charles.nunn@duke.edu.
(2)Department of Veterinary Population Medicine, University of Minnesota, St
Paul, MN 55108, USA.
(3)Department of Environmental Sciences and Program in Population Biology,
Ecology and Evolution, Emory University, Atlanta, GA 30322, USA Department of
Environmental Health, Rollins School of Public Health, Emory University, Atlanta,
GA 30322, USA.
(4)Department of Psychology, University of British Columbia, 2136 West Mall,
Vancouver, British Columbia, Canada V6T1Z4.
(5)Behavioral Ecology and Sociobiology Unit, German Primate Center, Göttingen,
Germany Department of Sociobiology/Anthropology, University of Göttingen,
Göttingen, Germany.
This theme issue has highlighted the links between sociality, health and fitness
in a broad range of organisms, and with approaches that include field and captive
studies of animals, comparative and meta-analyses, theoretical modelling and
clinical and psychological studies of humans. In this concluding chapter, we
synthesize the results of these diverse studies into some of the key concepts
discussed in this issue, focusing on risks of infectious disease through social
contact, the effects of competition in groups on susceptibility to disease, and
the integration of sociality into research on life-history trade-offs.
Interestingly, the studies in this issue both support pre-existing hypotheses,
and in other ways challenge those hypotheses. We focus on unexpected results,
including a lack of association between ectoparasites and fitness and weak
results from a meta-analysis of the links between dominance rank and immune
function, and place these results in a broader context. We also review relevant
topics that were not covered fully in this theme issue, including self-medication
and sickness behaviours, society-level defences against infectious disease,
sexual selection, evolutionary medicine, implications for conservation biology
and selective pressures on parasite traits. We conclude by identifying general
open questions to stimulate and guide future research on the links between
sociality, health and fitness.
© 2015 The Author(s) Published by the Royal Society. All rights reserved.
DOI: 10.1098/rstb.2014.0115
PMCID: PMC4410381
574. Ther Adv Drug Saf. 2018 Jun;9(6):309-321. doi: 10.1177/2042098618764536. Epub
2018 Mar 26.
The willingness and attitude of patients towards self-administration of

medication in hospital.
Vanwesemael T(1), Boussery K(2), van den Bemt P(3), Dilles T(4).
Author information:
(1)Department of Nursing Science and Midwifery, Centre for Research and
Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhac), Faculty of
Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610
Wilrijk, Belgium.
(2)Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent
University, Ghent, Belgium.
(3)Department of Hospital Pharmacy, Erasmus University Medical Center's
Gravendijkwal, CE Rotterdam, The Netherlands.
(4)Department of Healthcare, Thomas More University College, Lier, Belgium.
Background: Literature suggests a positive impact of self-administration of

medication during hospitalization on medication adherence and safety, and on
patient satisfaction. However, self-administration is not a common practice in
Belgian hospitals. The aim of this study was to describe patients' willingness
towards self-administration of medication while in hospital.
Methods: A cross-sectional observational study was conducted in three Belgian
hospitals in November and December 2015. All patients of 14 randomly selected
wards were asked to participate. The structured questionnaire comprised patient
characteristics, their willingness and attitude towards self-administration of
medication, perceived ability to self-administer during hospitalization, and
prerequisites and perceived consequences.
Results: In total, 124 patients participated (36% of all eligible patients). The
main reasons not to participate were the patients' physical and mental condition
(30%) and the absence of patients during the time of data collection (23%). The
majority of the 124 participating patients had a positive attitude towards the
implementation of self-administration; 83.9% were willing to self-administer
their medication while in hospital. Most important prerequisites were
self-administration at home before and after hospitalization, patients'
motivation, and a regular evaluation of the patients' competences. Patients
acknowledged benefits such as an increase in autonomy, independence and
medication knowledge. Patients did not expect self-administration would cause
important safety issues.
Conclusion: The majority of patients, capable of participating in the study,
would want to self-administer medication during hospitalization. They had a
positive attitude towards self-administration of medication. Nevertheless,
patients stated important conditions which need to be considered in order to
implement self-administration.
DOI: 10.1177/2042098618764536
PMCID: PMC5971398
PMID: 29854392

575. Parasit Vectors. 2018 Jun 19;11(1):357. doi: 10.1186/s13071-018-2940-3.
Can the intake of antiparasitic secondary metabolites explain the low prevalence
of hemoparasites among wild Psittaciformes?
Masello JF(1), Martínez J(2), Calderón L(3), Wink M(4), Quillfeldt P(3), Sanz
V(5), Theuerkauf J(6), Ortiz-Catedral L(7), Berkunsky I(8), Brunton D(7),
Díaz-Luque JA(9)(10), Hauber ME(11), Ojeda V(12), Barnaud A(13), Casalins L(12),
Jackson B(14)(15), Mijares A(16), Rosales R(16), Seixas G(17), Serafini P(18),
Silva-Iturriza A(16), Sipinski E(19), Vásquez RA(20), Widmann P(21), Widmann
I(21), Merino S(22).
Author information:
(1)Department of Animal Ecology and Systematics, Justus-Liebig Universität
Gießen, Heinrich-Buff-Ring 26, D-35392, Gießen, Germany.
juan.f.masello@bio.uni-giessen.de.
(2)Departamento de Biomedicina y Biotecnologıía, Area Parasitologıía, Facultad de
Farmacia, Universidad de Alcalá (UAH), NII Km 33.600, 28805 Alcalá de Henares,
Madrid, Spain.
(3)Department of Animal Ecology and Systematics, Justus-Liebig Universität
Gießen, Heinrich-Buff-Ring 26, D-35392, Gießen, Germany.
(4)Institute of Pharmacy and Molecular Biotechnology, Heidelberg University, INF
364, 69120, Heidelberg, Germany.
(5)Centro de Ecología, Instituto Venezolano de Investigaciones Científicas, Altos
de Pipe, Venezuela.
(6)Museum and Institute of Zoology, Polish Academy of Sciences, Wilcza 64,
00-679, Warsaw, Poland.
(7)Institute of Natural and Mathematical Sciences, Massey University, Auckland,
New Zealand.
(8)Instituto Multidisciplinario sobre Ecosistemas y Desarrollo Sustentable,
Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil,
Argentina.
(9)Fundación para la Investigación y la Conservación de los Loros en Bolivia
(CLB), Avenida Francisco Mora, Santa Cruz de la Sierra, Bolivia.
(10)Centro de Conservación de Loros Silvestres (CREA), Santa Cruz de la Sierra,
Bolivia.
(11)Department of Animal Biology, School of Integrative Biology, University of
Illinois, Urbana-Champaign, IL, 61801, USA.
(12)ZoologyDepartment (CRUB-UNCo), INIBIOMA (Universidad Nacional del
Comahue-CONICET), 8400, Bariloche, Argentina.
(13)Province des Iles Loyauté, Direction du Développement Economique, BP 50
98820, Wé, Lifou, New Caledonia.
(14)Auckland Zoological Park, Motions Road, Western Springs, Auckland, 1022, New
Zealand.
(15)School of Veterinary and Life Sciences, Murdoch University, Perth, WA,
Australia.
(16)Centro de Bioquímica y Biofísica, Instituto Venezolano de Investigaciones
Científicas, Altos de Pipe, Venezuela.
(17)Projeto Papagaio-verdadeiro, Fundação Neotropica do Brasil, Campo Grande,
Brazil.
(18)Base Multifuncional do CEMAVE em Florianópolis/SC, Estação Ecológica Carijós
- ICMBio, Florianópolis, Brazil.
(19)Projeto de Conservação do papagaio-de-cara-roxa, SPVS - Sociedade de Pesquisa
em Vida Selvagem e Educação Ambiental, Curitiba, Brazil.
(20)Institute of Ecology and Biodiversity, Departamento de Ciencias Ecológicas,
Facultad de Ciencias Universidad de Chile, Santiago, Chile.
(21)Katala Foundation, Inc., Puerto Princesa City, Palawan, Philippines.
(22)Departamento de Ecología Evolutiva, Museo Nacional de Ciencias Naturales,
Consejo Superior de Investigaciones Científicas, 28006, Madrid, Spain.
BACKGROUND: Parasites can exert selection pressure on their hosts through effects
on survival, on reproductive success, on sexually selected ornament, with
important ecological and evolutionary consequences, such as changes in population
viability. Consequently, hemoparasites have become the focus of recent avian
studies. Infection varies significantly among taxa. Various factors might explain
the differences in infection among taxa, including habitat, climate, host
density, the presence of vectors, life history and immune defence. Feeding
behaviour can also be relevant both through increased exposure to vectors and
consumption of secondary metabolites with preventative or therapeutic effects
that can reduce parasite load. However, the latter has been little investigated.
Psittaciformes (parrots and cockatoos) are a good model to investigate these
topics, as they are known to use biological control against ectoparasites and to
feed on toxic food. We investigated the presence of avian malaria parasites
(Plasmodium), intracellular haemosporidians (Haemoproteus, Leucocytozoon),
unicellular flagellate protozoans (Trypanosoma) and microfilariae in 19
Psittaciformes species from a range of habitats in the Indo-Malayan, Australasian
and Neotropical regions. We gathered additional data on hemoparasites in wild
Psittaciformes from the literature. We considered factors that may control the
presence of hemoparasites in the Psittaciformes, compiling information on diet,
habitat, and climate. Furthermore, we investigated the role of diet in providing
antiparasitic secondary metabolites that could be used as self-medication to
reduce parasite load.
RESULTS: We found hemoparasites in only two of 19 species sampled. Among them,
all species that consume at least one food item known for its secondary
metabolites with antimalarial, trypanocidal or general antiparasitic properties,
were free from hemoparasites. In contrast, the infected parrots do not consume
food items with antimalarial or even general antiparasitic properties. We found
that the two infected species in this study consumed omnivorous diets. When we
combined our data with data from studies previously investigating blood parasites
in wild parrots, the positive relationship between omnivorous diets and
hemoparasite infestation was confirmed. Individuals from open habitats were less
infected than those from forests.
CONCLUSIONS: The consumption of food items known for their secondary metabolites
with antimalarial, trypanocidal or general antiparasitic properties, as well as
the higher proportion of infected species among omnivorous parrots, could explain
the low prevalence of hemoparasites reported in many vertebrates.
DOI: 10.1186/s13071-018-2940-3
PMCID: PMC6008929
576. J Res Med Sci. 2018 Mar 27;23:26. doi: 10.4103/jrms.JRMS_629_17. eCollection
2018.
Plant toxins and acute medicinal plant poisoning in children: A systematic

literature review.
Ghorani-Azam A(1), Sepahi S(2), Riahi-Zanjani B(1), Alizadeh Ghamsari A(1),

Mohajeri SA(2)(3), Balali-Mood M(1).
Author information:
(1)Medical Toxicology Research Center, Mashhad University of Medical Sciences,
Mashhad, Iran.
(2)Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute,
Mashhad University of Medical Sciences, Mashhad, Iran.
(3)Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad
University of Medical Sciences, Mashhad, Iran.
Background: For many years, medicinal plants and herbal therapy have been widely
used in different societies for the treatment of various diseases. Besides their
therapeutic potency, some of the medicinal plants have strong toxicity in human,
especially in children and elderly. Despite common beliefs that natural products
are safe, there have been few reports on their toxicities.
Materials and Methods: In the present study, we aimed to systematically review
the literature wherein acute plant poisoning and herbal intoxication have been
reported in pediatric patients. After literature search and selection of the
appropriate documents, the desired data were extracted and described
qualitatively.
Results: A total of 127 articles with overall 1453 intoxicated cases were
collected. The results of this study showed that some medicinal plants can cause
acute poisoning and complications such as hepatic and renal failure in children.
Conclusion: The findings of this survey showed that acute plant poisoning can be
life?threatening in children, and since a single?ingested dose of toxic plants
can cause acute poisoning, parents should be aware of these toxic effects and
compare the side effects of self?medication with its potential benefits.
DOI: 10.4103/jrms.JRMS_629_17
PMCID: PMC5894275
PMID: 29692823
577. Malays Fam Physician. 2018 Aug 31;13(2):2-9. eCollection 2018.
A comparison of medication adherence between subsidized and self-paying patients

in Malaysia.
Aziz H(1), Hatah E(2), Makmor-Bakry M(3), Islahudin F(4), Ahmad Hamdi N(5), Mok
Pok Wan I(6).
Author information:
(1)PhD, MPharm (Clin), Bpharm (Hons), Faculty of Pharmacy Universiti Kebangsaan
Malaysia jalan Raja Muda Abdul Aziz 50300 Kuala Lumpur, Malaysia. Email address:
ernieda@ukm.edu.my.
(2)Bpharm (Hons), Master of Science (Pharm), Faculty of Pharmacy, Universiti
Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur Malaysia.
(3)PhD, MPharm (Clin), Bpharm (Hons), Faculty of Pharmacy, Universiti Kebangsaan
Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur Malaysia.
(4)Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul
Aziz, Kuala Lumpur Malaysia.
(5)Bpharm (Hons), Pharmacy Division, Ministry of Health Jalan Universiti,
Petaling Jaya Selangor, Malaysia.
(6)MPharm (Clin), Bpharm Universiti Kebangsaan Malaysia Medical Centre, Jalan
Yaacob Latif Bandar Tun Razak, 56000 Cheras Kuala Lumpur, Malaysia.
Background: Limited efforts have been made to evaluate medication adherence among
subsidized and self-paying patients.
Objective: To investigate medication adherence among patients with and without
medication subsidies and to identify factors that may influence patients'
adherence to medication. Setting: Government healthcare institutions in Kuala
Lumpur, Selangor, and Negeri Sembilan and private healthcare institutions in
Selangor and Negeri Sembilan, Malaysia.
Methods: This cross-sectional study sampled patients with and without medication
subsidies (self-paying patients). Only one of the patient's medications was
re-packed into Medication Event Monitoring Systems (MEMS) bottles, which were
returned after four weeks. Adherence was defined as the dose regimen being
executed as prescribed on 80% or more of the days. The factors that may influence
patients' adherence were modelled using binary logistic regression. Main outcome
measure: Percentage of medication adherence.
Results: A total of 97 patients, 50 subsidized and 47 self-paying, were included
in the study. Medication adherence was observed in 50% of the subsidized patients
and 63.8% of the self-paying patients (χ2=1.887, df=1, p=0.219). None of the
evaluated variables had a significant influence on patients' medication
adherence, with the exception of attending drug counselling. Patients who
attended drug counselling were found to be 3.3 times more likely to adhere to
medication than those who did not (adjusted odds ratio of 3.29, 95% CI was 1.42
to 7.62, p = 0.006).
Conclusion: There is no significant difference in terms of medication adherence
between subsidized and self-paying patients. Future studies may wish to consider
evaluating modifiable risk factors in the examination of non-adherence among
subsidized and self-paying patients in Malaysia.
PMCID: PMC6173959
PMID: 30302177
578. Indian J Psychol Med. 2014 Oct;36(4):392-6. doi: 10.4103/0253-7176.140724.
Medication Adherence, Work Performance and Self-Esteem among Psychiatric Patients

Attending Psychosocial Rehabilitation Services at Bangalore, India.
Gandhi S(1), Pavalur R(1), Thanapal S(2), Parathasarathy NB(3), Desai G(2), Bhola
P(4), Philip M(5), Chaturvedi SK(2).
Author information:
(1)Department of Nursing, National Institute of Mental Health and Neurosciences,
Bangalore, Karnataka, India.
(2)Department of Psychiatry, National Institute of Mental Health and
Neurosciences, Bangalore, Karnataka, India.
(3)Department of Psychiatric Social Work, National Institute of Mental Health and
(4)Department of Clinical Psychology, National Institute of Mental Health and
(5)Department of Biostatics, National Institute of Mental Health and
CONTEXT: Work benefits mental health in innumerable ways. Vocational

rehabilitation can enhance self-esteem. Medication adherence can improve work
performance and thereby the individuals' self-esteem.
AIM: To test the hypothesis that there would be a significant correlation between
medication adherence, work performance and self-esteem.
SETTING AND DESIGN: A quantitative, descriptive correlational research design was
adopted to invite patients attending psychiatric rehabilitation services to
participate in the research.
MATERIAL AND METHODS: Data was collected from a convenience sample of 60 subjects
using the 'Medication Adherence Rating scale', 'Griffiths work behaviour scale'
and the 'Rosenberg's Self-esteem scale'.
STATISTICAL ANALYSIS USED: Analysis was done using spss18 with descriptive
statistics, Pearsons correlation coefficient and multiple regression analysis.
RESULTS: There were 36 males and 24 females who participated in this study. The
subjects had good mean medication adherence of 8.4 ± 1.5 with median of 9.00,
high mean self-esteem of 17.65 ± 2.97 with median of 18.0 and good mean work
performance of 88.62 ± 22.56 with median of 93.0. Although weak and not
significant, there was a positive correlation (r = 0.22, P = 0.103) between
medication adherence and work performance; positive correlation between (r =
0.25, P = 0.067) medication adherence and self-esteem; positive correlation
between (r = 0.136, P = 0.299) work performance and self-esteem. Multiple
regression analysis showed no significant predictors for medication adherence,
work performance and self-esteem among patients with psychiatric illness.
CONCLUSIONS: Medication monitoring and strengthening of work habit can improve
self-esteem thereby, strengthening hope of recovery from illness.
DOI: 10.4103/0253-7176.140724
PMCID: PMC4201791
PMID: 25336771

eCollection 2019.
Medication used in intentional drug overdose in Flanders 2008-2013.
Vancayseele N(1), Rotsaert I(1)(2), Portzky G(1)(2), van Heeringen K(1).
Author information:
(1)Unit for Suicide Research, Ghent University, Ghent, Belgium.
(2)Flemish Centre of Expertise in Suicide Prevention, Ghent University, Ghent,
Belgium.
BACKGROUND: Intentional drug overdose is the most common method of self-harm. As

psychiatric disorders are very common in self-harm patients, the medication used
to treat these disorders can become the means for the self-harm act. The present
study aimed at investigating an association between the use of prescribed
medication (analgesics and antipyretics, anti-epileptics, antipsychotics,
antidepressants and psychostimulants) as a method of self-harm and prescription
rates of this medication in Flanders. We investigated the possible effect of
gender, alcohol use during the self-harm act and a history of self-harm.
METHODS: Data from the multicenter study of self-harm in Flanders between 2008
and 2013 were used. The significance of differences in percentages was calculated
by GEE and the strength by odds ratios (OR).
RESULTS: There was an increase in the odds of using antidepressants (0.8%) and
antipsychotics (2%) among females when the rate of prescription increases.
Analgesics and antipyretics (39.3/1,000) and antidepressants (124.9/1,000) were
the most commonly prescribed drugs among females. Antidepressants (63.9/1,000)
and antipsychotics (26.5/1,000) were the most commonly prescribed drugs among
males. Antidepressants and analgesics and antipyretics were the most frequently
used medications for self-harm. Analgesics and antipyretics during the self-harm
act were more common among first-timers, while repeaters more commonly overdosed
using antipsychotics and antidepressants.
CONCLUSION: These findings suggest that the availability of medication via
prescriptions plays an important role in the choice of the medication ingested
during the self-harm act. Precautions are necessary when prescribing medication,
including restrictions on the number of prescriptions and the return of unused
medication to pharmacies after cessation of treatment. These issues should be a
focus of attention in the education and training of physicians and pharmacists.
PMCID: PMC6497282
PMID: 31048918

interest exist.
580. Rev Lat Am Enfermagem. 2016;24:e2692. doi: 10.1590/1518-8345.0167.2692. Epub

2016
May 17.
Adaptation and evaluation of the measurement properties of the Brazilian version

of the Self-efficacy for Appropriate Medication Adherence Scale.
[Article in English, Portuguese, Spanish]
Pedrosa RB(1), Rodrigues RC(2).
Author information:
(1)Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP,
Brazil.
(2)Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP,
Brasil.
OBJECTIVES: to undertake the cultural adaptation of, and to evaluate the

measurement properties of, the Brazilian version of the Self-efficacy for
Appropriate Medication Adherence Scale in coronary heart disease (CHD) patients,
with outpatient monitoring at a teaching hospital.
METHOD: the process of cultural adaptation was undertaken in accordance with the
international literature. The data were obtained from 147 CHD patients, through
the application of the sociodemographic/clinical characterization instrument, and
of the Brazilian versions of the Morisky Self-Reported Measure of Medication
Adherence Scale, the General Perceived Self-Efficacy Scale, and the Self-efficacy
for Appropriate Medication Adherence Scale.
RESULTS: the Brazilian version of the Self-efficacy for Appropriate Medication
Adherence Scale presented evidence of semantic-idiomatic, conceptual and cultural
equivalencies, with high acceptability and practicality. The floor effect was
evidenced for the total score and for the domains of the scale studied. The
findings evidenced the measure's reliability. The domains of the Brazilian
version of the Self-efficacy for Appropriate Medication Adherence Scale presented
significant inverse correlations of moderate to strong magnitude between the
scores of the Morisky scale, indicating convergent validity, although
correlations with the measure of general self-efficacy were not evidenced. The
validity of known groups was supported, as the scale discriminated between
"adherents" and "non-adherents" to the medications, as well as to "sufficient
dose" and "insufficient dose".
CONCLUSION: the Brazilian version of the Self-efficacy for Appropriate Medication
Adherence Scale presented evidence of reliability and validity in coronary heart
disease outpatients.
DOI: 10.1590/1518-8345.0167.2692
PMCID: PMC4877142
581. Adv Biomed Res. 2017 May 29;6:63. doi: 10.4103/2277-9175.190997. eCollection
2017.
Relationship between Self-efficacy and Physical Activity, Medication Adherence in

Chronic Disease Patients.
Daniali SS(1), Darani FM(2), Eslami AA(2), Mazaheri M(3).

Author information:
(1)Department of Health, Student Research Center, School of Health, Isfahan
(3)Department of Traditional Medicine, School of Medicine, Isfahan University of
BACKGROUND: The global epidemic of unhealthy lifestyle causes to increase chronic

disease. It has been proven that psychological factors such as self-efficacy are
responsible to success in the process of lifestyle change. Low self-efficacy is
usually related to low level of physical activity and medication adherence.
Objective of the study was to investigate the effects of self-efficacy, other
physical symptoms on physical activity and medication adherence in patients with
chronic illness in public health centers.
MATERIALS AND METHODS: A cross-sectional study was conducted on 483 patients with
chronic diseases attended to governmental health care centers in Isfahan.
Participants were chosen by systematic random sampling. Inclusion criteria were
having a chronic illness at least 6-month ago while prescription of medication
and willing to take part in the survey. The parts of Stanford Self-management
Questionnaire were used. Data were analyzed by SPSS 18 software using the
descriptive and analytic statistics. P < 0.05 was considered significant.
RESULTS: Mean age of participants was 54.8 (7.22) years. The half of participants
had low self-efficacy and 87.2% had low physical activity. Nearly 80% of patients
had a good medication adherence. There was a significant relationship between
self-efficacy and physical activity (P = 0.336, β = 1.01, P < 0.001).
CONCLUSION: Although chronic disease patients had a good medication adherence,
other self-care behaviors such as physical activity has been neglected. It is
seemed that concentration on psychological factors such as self-efficacy should
be considered as a proximal factor to improve self-care.
DOI: 10.4103/2277-9175.190997
PMCID: PMC5458405
PMID: 28603704
582. Int J Environ Res Public Health. 2019 May 18;16(10). pii: E1762. doi:
10.3390/ijerph16101762.
The Prevalence of Smoking, Determinants and Chance of Psychological Problems

among Smokers in an Urban Community Housing Project in Malaysia.
Abd Rashid R(1)(2), Kanagasundram S(3), Danaee M(4), Abdul Majid H(5)(6),
Sulaiman AH(7), Ahmad Zahari MM(8), Ng CG(9), Francis B(10), Wan Husin WAI(11),
Su TT(12)(13).
Author information:
(1)University of Malaya Centre of Addiction Sciences (UMCAS), University of
Malaya, Kuala Lumpur 50603, Malaysia. rusdi@ummc.edu.my.
(2)Department of Psychological Medicine, Faculty of Medicine, University of
Malaya, Kuala Lumpur 50603, Malaysia. rusdi@ummc.edu.my.
Malaya, Kuala Lumpur 50603, Malaysia. sharmilla_kanagasundram@yahoo.com.
of Malaya, Kuala Lumpur 50603, Malaysia. mdanaee@um.edu.my.
of Malaya, Kuala Lumpur 50603, Malaysia. hazreen@ummc.edu.my.
(6)Centre for Population Health (CePH), Department of Social and Preventive
Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603,
Malaysia. hazreen@ummc.edu.my.
Malaya, Kuala Lumpur 50603, Malaysia. hatim@um.edu.my.
Malaya, Kuala Lumpur 50603, Malaysia. muhsin@ummc.edu.my.
Malaya, Kuala Lumpur 50603, Malaysia. chong_guan@um.edu.my.
Malaya, Kuala Lumpur 50603, Malaysia. ben.franciscan@gmail.com.
(11)University of Malaya Centre of Addiction Sciences (UMCAS), University of
Malaya, Kuala Lumpur 50603, Malaysia. irnee84_umcas@um.edu.my.
(12)Centre for Population Health (CePH), Department of Social and Preventive
Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603,
Malaysia. tstin@ummc.edu.my.
(13)South East Asia Community Observatory (SEACO), Monash University Malaysia,
Bandar Sunway 47500, Malaysia. tstin@ummc.edu.my.
Objective: This study was conducted to assess the prevalence, pattern of smoking
and sociodemographic factors among Kerinchi residents in Kuala Lumpur, as well as
to identify the association between smoking, stress, anxiety and depression.
Methods: This study was carried out at four community housing projects in the
Lembah Pantai area in Kuala Lumpur. Data was collected between 3 February 2012,
and 29 November 2012. Data collectors made house visits and used interviewer
administered questionnaires containing questions on demographic data and smoking
patterns. Depression anxiety stress scale (DASS) was used to assess psychological
symptoms. Alcohol smoking and substance involvement screening tool (ASSIST) scale
was used to assess nicotine use. Results: Data from 1989 individuals (833
households) showed the age of respondents ranged from 18 to 89 years and the mean
age was 39.12 years. There were 316 smokers indicating the prevalence of smoking
was 15.85%, with 35.5% among males and 1.8% among females. Further, 86.6% of
smokers were Malay and 87% were Muslims. Divorce was associated with smoking.
Unemployment and housewives were less associated with smoking. Depression and
anxiety were significantly associated with smoking (OR = 1.347. 95% CI:
1.042-1.741) and (OR = 1.401. 95% CI: 1.095-1.793) respectively. Conclusion:
Screening for depression and anxiety should be routinely performed in the primary
care setting and in population-based health screening to intervene early in
patients who smoke.
DOI: 10.3390/ijerph16101762
PMCID: PMC6571886
PMID: 31109033
583. BMC Health Serv Res. 2018 Aug 6;18(1):605. doi: 10.1186/s12913-018-3417-y.
Qualitative exploration of the modifiable factors for medication adherence among

subsidised and self-paying patients in Malaysia.
Aziz H(1), Hatah E(2), Makmor-Bakry M(3), Islahudin F(3), Ahmad Hamdi N(4), Mok
Pok Wan I(5).
Author information:
(1)Pharmacy Department, Putrajaya Hospital, Federal Government Administrative
Centre, Precinct 7, 62250, Putrajaya, Malaysia.
Aziz, 50300, Kuala Lumpur, Malaysia. ernieda@ukm.edu.my.
Aziz, 50300, Kuala Lumpur, Malaysia.
(4)Family Health Development Division, Ministry of Health, Parcel E, Federal
Government Administrative Centre, 62590, Putrajaya, Malaysia.
(5)Pharmacy Department, Universiti Kebangsaan Malaysia Medical Centre, Jalan
Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia.
BACKGROUND: Numerous studies have evaluated the related factors of medication

adherence among patients with chronic disease. However, the factors influencing
medication adherence and non-adherence among subsidised patients with chronic
diseases-for whom medication costs may not be a constraint-remain unexplored.
Thus, this study aims to identify and compare the potential factors that may
influence subsidised and non-subsidised (i.e., self-paying) patients' adherence
to medication.
METHODS: Subsidised and self-paying patients were identified at public and
private healthcare institutions in three states of Malaysia. Patients were then
purposively selected for semi-structured, face-to-face interviews according to
their medication adherence status (including adherent and non-adherent patients),
which was measured using the Medication Event Monitoring System (MEMS). Adherence
was defined as having 80% or more for the percentage of days in which the dose
regimen was executed as prescribed. The interview was conducted from January to
August 2016 and during the interviews, patients were asked to provide reasons for
their medication adherence or non-adherence. The patient interviews were audio
recorded and transcribed verbatim. Data were analysed using thematic analysis
with NVivo 11 software.
RESULTS: Thirteen subsidised and 12 self-paying patients were interviewed. The
themes found among subsidised and self-paying patients were similar. The factors
that influenced adherence to medication include the 'perceived importance of
quality of life' and 'perceived benefit or value of the medications'. A unique
factor reported by patients in this study included 'perceived value of the money
spent on medications'; more specifically, patients adhered to their medications
because they valued the money spent to buy/receive the medications.
CONCLUSION: Medication adherence among subsidised and self-paying patients was
influenced by many factors, including a unique factor relating to their
perceptions of the value of money spent on medications.
DOI: 10.1186/s12913-018-3417-y
PMCID: PMC6080501
584. J Public Health Res. 2016 Dec 21;5(3):762. doi: 10.4081/jphr.2016.762.

Intentional and Unintentional Medication Non-Adherence in Hypertension: The Role

of Health Literacy, Empowerment and Medication Beliefs.
Náfrádi L(1), Galimberti E(1), Nakamoto K(1), Schulz PJ(1).
Author information:
(1)Institute of Communication and Health, Università della Svizzera italiana ,
Lugano, Switzerland.
BACKGROUND: Medication non-adherence is a major public health issue, creating

obstacles to effective treatment of hypertension. Examining the underlying
factors of deliberate and non-deliberate non-adherence is crucial to address this
problem. Thus, the goal of the present study is to assess the socio-demographic,
clinical and psychological determinants of intentional and unintentional
non-adherence.
DESIGN AND METHODS: A cross-sectional survey was conducted between March, 2015
and April, 2016. The sample consisted of hypertension patients holding at least
one medical prescription (N=109). Measurements assessed patients' medication
adherence, health literacy, empowerment, self-efficacy, medication beliefs, and
patients' acceptance of their doctor's advice, socio-demographic and clinical
characteristics.
RESULTS: Patients who occasionally engaged in either intentional or unintentional
non-adherence reported to have lower adherence selfefficacy, higher medication
concern beliefs, lower meaningfulness scores and were less likely to accept the
doctor's treatment recommendations. Patients who occasionally engaged in
unintentional nonadherence were younger and had experienced more side effects
compared to completely adherent patients. Adherence self-efficacy was a mediator
of the effect of health literacy on patients' medication adherence and acceptance
of the doctor's advice was a covariate.
CONCLUSIONS: Regarding the research implications, health literacy and adherence
self-efficacy should be assessed simultaneously when investigating the factors of
non-adherence. Regarding the practical implications, adherence could be increased
if physicians i) doublecheck whether their patients accept the treatment advice
given and ii) if they address patients' concerns about medications. These steps
could be especially important for patients characterized with lower
self-efficacy, as they are more likely to engage in occasional nonadherence.
DOI: 10.4081/jphr.2016.762
PMCID: PMC5206775
PMID: 28083523
Conflict of interest statement: the authors declare no potential conflict of

interest.
585. Ital J Pediatr. 2016 Feb 26;42:20. doi: 10.1186/s13052-016-0219-x.
Acetaminophen administration in pediatric age: an observational prospective

Lubrano R(1), Paoli S(2), Bonci M(3), Di Ruzza L(4), Cecchetti C(5), Falsaperla
R(6), Pavone P(7), Matin N(8), Vitaliti G(9)(10), Gentile I(11).
Author information:
(1)Department of Pediatrics, La Sapienza University of Rome, Rome, Italy.
riccardo.lubrano@uniroma1.it.
sara.paoli@hotmail.it.
(3)Paediatrics Operative Unit, Grassi Hospital, Rome, Italy.
bonci.marco@gmail.com.
(4)Paediatrics Operative Unit, Policlinico Umberto I, Frosinone, Italy.
luidir@alice.it.
(5)Acute and Emergency Operative Unit, Bambino Gesù Paediatric Hospital, Rome,
Italy. corrado.cecchetti@opbg.net.
(6)General Paediatrics and Acute and Emergency Paediatrics Operative Unit,
Vittorio Emanuele University Hospital, Catania, Italy. r.falsaperla@ao-ve.it.
(7)General Paediatrics and Acute and Emergency Paediatrics Operative Unit,
Vittorio Emanuele University Hospital, Catania, Italy. ppavone@unict.it.
(8)University Medical Science of Teheran, University of Teheran, Teheran, Italy.
nsmatn@yahoo.com.
giovitaliti@yahoo.it.
(10)AOU Policlinico-OVE, University of Catania, Via Plebiscito n. 628, 95100,
Catania, Italy. giovitaliti@yahoo.it.
isottagentile@libero.it.
BACKGROUND: Parents often do not consider fever as an important physiological

response and mechanism of defense against infections that leads to inappropriate
use of antipyretics and potentially dangerous side effects. This study is
designed to evaluate the appropriateness of antipyretics dosages generally
administered to children with fever, and to identify factors that may influence
dosage accuracy.
RESULTS: In this cross-sectional study we analyzed the clinical records of 1397
children aged >1 month and < 16 years, requiring a primary care (ambulatory)
outpatient visit due to fever. We evaluated the number of children who had
received >90 mg/kg/day of acetaminophen, the prescriber, the medication formula
and the educational level of the caregiver who administered acetaminophen. Among
those children included in our study, 74 % were administered acetaminophen for
body temperature ≤ 38.4 °C. 24.12 % of children received >90 mg/kg/day of
acetaminophen. Parents with university qualifications most commonly
self-administered acetaminophen to their children, in a higher than standard
dose. Self medication was also described in 60 % of children, whose acetaminophen
was administered for temperatures < 38 °C. Acetaminophen over-dosage was also
favored by the use of drug formulations as drops or syrup.
CONCLUSIONS: Our study shows that preventive action should be taken regarding the
use of acetaminophen as antipyretic drug in children in order to reduce the fever
phobia and self-prescription, especially of caregivers with higher educational
levels. It is also necessary to promote a more appropriate use of acetaminophen
in those parents using drops or syrup formulations.
DOI: 10.1186/s13052-016-0219-x
PMCID: PMC4769520

eCollection 2016.
Development of a new diabetes medication self-efficacy scale and its association

with both reported problems in using diabetes medications and self-reported
adherence.
Sleath B(1), Carpenter DM(2), Blalock SJ(2), Davis SA(2), Hickson RP(2), Lee
C(3), Ferreri SP(4), Scott JE(5), Rodebaugh LB(6), Cummings DM(7).
Author information:
(1)Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of
Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, USA;
Cecil G. Sheps Center for Health Services Research, The University of North
Carolina at Chapel Hill, Chapel Hill, USA.
Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, USA.
(3)Polyglot Systems, Inc., Morrisville, USA.
(4)Division of Practice Advancement and Clinical Education, UNC Eshelman School
of Pharmacy, Chapel Hill, USA.
(5)Consortium for Implementation Science, Department of Health Policy and
Management, Gillings School of Global Public Health, The University of North
Carolina at Chapel Hill, Chapel Hill, USA.
(6)Department of Family Medicine, Brody School of Medicine, East Carolina
University, Greenville, USA.
(7)Department of Family Medicine, Brody School of Medicine, East Carolina
University, Greenville, USA; Department of Public Health, Brody School of
Medicine, East Carolina University, Greenville, NC, USA.
BACKGROUND: Although there are several different general diabetes self-efficacy
scales, there is a need to develop a self-efficacy scale that providers can use
to assess patient's self-efficacy regarding medication use. The purpose of this
study was to: 1) develop a new diabetes medication self-efficacy scale and 2)
examine how diabetes medication self-efficacy is associated with patient-reported
problems in using diabetes medications and self-reported adherence.
PATIENTS AND METHODS: Adult English-speaking patients with type 2 diabetes were
recruited from a family medicine clinic and a pharmacy in Eastern North Carolina,
USA. The patients were eligible if they reported being nonadherent to their
diabetes medicines on a visual analog scale. Multivariable regression was used to
examine the relationship between self-efficacy and the number of reported
diabetes medication problems and adherence.
RESULTS: The diabetes medication self-efficacy scale had strong reliability
(Cronbach's alpha =0.86). Among a sample (N=51) of mostly African-American female
patients, diabetes medication problems were common (6.1±3.1) and a greater number
of diabetes medications were associated with lower medication adherence (odds
ratio: 0.35; 95% confidence interval: 0.13, 0.89). Higher medication
self-efficacy was significantly related to medication adherence (odds ratio:
1.17; 95% confidence interval: 1.05, 1.30) and inversely related to the number of
self-reported medication problems (β=-0.13; P=0.006).
CONCLUSION: Higher diabetes medication self-efficacy was associated with fewer
patient-reported medication problems and better medication adherence. Assessing
medication-specific self-efficacy may help to identify medication-related
problems that providers can help the patients address, potentially improving
adherence and patient outcomes.
DOI: 10.2147/PPA.S101349
PMCID: PMC4908948
PMID: 27354769
587. Diabetol Int. 2016 Apr 6;7(4):398-403. doi: 10.1007/s13340-016-0265-z.

Clinical backgrounds associated with discrepancy between subjective and objective

assessments of medication adherence in Japanese type 2 diabetic patients.
Takahara M(1)(2), Shiraiwa T(3), Ogawa N(4), Katakami N(2), Matsuoka TA(2),
Shimomura I(2).
Author information:
(1)1Department of Diabetes Care Medicine, Osaka University Graduate School of
Medicine, 2-2, Yamadaoka, Suita City, Osaka 565-0871 Japan.
(2)2Department of Metabolic Medicine, Osaka University Graduate School of
Medicine, 2-2, Yamadaoka, Suita City, Osaka 565-0871 Japan.
(3)Shiraiwa Medical Clinic, Shiraiwa Medical Clinic, 4-10-24 Hozenji, Kashiwara
City, Osaka 582-0005 Japan.
(4)Smile Pharmacy, 4-10-25 Hozenji, Kashiwara City, Osaka 582-0005 Japan.
Although medication adherence can be easily assessed by self-reports in clinical

practice, accuracy is sometimes questionable. To make full use of self-reports on
medication adherence in clinical practice, understanding the discrepancy between
subjectively and objectively assessed adherence is important. The aim of this
study was to investigate which clinical characteristics would be associated with
such discrepancy regarding adherence to oral antidiabetic drugs (OADs) in type 2
diabetic patients. Our study assessed 406 Japanese type 2 diabetic outpatients
treated with OADs. Medication adherence to OADs was evaluated in percentage, both
subjectively by self-report and objectively by pill counts on the same day. We
developed a common regression model by extending the generalized linear mixed
model and statistically detected the difference in the impact of clinical
characteristics between the two measures. Subjectively measured adherence was
higher than objectively measured adherence, showing a 1.6-fold difference in odds
(p < 0.001). Male gender, older age, longer diabetic duration, and taking more
than two OADs daily were independently associated with the overrating of
medication adherence by self-report compared with the objectively measured
adherence. On the other hand, higher glycocylated hemoglobin (HbA1c) levels,
taking medication before meals, and taking medication outside the home were
independently associated with underrating medication adherence by self-report. In
conclusion, this study demonstrated clinical characteristics associated with
overrating and underrating of medication adherence by self-report in Japanese
type 2 diabetic patients treated with OADs.
DOI: 10.1007/s13340-016-0265-z
PMCID: PMC6224975
PMID: 30603292
Conflict of interest statement: All procedures followed were in accordance with

the ethical standards of the responsible committee on human experimentation
(institutional and national) and with the Helsinki Declaration of 1964 and later
revision. Informed consent or substitute for it was obtained from all patients
for being included in the study.The authors declare that they have no conflicts
of interests associated with this manuscript.
588. Trop Parasitol. 2019 Jan-Jun;9(1):36-44. doi: 10.4103/tp.TP_36_18. Epub 2019

May
22.
Impact of training of mothers, drug shop attendants and voluntary health workers
on effective diagnosis and treatment of malaria in Lagos, Nigeria.
Ajibaye O(1), Balogun EO(2)(3), Olukosi YA(1), Orok BA(1), Oyebola KM(1),
Iwalokun BA(4), Aina OO(1), Shittu O(5), Adeneye AK(6), Ojewunmi OO(7), Kita
K(6), Awolola ST(8).
Author information:
(1)Department of Biochemistry and Nutrition, Nigerian Institute of Medical
Research, Yaba, Lagos, Nigeria.
(2)Department of Biochemistry, Ahmadu Bello University, Zaria, Nigeria.
(3)Department of Biomedical Chemistry, Graduate School of Medicine, The
University of Tokyo, Tokyo, Japan.
(4)Department of Molecular Biology and Biotechnology, Nigerian Institute of
Medical Research, Yaba, Lagos, Nigeria.
(5)Department of Zoology, Parasitology Unit, University of Ilorin, Ilorin,
Nigeria.
(6)School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki,
Japan.
(7)Sickle Cell Foundation on Nigeria, Idi-Araba, Lagos, Nigeria.
(8)Department of Public Health and Molecular Entomology, Nigerian Institute of
Medical Research, Yaba, Lagos, Nigeria.
Background: The National Malaria Eradication Program and international agencies

are keen on scaling up the use of malaria rapid diagnostic tests (mRDTs) and
artemisinin-based combination therapies (ACTs) for effective diagnosis and
treatment of the disease. However, poor diagnostic skills and inappropriate
treatment are limiting the efforts. In Nigeria, a large proportion of infected
patients self-diagnose and treat while many others seek care from informal drug
attendants and voluntary health workers.
Aims: This study describes the impact of training voluntary health workers, drug
shop attendants, and mothers on effective case detection and treatment of malaria
in Lagos, Nigeria. METHODS: We trained mothers accessing antenatal care, drug
shop attendants, and voluntary health workers selected from the three districts
of Lagos, on the use of histidine-rich protein-2-based mRDTs and ACTs. Pre- and
post-training assessments, focus group discussions (FGDs), and in-depth
interviews (IDIs) were carried out.
Results: The knowledge, attitude, and skill of the participants to achieve the
goal of "test, treat, and track" using mRDT and ACTs were low (11%-55%). There
was a low awareness of other non-malaria fevers among mothers. Self-medication
was widely practiced (31.3%). FGDs and IDIs revealed that health-care providers
administered antimalarials without diagnosis. Training significantly improved
participants' knowledge and expertise on the use of mRDTs and ACTs (P = 0.02).
The participants' field performance on mRDT use was significantly correlated with
their category (bivariate r = 0.51, P = 0.001). There was no statistically
significant association between the participants' level of education or previous
field experience and their field performance on mRDT (r = 0.12, P = 0.9; χ 2= 38,
df = 2 and P = 0.49).
Conclusion: These findings suggest that training of stakeholders in malaria
control improves diagnosis and treatment of malaria. However, a broader scope of
training in other settings may be required for an effective malaria control in
Nigeria.
DOI: 10.4103/tp.TP_36_18
PMCID: PMC6542308
PMID: 31161091
589. Br J Dermatol. 2017 Mar;176(3):667-676. doi: 10.1111/bjd.15086. Epub 2016 Dec

17.
Nonadherence to psoriasis medication as an outcome of limited coping resources

and conflicting goals: findings from a qualitative interview study with people
with psoriasis.
Thorneloe RJ(1)(2)(3), Bundy C(1)(2)(4), Griffiths CE(1)(2)(4), Ashcroft DM(3),

Cordingley L(2)(5).
Author information:
(1)Centre for Dermatology Research, Manchester Academic Health Science Centre,
University of Manchester, Manchester, U.K.
(2)School of Biological Sciences, Manchester Academic Health Science Centre,
University of Manchester, Manchester, U.K.
(3)Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences,
Manchester Academic Health Science Centre, University of Manchester, Manchester,
U.K.
(4)Salford Royal NHS Foundation Trust, Manchester, U.K.
(5)Division of Musculoskeletal and Dermatological Sciences, University of
Manchester, Manchester, U.K.
Comment in
Br J Dermatol. 2017 Mar;176(3):558-559.
BACKGROUND: Medication nonadherence is known to limit the effectiveness of

available therapies; however, little is known specifically about medication
adherence in people with psoriasis. Medicines self-management can feel onerous to
those with dermatological conditions due to the nature of therapies prescribed
and many individuals with psoriasis experience additional challenges such as
physical and psychological comorbidities that place significant additional
demands on individuals and may undermine adherence. Viewing nonadherence to
medication as an outcome of limited personal coping resources and conflicting
goals may help to explain medication nonadherence.
OBJECTIVES: To explore individuals' perspectives of their psoriasis, medication
and its management.
METHODS: Twenty people with psoriasis were recruited from community samples in
England and interviewed in-depth about their perceptions of their psoriasis,
medication, and adherence to medication and self-management advice. Data were
analysed using Framework Analysis.
RESULTS: Participants reported that adhering to recommended treatment regimens
conflicted with the management of the physical and psychological demands of
living with psoriasis. Medication usage was viewed as a source of unresolved
emotional distress and, for some, resulted in poor self-reported adherence, which
included medication overuse, underuse and rejection of prescribed therapies.
Perceived lack of engagement by clinicians with participants' self-management
difficulties was viewed as an additional source of stress and distress.
CONCLUSIONS: Adhering to medication in psoriasis can be an additional source of
considerable emotional distress. We interpreted some episodes of nonadherence to
psoriasis medication as rational attempts by individuals to minimize distress and
to gain control over their life.
© 2016 The Authors. British Journal of Dermatology published by John Wiley & Sons
Ltd on behalf of British Association of Dermatologists.
DOI: 10.1111/bjd.15086
PMCID: PMC5363250
590. J Pain Symptom Manage. 2014 Nov;48(5):770-83. doi:

10.1016/j.jpainsymman.2013.12.242. Epub 2014 Apr 4.
Pain medication management processes used by oncology outpatients and family

caregivers part I: health systems contexts.
Schumacher KL(1), Plano Clark VL(2), West CM(3), Dodd MJ(3), Rabow MW(3),
Miaskowski C(3).
Author information:
(1)College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska,
USA. Electronic address: kschumacher@unmc.edu.
(2)University of Cincinnati, Cincinnati, Ohio, USA.
(3)University of California, San Francisco, San Francisco, California, USA.
Comment in
J Pain Symptom Manage. 2014 Nov;48(5):760-1.
CONTEXT: Oncology patients with persistent pain treated in outpatient settings

and their family caregivers have significant responsibility for managing pain
medications. However, little is known about their practical day-to-day
experiences with pain medication management.
OBJECTIVES: The aim was to describe day-to-day pain medication management from
the perspectives of oncology outpatients and their family caregivers who
participated in a randomized clinical trial of a psychoeducational intervention
called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on
pain medication management by patients and family caregivers in the context of
multiple complex health systems.
METHODS: We qualitatively analyzed audio-recorded intervention sessions that
included extensive dialogue between patients, family caregivers, and nurses about
pain medication management during the 10-week intervention.
RESULTS: The health systems context for pain medication management included
multiple complex systems for clinical care, reimbursement, and regulation of
analgesic prescriptions. Pain medication management processes particularly
relevant to this context were getting prescriptions and obtaining medications.
Responsibilities that fell primarily to patients and family caregivers included
facilitating communication and coordination among multiple clinicians, overcoming
barriers to access, and serving as a final safety checkpoint. Significant effort
was required of patients and family caregivers to insure safe and effective pain
medication management.
CONCLUSION: Health systems issues related to access to needed analgesics,
medication safety in outpatient settings, and the effort expended by oncology
patients and their family caregivers require more attention in future research
and health-care reform initiatives.
Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published

by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.jpainsymman.2013.12.242
PMCID: PMC4185257
Emergence of fluoroquinolone resistance among drug resistant tuberculosis

patients at a tertiary care facility in Karachi, Pakistan.
Zaidi SMA(1), Haseeb A(2), Habib SS(3), Malik A(1), Khowaja S(1), SaifUllah N(2),
Rizvi N(2).
Author information:
(1)Interactive Research & Development, Suite 508, Ibrahim Trade Tower, Main
Shahrah-e-Faisal, Karachi, Pakistan.
(2)Department of Chest Medicine, Jinnah Post Graduate Medical Centre, Rafiqi H J
Rd, Karachi, Pakistan.
(3)Interactive Research & Development, Suite 508, Ibrahim Trade Tower, Main
Shahrah-e-Faisal, Karachi, Pakistan. shifa.habib@irdresearch.org.
BACKGROUND: Pakistan is classified as one of the high multi-drug resistant

tuberculosis (MDR-TB) burden countries. A poorly regulated private sector,
over-prescription of antibiotics and self-medication has led to augmented rates
of drug-resistance in the country. Pakistan's first national anti-tuberculosis
drug resistance survey identified high prevalence of fluoroquinolone resistance
among MDR-TB patients. Further institutional evidence of fluoroquinolone
drug-resistance can support re-evaluation of treatment regimens as well as
invigorate efforts to control antibiotic resistance in the country.
FINDINGS: In this study, data for drug-susceptibility testing (DST) was
retrospectively analyzed for a total of 133 patients receiving MDR-TB treatment
at the Chest Department of Jinnah Postgraduate Medical Center, Karachi, Pakistan.
Frequency analyses for resistance patterns was carried out and association of
fluoroquinolone (ofloxacin) resistance with demographics and past TB treatment
category were assessed. Within first-line drugs, resistance to isoniazid was
detected in 97.7% of cases, followed by rifampicin (96.9%), pyrazinamide (86.4%),
ethambutol (69.2%) and streptomycin (64.6%). Within second-line drugs, ofloxacin
resistance was detected in 34.6% of cases. Resistance to ethionamide and amikacin
was 2.3% and 1.6%, respectively. Combined resistance of oflaxacin and isoniazid
was detected in 33.9% of cases. Age, gender and past TB treatment category were
not significantly associated with resistance to ofloxacin.
CONCLUSION: Fluoroquinolone resistance was observed in an alarmingly high
proportion of MDR-TB cases. Our results suggest caution in their use for
empirical management of MDR-TB cases and recommended treatment regimens for
MDR-TB may require re-evaluation. Greater engagement of private providers and
stringent pharmacy regulations are urgently required.
DOI: 10.1186/s13104-017-2633-6
PMCID: PMC5526320
592. Antibiotics (Basel). 2019 Apr 1;8(2). pii: E35. doi:

10.3390/antibiotics8020035.
Quality of Community Pharmacy Practice in Antibiotic Self-Medication Encounters:

A Simulated Patient Study in Upper Egypt.
Abdelaziz AI(1), Tawfik AG(2), Rabie KA(3), Omran M(4), Hussein M(5), Abou-Ali
A(6), Ahmed AF(7).
Author information:
(1)Department of Pharmaceutics, Faculty of Pharmacy, Minia University, Minia
61519, Egypt. abdullahislam.mu@gmail.com.
(2)Department of Pharmacology and Toxicology, Faculty of Pharmacy, Deraya
University, Minia 61512, Egypt. abdelrahman.gamal@deraya.edu.eg.
(3)Medical Representative, Novartis 61519, Egypt. khalid.ahmed.rabie@gmail.com.
(4)Community Pharmacist, Minia 61519, Egypt. muhammad.o.yusef@gmail.com.
(5)Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee,
Milwaukee, WI 53201, USA. husseimh@uwm.edu.
(6)Global Safety Officer at Sanofi Pasteur, Toronto Area, ON M2R 3T4, Canada.
adel.abouali@gmail.com.
(7)Department of Pharmacology and Toxicology, Faculty of Pharmacy, Minia
University, Minia 61519, Egypt. shaimaa.faissal@minia.edu.eg.
Antibiotic misuse, either by patients or healthcare professionals, is one of the

major contributing factors to antimicrobial resistance. In many Middle Eastern
countries including Egypt, there are no strict regulations regarding antibiotic
dispensing by community pharmacies. In this study, we examined antibiotic
dispensing patterns in Egyptian community pharmacies. About 150 community
pharmacies were randomly chosen using convenience sampling from the five most
populous urban districts of Minia Governorate in Egypt. Two simulated patient
(SP) scenarios of viral respiratory tract infection requiring no antibiotic
treatment were used to assess the actual antibiotics dispensing practice of.
Face-to-face interviews were then conducted to assess the intended dispensing
practice. Descriptive statistics were calculated to report the main study
outcomes. In 238 visits of both scenarios, 98.3% of service providers dispensed
amoxicillin. Although stated otherwise in interviews, most pharmacy providers
(63%) dispensed amoxicillin without collecting relevant information from
presenting SPs. Findings showed high rates of antibiotic misuse in community
pharmacies. Discrepancies between interviews and patient simulation results also
suggest a practice‒knowledge gap. Corrective actions, whether legislation,
enforcement, education, or awareness campaigns about antibiotic misuse, are
urgently needed to improve antibiotic dispensing practices in Egyptian community
pharmacies.
DOI: 10.3390/antibiotics8020035
PMCID: PMC6627069
PMID: 30939797
593. BMC Complement Altern Med. 2018 Mar 15;18(1):92. doi: 10.1186/s12906-018-2160-
6.
Why people use herbal medicine: insights from a focus-group study in Germany.
Welz AN(1), Emberger-Klein A(1), Menrad K(2).
Author information:
(1)TUM Campus Straubing for Biotechnology and Sustainability,
Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315,
Straubing, Germany.
(2)TUM Campus Straubing for Biotechnology and Sustainability,
Weihenstephan-Triesdorf University of Applied Sciences, Petersgasse 18, 94315,
Straubing, Germany. klaus.menrad@hswt.de.
BACKGROUND: The use of herbal medicine, as one element of complementary and

alternative medicine, is increasing worldwide. Little is known about the reasons
for and factors associated with its use. This study derives insights for the use
of herbal medicine in Germany regarding the usage aims, role played by the type
of illness, reasons for preferred usage and sources of information.
METHODS: Using a qualitative methodological approach, six focus groups (n = 46)
were conducted. Two groups with young, middle-aged and elderly participants,
respectively. After audiotaping and verbatim transcription, the data were
analysed with a qualitative content analysis.
RESULTS: We found that treating illnesses was the most frequently discussed aim
for using herbal medicine over all age groups. Preventing illnesses and promoting
health were less frequently mentioned overall, but were important for elderly
people. Discussions on herbal medicine were associated with either mild/moderate
diseases or using herbal medicine as a starting treatment before applying
conventional medicine. In this context, participants emphasized the limits of
herbal medicine for severe illnesses. Dissatisfaction with conventional
treatment, past good experiences, positive aspects associated with herbal
medicine, as well as family traditions were the most commonly-mentioned reasons
why herbal medicine was preferred as treatment. Concerning information sources,
independent reading and family traditions were found to be equally or even more
important than consulting medicinal experts.
CONCLUSIONS: Although herbal medicine is used mostly for treating mild to
moderate illnesses and participants were aware of its limits, the combination of
self-medication, non-expert consultation and missing risk awareness of herbal
medicine is potentially harmful. This is particularly relevant for elderly users
as, even though they appeared to be more aware of health-related issues, they
generally use more medicine compared to younger ones. In light of our finding
that dissatisfaction with conventional medicine was the most important reason for
a preferred use of herbal medicine, government bodies, doctors, and
pharmaceutical companies need to be aware of this problem and should aim to
establish a certain level of awareness among users concerning this issue.
DOI: 10.1186/s12906-018-2160-6
PMCID: PMC5855977
594. Patient Prefer Adherence. 2018 Nov 27;12:2517-2525. doi: 10.2147/PPA.S170144.

eCollection 2018.
Validation of diabetes medication self-efficacy scale in Chinese with type 2
diabetes.
Zheng J(1), Wang Y(2), Ye X(3), Xiao L(4), Ye J(5), Li X(6), Zhong M(1).
Author information:
(1)Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200040,
China, hsmkzhong@hotmail.com.
(2)Health Services and Systems Research, Duke-NUS Medical School, Singapore
169857, Singapore.
(3)Department of Endocrinology, Xiamen Municipal Hospital of Traditional Chinese
Medicine, Xiamen 361009, China.
(4)Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai
201508, China.
(5)School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350001,
China.
(6)Department of Psychology, School of Social Development and Public Policy,
Fudan University, Shanghai 200433, China, lixiaoru@fudan.edu.cn.
Aims: Greater diabetes medication self-efficacy has been shown to associate with
better medication adherence, which is critical for disease control for people
living with type 2 diabetes (T2D). The Diabetes Medication Self-efficacy Scale
(DMSS) is a 19-item instrument to measure diabetes medication self-efficacy. The
aim of the current study was to translate the DMSS into Chinese and validate the
Chinese version of DMSS (CDMSS) among Chinese T2D patients.
Methods: The CDMSS was translated using forward-backward method, and its validity
and reliability were assessed among 257 Chinese T2D patients. Exploratory factor
analysis, Cronbach's α and Spearman's rank correlation coefficients were used to
evaluate the psychometric properties of CDMSS. Receiver operating characteristic
analysis was used to assess the discrimination of CDMSS for medication adherence
and glycemic control.
Results: Exploratory factor analysis has generated a one-factor structure of the
11-item version of CDMSS (CDMSS-11), which accounted for 63.1% of the variance.
The Spearman's rank correlation coefficient between the original 19-item and
11-item scale was 0.96. The Cronbach's α for internal consistency was 0.94, and
the test-retest reliability coefficient was 0.76. The CDMSS-11 score was
significantly correlated with diabetes distress, medication adherence, as well as
blood levels of fasting plasma glucose and hemoglobin A1c (both P<0.001). The
area under receiver operating characteristic curve and its corresponding 95% CI
was 0.79 (0.73-0.84) for medication adherence, and it was 0.65 (0.57-0.72) for
better glycemic control.
Conclusion: The CDMSS-11 is a valid and reliable measure to assess medication
self-efficacy among Chinese T2D patients.
DOI: 10.2147/PPA.S170144
PMCID: PMC6267354
PMID: 30568430

595. BMC Nephrol. 2017 May 22;18(1):167. doi: 10.1186/s12882-017-0583-9.
Medication adherence perspectives in haemodialysis patients: a qualitative study.
Ghimire S(1), Castelino RL(1)(2)(3), Jose MD(4)(5), Zaidi STR(6).
Author information:
(1)Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School
of Medicine, Faculty of Health, University of Tasmania, Hobart, 7001, Australia.
(2)Sydney Nursing School, University of Sydney, Sydney, Australia.
(3)Blacktown Hospital, Western Sydney Local Health District, Sydney, Australia.
(4)School of Medicine, Faculty of Health, University of Tasmania, Hobart,
Australia.
(5)Department of Nephrology, Royal Hobart Hospital, Hobart, Australia.
(6)Unit for Medication Outcomes Research and Education (UMORE), Pharmacy, School
of Medicine, Faculty of Health, University of Tasmania, Hobart, 7001, Australia.
tabish.razizaidi@utas.edu.au.
BACKGROUND: End-stage kidney disease patients undergoing haemodialysis are

prescribed with multiple complex regimens and are predisposed to high risk of
medication nonadherence. The aims of this study were to explore factors
associated with medication adherence, and, to examine the differential
perspectives on medication-taking behaviour shown by adherent and nonadherent
haemodialysis patients.
METHODS: A qualitative exploratory design was used. One-on-one semi-structured
interviews were conducted with 30 haemodialysis patients at the outpatient
dialysis facility in Hobart, Australia. Patient self-reported adherence was
measured using 4-item Morisky Green Levine scale. Interview transcripts were
thematically analysed and mapped against the World Health Organization (WHO)
determinants of medication adherence.
RESULTS: Participants were 44-84 years old, and were prescribed with 4-19
medications daily. More than half of the participants were nonadherent to their
medications based on self-reported measure (56.7%, n = 17). Themes mapped against
WHO adherence model comprised of patient-related (knowledge, awareness, attitude,
self-efficacy, action control, and facilitation); health system/ healthcare team
related (quality of interaction, and mistrust and collateral arrangements);
therapy-related (physical characteristics of medicines, packaging, and side
effects); condition-related (symptom severity); and social/ economic factors
(access to medicines, and relative affordability).
CONCLUSIONS: Patients expressed a number of concerns that led to nonadherence
behaviour. Many of the issues identified were patient-related and potentially
modifiable by using psycho-educational or cognitive-behavioural interventions.
Healthcare professionals should be more vigilant towards identifying these
concerns to address adherence issues. Future research should be aimed at
understanding healthcare professionals' perceptions and practices of assessing
medication adherence in dialysis patients that may guide intervention to resolve
this significant issue of medication nonadherence.
DOI: 10.1186/s12882-017-0583-9
PMCID: PMC5440949
596. Health Educ Behav. 2017 Apr;44(2):285-296. doi: 10.1177/1090198116656331. Epub

2016 Jul 18.
Mediators and Moderators of Improvements in Medication Adherence.
Hofer R(1), Choi H(1), Mase R(1)(2), Fagerlin A(1)(2)(3), Spencer M(1), Heisler
M(1)(2).
Author information:
(1)1 University of Michigan, Ann Arbor, MI, USA.
(2)2 Ann Arbor Veterans' Affairs Healthcare System, Ann Arbor, MI, USA.
(3)3 Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI, USA.
OBJECTIVE: In a randomized controlled trial we compared two models of community
health worker-led diabetes medication decision support for low-income Latino and
African American adults with diabetes. Most outcomes were improved when community
health workers used either an interactive e-Health tool or print materials. This
article investigates mediators and moderators of improved medication adherence in
these two models.
METHOD: Because both programs significantly improved satisfaction with medication
information, medication knowledge, and decisional conflict, we examined whether
improvements in each of these outcomes in turn were associated with improvements
in self-reported medication adherence, and if so, whether these improvements were
mediated by improvements in diabetes self-efficacy or diabetes distress.
Potential moderators of improvement included gender, race/ethnicity, age,
education, insulin use, health literacy, and baseline self-efficacy, diabetes
distress, and A1c.
RESULTS: A total of 176 participants (94%) completed all assessments. After
adjusting for potential confounders, only increased satisfaction with medication
information was correlated with improved medication adherence ( p = .024).
Improved self-efficacy, but not diabetes distress, was associated with
improvements in both satisfaction with medication information and medication
adherence. However, the Sobel-Goodman Mediation test did not support improvements
in self-efficacy as a mechanism by which improved satisfaction led to better
adherence. None of the examined variables achieved statistical significance as
moderators.
CONCLUSIONS: Improvements in satisfaction with medication information but not in
medication knowledge or decision conflict were associated with improvements in
medication adherence. Interventions that target low-income ethnic and racial
minorities may need to focus on increasing participants' satisfaction with
information provided on diabetes medications and not just improving their
knowledge about medications. Future research should explore in more depth other
possible mediators and moderators of improvements in medication adherence in
low-income minority populations.
DOI: 10.1177/1090198116656331
PMCID: PMC5237412

eCollection 2015.
Determinants of adherence to treatment in hypertensive patients of African

descent and the role of culturally appropriate education.
Meinema JG(1), van Dijk N(1), Beune EJ(2), Jaarsma DA(3), van Weert HC(1),
Haafkens JA(1).
Author information:
(1)Department of General Practice/Family Medicine, Academic Medical
Center-University of Amsterdam, Amsterdam, the Netherlands.
(2)Department of Social Medicine, Academic Medical Center-University of
Amsterdam, Amsterdam, the Netherlands.
(3)Department of Evidence-based medical education, University Medical Center of
Groningen, Groningen, the Netherlands.
BACKGROUND: In Western countries, better knowledge about patient-related

determinants of treatment adherence (medication and lifestyle) is needed to
improve treatment adherence and outcomes among hypertensive ethnic minority
patients of African descent.
OBJECTIVE: To identify patient-related determinants of adherence to lifestyle and
medication recommendations among hypertensive African Surinamese and Ghanaian
patients with suboptimal treatment results (SBP≥140) living in the Netherlands
and how culturally appropriate hypertension education (CAHE) influenced those
determinants.
METHODS: This study analysed data of 139 patients who participated in the CAHE
trial. Univariate logistic regression analysis was used to measure the
association between patient-related determinants (medication self-efficacy,
beliefs about medication and hypertension, social support, and satisfaction with
care) and treatment adherence. We also tested whether CAHE influenced the
determinants.
RESULTS: Medication self-efficacy and social support were associated with
medication adherence at baseline. At six months, more medication self-efficacy
and fewer concerns about medication use were associated with improved medication
adherence. Self-efficacy was also associated with adherence to lifestyle
recommendations at baseline. CAHE influenced patients' illness perceptions by
creating more understanding of hypertension, its chronic character, and more
concerns about the associated risks.
CONCLUSION: In this high-risk population, health care providers can support
medication adherence by paying attention to patients' medication self-efficacy,
the concerns they may have about medication use and patients' perceptions on
hypertension. The CAHE intervention improved patients' perception on
hypertension.
PMCID: PMC4534399
598. Patient Prefer Adherence. 2017 Sep 28;11:1687-1699. doi: 10.2147/PPA.S142653.

eCollection 2017.
Swallowing difficulties with medication intake assessed with a novel self-report

questionnaire in patients with systemic sclerosis - a cross-sectional population
study.
Messerli M(1)(2), Aschwanden R(1), Buslau M(2), Hersberger KE(1), Arnet I(1).
Author information:
(1)Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences,
University of Basel, Basel, Switzerland.
(2)European Centre for the Rehabilitation of Scleroderma, Reha Rheinfelden,
Rheinfelden, Switzerland.
OBJECTIVES: To assess subjective swallowing difficulties (SD) with medication

intake and their practical consequences in patients suffering from systemic
sclerosis (SSc) with a novel self-report questionnaire.
DESIGN AND SETTING: Based on a systematic literature review, we developed a
self-report questionnaire and got it approved by an expert panel. Subsequently,
we sent the questionnaire by post mail to SSc patients of the European Center for
the Rehabilitation of Scleroderma Rheinfelden, Switzerland.
PARTICIPANTS: Patients were eligible if they were diagnosed with SSc, treated at
the center, and were of age ≥18 years at the study start.
MAIN OUTCOME MEASURES: Prevalence and pattern of SD with oral medication intake,
including localization and intensity of complaints.
RESULTS: The questionnaire consisted of 30 items divided into five sections
Complaints, Intensity, Localization, Coping strategies, and Adherence. Of the 64
SSc patients eligible in 2014, 43 (67%) returned the questionnaire. Twenty
patients reported SD with medication intake (prevalence 47%), either currently
(11; 26%) or in the past that had been overcome (9; 21%). Self-reported SD were
localized mostly in the larynx (43%) and esophagus (34%). They were of moderate
(45%) or strong to unbearable intensity (25%). Modification of the dosage form
was reported in 40% of cases with SD. Adherence was poor for 20 (47%) patients
and was not associated with SD (p=0.148).
CONCLUSION: Our novel self-report questionnaire is able to assess the pattern of
complaints linked to medication intake, that is, localization and intensity. It
may serve as a guide for health care professionals in selecting the most suitable
therapy option, enabling tailored counseling to reduce inappropriate medication
modifications.
DOI: 10.2147/PPA.S142653
PMCID: PMC5630072
PMID: 29033556
Conflict of interest statement: Disclosure All authors have completed the ICMJE
uniform disclosure form at www.icmje.org/coi_disclosure.pdf. The authors report
no conflicts of interest in this work and declare no support from any
organization for the submitted work, no financial relationships with any
organizations that might have an interest in the submitted work in the previous 3
years, and no other relationships or activities that could appear to have
influenced the submitted work.
599. Arch Clin Neuropsychol. 2019 May 1;34(3):290-300. doi: 10.1093/arclin/acy038.
Medication Management Performance and Associated Cognitive Correlates in Healthy

Older Adults and Older Adults with aMCI.
Sumida CA(1), Vo TT(1), Van Etten EJ(2), Schmitter-Edgecombe M(1).
Author information:
(1)Department of Psychology, Washington State University, Pullman, WA, USA.
(2)Department of Psychology, University of Arizona, Tucson, AZ, USA.
OBJECTIVE: Difficulties managing medications, particularly among older adults

experiencing cognitive deficits, is an important contributing factor to
medication nonadherence that may have significant negative financial and health
outcomes. The current study examined the performance of healthy older adults'
(HOA) and individuals with amnestic mild cognitive impairment (aMCI) on the
medication management abilities assessment's (MMAA, a performance-based measure
of medication management) original scoring criteria and derived error process
measures, assessing medication overtaking and undertaking magnitude. Exploratory
correlations between performances on the MMAA and self-reported confidence in
medication management skills and cognitive abilities were also examined.
METHOD: A sample of 25 HOAs with aMCI and 25 age- and education-matched HOAs
completed the MMAA, a self-reported medication management confidence rating and a
battery of neuropsychological tests.
RESULTS: HOAs performed significantly better on the MMAA score and committed
significantly less process errors than individuals with aMCI. Despite these
differences in MMAA performance, the HOA and aMCI groups rated similar high
levels of confidence in their ability to manage a new medication routine.
Notably, while the HOA group's performance on all of the MMAA measures did not
relate to cognitive measures, the aMCI group's performance on the MMAA score was
significantly related to memory and executive functioning and a new process error
score for overtaking was related to processing speed.
CONCLUSIONS: Although these results present promising potential for the MMAA as a
measure of medication management in a clinical setting, further studies need to
examine the validity of the MMAA against real-world adherence measures.
© The Author(s) 2018. Published by Oxford University Press. All rights reserved.
For permissions, please e-mail: journals.permissions@oup.com.
DOI: 10.1093/arclin/acy038
PMCID: PMC6454840
600. J Pharm Health Care Sci. 2017 Jan 10;3:2. doi: 10.1186/s40780-016-0070-7.
eCollection 2017.
Development and evaluation of a formula for predicting introduction of medication

self-management in stroke patients in the Kaifukuki rehabilitation ward.
Fujihara H(1), Kogo M(2), Saito I(3), Kawate N(4), Mizuma M(4), Suzuki H(5),
Murayama JI(6), Sasaki T(6).
Author information:
(1)Department of Pharmacy, Showa University Fujigaoka Rehabilitation Hospital,
2-1-1 Fujigaoka, Aoba-ku, Yokohama, Kanagawa 227-8518 Japan ; Department of
Hospital Pharmaceutics, School of Pharmacy, Showa University, 1-5-8 Hatanodai,
Shinagawa-ku, Tokyo, 142-8555 Japan.
(2)Department of Hospital Pharmaceutics, School of Pharmacy, Showa University,
1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan ; Department of Pharmacy,
Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa,
227-8501 Japan.
1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan.
(4)Department of Rehabilitation Medicine, School of Medicine, Showa University,
2-1-1 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501 Japan.
(5)Department of Pharmacy, Showa University Fujigaoka Rehabilitation Hospital,
2-1-1 Fujigaoka, Aoba-ku, Yokohama, Kanagawa 227-8518 Japan.
1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan ; Department of Pharmacy,
Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666 Japan.
BACKGROUND: Medication self-management in stroke patients is important to prevent

further progression of disease and incidence of side effects. The purpose of this
study was to create a formula for predicting medication self-management
introduction in stroke patients using functional independence measure items and
patient data, including medication-related information.
METHODS: This was a retrospective analysis of 104 patients (cerebral infarction,
cerebral hemorrhage, subarachnoid hemorrhage) discharged from the Kaifukuki
rehabilitation ward at Showa University Fujigaoka Rehabilitation Hospital from
January to December 2012. Multivariate analysis was performed to develop a
formula for predicting achievement of medication self-management.
RESULTS: Of the 104 patients, 39 (37.5%) achieved medication self-management. In
the logistic regression analysis, number of drugs, age, walk/wheelchair mobility
FIM, and memory FIM were extracted as significant factors independently
contributing to achievement of medication self-management (p < 0.05). The
prediction formula was [4.404 - 0.229 × number of drugs at
admission + 0.470 × walk/wheelchair mobility FIM at admission + 0.416 × memory
FIM at admission - 0.112 × age].
CONCLUSIONS: In the future, this formula may be used as an index to predict
success of medication self-management in stroke patients.
DOI: 10.1186/s40780-016-0070-7
PMCID: PMC5223740
PMID: 28097014
eCollection 2016.
"Tazomoka Is Not a Problem". Local Perspectives on Malaria, Fever Case Management

and Bed Net Use in Madagascar.
Mattern C(1), Pourette D(2)(3), Raboanary E(1), Kesteman T(4), Piola P(1),
Randrianarivelojosia M(4), Rogier C(5).
Author information:
(1)Epidemiology Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar.
(2)Centre Population et Développement (CEPED), Institut de Recherche pour le
Développement, Paris, France.
(3)Université Catholique de Madagascar, Antananarivo, Madagascar.
(4)Malaria research Unit, Institut Pasteur de Madagascar, Antananarivo,
Madagascar.
(5)Institut Pasteur de Madagascar, Antananarivo, Madagascar.
BACKGROUND: Although its incidence has been decreasing during the last decade,
malaria is still a major public health issue in Madagascar. The use of Long
Lasting Insecticidal Nets (LLIN) remains a key malaria control intervention
strategy in Madagascar, however, it encounters some obstacles. The present study
aimed to explore the local terminology related to malaria, information channels
about malaria, attitude towards bed nets, and health care seeking practices in
case of fever. This article presents novel qualitative findings about malaria.
Until now, no such data has been published for Madagascar.
METHODS: A comparative qualitative study was carried out at four sites in
Madagascar, each differing by malaria epidemiology and socio-cultural background
of the populations. Seventy-one semi-structured interviews were conducted with
biomedical and traditional caregivers, and members of the local population. In
addition, observations of the living conditions and the uses of bed net were
conducted.
RESULTS: Due to the differences between local and biomedical perspectives on
malaria, official messages did not have the expected impact on population in
terms of prevention and care seeking behaviors. Rather, most information retained
about malaria was spread through informal information circulation channels. Most
interviewees perceived malaria as a disease that is simple to treat. Tazomoka
("mosquito fever"), the Malagasy biomedical word for malaria, was not used by
populations. Tazo ("fever") and tazomahery ("strong fever") were the terms more
commonly used by members of the local population to refer to malaria related
symptoms. According to local perceptions in all areas, tazo and tazomahery were
not caused by mosquitos. Each of these symptoms required specific health
recourse. The usual fever management strategies consisted of self-medication or
recourse to traditional and biomedical caregivers. Usage of bed nets was
intermittent and was not directly linked to protection against malaria in the
eyes of most Malagasy people.
CONCLUSIONS: This article highlights the conflicting understanding of malaria
between local perceptions and the biomedical establishment in Madagascar. Local
perceptions of malaria present a holistic vision of the disease that includes
various social and cultural dimensions, rather than reflecting one universal
understanding, as in the biomedical image. The consideration of this "holistic
vision" and other socio-cultural aspects surrounding the understanding of malaria
is essential in implementing successful control intervention strategies.
PMCID: PMC4778873
602. Ann Oncol. 2017 Jun 1;28(6):1260-1267. doi: 10.1093/annonc/mdx100.
The development of a prediction tool to identify cancer patients at high risk for
chemotherapy-induced nausea and vomiting.
Dranitsaris G(1), Molassiotis A(2), Clemons M(1), Roeland E(3), Schwartzberg

L(4), Dielenseger P(5), Jordan K(6), Young A(7), Aapro M(8).
Author information:
(1)The Ottawa Hospital Regional Cancer Centre, Ottawa, Canada.
(2)Hong Kong Polytechnic University, Hong Kong.
(3)UC San Diego Moores Cancer Center, La Jolla.
(4)The West Clinic, Memphis, USA.
(5)Institut de Cancérologie Gustave Roussy, Villejuif, France.
(6)Department of Medicine V, University of Heidelberg, Heidelberg, Germany.
(7)Cancer Research Center, University of Warwick, Conventry, UK.
(8)Cancer Center, Clinique de Genolier, Genolier, Switzerland.
Comment in
Ann Oncol. 2017 Jun 1;28(6):1165-1167.
Background: Despite the availability of effective antiemetics and evidence-based

guidelines, up to 40% of cancer patients receiving chemotherapy fail to achieve
complete nausea and vomiting control. In addition to type of chemotherapy,
several patient-related risk factors for chemotherapy-induced nausea and vomiting
(CINV) have been identified. To incorporate these factors into the optimal
selection of prophylactic antiemetics, a repeated measures cycle-based model to
predict the risk of ≥ grade 2 CINV (≥2 vomiting episodes or a decrease in oral
intake due to nausea) from days 0 to 5 post-chemotherapy was developed.
Patients and methods: Data from 1198 patients enrolled in one of the five
non-interventional CINV prospective studies were pooled. Generalized estimating
equations were used in a backwards elimination process with the P-value set
at <0.05 to identify the relevant predictive factors. A risk scoring algorithm
(range 0-32) was then derived from the final model coefficients. Finally, a
receiver-operating characteristic curve (ROCC) analysis was done to measure the
predictive accuracy of the scoring algorithm.
Results: Over 4197 chemotherapy cycles, 42.2% of patients experienced ≥grade 2
CINV. Eight risk factors were identified: patient age <60 years, the first two
cycles of chemotherapy, anticipatory nausea and vomiting, history of morning
sickness, hours of sleep the night before chemotherapy, CINV in the prior cycle,
patient self-medication with non-prescribed treatments, and the use of platinum
or anthracycline-based regimens. The ROC analysis indicated good predictive
accuracy with an area-under-the-curve of 0.69 (95% CI: 0.67-0.70). Before to each
cycle of therapy, patients with risk scores ≥16 units would be considered at high
risk for developing ≥grade 2 CINV.
Conclusions: The clinical application of this prediction tool will be an
important source of individual patient risk information for the oncology
clinician and may enhance patient care by optimizing the use of the antiemetics
in a proactive manner.
© The Author 2017. Published by Oxford University Press on behalf of the European
Society for Medical Oncology.
DOI: 10.1093/annonc/mdx100
PMCID: PMC5452068
603. Case Rep Infect Dis. 2016;2016:4632369. doi: 10.1155/2016/4632369. Epub 2016
Aug
7.
A Case of Fluoroquinolone-Resistant Leprosy Discovered after 9 Years of

Misdiagnosis.
Raharolahy O(1), Ramarozatovo LS(1), Ranaivo IM(1), Sendrasoa FA(1),

Andrianarison M(1), Andrianarivelo MR(2), Cambau E(3), Rabenja FR(1).
Author information:
(1)USFR Dermatologie, Centre Hospitalier Universitaire Joseph Raseta
Befelatanana, 101 Antananarivo, Madagascar.
(2)Centre d'Infectiologie Charles Mérieux, Université d'Antananarivo, 101
Antananarivo, Madagascar.
(3)APHP, Hôpital Lariboisière, Bactériologie, Centre National de Référence des
Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, 75475
Paris Cedex 10, France.
We report a case of misdiagnosed leprosy in a 21-year-old Malagasy male, who,

improperly treated, developed secondary mycobacterial resistance to
fluoroquinolone. The patient contracted the infection 9 years prior to the
current consultation, displaying on the right thigh a single papulonodular
lesion, which progressively spread to the lower leg, back, and face. Initial
administration of ciprofloxacin and prednisolone led to temporary and fluctuating
improvement. Subsequent long-term self-medication with ciprofloxacin and
corticosteroid did not heal the foul and nonhealing ulcers on the legs and under
the right sole. Histopathological findings were compatible with lepromatous
leprosy. Skin biopsy was positive for acid-fast bacilli and PCR assay confirmed
the presence of a fluoroquinolone-resistant strain of Mycobacterium leprae (gyrA
A91V). After 6 months of standard regimen with rifampicin, clofazimine, and
dapsone, clinical outcome significantly improved. Clinical characteristics and
possible epidemiological implications are discussed.
DOI: 10.1155/2016/4632369
PMCID: PMC4992523
PMID: 27579195
604. Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):290-298. doi:

10.4103/apjon.apjon_35_17.
The Effect of Structured Education to Patients Receiving Oral Agents for Cancer
Treatment on Medication Adherence and Self-efficacy.
Tokdemir G(1), Kav S(2).
Author information:
(1)Department of Nursing, Başkent University Ankara Hospital, Ankara, Turkey.
(2)Department of Nursing, Faculty of Health Sciences, Başkent University, Ankara,
Turkey.
OBJECTIVE: This study was conducted to examine the effect of structured education
on medication adherence and self-efficacy through the use of the MASCC Oral Agent
Teaching Tool (MOATT) for patients receiving oral agents for cancer treatment.
METHODS: This quasi-experimental study has been conducted at two hospitals; 41
patients were included in the study. Data were obtained using a questionnaire,
medication adherence self-efficacy scale (MASES), memorial symptom assessment
scale, and a follow-up form (diary). Patients were educated through the use of
the MOATT at a scheduled time; drug-specific information was provided along with
a treatment scheme and follow-up diary. Phone interviews were completed 1 and 2
weeks after the educational session. At the next treatment cycle, the patients
completed the same questionnaires.
RESULTS: Majority of the patients were receiving capecitabine (90.2%; n = 37) as
an oral agent for breast (51.2%; n = 21) and stomach cancer (24.6%; n = 10)
treatment. About 90.2% of patients (n = 37) stated that they did not forget to
take their medication and experienced medication-related side effects (78%; n =
32). The total score of MASES was increased after the education (66.39 vs. 71.04,
P < 0.05).
CONCLUSIONS: It was shown that individual education with the MOATT and follow-up
for patients receiving oral agents for cancer treatment increased patient
medication adherence self-efficacy.
DOI: 10.4103/apjon.apjon_35_17
PMCID: PMC5559938
PMID: 28966956
Understanding symptom appraisal and help-seeking in people with symptoms

suggestive of pancreatic cancer: a qualitative study.
Mills K(1), Birt L(1), Emery JD(2), Hall N(3), Banks J(4), Johnson M(1),
Lancaster J(1), Hamilton W(5), Rubin GP(3), Walter FM(1).
Author information:
(1)Department of Public Health and Primary Care, The Primary Care Unit,
University of Cambridge, Cambridge, UK.
(2)Department of General Practice, Primary Care Cancer Research, University of
Melbourne, Carlton, Victoria, Australia.
(3)Evaluation Research Development Unit, School of Medicine, Pharmacy & Health,
Durham University, Bristol, UK.
(4)Centre for Academic Primary Care, School of Social and Community Medicine,
University of Bristol, Bristol, UK.
(5)Department of Primary Care Diagnostics, College House, St Luke's Campus,
University of Exeter, Exeter, UK.
OBJECTIVE: Pancreatic cancer has poor survival rates due to non-specific symptoms
leading to later diagnosis. Understanding how patients interpret their symptoms
could inform approaches to earlier diagnosis. This study sought to explore
symptom appraisal and help-seeking among patients referred to secondary care for
symptoms suggestive of pancreatic cancer.
DESIGN: Qualitative analysis of semistructured in-depth interviews. Data were
analysed iteratively and thematically, informed by the Model of Pathways to
Treatment.
PARTICIPANTS AND SETTING: Pancreatic cancer occurs rarely in younger adults,
therefore patients aged ≥40 years were recruited from nine hospitals after being
referred to hospital with symptoms suggestive of pancreatic cancer; all were
participants in a cohort study. Interviews were conducted soon after referral,
and where possible, before diagnosis.
RESULTS: Twenty-six interviews were conducted (cancer n=13 (pancreas n=9, other
intra-abdominal n=4), non-cancer conditions n=13; age range 48-84 years; 14
women). Time from first symptoms to first presentation to healthcare ranged from
1 day to 270 days, median 21 days. We identified three main themes. Initial
symptom appraisal usually began with intermittent, non-specific symptoms such as
tiredness or appetite changes, attributed to diet and lifestyle, existing
gastrointestinal conditions or side effects of medication. Responses to initial
symptom appraisal included changes in meal type or frequency, or self-medication.
Symptom changes such as alterations in appetite and enjoyment of food or weight
loss usually prompted further appraisal. Triggers to seek help included a change
or worsening of symptoms, particularly pain, which was often a 'tipping point'.
Help-seeking was often encouraged by others. We found no differences in symptom
appraisal and help-seeking between people diagnosed with cancer and those with
other conditions.
CONCLUSIONS: Greater public and healthcare professional awareness of the
combinations of subtle and intermittent symptoms, and their evolving nature, is
needed to prompt timelier help-seeking and investigation among people with
symptoms of pancreatic cancer.
DOI: 10.1136/bmjopen-2016-015682
PMCID: PMC5588944
606. J Clin Nurs. 2017 Mar;26(5-6):586-598. doi: 10.1111/jocn.13588. Epub 2016 Nov
29.
Medication-taking behaviours in chronic kidney disease with multiple chronic

conditions: a meta-ethnographic synthesis of qualitative studies.
Bartlett Ellis RJ(1), Welch JL(1).
Author information:
(1)Department of Science of Nursing Care, Indiana University School of Nursing,
Indianapolis, IN, USA.
AIMS AND OBJECTIVES: To identify behaviours associated with taking medications

and medication adherence reported in qualitative studies of adults with chronic
kidney disease and coexisting multiple chronic conditions.
BACKGROUND: To inform medication adherence interventions, information is needed
to clarify the nature of the relationships between behaviours that support
medication-taking and medication adherence in multiple chronic conditions.
DESIGN: Meta-ethnographic review and synthesis.
METHODS: CINAHL Complete, MEDLINE and PsycINFO databases were searched. Five
qualitative studies met the inclusion criteria. A meta-ethnographic approach was
used for synthesis. Medication-taking behaviours were abstracted from study
findings and synthesised according to the contexts in which they occur and
interpreted within a new developing framework named the Medication-taking Across
the Care Continuum and Adherence-related Outcomes.
RESULTS: Twenty categories of medication-taking behaviours occurred in three main
contexts: (1) patient-provider clinical encounters, (2) pharmacy encounters and
(3) day-to-day management. These behaviours are distinctly different, multilevel
and interrelated. Together they represent a process occurring across a continuum.
CONCLUSIONS: Future medication adherence research should consider using a
multilevel ecological view of medication management. Clinical practice and policy
development can benefit from further understanding socio-contextual behaviours
that occur across the continuum. Nurses should have greater presence in chronic
disease management and be positioned to support the day-to-day home management of
patients' medications.
RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals can partner with
patients to elucidate how these behaviours are enacted across the care continuum
and in day-to-day management to identify opportunities to intervene on specific
behaviours and promote medication adherence.
DOI: 10.1111/jocn.13588
607. BMC Gastroenterol. 2014 Dec 19;14:220. doi: 10.1186/s12876-014-0220-z.
A screening instrument to identify ulcerative colitis patients with the high

possibility of current non-adherence to aminosalicylate medication based on the
Health Belief Model: a cross-sectional study.
Kawakami A(1)(2), Tanaka M(3), Nishigaki M(4), Yoshimura N(5), Suzuki R(6), Maeda
S(7), Kunisaki R(8), Yamamoto-Mitani N(9).
Author information:
(1)Inflammatory Bowel Disease Center, Yokohama City University Medical Center,
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
akikawakami-tky@umin.ac.jp.
(2)Department of Gastroenterology, Yokohama City University Graduate School of
Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
akikawakami-tky@umin.ac.jp.
(3)Department of Advanced Clinical Nursing, Graduate School of Medicine, the
University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
hmakoto-tky@umin.ac.jp.
(4)Department of Adult Nursing, Graduate school of Medicine the University of
Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Japan. nishigaki-tky@umin.ac.jp.
(5)Department of Gastroenterology, Social Insurance Central General Hospital,
3-22-1 Hyakuninn-cho, Shinjyuku-ku, Tokyo, 169-0073, Japan. ynaokun@yahoo.co.jp.
(6)Kannai Suzuki Clinic, 3-28 Onoue-cho, Naka-ku, Yokohama, 231-0028, Japan.
kannaisuzuki@muse.ocn.ne.jp.
Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
smaeda@med.yokohama-cu.ac.jp.
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
reikok@urahp.yokohama-cu.ac.jp.
(9)Department of Adult Nursing, Graduate school of Medicine the University of
Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Japan. noriko-tky@umin.ac.jp.
BACKGROUND: Non-adherence to aminosalicylates is observed among 30% to 45% of

patients with ulcerative colitis and increases the risk of relapse. The Health
Belief Model is a theoretical model that could offer a broader perspective to
improve patients' self-medication adherence. This study aimed to develop a
screening instrument based on the Health Belief Model to screen patients with
ulcerative colitis who had a high possibility of current non-adherence to
aminosalicylates. The study was also designed to allow examination of factors of
non-adherence.
METHODS: A multicenter, cross-sectional study was conducted in outpatients
diagnosed with ulcerative colitis and prescribed aminosalicylates. Non-adherence
was defined as taking less than 80% of the prescribed dose. We hypothesized that
there was a significant relationship between current aminosalicylate
non-adherence and five components of the HBM: beliefs about taking
aminosalicylates, disease characteristics, medication characteristics, abdominal
symptoms, and sociodemographic characteristics. A logistic regression model was
applied and the coefficients converted to a numeric scores in order to develop a
screening instrument which could reliably discriminate non-adherent and adherent
subjects.
RESULTS: Non-adherence was observed in 127 (29.6%) of the 429 enrolled subjects.
Lower perceptions of belief in taking aminosalicylates, absence of visible
bleeding, eight daily tablets or less taken, and no concomitant use of
thiopurines were related to non-adherence. We then developed a screening
instrument comprising 22 items. When the cut-off point was set at 60, the
instrument showed 85.0% sensitivity and 69.2% specificity with an area under the
curve of 0.84 (95% confidence interval = 0.79-0.91).
CONCLUSIONS: The instrument appeared to be reliable for identifying patients with
a high possibility of current non-adherence to aminosalicylates. Further, the
instrument may provide useful information for detecting patients with a high
possibility of current non-adherence and for assessing factors of non-adherence.
On the other hand, we need to evaluate disease activity more strictly and examine
whether it is included in the screening instrument in the future.
DOI: 10.1186/s12876-014-0220-z
PMCID: PMC4279902
608. J Pediatr Pharmacol Ther. 2016 Nov-Dec;21(6):502-511. doi:

10.5863/1551-6776-21.6.502.
Evaluation of Medication-related Self-care Skills in Patients With Cystic

Fibrosis.
Lewis KL(1), John B(2), Condren M(3), Carter SM(4).
Author information:
(1)Department of Pharmacy, Washington Regional Medical Center, Fayetteville,
Arkansas.
(2)Department of Pharmacy, The Children's Hospital at Saint Francis, Tulsa,
Oklahoma.
(3)Professor and Department Chair, Department of Pharmacy: Clinical and
Administrative Sciences-Tulsa, University of Oklahoma College of Pharmacy;
Department of Pediatrics, University of Oklahoma School of Community Medicine,
Tulsa, Oklahoma.
(4)University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma.
BACKGROUND: As the life expectancy of patients with cystic fibrosis (CF)

increases, the focus on ensuring success with medication therapies is
increasingly important. The ability of patients to autonomously manage
medications and related therapies is poorly described in the literature.
OBJECTIVE: The goal of this project was to assess the level of medication-related
knowledge and self-care skills in patients with CF. METHODS: This project took
place in a Cystic Fibrosis Foundation accredited affiliate center. Eighty-nine
patients between the ages of 6 and 60 were eligible to participate based on
inclusion and exclusion criteria. Pharmacists administered a 16-item
questionnaire and detailed medication history during clinic visits from January
through May 2014. RESULTS: Forty-five patients 6 to 41 years old participated in
the study. The skills most often performed independently were preparing nebulizer
treatments (85%) and telling someone if they feel their medicines are causing a
problem (89%). Skills least often performed were carrying a medication list (82%)
and bringing a medication list to appointments (76%). In respondents 21 years of
age and older, less than 75% of respondents were involved with obtaining
financial resources, maintaining equipment, carrying a medication list, or
rinsing their mouth after using inhaled medicines. Participants were able to
provide drug name, dose, and frequency of use for pancreatic enzymes and
azithromycin 37% and 24% of the time, respectively. CONCLUSIONS: In the
population surveyed, many medication-related skills had not been acquired by
early adulthood. Assessing and providing education for medication-related
self-care skills at all ages are needed.
DOI: 10.5863/1551-6776-21.6.502
PMCID: PMC5178812
PMID: 28018152
609. Interv Med Appl Sci. 2018 Jun;10(2):87-94. doi: 10.1556/1646.10.2018.05.
Determination of the psychometric properties of the Patients' Self-Efficacy Scale

in blood pressure patients.
Ghadiri R(1), Alimohammadi M(2), Majdabadi HA(3).
Author information:
(1)Semnan Health Center, Semnan University of Medical Sciences, Semnan, Iran.
(2)Psychology Unit, School of Allied Medical Sciences, Semnan University of
Medical Sciences, Semnan, Iran.
(3)Nursing Care Research Center, Semnan University of Medical Sciences Semnan,
Semnan, Iran.
Introduction: This study was designed to determine self-efficacy and its related
factors in patients with hypertension.
Materials and methods: This study is descriptive-sectional from the correlation.
A total of 250 patients from a blood pressure clinic of Semnan city (in Iran)
completed Medication Understanding and Use Self-Efficacy Scale were randomly
selected in 2017. Data were analyzed using variance, Pearson's Correlation, and
χ2 using the LISREL 8.8 software.
Results: The items 1, 6, 7, and 8 have high correlation (at least higher than
0.60), indicating the possibility of aggregation of these four variables in the
first factor (taking medication), and the four items 2, 3, 4, and 5 are highly
correlated with each other, which are the second factor (learning about
medication). In addition, Cronbach's α of reliability (taking medication) for the
first factor was 0.67 and 0.63 for the second factor (learning about medication)
and 0.69 for the whole scale.
Conclusion: The effectiveness of blood pressure self-efficacy is an appropriate
tool for measure-taking responsibility for the time and taking medications by
patients, and researchers can use it as a valid tool in therapeutic,
psychological, and health research.
DOI: 10.1556/1646.10.2018.05
PMCID: PMC6167625
PMID: 30363355
610. Prim Care Companion CNS Disord. 2014 Dec 4;16(6). doi: 10.4088/PCC.14m01686.
eCollection 2014.
Promoting medication adherence in older adults through early diagnosis of

neurocognitive disorders.
George NR(1), Steffen AM(1).

Author information:
(1)Department of Psychology, University of Missouri, St Louis.
OBJECTIVE: Community-dwelling older adults with neurocognitive disorders

experience high risk of and often suffer severe consequences from medication
nonadherence. Due to the important role of informal caregivers in the care of
patients with neurocognitive disorders, medication management involves both
patients and families. A formal diagnosis of a neurocognitive disorder may
improve both provider-patient and provider-family communications and resulting
regimen adherence, yet many with signs of neurocognitive disorders remain
undiagnosed. The goal of this study was to examine the differences in medication
management behaviors for family caregivers of mildly impaired older adults with
or without a formal neurocognitive disorder diagnosis.
METHOD: The study included 112 women who provided at least 2 forms of medication
assistance for a mildly cognitively impaired older adult with (n = 38, 34%) or
without (n = 75, 66%) a reported neurocognitive disorder diagnosis and who
completed online self-assessments of medication adherence and self-efficacy for
medication management from May 2012 to May 2013. Cases were selected for analyses
based on analog Clinical Dementia Rating scores between 0.5 and 1, indicating
mild cognitive impairment in the older adult.
RESULTS: Compared to families unaware of a neurocognitive disorder diagnosis,
caregivers reporting knowledge of a neurocognitive disorder diagnosis in their
older family member endorsed higher medication management self-efficacy and
increased levels of adherence-related behaviors. Step-wise logistic regression
analyses demonstrated statistical significance in using these adherence and
self-efficacy variables to differentiate between the presence or absence of a
known neurocognitive disorder diagnosis (N = 112, χ (2) 6 = 22.84, P < .05).
CONCLUSIONS: A formally charted and communicated neurocognitive disorder
diagnosis is associated with improved medication management behaviors and
medication-related self-efficacy in neurocognitive disorder family caregivers.
DOI: 10.4088/PCC.14m01686
PMCID: PMC4374825
PMID: 25834766
611. J Child Adolesc Psychopharmacol. 2016 Dec;26(10):864-872. Epub 2016 Jul 15.
Medication Adherence Among Adolescents with Bipolar Disorder.
Goldstein TR(1), Krantz M(1), Merranko J(1), Garcia M(1), Sobel L(1), Rodriguez
C(2), Douaihy A(1), Axelson D(3), Birmaher B(1).
Author information:
(1)1 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical
Center , Pittsburgh, Pennsylvania.
(2)2 Hospital of Fuerteventura , Canary Health Service, Canary Islands, Spain .
(3)3 Nationwide Children's Hospital , Columbus, Ohio.
OBJECTIVE: To examine medication adherence and associated factors among

adolescents with bipolar disorder (BP) using both objective and subjective
methods.
METHOD: Participants were 21 adolescents with a primary BP diagnosis recruited
from a pediatric specialty clinic. All participants were prescribed at least one
psychotropic medication. Self- and parent-reported adherence were assessed
monthly over 6 months. Objective data on medication adherence were gathered
through an electronic weekly pillbox. Demographic and clinical factors were
assessed through self, parent, and physician ratings at baseline, 3, and 6
months.
RESULTS: Objective data indicate 41.5% of doses (58.6% of days) were not taken as
prescribed over a mean of 3 months of follow-up. Subjective reports (patient,
parent, and physician) significantly overestimated adherence as compared with
objective data. Factors from multiple domains were associated with poorer
adherence, including more daily doses, higher weight, dose timing (poorer on
mornings/afternoons and weekends), less temporal proximity to medication
management appointment, greater self-reported cognitive difficulties with
adhering to treatment; the most potent predictor of missed doses was greater
overall illness severity.
CONCLUSIONS: Findings provide further evidence of poor medication adherence among
youth with BP, and highlight the limits of subjective report of adherence.
Providers should give careful attention to adherence when making decisions
regarding treatment response and changes to medication regimen when working with
youth with BP.
DOI: 10.1089/cap.2016.0030
PMCID: PMC5178003
An Evidence-Based Procedure for Self-Management of Medication in Hospital:

Development and Validation of the SelfMED Procedure.
Vanwesemael T(1)(2), Dilles T(3)(4), Van Rompaey B(5), Boussery K(6).
Author information:
(1)Department of Healthcare, Thomas More University College, 2500 Lier, Belgium.
toke.vanwesemael@uantwerpen.be.
(2)Department of Nursing Science and Midwifery, Centre For Research and
Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium.
toke.vanwesemael@uantwerpen.be.
(3)Department of Healthcare, Thomas More University College, 2500 Lier, Belgium.
tinne.dilles@uantwerpen.be.
tinne.dilles@uantwerpen.be.
bart.vanrompaey@uantwerpen.be.
University, 9000 Ghent, Belgium. koen.boussery@ugent.be.
AIM: To develop and validate a procedure for self-management of medication by

patients whilst in hospital.
BACKGROUND: Self-management of medication allows patients to self-manage their
medication in a controlled and supportive hospital environment. This practice is
encouraged worldwide, yet an evidence-based procedure to evaluate the ability of
patients to self-manage and to monitor and support self-management are absent.
METHODS: The evidence-based procedure for self-management of medication (SelfMED)
was developed based on previous conducted qualitative research, literature
review, and the current regulation. It was validated by healthcare providers and
a multidisciplinary expert meeting. Questions within the procedure that could be
biased were tested for inter-rater reliability.
RESULTS: First, the SelfMED procedure was developed. It consists of a stepped
assessment of patient's competencies for self-management performed by healthcare
providers and the patient. When self-management is allowed, the SelfMED
monitoring tool monitors the patient's intake of self-managed medication.
Secondly, the procedure was revised for clarity, appropriateness, and face
validity by five healthcare providers and a multidisciplinary expert meeting,
resulting in the final version. Thirdly, three questions from the final version
were tested for interrater reliability. Cohen's Kappa showed moderate to strong
levels of agreement.
CONCLUSIONS: The developed SelfMED procedure provides an evidence based approach
of facilitating self-management of medication. The content of the procedure was
found valid to evaluate the patient's ability to self-manage and to monitor them
while self-managing.
DOI: 10.3390/pharmacy6030077
PMCID: PMC6164845
PMID: 30049965
Conflict of interest statement: The authors declare no conflicts of interest. We

state that the funder had no role in the design of the study; in the collection,
analyses, or interpretation of data; in the writing of the manuscript, and in the
decision to publish the results.

eCollection 2018.
Medication adherence in renal transplant recipients: A latent variable model of

psychosocial and neurocognitive predictors.
Paterson TSE(1), O'Rourke N(2), Shapiro RJ(3), Loken Thornton W(1).
Author information:
(1)Department of Psychology, Simon Fraser University, Burnaby, British Columbia,
Canada.
(2)Ben-Gurion University of the Negev, Beersheba, Israel.
(3)University of British Columbia, Vancouver, British Columbia, Canada.
OBJECTIVE: Estimates indicate that 20-70% of renal transplant recipients are

medication non-adherent, significantly increasing the risk of organ rejection.
Medication adherence is negatively impacted by lower everyday problem solving
ability, and associations between depressive symptoms, self-efficacy, and
adherence are reported in renal transplant recipients. Nonetheless, to date,
these associations have not been examined concurrently. Given the relationship
between non-adherence and organ rejection, it is critical to gain a better
understanding of the predictors of adherence in renal transplant recipients. To
this end, we modeled relationships among cognitive abilities, depressive
symptoms, self-efficacy, and adherence in this group.
METHODS: Participants (N = 211) underwent renal transplant at least one year
prior to participation. Adherence was measured via self-report, medication
possession ratio, and immunosuppressant blood-level. Traditionally-measured
neurocognitive and everyday problem-solving abilities were assessed. Depressive
symptoms were measured via self-report, as were general and medication adherence
related self-efficacy. Structural equation modeling was used to assess the fit of
the model to available data.
RESULTS: Everyday problem solving and self-efficacy had direct positive
associations with adherence. Depressive symptoms were negatively associated with
self-efficacy, but not adherence. Traditionally-measured neurocognitive abilities
were positively associated with self-efficacy, and negatively associated with
depressive symptoms.
CONCLUSIONS: We present a comprehensive investigation of relationships between
cognitive and psychosocial factors and adherence in medically stable renal
transplant recipients. Findings confirm the importance of everyday problem
solving and self-efficacy in predicting adherence and suggest that influences of
depressive symptoms and neurocognitive abilities are indirect. Findings have
important implications for future development of interventions to improve
medication adherence in renal transplant recipients.
PMCID: PMC6161882

interests exist.
614. BMC Nurs. 2016 Feb 8;15:9. doi: 10.1186/s12912-016-0130-1. eCollection 2016.
Effects of a nurse-led medication self-management programme in cancer patients:

protocol for a mixed-method randomised controlled trial.
Komatsu H(1), Yagasaki K(1), Yamaguchi T(2).
Author information:
(1)Faculty of Nursing and Medical Care, Keio University, 35 Shinanomachi,
Shinjuku-ku, Tokyo 160-8582 Japan.
(2)Division of Biostatistics, Tohoku University Graduate School of Medicine, 1-1
Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574 Japan.
Erratum in
BMC Nurs. 2016 Oct 24;15:61.
BACKGROUND: With the widespread use of orally administered anticancer agents,

self-management by cancer patients is inevitable, and adherence to medication is
becoming the centre of interest in oncology.
METHODS/DESIGN: This mixed-method study is a two-phased approach with a combined
quantitative and qualitative design. In the first phase, we will conduct a
prospective randomised controlled study to assess the effects of a nurse-led
medication self-management programme for patients receiving oral anticancer
treatment. Patients with metastatic breast cancer, who have been newly prescribed
an oral chemotherapy or a targeted therapy agent will be enrolled in the study.
The participants will be randomly assigned to either the medication
self-management support programme group (intervention group) or the conventional
care group (control group). This will be an open-label study; therefore, neither
the patients nor the nurses will be blinded. Nurses will provide patients in the
intervention group with information by using the teach-back method, help patients
set a goal based on their preferences, and solve problems through follow-up
counselling. The primary outcome measure is adherence to medication, to be
measured on the basis of the medication possession ratio (MPR), which is the
ratio of the number of days of medication supply to the total days at a specified
time interval. We hypothesize that the intervention group will have an MPR of
≥90 % that is significantly higher than that of the control group. Secondary
outcome measures include self-efficacy, quality of life, psychological distress,
severity and interference of symptoms, patient satisfaction, emergency department
visits, and hospital admissions. In the second phase, we will conduct focus-group
interviews with intervention nurses, and perform a content analysis to understand
their role and challenges these nurses will face in the programme while improving
patients' medication adherence.
DISCUSSION: The present study will be the first Japanese study to evaluate the
effects of medication self-management support provided by nurses to patients with
metastatic breast cancer who are receiving oral anticancer treatment. The study
is characterised by a unique patient-centred approach aiming to help patients
manage their medication based on their needs and preferences, with both
quantitative and qualitative evaluations. The findings will contribute to the
facilitation of medication management in cancer patients.
TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR), Japan,
UMIN000016597. (27 February 2015).
DOI: 10.1186/s12912-016-0130-1
PMCID: PMC4745168
PMID: 26858582
615. Br J Clin Pharmacol. 2016 Jul;82(1):268-79. doi: 10.1111/bcp.12942. Epub 2016

May
2.
A scoping review of studies comparing the medication event monitoring system

(MEMS) with alternative methods for measuring medication adherence.
El Alili M(1), Vrijens B(2)(3), Demonceau J(2), Evers SM(1)(4), Hiligsmann M(1).
Author information:
(1)Department of Health Services Research, CAPHRI School for Public Health and
Primary Care, Maastricht University, Maastricht, The Netherlands.
(2)WestRock Healthcare, Visé, Belgium.
(3)Department of Public Health, University of Liège, Liège, Belgium.
(4)Trimbos Institute of Mental Health and Addiction, Utrecht, The Netherlands.
Different methods are available for measuring medication adherence. In this

paper, we conducted a scoping review to identify and summarize evidence of all
studies comparing the Medication Event Monitoring System (MEMS) with alternative
methods for measuring medication adherence. A literature search was performed
using the open database www.iAdherence.org that includes all original studies
reporting findings from the MEMS. Papers comparing methods for measuring
adherence to solid oral formulations were included. Data was extracted using a
standardized extraction table. A total of 117 articles fulfilled the inclusion
criteria, including 251 comparisons. Most frequent comparisons were against
self-report (n = 119) and pill count (n = 59). Similar outcome measures were used
in 210 comparisons (84%), among which 78 used dichotomous variables (adherent or
not) and 132 used continuous measures (adherence expressed as percentage).
Furthermore, 32% of all comparisons did not estimate adherence over the same
coverage period and 44% of all comparisons did not use a statistical method or
used a suboptimal one. Only eighty-seven (35%) comparisons had similar coverage
periods, similar outcome measures and optimal statistical methods. Compared to
MEMS, median adherence was grossly overestimated by 17% using self-report, by 8%
using pill count and by 6% using rating. In conclusion, among all comparisons of
MEMS versus alternative methods for measuring adherence, only a few used adequate
comparisons in terms of outcome measures, coverage periods and statistical
method. Researchers should therefore use stronger methodological frameworks when
comparing measurement methods and be aware that non-electronic measures could
lead to overestimation of medication adherence.
© 2016 The British Pharmacological Society.
DOI: 10.1111/bcp.12942
PMCID: PMC4917812
616. Sultan Qaboos Univ Med J. 2017 Aug;17(3):e329-e333. doi:

10.18295/squmj.2017.17.03.012. Epub 2017 Oct 10.
Relationship Between Medication Adherence and Health Beliefs Among Patients with
Hypertension in Oman: Pilot study.
Al-Noumani H(1), Wu JR(2), Barksdale D(3), Alkhasawneh E(4), Knafl G(2), Sherwood
G(2).
Author information:
(1)Departments of Adult Health & Critical Care, College of Nursing, Sultan Qaboos
University, Muscat, Oman.
(2)Department of Adult Health, School of Nursing, University of North Carolina,
Chapel Hill, North Carolina, USA.
(3)Associate Dean of Academic Affairs, School of Nursing, Virginia Commonwealth
University, Richmond, Virginia, USA.
(4)Maternal & Child Health, College of Nursing, Sultan Qaboos University, Muscat,
Oman.
OBJECTIVES: The prevalence of hypertension (HTN) in Oman is alarmingly high and

patient adherence to antihypertensive medications is inadequate. This study aimed
to assess the relationship between medication adherence and health beliefs among
Omani patients with HTN.
METHODS: This descriptive cross-sectional pilot study was conducted in December
2015 and included 45 patients with HTN recruited from four primary health centres
in Al Dakhiliyah and Muscat governorates, Oman. Medication adherence and health
beliefs were assessed using the Morisky Medication Adherence Scale (MMAS),
Beliefs about Medicines Questionnaire, Brief Illness Perception Questionnaire and
the revised Medication Adherence Self-Efficacy Scale.
RESULTS: The mean MMAS score was 5.3 ± 2.0, with 48.9% of patients reporting high
adherence. Higher self-efficacy and stronger beliefs regarding medication
necessity were significantly related to adherence (P = 0.012 and 0.028,
respectively).
CONCLUSION: The findings of this pilot study emphasise the role of health beliefs
with regards to Omani patients' adherence to antihypertensive medications.
DOI: 10.18295/squmj.2017.17.03.012
PMCID: PMC5642364
Conflict of interest statement: CONFLICT OF INTEREST The authors declare no

conflicts of interest.
617. Medicine (Baltimore). 2018 Jun;97(22):e10876. doi:

10.1097/MD.0000000000010876.
The effectiveness of culturally tailored video narratives on medication

understanding and use self-efficacy among stroke patients: A randomized
controlled trial study protocol.
Appalasamy JR(1), Tha KK(1), Quek KF(1), Ramaiah SS(2), Joseph JP(3), Md Zain
AZ(1).
Author information:
(1)Jeffrey Cheah School of Medicine and Health Sciences, Monash University
Malaysia.
(2)Subang Jaya Medical Centre, Jalan SS12/1a, Selangor.
(3)Neurology Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
INTRODUCTION: A substantial number of the world's population appears to end with

moderate to severe long-term disability after stroke. Persistent uncontrolled
stroke risk factor leads to unpredicted recurrent stroke event. The increasing
prevalence of stroke across ages in Malaysia has led to the adaptation of
medication therapy adherence clinic (MTAC) framework. The stroke care unit has
limited patient education resources especially for patients with medication
understanding and use self-efficacy. Nevertheless, only a handful of studies have
probed into the effectiveness of video narrative at stroke care centers.
METHOD: This is a behavioral randomized controlled trial of patient education
intervention with video narratives for patients with stroke lacking medication
understanding and use self-efficacy. The study will recruit up to 200 eligible
stroke patients at the neurology tertiary outpatient clinic, whereby they will be
requested to return for follow-up approximately 3 months once for up to 12
months. Consenting patients will be randomized to either standard patient
education care or intervention with video narratives. The researchers will ensure
control of potential confounding factors, as well as unbiased treatment review
with prescribed medications only obtained onsite.
RESULTS: The primary analysis outcomes will reflect the variances in medication
understanding and use self-efficacy scores, as well as the associated factors,
such as retention of knowledge, belief and perception changes, whereas stroke
risk factor control, for example, self-monitoring and quality of life, will be
the secondary outcomes.
DISCUSSION AND CONCLUSION: The study should be able to determine if video
narrative can induce a positive behavioral change towards stroke risk factor
control via enhanced medication understanding and use self-efficacy. This
intervention is innovative as it combines health belief, motivation, and role
model concept to trigger self-efficacy in maintaining healthy behaviors and
better disease management.
TRIAL REGISTRATION: ACTRN (12618000174280).
DOI: 10.1097/MD.0000000000010876
PMCID: PMC6393048
618. Front Pharmacol. 2019 Jul 19;10:822. doi: 10.3389/fphar.2019.00822.

eCollection
2019.
Association Between Medication Literacy and Medication Adherence Among Patients

With Hypertension.
Shi S(1)(2), Shen Z(1), Duan Y(1), Ding S(1)(2), Zhong Z(1)(2).
Author information:
(1)Nursing Department, Third Xiangya Hospital, Central South University,
Changsha, China.
(2)Xiangya School of Nursing, Central South University, Changsha, China.
Background: Few studies have investigated the association between medication

literacy and medication adherence as well as the influence of medication literacy
on medication adherence in hypertensive patients. Thus, the goal of the present
study was to determine the association between medication literacy and medication
adherence in hypertensive patients. Methods: A cross-sectional survey was
conducted between August 2016 and December 2016. Self-administered questionnaires
were completed, including a self-developed and structured socio-demographic
questionnaire; a self-developed, validated, and self-reported Medication Literacy
Scale for Hypertensive Patients (C-MLSHP) used for medication literacy
measurement; and the Chinese Version of the Morisky Medication Adherence Scale-8
(C-MMAS-8), an eight-item validated, self-report scale for adherence measurement
with a total score range of 0-8. A cut-off of 6 was applied to differentiate
adherence levels, including patients with an MMAS score <6 (low adherence), MMAS
score = 8 (high adherence), and MMAS score ≥6 and <8 (moderate adherence). In
this study, hypertensive patients' medication literacy levels and adherence to
antihypertensive agents were identified. Pearson correlation analysis was carried
out to identify the correlation between medication literacy and adherence. Binary
logistic regression analysis was performed with medication adherence as the
outcome variable in order to confirm factors associated with medication
adherence. Results: A total of 420 hypertensive patients, including 198 women and
222 men with a mean age of 60.6 years (SD = 12.4), were recruited. The mean score
of hypertensive patients on the medication literacy scale was 24.03 (SD = 5.13).
The mean scores of the four dimensions of knowledge, attitude, skill, and
behavior on the medication literacy scale of this study were 6.22 ± 2.22, 5.04 ±
1.16, 4.50 ± 2.21, and 8.27 ± 1.90, respectively. Regarding medication adherence,
the mean score of the C-MMAS-8 in this study was 4.82 (SD = 2.11). A total of
63.6% of patients presented with low adherence, 29.5% presented with moderate
adherence, and 7.6% presented with high adherence. The Pearson correlation
results showed that medication literacy (r = 0.342, P < 0.01) as a whole variable
and the three dimensions of knowledge (r = 0.284, P < 0.01), attitude (r = 0.405,
P < 0.01), and behavior (r = 0.237, P < 0.01) were significantly associated with
medication adherence. Binary logistic regression analysis indicated that annual
income [OR 1.199 (95% CI: 1.011-1.421); P = 0.037] and two dimensions of attitude
[OR 2.174 (95% CI: 1.748-2.706); P = 0.000] and behavior [OR 1.139 (95% CI:
1.002-1.294); P = 0.046] in medication literacy were found to be independent
predictors of medication adherence. Individuals with better attitudes and
behavior literacy in medication literacy were more likely to adhere to the use of
antihypertensive agents. Those who had higher annual incomes were more likely to
adhere to the use of antihypertensive agents. Conclusion: The levels of
medication literacy and medication adherence of hypertensive patients are
suboptimal and need to be improved in China. The level of medication literacy in
patients with hypertension could affect their adherence to antihypertensive
drugs. It was suggested that hypertensive patients' medication adherence could be
improved and driven by increasing the medication literacy level, especially in
the attitude and behavior domains. Pertinent strategies that are specific to
several dimensions of medication literacy should be developed and implemented in
order to promote full medication literacy among hypertensive patients, thus
facilitating optimal adherence and blood pressure control.
DOI: 10.3389/fphar.2019.00822
PMCID: PMC6664237
PMID: 31396088

eCollection 2017.
Patient knowledge and pulmonary medication adherence in adult patients with

cystic fibrosis.
Lin AH(1), Kendrick JG(2)(3), Wilcox PG(4)(5), Quon BS(4)(5).
Author information:
(1)Faculty of Medicine.
(2)Faculty of Pharmaceutical Sciences, University of British Columbia.
(3)Department of Pharmacy, Children's and Women's Health Centre of British
Columbia.
(4)Department of Medicine, Division of Respiratory Medicine, University of
British Columbia.
(5)Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada.
BACKGROUND AND OBJECTIVES: Patient knowledge of lung function (ie, forced

expiratory volume in 1 s [FEV1]% predicted) and the intended benefits of their
prescribed pulmonary medications might play an important role in medication
adherence, but this relationship has not been examined previously in patients
with cystic fibrosis (CF).
METHODS: All patients diagnosed with CF and without prior lung transplantation
were invited to complete knowledge and self-reported medication adherence
questionnaires during routine outpatient visits to the Adult CF Clinic, St Paul's
Hospital, Vancouver, Canada from June 2013 to August 2014.
RESULTS: A total of 142 out of 167 (85%) consecutive adults attending CF clinic
completed patient knowledge and medication adherence survey questionnaires.
Sixty-four percent of the patients recalled their last FEV1% predicted value
within 5%, and 70% knew the intended benefits of all their prescribed
medications. Self-reported adherence rates were highest for inhaled antibiotics
(81%), azithromycin (87%), and dornase alpha (76%) and lowest for hypertonic
saline (47%). Individuals who knew their FEV1% predicted value within 5% were
more likely to self-report adherence to dornase alpha (84% vs 62%, P=0.06) and
inhaled antibiotics (88% vs 64%, P=0.06) compared to those who did not, but these
associations were not statistically significant. There were no significant
associations observed between patient knowledge of intended medication benefits
and self-reported medication adherence.
CONCLUSION: Contrary to our hypothesis, disease- and treatment-related knowledge
was not associated with self-reported medication adherence. This suggests other
barriers to medication adherence should be targeted in future studies aiming to
improve medication adherence in adults with CF.
DOI: 10.2147/PPA.S129088
PMCID: PMC5383089
PMID: 28408806


eCollection 2017.
Is patient empowerment the key to promote adherence? A systematic review of the

relationship between self-efficacy, health locus of control and medication
adherence.
Náfrádi L(1), Nakamoto K(1), Schulz PJ(1).
Author information:
(1)Institute of Communication and Health, Università della Svizzera italiana,
Lugano, Switzerland.
BACKGROUND: Current health policies emphasize the need for an equitable

doctor-patient relationship, and this requires a certain level of patient
empowerment. However, a systematic review of the empirical evidence on how
empowerment affects medication adherence-the extent to which patients follow the
physician's prescription of medication intake-is still missing. The goal of this
systematic review is to sum up current state-of-the-art knowledge concerning the
relationship between patient empowerment and medication adherence across medical
conditions. As our conceptualization defines health locus of control and
self-efficacy as being crucial components of empowerment, we explored the
relationship between these two constructs and medication adherence.
METHODS: Relevant studies were retrieved through a comprehensive search of
Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were
identified. After applying inclusion and exclusion criteria and quality
assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in
English, addressing the relationship between empowerment (predictor) and
medication adherence (outcome) were included.
FINDINGS: High levels of self-efficacy and Internal Health Locus of Control are
consistently found to promote medication adherence. External control dimensions
were found to have mainly negative (Chance and God attributed control beliefs) or
ambiguous (Powerful others attributed control beliefs) links to adherence, except
for Doctor Health Locus of Control which had a positive association with
medication adherence. To fully capture how health locus of control dimensions
influence medication adherence, the interaction between the sub-dimensions and
the attitudinal symmetry between the doctor and patient, regarding the patient's
control over the disease management, can provide promising new alternatives.
DISCUSSION: The beneficial effect of patients' high internal and concurrent
physician-attributed control beliefs suggests that a so-called "joint
empowerment" approach can be suitable in order to foster medication adherence,
enabling us to address the question of control as a versatile component in the
doctor-patient relationship.
PMCID: PMC5645121
621. Int J Pharm Pract. 2017 Jun;25(3):185-194. doi: 10.1111/ijpp.12242. Epub 2016
Feb
1.
A systematic review of electronic multi-compartment medication devices with

reminder systems for improving adherence to self-administered medications.
Paterson M(1), Kinnear M(2), Bond C(3), McKinstry B(1)(4).
Author information:
(1)e-Health Research Group, Centre for Population Health Sciences, University of
Edinburgh, Edinburgh, UK.
(2)NHS Lothian Pharmacy Service, Western General Hospital, Edinburgh, UK.
(3)Centre for Academic Primary Care, Polwarth Building West Block, Aberdeen, UK.
(4)Edinburgh Health Services Research Unit, University of Edinburgh, Edinburgh,
UK.
BACKGROUND: Many patients experience difficulties adhering to medication regimes.

For people who forget or get confused about medication, there are products to
help them such as multi-compartment medication devices (MMDs). Some of these,
known as electronic MMDs (eMMDs), use audible and/or visual signals to prompt the
patient when to take medication, dispense medications, give instructions to the
patient, and contact a caregiver (mobile Internet or text to a carer) as needed.
AIM: To systematically review the literature on the use of eMMDs, to determine
what evidence for their effectiveness is available.
METHODS: A comprehensive literature search of 10 databases, plus an Internet
search and hand searching was conducted, using the MeSH terms reminder
systems/patient compliance/medication adherence. There were no date restrictions.
Inclusion criteria were patients in any community setting, in any country and
with no restrictions of age, gender, ethnicity or medical condition, using an
eMMD. Peer-reviewed quantitative or qualitative studies of any design were
included.
RESULTS: Of 805 abstracts identified and 99 full text papers retrieved, six met
the inclusion criteria. Five of the studies reported adherence to medication
regimes; one reported design factors to improve adherence. Adherence varied by
the context of the reminders, the target group and usability of the devices. The
studies were small scale and only one was a well conducted randomised controlled
trial.
CONCLUSION: Overall methodological quality of the studies was poor. Although
positive effects on adherence were reported further, rigorously conducted,
studies are needed to inform the use of eMMDs.
© 2016 Royal Pharmaceutical Society.
DOI: 10.1111/ijpp.12242
622. J Public Health Afr. 2018 Dec 21;9(3):826. doi: 10.4081/jphia.2018.826.

The effect of self-efficacy and outcome expectation on medication adherence

behavior.
Okuboyejo S(1), Mbarika V(2), Omoregbe N(1).
Author information:
(1)Department of Computer and Information Sciences, Covenant University, Nigeria.
(2)International Center for IT and Development, Southern University and A&M,
Baton Rouge, LA, USA.
Medication adherence still ranks as a big challenge for clinicians and health
workers. Based on a social learning theoretical framework, this study explores
the adoption of patient adherence, medication adherence as a catalyst for
improving the health and quality of life of individuals in Nigeria. Structural
Equation Modelling technique was used to analyze the empirical data obtained. SLT
variables including self-efficacy and outcome expectation were tested against
medication adherence behavior. The constructs are related and positively
correlated except definition which is contrary to previous researches. The
research discusses these findings while also highlighting the implications for
practice and policy.
DOI: 10.4081/jphia.2018.826
PMCID: PMC6379697
PMID: 30854176
Conflict of interest statement: Conflict of interests: the authors declare no

potential conflict of interest.
623. Br J Gen Pract. 2016 Aug;66(649):e568-76. doi: 10.3399/bjgp16X685609. Epub

2016
May 23.
Barriers to medication adherence for the secondary prevention of stroke: a

qualitative interview study in primary care.
Jamison J, Graffy J, Mullis R, Mant J, Sutton S.

BACKGROUND: Medications are highly effective at reducing risk of recurrent
stroke, but success is influenced by adherence to treatment. Among survivors of
stroke and transient ischaemic attack (TIA), adherence to medication is known to
be suboptimal.
AIM: To identify and report barriers to medication adherence for the secondary
prevention of stroke/TIA.
DESIGN AND SETTING: A qualitative interview study was conducted within general
practice surgeries in the East of England, UK.
METHOD: Patients were approached by letter and invited to take part in a
qualitative research study. Semi-structured interviews were undertaken with
survivors of stroke, caregivers, and GPs to explore their perspectives and views
around secondary prevention and perceived barriers to medication adherence. Key
themes were identified using a grounded theory approach. Verbatim quotes
describing the themes are presented here.
RESULTS: In total, 28 survivors of stroke, including 14 accompanying caregivers
and five GPs, were interviewed. Two key themes were identified. Patient level
barriers included ability to self-care, the importance people attach to a stroke
event, and knowledge of stroke and medication. Medication level barriers included
beliefs about medication and beliefs about how pills work, medication routines,
changing medications, and regimen complexity and burden of treatment.
CONCLUSION: Patients who have had a stroke are faced with multiple barriers to
taking secondary prevention medications in UK general practice. This research
suggests that a collaborative approach between caregivers, survivors, and
healthcare professionals is needed to address these barriers and facilitate
medication-taking behaviour.
© British Journal of General Practice 2016.
DOI: 10.3399/bjgp16X685609
PMCID: PMC4979933
Pilot and Feasibility of Combining a Medication Adherence Intervention and Group

Diabetes Education for Patients with Type-2 Diabetes.
Witry M(1), Ernzen M(2), Pape A(2), Viyyuri BR(3).
Author information:
(1)Department of Pharmacy Practice and Science, University of Iowa College of
Pharmacy, Iowa City, IA 52242, USA. matthew-witry@uiowa.edu.
(2)Mercy Family Pharmacy, Dubuque, IA 52001, USA.
(3)Department of Pharmacy Practice and Science, University of Iowa College of
Pharmacy, Iowa City, IA 52242, USA.
Introduction: Controlling diabetes typically requires self-management and

medications. Community pharmacists are positioned to support patients with both.
Methods: This study assessed the feasibility and potential benefit of combining
pharmacist-provided group diabetes education (up to eight sessions) and
medication synchronization using a three-group design. Data were collected using
pre-post paper surveys and electronic health record data. One group received both
education and synchronization services, another group received medication
synchronization only, and a third served as control. Results: Of 300 contacted
patients, eighteen patients participated in group diabetes education, 14 had
medication synchronization only, and 12 comprised a control group. There was
little change in HbA1c over the study period. Medication adherence appeared to be
positively aided by medication synchronization, although all groups started with
high adherence. Some medication beliefs and self-care activities may have been
positively impacted by group diabetes education. Both groups receiving medication
synchronization were satisfied. Conclusions: Participants strongly agreed they
would recommend group diabetes education from the study pharmacy to a friend and
were satisfied with medication synchronization; however, it was difficult to tell
if there was a synergistic effect by combining the two services. Reimbursement
for diabetes education was not obtained despite multiple attempts, hindering
sustainability.
DOI: 10.3390/pharmacy7030076
PMID: 31261613

eCollection 2016.
Rates of Intentional and Unintentional Nonadherence to Peritoneal Dialysis

Regimes and Associated Factors.
Yu ZL(1), Lee VY(1), Kang AW(1), Chan S(2), Foo M(3), Chan CM(3), Griva K(1)(4).
Author information:
(1)Department of Psychology, National University of Singapore, Singapore,
Singapore.
(2)Alice Lee Centre for Nursing Studies, National University Hospital, Singapore,
Singapore.
(3)Department of Renal Medicine, Singapore General Hospital, Singapore,
Singapore.
(4)Health Services Research Group, City University London, London, United
Kingdom.
With increasing emphasis on expanding home-based dialysis, there is a need to

understand adherence outcomes. This study set out to examine the prevalence and
predictors of nonadherence among patients undergoing peritoneal dialysis. A cross
sectional sample of 201 peritoneal dialysis patients recruited between 2010-2011
from Singapore General Hospital completed measures of quality of life, medication
beliefs, self-efficacy and emotional distress. Nonadherence rates were high; 18%
for dialysis, 46% for medication and 78% for diet. Intentional nonadherence was
more common for dialysis (p = .03), whereas unintentional nonadherence was more
common for medication (p = .002). Multivariate models indicated significant
associations for higher education (intermediate vs low OR = 3.18, high vs low OR
= 4.70), lower environment quality of life (OR = 0.79), dialysis self-efficacy
(OR = 0.80) with dialysis nonadherence; higher education (OR = 2.22), self-care
peritoneal dialysis (OR = 3.10), perceived necessity vs concerns over medication
(OR = 0.90), self-efficacy (OR = 0.76) with nonadherence to medication. The odds
for nonadherence to diet were higher among patients who were younger (OR = 0.96),
of Chinese ethnicity (OR = 2.99) and those reporting better physical health (OR =
1.30) and lower self-efficacy (OR = 0.49). Nonadherence is common in peritoneal
dialysis. Self-efficacy and beliefs about medication are promising targets for
interventions designed to improve adherence.
PMCID: PMC4769138
626. SAGE Open Med. 2015 Aug 19;3:2050312115595822. doi: 10.1177/2050312115595822.

eCollection 2015.
Understanding the role of the healthcare professional in patient self-management
of allergic rhinitis.
Kuehl BL(1), Abdulnour S(2), O'Dell M(3), Kyle TK(4).
Author information:
(1)Scientific Insights Consulting Group Inc., Mississauga, ON, Canada.
(2)University of Toronto Mississauga, Mississauga, ON, Canada.
(3)Truman Medical Centre, Kansas City, MO, USA; Department of Community & Family
Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
(4)ConscienHealth, Pittsburgh, PA, USA.
OBJECTIVE: Allergic rhinitis is a common, usually long-standing, condition that

may be self-diagnosed or have a formal diagnosis. Our aim was to identify how
allergic rhinitis sufferers self-manage their condition.
METHODS: A sample of 276 self-identified adult allergy sufferers pooled from
social media completed an online survey comprising 13 questions. The survey was
fielded by a professional research organization (Lab42). The main outcome
measures included the use of prescription and/or non-prescription allergy
medication, and interactions with physician and/or pharmacist with respect to
medication use.
RESULTS: Of the respondents, 53% (146/276) indicated that they used both
prescription and over-the-counter medication to manage their allergy symptoms. Of
those who used prescription medication, 53% reported that they discussed their
prescription medication in great detail with their physician when it was
prescribed, while 42% spoke about it briefly. Following the initial prescription,
few discussions about the prescription occur with the physician (45% indicate
several discussions, 40% indicate one or two discussions, and 10% indicate no
discussions). In most cases (~75% of the time), allergy prescription refills did
not require a doctor visit with patients obtaining refills through phone calls to
the doctor's office or through the pharmacy. Two-thirds of patients (69%) report
that they have discussed their prescription allergy medication with a pharmacist,
with greater than half of respondents having discussed the use of the
non-prescription medication with their doctor.
CONCLUSION: Patients with diagnosed allergic rhinitis appear to be self-managing
their condition with few interactions with their doctor about their allergy
prescription. Interactions with a pharmacist about allergy medication
(prescription and non-prescription) appear to be more common than interactions
with a physician.
DOI: 10.1177/2050312115595822
PMCID: PMC4679322
PMID: 26770793
627. Psychopharmacology (Berl). 2016 Jun;233(12):2301-8. doi:

10.1007/s00213-016-4276-z. Epub 2016 Apr 5.
Nicotine-induced cortical activation among nonsmokers with moderation by trait

cognitive control.
Sutton SK(1)(2), Van Rensburg KJ(3), Jentink KG(4), Drobes DJ(1)(3)(5), Evans
DE(6)(7)(8).
Author information:
(1)Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa,
FL, USA.
(2)Department of Psychology, University of South Florida, Tampa, FL, USA.
(3)Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL,
USA.
(4)Department of Psychology, Colorado State University, Fort Collins, CO, USA.
(5)Department of Oncologic Sciences, University of South Florida, 4115 E Fowler
Ave., Tampa, FL, 33617, USA.
(6)Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa,
FL, USA. david.evans@moffitt.org.
(7)Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL,
USA. david.evans@moffitt.org.
(8)Department of Oncologic Sciences, University of South Florida, 4115 E Fowler
Ave., Tampa, FL, 33617, USA. david.evans@moffitt.org.
RATIONALE: Considerable research suggests that nicotine enhances cognitive

control-related processes (e.g., attention, memory) among nicotine-deprived
smokers, both in terms of behavior and neural indices (e.g., ERP, slow-wave EEG).
Nicotine may also increase cognitive control among nonsmokers, and this may vary
as a function of trait cognitive control. It is important to examine the effects
of nicotine on cognitive control-related processes among nonsmokers as these
effects may provide a path for the initiation of smoking.
OBJECTIVES: The objectives of the study were to examine in nonsmokers (1) the
effect of nicotine on resting cortical activity, an indirect measure of cognitive
control, and (2) trait cognitive control as a moderator of nicotine-induced
cortical activity changes.
METHOD: Eighty participants were given placebo and 7-mg nicotine patches in
separate sessions for this counter-balanced, double-blind, within-subject study.
Resting cortical activity was measured with EEG for a 3-min period with eyes
opened.
RESULTS: Average alpha-1 band power density values in frontal and central regions
were lower during the nicotine versus placebo condition, which provides evidence
of nicotine-induced cortical activation. Furthermore, those with lower
self-reported cognitive control exhibited greater nicotine-induced reductions in
alpha-1 power density values.
CONCLUSIONS: These individual differences in nicotine-induced cortical activation
are consistent with a model of nicotine self-medication whereby individuals with
lower cognitive control may find smoking more reinforcing via amelioration of
related cognitive deficits.
DOI: 10.1007/s00213-016-4276-z
PMCID: PMC6036628
628. JMIR Res Protoc. 2015 Jul 20;4(3):e88. doi: 10.2196/resprot.4282.
Development of Motivate4Change Using the Intervention Mapping Protocol: An

Interactive Technology Physical Activity and Medication Adherence Promotion
Program for Hospitalized Heart Failure Patients.
Oosterom-Calo R(1), Te Velde SJ, Stut W, Brug J.
Author information:
(1)Philips Research, Briarcliff Manor, NY, United States. rony.calo@philips.com.
BACKGROUND: It is important that heart failure (HF) patients adhere to their

medication regimen and engage in physical activity. Evidence shows that adherence
to these HF self-management behaviors can be improved with appropriate
interventions.
OBJECTIVE: To further promote medication adherence and physical activity among HF
patients, we developed an intervention for hospitalized HF patients.
METHODS: The intervention mapping protocol was applied in the development of the
intervention. This entailed performing a needs assessment, defining change
objectives, selecting determinants and strategies, and developing the materials.
RESULTS: The resulting intervention, Motivate4Change, makes use of interactive
technology and provides HF patients with personalized feedback and advice.
Specific change objectives were defined. The relevant behavioral determinants for
the physical activity program were practical knowledge on physical activity
performance and self-efficacy for, and perceived benefits of, physical activity.
For medication-taking, the selected determinants were practical knowledge on
medication-taking, perceived barriers to medication-taking, beliefs about the
necessity and harm regarding the medication prescribed, and beliefs about
overprescribing and harm of medication in general. The change objectives and
behavior change determinants were translated in feedback and advice strategies in
an interactive technology program that included tailored feedback and advice, and
role models in videos in which the behaviors and overcoming barriers were
demonstrated. Relevant stakeholders were involved in the interventions
development process. The intervention was pretested among HF patients and
adjustments were made accordingly.
CONCLUSIONS: The interactive technology physical activity and medication
adherence promotion program for hospitalized HF patients was systematically
developed using the intervention mapping protocol and was based on the available
theory and evidence regarding HF self-management behavior change. The
intervention's efficacy is yet to be determined in evaluation research.
DOI: 10.2196/resprot.4282
PMCID: PMC4527006
PMID: 26195072
629. Prev Chronic Dis. 2016 Dec 29;13:E179. doi: 10.5888/pcd13.160236.
Community Health Workers as Allies in Hypertension Self-Management and Medication

Adherence in the United States, 2014.
Allen CG(1), Brownstein JN(2), Satsangi A(2), Escoffery C(2).
Author information:
(1)Boston University, Department of Medicine, 72 E Concord St, Boston, MA 02118.
Email: caallen89@gmail.com.
(2)Emory University, Rollins School of Public Health, Atlanta, Georgia.
INTRODUCTION: Rates of hypertension control remain low among underserved

populations in the United States; moreover, disparities in hypertension-related
cardiovascular disease death are increasing. Community health workers (CHWs) can
address barriers to hypertension control among underrepresented and diverse
populations. We identify unique roles CHWs play in hypertension self-management
and medication adherence.
METHODS: In 2014, we conducted a mixed methods study with an online survey of 265
CHWs and 23 telephone interviews. The survey and interview guide contained
questions about CHWs' roles in hypertension self-management and hypertension
medication adherence. We used descriptive statistics to analyze survey data and
used inductive thematic analysis for the qualitative data.
RESULTS: CHWs described working in partnership with patients and various health
care providers to assist people in hypertension self-management. Roles were
flexible and multifaceted but patient-driven. CHWs used various delivery methods
to assist patients in overcoming barriers to medication adherence. CHWs
interacted with patients primarily through individual clinical sessions or home
visits. On average, they visit about 8 times per month, about 40 minutes per
visit, over 7 months. CHWs often addressed barriers related to medicine-taking
and refills and support patient-provider communications.
CONCLUSION: Results from this study will help health care professionals, policy
makers, and academics better understand the work of CHWs. CHWs are important
provider allies for improving hypertension prevention and self-management,
especially among underserved and diverse populations in the United States.
DOI: 10.5888/pcd13.160236
PMCID: PMC5201147
630. J Taibah Univ Med Sci. 2017 Jul 25;13(1):97-102. doi:

10.1016/j.jtumed.2017.06.006. eCollection 2018 Feb.
Social stigma, adherence to medication and motivation for healing: A

cross-sectional study of leprosy patients at Jember Public Health Center,
Indonesia.
Susanti IA(1), Mahardita NGP(1), Alfianto R(2), Sujana IMIWC(2), Siswoyo(3),

Susanto T(4).
Author information:
(1)School of Nursing, University of Jember, Indonesia.
(2)School of Engineering, University of Jember, Indonesia.
(3)Department of Medical and Surgical Nursing, School of Nursing, University of
Jember, Indonesia.
(4)Department of Family and Community Health Nursing, School of Nursing,
University of Jember, Indonesia.
Objectives: Social stigma surrounding leprosy patients (LPs) in the community is

still related to the adherence of these patients to medication and to their
internal motivation for healing. Unfortunately, the leprosy case programme has
not been optimally established in public health centres (PHCs). The aim of this
study was to assess the social stigma towards adherence to medication and
motivation for healing among LPs in PHCs in Indonesia.
Methods: A cross-sectional study was conducted from March to May 2017 at PHCs in
Jember, Indonesia. Data were collected using a self-administered questionnaire,
and secondary data related to medical treatment was assessed from PHCs' medical
records. The data were analysed using a t-test and a Chi-square test, while
linear regression was used to evaluate factors that could influence LPs'
adherence to medication and their motivation for healing.
Results: Among the 35 LPs in this study, 25.7% and 74.3%, respectively, had
paucibacillary and multibacillary types of leprosy. The type of leprosy was
associated with the length of time patients were infected with the disease, their
adherence to medication and their motivation for healing. The factors that
influenced adherence to medication and motivation for healing were the time
period that the LP remained infected and the type of leprosy.
Conclusions: Infection period and type of leprosy were associated with adherence
to medication and motivation for healing in the community. Efforts should be made
to find active cases of leprosy at PHCs. Activities at PHCs should include
self-care groups to improve LP adherence to medication and their motivation for
healing in the community.
Publisher: ‫ل تزال الوصمة الجتماعية المحيطة بمرضى الجذام في المجتمع مرتبطة‬

‫ لم يتم تأسيس برنامج حالت‬،‫ ولسوء الحظ‬.‫بالتزامهم بالدواء والدافع الداخلي للشفاء‬
‫ والهدف من هذه الدراسة هو تقييم‬.‫الجذام على النحو المثل في مراكز الصحة العامة‬
‫الوصمة الجتماعية نحو اللتزام بالدواء والتحفيز للشفاء بين مرضى الجذام في مراكز‬
‫ في مراكز‬٢٠١٧ ‫أجريت دراسة مستعرضة خلل مارس إلى مايو‬.‫الصحة العامة في إندونيسيا‬
‫ وعملت استبانة ذاتية لجمع البيانات وتم قياس‬.‫الصحة العامة في جمبر بإندونيسيا‬
‫البيانات الثانوية المتعلقة بالعلج الطبي من السجلت الطبية في مراكز الصحة العامة‬.
‫ واستخدام اختبار النحدار الخطي لقياس العوامل التي يمكن أن‬،‫وتم تحليل البيانات‬
‫ من مرضى‬٣٥ ‫من بين‬.‫تؤثر على اللتزام بالدواء والتحفيز للشفاء في مرضى الجذام‬
‫ كانت النسب المئوية لمرضى الجذام من نوع ”قليل العصيات“ ونوع ”متعدد‬،‫الجذام‬
‫ وكان نوع الجذام مرتبطا بطول فترة إصابة‬.‫ على التوالي‬٪٧٤.٣ ‫ و‬٪٢٥.٧ ‫العصيات“ بنسب‬
‫ وكانت العوامل التي أثرت على‬.‫ واللتزام بالدوية والدافع للشفاء‬،‫المريض بالجذام‬
‫اللتزام بالدواء والتحفيز للشفاء في مرضى الجذام هي الفترة الزمنية التي بقي فيها‬
‫ارتبطت فترة العدوى ونوع الجذام بكل من‬.‫ على التوالي‬،‫المريض مصابا ونوع الجذام‬
‫ وينبغي توجيه المحاولت ليجاد حالت‬.‫اللتزام بالعلج والدافع للشفاء في المجتمع‬
‫ وينبغي أن تشمل هذه النشطة في مراكز الصحة‬.‫نشطة من الجذام في مراكز الصحة العامة‬
‫العامة مرضى الجذام من خلل مجموعات الرعاية الذاتية لتحسين اللتزام بالدواء‬
‫والتحفيز للشفاء في المجتمع‬.
DOI: 10.1016/j.jtumed.2017.06.006
PMCID: PMC6695038
PMID: 31435310
631. New Microbes New Infect. 2015 Apr 16;6:22-9. doi: 10.1016/j.nmni.2015.02.007.
eCollection 2015 Jul.
The global threat of antimicrobial resistance: science for intervention.
Roca I(1), Akova M(2), Baquero F(3), Carlet J(4), Cavaleri M(5), Coenen S(6),
Cohen J(7), Findlay D(8), Gyssens I(9), Heuer OE(10), Kahlmeter G(11), Kruse
H(12), Laxminarayan R(13), Liébana E(14), López-Cerero L(15), MacGowan A(16),
Martins M(17), Rodríguez-Baño J(18), Rolain JM(19), Segovia C(20), Sigauque
B(21), Tacconelli E(22), Wellington E(23), Vila J(24).
Author information:
(1)ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital
Clínic-Universitat de Barcelona, Barcelona, Spain.
(2)Department of Medicine, Section of Infectious Diseases, Hacettepe University
School of Medicine, Ankara, Turkey ; ESCMID Executive Committee, Basel,
Switzerland.
(3)Department of Microbiology at the Ramón y Cajal University Hospital, Ramón y
Cajal Institute for Health Research (IRYCIS), Division for Research in Microbial
Biology and Evolution, CIBERESP, Madrid, Spain.
(4)Fondation Hôpital St, Joseph, Paris, France and World Alliance Against
Antibiotic Resistance (WAAAR), Creteil, France.
(5)European Medicines Agency (EMA), London, UK.
(6)Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute
(VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp,
Antwerp, Belgium.
(7)Brighton and Sussex Medical School, Brighton, UK.
(8)Global Commercial Lead, GlaxoSmithKline (GSK), London, UK.
(9)Department of Medicine, Radboud University Medical Center and Department of
Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital,
Nijmegen, The Netherlands.
(10)European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
(11)Clinical Microbiology, Central Hospital, Växjö, Sweden ; ESCMID Executive
Committee, Basel, Switzerland ; EUCAST Steering Committee, Växjö, Sweden.
(12)WHO Regional Office for Europe, UN City, Marmorvej, Copenhagen, Denmark.
(13)Center for Disease Dynamics, Economics and Policy, Washington, DC, USA ;
Princeton University, Princeton, NJ, USA.
(14)Scientific Unit on Biological Hazards, European Food Safety Authority (EFSA),
Parma, Italy.
(15)Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital
Universitario Virgen Macarena, Seville, Spain.
(16)Department of Medical Microbiology, Southmead Hospital, Bristol, UK ; EUCAST
Steering Committee, Växjö, Sweden.
(17)School of Public Health, Physiotherapy and Population Science, UCD Centre for
Food and Safety, Molecular Innovation and Drug Discovery, University College
Dublin, Dublin, Ireland.
(18)Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital
Universitario Virgen Macarena, and Departamento de Medicina, Universidad de
Sevilla, Seville, Spain ; ESCMID Executive Committee, Basel, Switzerland.
(19)Aix-Marseille Université, Unité de Recherche en Maladies Infectieuses et
Tropicales Emergentes (URMITE), Inserm, IHU Méditerranée Infection, Faculté de
Médecine et de Pharmacie, and APHM, CHU Timone, Pôle Infectieux, Marseille,
France.
(20)Instituto de Salud Carlos III, ISCIII, Madrid, Spain.
(21)Centro de Investigação em Saúde da Manhiça and Instituto Nacional de
Saúde/Ministério de Saúde, Maputo, Mozambique.
(22)Division of Infectious Diseases, Department of Internal Medicine I, Tübingen
University Hospital, Tübingen, Germany ; ESCMID Executive Committee, Basel,
Switzerland.
(23)School of Life Sciences, University of Warwick, Coventry, UK.
(24)ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital
Clínic-Universitat de Barcelona, Barcelona, Spain ; ESCMID Executive Committee,
Basel, Switzerland.
Erratum in
New Microbes New Infect. 2015 Nov;8:175.
In the last decade we have witnessed a dramatic increase in the proportion and
absolute number of bacterial pathogens resistant to multiple antibacterial
agents. Multidrug-resistant bacteria are currently considered as an emergent
global disease and a major public health problem. The B-Debate meeting brought
together renowned experts representing the main stakeholders (i.e. policy makers,
public health authorities, regulatory agencies, pharmaceutical companies and the
scientific community at large) to review the global threat of antibiotic
resistance and come up with a coordinated set of strategies to fight
antimicrobial resistance in a multifaceted approach. We summarize the views of
the B-Debate participants regarding the current situation of antimicrobial
resistance in animals and the food chain, within the community and the healthcare
setting as well as the role of the environment and the development of novel
diagnostic and therapeutic strategies, providing expert recommendations to tackle
the global threat of antimicrobial resistance.
DOI: 10.1016/j.nmni.2015.02.007
PMCID: PMC4446399
PMID: 26029375
632. Breast. 2015 Oct;24(5):630-6. doi: 10.1016/j.breast.2015.06.010. Epub 2015 Jul

16.
Medication taking behaviors among breast cancer patients on adjuvant endocrine

therapy.
Kimmick G(1), Edmond SN(2), Bosworth HB(3), Peppercorn J(4), Marcom PK(4),
Blackwell K(4), Keefe FJ(2), Shelby RA(2).
Author information:
(1)Duke Cancer Institute, Duke University Medical Center, DUMC Box 3204, Durham,
NC 27710, USA. Electronic address: gretchen.kimmick@duke.edu.
(2)Department of Psychiatry and Behavioral Sciences, Duke University Medical
Center, USA.
(3)Department of Medicine, Psychiatry, and School of Nursing, Duke University
Medical Center; Center for Health Services Research, Durham VAMC, USA.
(4)Duke Cancer Institute, Duke University Medical Center, DUMC Box 3204, Durham,
NC 27710, USA.
PURPOSE: To explore how symptoms and psychosocial factors are related to

intentional and unintentional non-adherent medication taking behaviors.
METHODS: Included were postmenopausal women with hormone receptor positive, stage
I-IIIA breast cancer, who had completed surgery, chemotherapy, and radiation, and
were taking endocrine therapy. Self-administered, standardized measures were
completed during a routine clinic visit: Brief Fatigue Inventory, Brief Pain
Inventory, Menopause Specific Quality of Life Questionnaire, Functional
Assessment of Cancer Therapy General and Neurotoxicity scales, and Self-Efficacy
for Appropriate Medication Use Scale. Regression analyses were performed to
determine the degree to which demographic, medical, symptom, and psychosocial
variables, explain intentional, such as changing one's doses or stopping
medication, and unintentional, such as forgetting to take one's medication,
non-adherent behaviors.
RESULTS: Participants were 112 women: mean age 64 (SD = 9) years; 81% white; mean
time from surgery 40 (SD = 28) months; 49% received chemotherapy (39% including a
taxane); mean time on endocrine therapy, 35 (SD = 29.6) months; 82% taking an
aromatase inhibitor. Intentional and unintentional non-adherent behaviors were
described in 33.9% and 58.9% of participants, respectively. Multivariate analysis
showed that higher self-efficacy for taking medication was associated with lower
levels of unintentional (p = 0.002) and intentional (p = 0.004) non-adherent
behaviors. The presence of symptoms (p = 0.03) and lower self-efficacy for
physician communication (p = 0.009) were associated with higher levels of
intentional non-adherent behaviors.
CONCLUSIONS: These results suggest that women who report greater symptoms, lower
self-efficacy for communicating with their physician, and lower self-efficacy for
taking their medication are more likely to engage in both intentional and
unintentional non-adherent behaviors.
DOI: 10.1016/j.breast.2015.06.010
PMCID: PMC4824055
633. Pain Med. 2019 May 1;20(5):925-933. doi: 10.1093/pm/pny241.
Turning Pain into Gain: Evaluation of a Multidisciplinary Chronic Pain Management

Program in Primary Care.
Joypaul S(1), Kelly FS(1), King MA(1).
Author information:
(1)School of Pharmacy and Pharmacology, Gold Coast Campus, Griffith University,
Queensland 4222, Australia and Menzies Health Institute Queensland, Gold Coast
Campus, Griffith University, Queensland, Australia.
OBJECTIVE: To measure the impact of the multidisciplinary Turning Pain Into Gain
program in people experiencing chronic pain of any etiology.
METHODS: A mixed-methods observational study of 252 participants was used to
explore the impact of Turning Pain Into Gain on medication use; quality of life
and functioning, as measured by the Pain Self-Efficacy Questionnaire; and
self-reported hospitalizations between 2015 and 2016.
RESULTS: Responses from 178 participants showed an increased alignment with
Australian pain medication guidelines (e.g., a 7.3% reduction in paracetamol
duplication was reported with a concurrent 5.1% rise in the administration of
sustained-release paracetamol formulations); improved Pain Self-Efficacy
Questionnaire scores from 23.1 (out of a possible score of 60) preprogram to 35.3
postprogram; and a reduction in self-reported hospitalizations from 50 cases in
the 12 months preprogram to 11 cases in the 12 months postprogram.
CONCLUSIONS: Positive medication, Pain Self-Efficacy Questionnaire, and
hospitalization changes provide evidence for the broader implementation of
similar patient-centered programs to promote more holistic management of diverse
types of chronic pain in primary care. Reduced hospitalization reflects potential
for this intervention to be cost-effective, which could be investigated further.
© 2018 American Academy of Pain Medicine.
DOI: 10.1093/pm/pny241
PMCID: PMC6497132
PMID: 30541054
634. BMC Med. 2019 Jul 17;17(1):127. doi: 10.1186/s12916-019-1362-1.
Medication management support in diabetes: a systematic assessment of diabetes

self-management apps.
Huang Z(1)(2), Lum E(3)(4)(5), Jimenez G(3), Semwal M(3), Sloot P(6)(7)(8), Car
J(3).
Author information:
(1)Centre for Population Health Sciences, Lee Kong Chian School of Medicine,
Nanyang Technological University, Clinical Sciences Building, Level 18, 11
Mandalay Road, Singapore, 308232, Singapore. ZHUANG014@e.ntu.edu.sg.
(2)NTU Institute for Health Technologies (HealthTech NTU), Interdisciplinary
Disciplinary School, Nanyang Technological University, Singapore, Singapore.
ZHUANG014@e.ntu.edu.sg.
(3)Centre for Population Health Sciences, Lee Kong Chian School of Medicine,
Nanyang Technological University, Clinical Sciences Building, Level 18, 11
Mandalay Road, Singapore, 308232, Singapore.
(4)Institute of Health and Biomedical Innovation, Queensland University of
Technology, Brisbane, Australia.
(5)School of Clinical Sciences, Faculty of Health, Queensland University of
Technology, Brisbane, Australia.
(6)Institute for Advanced Study, University of Amsterdam, Amsterdam, The
Netherlands.
(7)ITMO University, Saint Petersburg, Russia.
(8)Complexity Institute, Nanyang Technological University, Singapore, Singapore.
BACKGROUND: Smartphone apps are becoming increasingly popular for supporting

diabetes self-management. A key aspect of diabetes self-management is appropriate
medication-taking. This study aims to systematically assess and characterise the
medication management features in diabetes self-management apps and their
congruence with best-practice evidence-based criteria.
METHODS: The Google Play and Apple app stores were searched in June 2018 using
diabetes-related terms in the English language. Apps with both medication and
blood glucose management features were downloaded and evaluated against
assessment criteria derived from international medication management and diabetes
guidelines.
RESULTS: Our search yielded 3369 Android and 1799 iOS potentially relevant apps;
of which, 143 apps (81 Android, 62 iOS) met inclusion criteria and were
downloaded and assessed. Over half 58.0% (83/143) of the apps had a medication
reminder feature; 16.8% (24/143) had a feature to review medication adherence;
39.9% (57/143) allowed entry of medication-taking instructions; 5.6% (8/143)
provided information about medication; and 4.2% (6/143) displayed motivational
messages to encourage medication-taking. Only two apps prompted users on the use
of complementary medicine. Issues such as limited medication logging capacity,
faulty reminder features, unclear medication adherence assessment, and visually
distracting excessive advertising were observed during app assessments.
CONCLUSIONS: A large proportion of diabetes self-management apps lacked features
for enhancing medication adherence and safety. More emphasis should be given to
the design of medication management features in diabetes apps to improve their
alignment to evidence-based best practice.
DOI: 10.1186/s12916-019-1362-1
PMCID: PMC6636047
PMID: 31311573
635. J Subst Abuse Treat. 2015 Oct;57:70-4. doi: 10.1016/j.jsat.2015.05.002. Epub

2015
May 7.
Concordance of Direct and Indirect Measures of Medication Adherence in A

Treatment Trial for Cannabis Dependence.
McRae-Clark AL(1), Baker NL(2), Sonne SC(3), DeVane CL(3), Wagner A(3), Norton
J(3).
Author information:
(1)Department of Psychiatry, Medical University of South Carolina, Charleston, SC
29425. Electronic address: mcraeal@musc.edu.
Charleston, SC 29425.
(3)Department of Psychiatry, Medical University of South Carolina, Charleston, SC
29425.
The current study compared adherence rates as measured by two indirect

measurement methods (pill count and daily medication diary) to two direct
measurement methods (urine riboflavin and serum 6-OH-buspirone level measurement)
among participants (n = 109) in a medication treatment trial for cannabis
dependence. Pill count and diary data showed high levels of percent agreement and
strong kappa coefficients throughout the study. Riboflavin levels indicated lower
level of percent in adherence during the study as compared to both pill count and
self-report. In the subset of participants with 6-OH-buspirone levels (n = 58),
the kappa coefficient also showed low to moderate agreement between the pill
count and medication diaries with 6-OH-buspirone levels. In contrast to pill
count and medication diaries, adherence as measured by riboflavin and
6-OH-buspirone significantly decreased over time. The findings from this study
support previous work demonstrating that pill count and patient self-report of
medication taking likely overestimate rates of medication adherence, and may
become less reliable as the duration of a clinical trial increases.
DOI: 10.1016/j.jsat.2015.05.002
PMCID: PMC4561011

eCollection 2017.
Self-care management strategies used by Black women who self-report consistent

adherence to antihypertensive medication.
Abel WM(1), Joyner JS(2), Cornelius JB(1), Greer DB(3).
Author information:
(1)School of Nursing, The University of North Carolina at Charlotte, Charlotte,
NC, USA.
(2)Internal Medicine, Novant Health First Charlotte Physicians, Matthews, NC,
USA.
(3)School of Nursing, The University of Texas at Tyler, Tyler, TX, USA.
BACKGROUND: Black women in the USA have the highest prevalence rate of
hypertension (HTN) contributing to a higher risk of organ damage and death.
Research has focused primarily on poorly controlled HTN, negative belief systems,
and nonadherence factors that hinder blood pressure control. No known research
studies underscore predominantly Black women who report consistent adherence to
their antihypertensive medication-taking. The purpose of this study was to
describe self-care management strategies used by Black women who self-report
consistent adherence to their antihypertensive medication and to determine the
existence of further participation in lifestyle modifications, such as eating a
healthy diet and increasing physical activity.
METHODS: Using a qualitative descriptive design, four focus groups with a total
of 20 Black women aged 25-71 years were audio-taped. Transcripts were analyzed
using qualitative content analysis. Participants were included in the study if
they scored perfect adherence on the medication subscale of the Hill-Bone
Compliance to High Blood Pressure Therapy Scale.
RESULTS: Medication adherence was predicated on three themes: HTN experience,
involvement with treatment regimen, and a strong motivated mentality. Black women
would benefit from treatment approaches that are sensitive to 1) diverse
emotional responses, knowledge levels, and life experiences; 2) two-way
communication and trusting, collaborative relationships with active involvement
in the treatment regimen; 3) lifestyle modifications that focus on health
benefits and individual preferences; and 4) spiritual/religious influences on
adherence.
CONCLUSION: The use of self-care management strategies to enhance
antihypertensive medication adherence is key to adequate blood pressure control
and the reduction of cardiovascular events. This study provides preliminary
insight for future research to develop interventions to aid those Black women who
struggle with medication adherence and are disproportionately impacted by HTN.
DOI: 10.2147/PPA.S138162
PMCID: PMC5565386
PMID: 28860723


eCollection 2016.
Psychometric properties of the Chinese version of the Self-Efficacy for

Appropriate Medication Use Scale in patients with stroke.
Dong XF(1), Liu YJ(2), Wang AX(1), Lv PH(1).

Author information:
(1)Neurology Department, The First Affiliated Hospital of Zhengzhou University,
Zhengzhou, People's Republic of China.
(2)Nursing Department, The First Affiliated Hospital of Zhengzhou University,
Zhengzhou, People's Republic of China.
BACKGROUND: It has been reported that stroke has a higher incidence and mortality
rate in the People's Republic of China compared to the global average. These
conditions can be managed by proper medication use, but ensuring medication
adherence is challenging.
OBJECTIVE: To translate the Self-Efficacy for Appropriate Medication Use Scale
into Chinese and test its validity and reliability in patients with stroke.
METHODS: Instrument performances were measured from January 15, 2015 to April 28,
2015 on a convenience sample of 400 patients with stroke recruited at four
neurology departments of the First Affiliated Hospital of Zhengzhou University.
Questionnaires included the Chinese versions of the Self-Efficacy for Appropriate
Medication Use Scale (C-SEAMS) and the General Self-Efficacy Scale (C-GSE).
Construct validity, convergent validity, internal consistency, and test-retest
reliability were measured.
RESULTS: Item analysis showed that item-to-total correlations were in the range
of 0.362-0.672. Exploratory factor analysis revealed two factors (which accounted
for 60.862% of total variance), with factor loading ranging from 0.534 to 0.756.
Confirmatory factor analysis was performed to support the results, with an
acceptable fit (χ (2)=73.716; df=64; P<0.01; goodness-of-fit index =0.902;
adjusted goodness-of-fit index =0.897; comparative fit index =0.865;
root-mean-square error of approximation =0.058). The convergent validity of the
C-SEAMS correlated well with the validated measure of the C-GSE in measuring
self-efficacy (r=0.531, P<0.01). Good internal consistency (Cronbach's alpha
ranged from 0.826 to 0.915) and test-retest reliability (Pearson's correlation
coefficient r=0.642, P<0.01) were found.
CONCLUSION: The C-SEAMS is a brief and psychometrically sound measure for
evaluating self-efficacy for medication adherence in the Chinese population with
stroke.
DOI: 10.2147/PPA.S101844
PMCID: PMC4798205
PMID: 27042023

eCollection 2018.
Cognitive factors predict medication adherence and asthma control in urban

adolescents with asthma.
Rhee H(1), Wicks MN(2), Dolgoff JS(2), Love TM(3), Harrington D(3).
Author information:
(1)University of Rochester School of Nursing, Rochester, NY, USA.
(2)College of Nursing, University of Tennessee Health Science Center, Memphis,
TN, USA.
(3)Department of Biostatistics and Computational Biology, University of Rochester
Medical Center, Rochester, NY, USA.
Purpose: Adolescents with asthma often report poor medication adherence and
asthma control. Cognitive factors embedded in the social cognitive theory
including self-efficacy, outcome expectations, and barrier perceptions may
explain poor asthma outcomes in this population. This study was performed to
examine the extent to which these cognitive factors are intercorrelated and
explain medication adherence and asthma control in urban adolescents.
Patients and methods: A total of 373 urban adolescents (12-20 years) with asthma
completed questionnaires measuring asthma-related self-efficacy, outcome
expectations, barrier perceptions, medication adherence, and asthma control.
Multiple linear regression was conducted to examine the extent to which the three
cognitive factors predicted medication adherence and asthma control after
controlling for covariates including age, sex, household income, and age at
diagnosis.
Results: Participants' ages were on average 14.68 (±1.94) years; 50% were female,
and most (78.6%) were African American. Higher self-efficacy associated with
lower barrier perceptions and higher outcome expectations (r=0.50, p<0.001;
r=-0.26, p<0.001, respectively). Self-efficacy predicted better asthma control
(B=-0.098, p=0.004) and adherence (B=0.426, p=0.011), whereas barrier perceptions
predicted poorer asthma control (B=0.13, p<0.001) and adherence (B=-0.568,
p<0.001). Self-efficacy independently predicted fewer missed doses (B=-0.621,
p=0.006), and barrier perception independently predicted asthma control (B=0.12,
p<0.001) and adherence (B=-0.519, p<0.001).
Conclusion: Improving medication adherence and asthma control among adolescents
may require a multifaceted approach. Interventions focused on increasing
self-efficacy and addressing barriers, actual or potential, to medication
adherence could ameliorate asthma disparities in urban adolescents.
DOI: 10.2147/PPA.S162925
PMCID: PMC5973469
PMID: 29872278

639. SAGE Open Med. 2017 Mar 23;5:2050312117700301. doi: 10.1177/2050312117700301.

eCollection 2017.
Medication self-management skills and cognitive impairment in older adults

hospitalized for heart failure: A cross-sectional study.
Howell EH(1), Senapati A(2), Hsich E(3), Gorodeski EZ(3)(4).
Author information:
(1)Department of Medicine, University of Rochester Medical Center, Rochester, NY,
USA.
(2)Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
(3)Section of Heart Failure and Cardiac Transplantation, Tomsich Family
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland
Clinic, Cleveland, OH, USA.
(4)Center for Connected Care, Cleveland Clinic, Cleveland, OH, USA.
BACKGROUND: Cognitive impairment is highly prevalent among older adults (aged

≥65 years) hospitalized for heart failure and has been associated with poor
outcomes. Poor medication self-management skills have been associated with poor
outcomes in this population as well. The presence and extent of an association
between cognitive impairment and poor medication self-management skills in this
population has not been clearly defined.
OBJECTIVE: We assessed the cognition of consecutive older adults hospitalized for
heart failure, in relation to their medication self-management skills.
METHODS: We conducted a cross-sectional study of older adults (aged ≥65 years)
who were hospitalized for heart failure and were being discharged home. Prior to
discharge, we assessed cognition using the Mini-Cog. We also tested patients'
ability to read a pill bottle label, open a pill bottle safety cap, and allocate
mock pills to a pill box. Pill allocation performance was assessed quantitatively
(counts of errors of omission and commission) and qualitatively (patterns
suggestive of knowledge-based mistakes, rule-based mistakes, or skill-based
slips).
RESULTS: Of 55 participants, 22% were found to have cognitive impairment.
Patients with cognitive impairment tended to be older as compared to those
without cognitive impairment (mean age = 81 vs 76 years, p = NS). Patients with
cognitive impairment had a higher prevalence of inability to read pill bottle
label (prevalence ratio = 5.8, 95% confidence interval = 3.2-10.5, p = 0.001) and
inability to open pill bottle safety cap (prevalence ratio = 3.3, 95% confidence
interval = 1.3-8.4, p = 0.03). While most patients (65%) had pill-allocation
errors regardless of cognition, those patients with cognitive impairment tended
to have more errors of omission (mean number of errors = 48 vs 23, p = 0.006), as
well as more knowledge-based mistakes (75% vs 40%, p = 0.03).
CONCLUSION: There is an association between cognitive impairment and poor
medication self-management skills. Medication taking failures due to poor
medication self-management skills may be part of the pathway linking cognitive
impairment to poor post-discharge outcomes among patients with heart failure
transitioning from hospital to home.
DOI: 10.1177/2050312117700301
PMCID: PMC5433792
PMID: 28540048
Conflict of interest statement: Declaration of conflicting interests: The

author(s) declared the following potential conflicts of interest with respect to
the research, authorship, and/or publication of this article:Dr Gorodeski was a
consultant for Novartis in 2015.
640. J Hum Hypertens. 2017 May;31(5):320-326. doi: 10.1038/jhh.2016.80. Epub 2016

Nov
17.
Factors associated with false-positive self-reported adherence to

antihypertensive drugs.
Tedla YG(1), Bautista LE(2).
Author information:
(1)Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL, USA.
(2)Department of Population Health Sciences, University of Wisconsin at Madison,
Madison, WI, USA.
Self-reported medication adherence is known to overestimate true adherence.

However, little is known about patient factors that may contribute to the upward
bias in self-reported medication adherence. The objective of this study is to
examine whether demographic, behavioral, medication and mood factors are
associated with being a false-positive self-reported adherer (FPA) to
antihypertensive drug treatment. We studied 175 patients (mean age: 50 years; 57%
men) from primary-care clinics starting antihypertensive drug treatment.
Self-reported adherence (SRA) was measured with the Medication Adherence Report
Scale (MARS) and by the number of drug doses missed in the previous week/month,
and compared with pill count adherence ratio (PCAR) as gold standard. Data on
adherence, demographic, behavioral, medication and mood factors were collected at
baseline and every 3 months up to 1 year. FPA was defined as being a non-adherer
by PCAR and an adherer by self-report. Mixed effect logistic regression was used
for the analysis. Twenty percent of participants were FPA. Anxiety increased
(odds ratio (OR): 3.00; P=0.01), whereas smoking (OR: 0.40; P=0.03) and drug side
effects (OR: 0.46, P=0.03) decreased the probability for FPA by MARS. Education
below high-school completion increased the probability of being an FPA as
measured by missing doses in the last month (OR: 1.66; P=0.04) and last week (OR:
1.88; P=0.02). The validity of SRA varies significantly according to drug side
effects, behavioral factors and patient's mood. Careful consideration should be
given to the use of self-reported measures of adherence among patients likely to
be false-positive adherers.
DOI: 10.1038/jhh.2016.80
PMCID: PMC6062205
641. J Gen Intern Med. 2015 Jan;30(1):83-90. doi: 10.1007/s11606-014-3072-x.
Medication non-adherence after myocardial infarction: an exploration of modifying

factors.
Crowley MJ(1), Zullig LL, Shah BR, Shaw RJ, Lindquist JH, Peterson ED, Bosworth
HB.
Author information:
(1)Center for Health Services Research in Primary Care, Durham VA Medical Center,
HSR&D (152), 508 Fulton Street, Durham, NC, 27705, USA,
matthew.crowley@dm.duke.edu.
BACKGROUND: Medication non-adherence is a major impediment to the management of

cardiovascular disease risk factors. A better understanding of the modifying
factors underlying medication non-adherence among individuals with known
cardiovascular disease may inform approaches for addressing non-adherence.
OBJECTIVE: The purpose of this study was to identify demographic and patient
characteristics, medical comorbidities, psychosocial factors, and health
belief-related factors associated with medication non-adherence among patients
with known cardiovascular disease.
DESIGN: We performed secondary analysis of baseline data from a randomized trial.
PATIENTS: The study included 405 patients with a diagnosis of hypertension and
history of acute myocardial infarction that was diagnosed within a three-year
period prior to enrollment.
MAIN MEASURES: Baseline demographics and patient characteristics, medical
comorbidities, psychosocial factors, health belief-related factors, and
patient-reported medication non-adherence were analyzed.
KEY RESULTS: Of 405 patients, 173 (42.7 %) reported medication non-adherence.
Factors associated with non-adherence in bivariate analysis included younger age,
non-white race, having less than 12 years of education, smoking, financial
insecurity, identifying as nervous or tense, higher life chaos score, greater
worry about having a myocardial infarction, and greater worry about having a
stroke. Using multivariable modeling, we determined that age (OR 0.97 per
additional year, 95 % CI, 0.95-0.99), life chaos (OR 1.06 per additional point,
95 % CI, 1.00-1.11), and worry about stroke (OR 1.12 per additional point, 95 %
CI, 1.01-1.25) remained significantly associated with self-reported medication
non-adherence.
CONCLUSIONS: We found that worry about having a stroke, higher life chaos, and
younger age were all significantly associated with self-reported medication
non-adherence in patients with cardiovascular disease and a history of myocardial
infarction. Further research exploring these factors as targets for intervention
is needed, as is additional research examining modifiable causes of medication
non-adherence among patients with cardiovascular disease.
DOI: 10.1007/s11606-014-3072-x
PMCID: PMC4284283
642. Ment Health Clin. 2018 Aug 30;8(5):214-221. doi: 10.9740/mhc.2018.09.214.

eCollection 2018 Sep.
Self-stigma of antidepressant users through secondary analysis of PhotoVoice

data.
Nelson E(1), Werremeyer A(2), Kelly GA(3), Skoy E(4).
Author information:
(1)(Corresponding author) PharmD Candidate 2018, North Dakota State University,
School of Pharmacy, Fargo, North Dakota, n_erik@hotmail.com.
(2)Faculty Mentor, Associate Professor of Practice, North Dakota State
University, School of Pharmacy, Fargo, North Dakota.
(3)Associate Professor of Sociology, North Dakota State University, School of
Sociology and Anthropology, Fargo, North Dakota.
(4)Associate Professor of Practice, North Dakota State University, School of
Pharmacy, Fargo, North Dakota.
Introduction: Aspects of self-stigma and medication-related stigma among

individuals with depressive disorders remain largely unexplored. The primary
objective of this study is to highlight and characterize self-stigma and
medication-related stigma experiences of antidepressant users.
Methods: This is a secondary analysis of data obtained from PhotoVoice studies
examining psychotropic medication experiences. Transcripts of reflections from 12
individuals self-reporting a depressive disorder diagnosis and receipt of a
prescription for an antidepressant were included. A directed content analysis
approach based on expansion of the Self-Stigma of Depression Scale and an
iterative process of identification of medication-stigma and stigma-resistance
were used. Total mentions of self-stigma, stigma resistance, medication stigma,
and underlying themes were tallied and evaluated.
Results: Self-stigma was mentioned a total of 100 times with at least 2 mentions
per participant. Self-blame was the most prominent construct of self-stigma and
was mentioned nearly twice as often as any other self-stigma construct. Most
participants also made mentions of self-stigma resistance. Half of the individual
participants mentioned stigma resistance more times than they mentioned
self-stigma, which suggests some surmounting of self-stigma. Medication-related
stigma was also prominent, denoting negativity about the presence of medications
in one's life.
Discussion: Self-stigma related to self-blame may be problematic for
antidepressant users. Identification and measurement of stigma resistance,
especially in peer interactions, may represent a promising concept in overcoming
self-stigma. Future work should explore emphasizing self-blame aspects when
designing interventions to reduce self-stigma among individuals with depressive
disorders and explore development of tools to measure stigma resistance.
DOI: 10.9740/mhc.2018.09.214
PMCID: PMC6125114
PMID: 30206504
Conflict of interest statement: Disclosures: The authors have nothing to

disclose.
643. World J Diabetes. 2019 Mar 15;10(3):200-211. doi: 10.4239/wjd.v10.i3.200.

Burden of diabetic foot ulcer in Nigeria: Current evidence from the multicenter
evaluation of diabetic foot ulcer in Nigeria.
Ugwu E(1), Adeleye O(2), Gezawa I(3), Okpe I(4), Enamino M(5), Ezeani I(6).
Author information:
(1)Department of Medicine, Enugu State University of Science and Technology
Enugu, Enugu 400001, Nigeria. ofornet@yahoo.com.
(2)Department of Medicine, Lagos State University Lagos, Lagos 100001, Nigeria.
(3)Department of Medicine, Bayero University Kano, Kano 700001, Nigeria.
(4)Department of Medicine, Ahmadu Bello University Zaria, Kaduna 800001, Nigeria.
(5)Department of Medicine, Federal Medical Center Keffi, Nasarawa 961101,
Nigeria.
(6)Department of Medicine, Federal Medical Center Umuahia, Abia 440001, Nigeria.
BACKGROUND: Nigeria bears the greatest burden of diabetes prevalence in

Sub-Saharan Africa. Diabetic foot ulcer (DFU) is a serious and potentially
life-threatening complication of diabetes. Significant improvements in diabetic
foot incidence and outcomes have been recorded in many Western countries in the
past decade. However, the current burden of DFU in Nigeria is largely unknown.
AIM: To evaluate the patients' profile, ulcer characteristics, associated
co-morbidities and outcome of patients with DFU in Nigeria.
METHODS: Multicenter evaluation of diabetic foot ulcer in Nigeria was a one year
multicenter observational study of patients hospitalized for DFU in six tertiary
health institutions in Nigeria from March 2016 to March 2017. Demographic and
diabetes information, ulcer characteristics and associated co-morbidities were
assessed. Relevant laboratory and imaging studies were performed. All patients
received appropriate multi-disciplinary care and were followed up until discharge
or death. Outcome variables of interest were ulcer healing, lower extremity
amputation (LEA), duration of hospitalization and mortality.
RESULTS: A total of 336 patients (55.1% male) with mean age of 55.9 ± 12.5 years
were enrolled into this study. Majority (96.1%) had type 2 diabetes. Only 25.9%
of the subjects had prior foot care knowledge. Most of the subjects presented
late to the hospital and median (IQR) duration of ulcer at presentation was 39
(28-54) d. Ulcers were already advanced (Wagner grades ≥ 3) in 79.2% of the
subjects while 76.8% of the ulcers were infected at the time of admission. The
commonest co-morbidities were systemic hypertension, anemia and hyperglycemic
emergencies. One hundred and nineteen subjects (35.4%) suffered LEA while 10.4%
left against medical advice. The median (IQR) duration of hospitalization was
52.0 (29-66) d with case fatality rate of 20.5%.
CONCLUSION: The burden of DFU in Nigeria is very high. The major gaps include low
level of foot care knowledge among diabetic patients, overdependence on
self-medication and unorthodox medicine following development of foot ulceration,
late hospital presentation, and high amputation and mortality rates. Extensive
foot care education within the framework of a multi-disciplinary foot care team
is highly desirable.
DOI: 10.4239/wjd.v10.i3.200
PMCID: PMC6422858
PMID: 30891155
Conflict of interest statement: Conflict-of-interest statement: All authors

declare no conflict of interest. This study did not receive funding from any
external source.
644. BMC Complement Altern Med. 2018 Feb 15;18(1):62. doi: 10.1186/s12906-018-2129-
5.
Traditional healing practices in rural Bangladesh: a qualitative investigation.
Haque MI(1)(2), Chowdhury ABMA(3), Shahjahan M(3), Harun MGD(3).
Author information:
(1)Department of Public Health, Daffodil International University, 102 & 102/1
Shukrabad, Mirpur Road, Dhanmondi, Dhaka, 1207, Bangladesh.
imdadul.ph@diu.edu.bd.
(2)Health, Nutrition and Population Program, BRAC, Mirpur, Dhaka, 1216,
Bangladesh. imdadul.ph@diu.edu.bd.
(3)Department of Public Health, Daffodil International University, 102 & 102/1
Shukrabad, Mirpur Road, Dhanmondi, Dhaka, 1207, Bangladesh.
BACKGROUND: Traditional healing practice is an important and integral part of

healthcare systems in almost all countries of the world. Very few studies have
addressed the holistic scenario of traditional healing practices in Bangladesh,
although these serve around 80% of the ailing people. This study explored
distinctive forms of traditional healing practices in rural Bangladesh.
METHODS: During July to October 2007, the study team conducted 64 unstructured
interviews, and 18 key informant interviews with traditional healers and patients
from Bhabanipur and Jobra, two adjacent villages in Chittagong district,
Bangladesh. The study also used participatory observations of traditional healing
activities in the treatment centers.
RESULTS: Majority of the community members, especially people of low
socioeconomic status, first approached the traditional healers with their medical
problems. Only after failure of such treatment did they move to qualified
physicians for modern treatment. Interestingly, if this failed, they returned to
the traditional healers. This study identified both religious and non-religious
healing practices. The key religious healing practices reportedly included
Kalami, Bhandai, and Spiritual Healing, whereas the non-religious healing
practices included Sorcery, Kabiraji, and Home Medicine. Both patients and
healers practiced self-medication at home with their indigenous knowledge.
Kabiraji was widely practiced based on informal use of local medicinal plants in
rural areas. Healers in both Kalami and Bhandari practices resorted to religious
rituals, and usually used verses of holy books in healing, which required a firm
belief of patients for the treatment to be effective. Sorcerers deliberately used
their so-called supernatural power not only to treat a patient but also to cause
harm to others upon secret request. The spiritual healing reportedly diagnosed
and cured the health problems through communication with sacred spirits. Although
the fee for diagnosis was small, spiritual healing required different types of
treatment instruments, which made the treatment implicitly expensive.
CONCLUSIONS: Traditional healing was widely practiced as the means of primary
healthcare in rural areas of Bangladesh, especially among the people with low
socioeconomic status. The extent of services showed no decline with the
advancement of modern medical sciences; rather it has increased with the passage
of time.
DOI: 10.1186/s12906-018-2129-5
PMCID: PMC5815193
645. Neuropharmacology. 2017 Feb;113(Pt A):386-395. doi:

10.1016/j.neuropharm.2016.10.021. Epub 2016 Oct 23.
Nicotine-induced neuroplasticity counteracts the effect of schizophrenia-linked

neuregulin 1 signaling on NMDAR function in the rat hippocampus.
Yamazaki Y(1), Sumikawa K(2).
Author information:
(1)Department of Neurobiology and Behavior, University of California, Irvine, CA
92697-4550, USA; Department of Neurophysiology, Yamagata University School of
Medicine, Yamagata 990-9585, Japan.
(2)Department of Neurobiology and Behavior, University of California, Irvine, CA
92697-4550, USA. Electronic address: ksumikaw@uci.edu.
A high rate of heavy tobacco smoking among people with schizophrenia has been
suggested to reflect self-medication and amelioration of cognitive dysfunction, a
core feature of schizophrenia. NMDAR hypofunction is hypothesized to be a
mechanism of cognitive dysfunction, and excessive schizophrenia-linked neuregulin
1 (NRG1) signaling through its receptor ErbB4 can suppress NMDAR function by
preventing Src-mediated enhancement of NMDAR responses. Here we investigated
whether chronic nicotine exposure in rats by subcutaneous injection of nicotine
(0.5-1 mg/kg, twice daily for 10-15 days) counteracts the suppressive effect of
NRG1β on NMDAR-mediated responses recorded from CA1 pyramidal cells in acute
hippocampal slices. We found that NRG1β, which prevents the enhancement of NMDAR
responses by the Src-family-kinase-activating peptide pYEEI in naive rats, failed
to block the effect of pYEEI in nicotine-exposed rats. In naive rats, NRG1β acts
only on GluN2B-NMDARs by blocking their Src-mediated upregulation. Chronic
nicotine exposure causes enhanced GluN2B-NMDAR responses via Src upregulation and
recruits Fyn for the enhancement of GluN2A-NMDAR responses. NRG1β has no effect
on both enhanced basal GluN2B-NMDAR responses and Fyn-mediated enhancement of
GluN2A-NMDAR responses. Src-mediated enhancement of GluN2B-NMDAR responses and
Fyn-mediated enhancement of GluN2A-NMDAR responses initiate long-term
potentiation (LTP) of AMPAR synaptic responses in naive and nicotine-exposed CA1
pyramidal cells, respectively. These results suggest that NRG1β suppresses LTP by
blocking Src-mediated enhancement of GluN2B-NMDAR responses, but has no effect on
LTP in nicotine-exposed rats. These effects of chronic nicotine exposure may
counteract the negative effect of increased NRG1-ErbB4 signaling on the cellular
mechanisms of learning and memory in individuals with schizophrenia, and
therefore may motivate heavy smoking.
Copyright Â© 2016 Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.neuropharm.2016.10.021
PMCID: PMC5148721
646. Nat Commun. 2016 Sep 26;7:12867. doi: 10.1038/ncomms12867.
FMRP regulates an ethanol-dependent shift in GABABR function and expression with

rapid antidepressant properties.
Wolfe SA(1)(2)(3), Workman ER(2)(4), Heaney CF(2)(4), Niere F(2)(4), Namjoshi

S(2)(3), Cacheaux LP(2)(4), Farris SP(1)(4), Drew MR(2)(3)(4), Zemelman
BV(2)(3)(4), Harris RA(1)(3)(4), Raab-Graham KF(1)(2)(3)(4)(5).
Author information:
(1)Waggoner Center for Alcohol and Addiction Research, The University of Texas at
Austin, Austin, Texas 78712, USA.
(2)Center for Learning and Memory, The University of Texas at Austin, Austin,
Texas 78712, USA.
(3)Institute of Cell and Molecular Biology, The University of Texas at Austin,
Austin, Texas 78712, USA.
(4)Department of Neuroscience, The University of Texas at Austin, Austin, Texas
78712, USA.
(5)Department of Physiology and Pharmacology, Wake Forest University School of
Medicine, Winston-Salem, North Carolina 27101, USA.
Alcohol promotes lasting neuroadaptive changes that may provide relief from
depressive symptoms, often referred to as the self-medication hypothesis.
However, the molecular/synaptic pathways that are shared by alcohol and
antidepressants are unknown. In the current study, acute exposure to ethanol
produced lasting antidepressant and anxiolytic behaviours. To understand the
functional basis of these behaviours, we examined a molecular pathway that is
activated by rapid antidepressants. Ethanol, like rapid antidepressants, alters
γ-aminobutyric acid type B receptor (GABABR) expression and signalling, to
increase dendritic calcium. Furthermore, new GABABRs are synthesized in response
to ethanol treatment, requiring fragile-X mental retardation protein (FMRP).
Ethanol-dependent changes in GABABR expression, dendritic signalling, and
antidepressant efficacy are absent in Fmr1-knockout (KO) mice. These findings
indicate that FMRP is an important regulator of protein synthesis following
alcohol exposure, providing a molecular basis for the antidepressant efficacy of
acute ethanol exposure.
DOI: 10.1038/ncomms12867
PMCID: PMC5052688
PMID: 27666021
647. Cancer Epidemiol. 2015 Dec;39 Suppl 1:S107-19. doi:

10.1016/j.canep.2015.08.003.
Epub 2015 Sep 26.
European Code against Cancer 4th Edition: Medical exposures, including hormone
therapy, and cancer.
Friis S(1), Kesminiene A(2), Espina C(2), Auvinen A(3), Straif K(2), Schüz J(4).
Author information:
(1)Danish Cancer Society Research Center, Danish Cancer Society,
Strandboulevarden 49, 2100 Copenhagen, Denmark; Department of Public Health,
University of Copenhagen, 2100 Copenhagen, and Department of Clinical
Epidemiology, Faculty of Health, Aarhus University Hospital, 8200 Aarhus N,
Denmark.
(2)International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas,
69372 Lyon, France.
(3)School of Health Sciences, University of Tampere, FI-33014 Tampere, Finland;
STUK-Radiation and Nuclear Safety Authority, Research and Environmental
Surveillance, FI-00881 Helsinki, Finland.
(4)International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas,
69372 Lyon, France. Electronic address: secretariat-cancer-code-europe@iarc.fr.
The 4th edition of the European Code against Cancer recommends limiting - or
avoiding when possible - the use of hormone replacement therapy (HRT) because of
the increased risk of cancer, nevertheless acknowledging that prescription of HRT
may be indicated under certain medical conditions. Current evidence shows that
HRT, generally prescribed as menopausal hormone therapy, is associated with an
increased risk of cancers of the breast, endometrium, and ovary, with the risk
pattern depending on factors such as the type of therapy (oestrogen-only or
combined oestrogen-progestogen), duration of treatment, and initiation according
to the time of menopause. Carcinogenicity has also been established for
anti-neoplastic agents used in cancer therapy, immunosuppressants,
oestrogen-progestogen contraceptives, and tamoxifen. Medical use of ionising
radiation, an established carcinogen, can provide major health benefits; however,
prudent practices need to be in place, with procedures and techniques providing
the needed diagnostic information or therapeutic gain with the lowest possible
radiation exposure. For pharmaceutical drugs and medical radiation exposure with
convincing evidence on their carcinogenicity, health benefits have to be balanced
against the risks; potential increases in long-term cancer risk should be
considered in the context of the often substantial and immediate health benefits
from diagnosis and/or treatment. Thus, apart from HRT, no general recommendations
on reducing cancer risk were given for carcinogenic drugs and medical radiation
in the 4th edition of European Code against Cancer. It is crucial that the
application of these measures relies on medical expertise and thorough
benefit-risk evaluation. This also pertains to cancer-preventive drugs, and
self-medication with aspirin or other potential chemopreventive drugs is strongly
discouraged because of the possibility of serious, potentially lethal, adverse
events.
Copyright © 2015 International Agency for Research on Cancer. Published by

Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.canep.2015.08.003

eCollection 2015.
Revisiting community case management of childhood pneumonia: perceptions of

caregivers and grass root health providers in Uttar Pradesh and Bihar, northern
India.
Awasthi S(1), Nichter M(2), Verma T(1), Srivastava NM(3), Agarwal M(4), Singh
JV(4); CAP-Lucknow Team.
Collaborators: Mishra AP, Sami G, Sharma RD, Khare R, Verma V, Pandey M, Shukla
V, Kumar S, Chandra A, Hasib-ur-Rehman, Pandey S.
Author information:
(1)Department of Pediatrics, King George's Medical University, Lucknow, India.
(2)The School of Anthropology, University of Arizona, Tucson, United States of
America.
(3)UNICEF's Office for Uttar Pradesh, Lucknow, India.
(4)Department of Community Medicine, King George's Medical University, Lucknow,
India.
BACKGROUND: Community-acquired pneumonia (CAP) is the leading cause of under-five

mortality globally with almost one-quarter of deaths occurring in India.
OBJECTIVES: To identify predisposing, enabling and service-related factors
influencing treatment delay for CAP in rural communities of two states in India.
Factors investigated included recognition of danger signs of CAP, health care
decision making, self-medication, treatment and referral by local practitioners,
and perceptions about quality of care.
METHODS: Qualitative research employing case studies (CS) of care-seeking, key
informant interviews (KII), semi-structured interviews (SSI) and focus group
discussions (FGD) with both video presentations of CAP signs, and case scenarios.
Interviews and FGDs were conducted with parents of under-five children who had
suffered CAP, community health workers (CHW), and rural medical practitioners
(RMP).
RESULTS: From September 2013 to January 2014, 30 CS, 43 KIIs, 42 SSIs, and 42
FGDs were conducted. Recognition of danger signs of CAP among caregivers was
poor. Fast breathing, an early sign of CAP, was not commonly recognized. Chest
in-drawing was recognized as a sign of serious illness, but not commonly
monitored by removing a child's clothing. Most cases of mild to moderate CAP were
brought to RMP, and more severe cases taken to private clinics in towns. Mothers
consulted local RMP directly, but decisions to visit doctors outside the village
required consultation with husband or mother-in-law. By the time most cases
reached a public tertiary-care hospital, children had been ill for a week and
treated by 2-3 providers. Quality of care at government facilities was deemed
poor by caregivers.
CONCLUSION: To reduce CAP-associated mortality, recognition of its danger signs
and the consequences of treatment delay needed to be better recognized by
caregivers, and confidence in government facilities increased. The involvement of
RMP in community based CAP programs needs to be investigated further given their
widespread popularity.
PMCID: PMC4405201
649. Front Behav Neurosci. 2014 Dec 22;8:441. doi: 10.3389/fnbeh.2014.00441.

eCollection 2014.
Increased conditioned place preference for cocaine in high anxiety related

behavior (HAB) mice is associated with an increased activation in the accumbens
corridor.
Prast JM(1), Schardl A(1), Sartori SB(2), Singewald N(2), Saria A(1), Zernig
G(3).
Author information:
(1)Department of General Psychiatry and Psychiatry, Experimental Psychiatry Unit,
Medical University of Innsbruck Innsbruck, Austria.
(2)Department of Pharmacology and Toxicology, Institute of Pharmacy and Center
for Molecular Biosciences Innsbruck, University of Innsbruck Innsbruck, Austria.
(3)Department of General Psychiatry and Psychiatry, Experimental Psychiatry Unit,
Medical University of Innsbruck Innsbruck, Austria ; Department of Psychology,
University of Innsbruck Innsbruck, Austria.
Anxiety disorders and substance use disorders are strongly associated in humans.
Accordingly, a widely held but controversial concept in the addiction field, the
so-called "self-medication hypothesis," posits that anxious individuals are more
vulnerable for drug dependence because they use drugs of abuse to alleviate their
anxiety. We tested this hypothesis under controlled experimental conditions by
quantifying the conditioned place preference (CPP) to 15 mg/kg i.p. cocaine given
contingently (COCAINE) in CD1 mice selectively bred for high anxiety-related
behavior (HAB) vs. normal anxiety-related behavior (NAB). Cocaine was conditioned
to the initially non-preferred compartment in an alternate day design (cocaine
vs. saline, four pairings each). HAB and NAB mice were also tested for the
effects of non-contingent (NONCONT) cocaine administration. HAB mice showed a
slightly higher bias for one of the conditioning compartments during the pretest
than NAB mice that became statistically significant (p = 0.045) only after
pooling COCAINE and NONCONT groups. Cocaine CPP was higher (p = 0.0035) in HAB
compared to NAB mice. The increased cocaine CPP was associated with an increased
expression of the immediate early genes (IEGs) c-Fos and Early Growth Related
Protein 1 (EGR1) in the accumbens corridor, i.e., a region stretching from the
anterior commissure to the interhemispheric border and comprising the medial
nucleus accumbens core and shell, the major island of Calleja and intermediate
part of the lateral septum, as well as the vertical limb of the diagonal band and
medial septum. The cocaine CPP-induced EGR1 expression was only observed in D1-
and D2-medium spiny neurons, whereas other types of neurons or glial cells were
not involved. With respect to the activation by contingent vs. non-contingent
cocaine EGR1 seemed to be a more sensitive marker than c-Fos. Our findings
suggest that cocaine may be more rewarding in high anxiety individuals, plausibly
due to an anxiolytic effect.
DOI: 10.3389/fnbeh.2014.00441
PMCID: PMC4273636
PMID: 25566008
650. Multidiscip Respir Med. 2016 Dec 5;11:42. eCollection 2016.
Personality and unachieved treatment goals related to poor adherence to asthma

medication in a newly developed adherence questionnaire - a population-based
study.
Axelsson M(1), Ekerljung L(2), Lundbäck B(2), Lötvall J(2).
Author information:
(1)Krefting Research Centre, Institute of Medicine, Internal Medicine and
Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 424,
SE-405 30 Gothenburg, Sweden ; Department of Care Science, Faculty of Health and
Society, Malmö University, Jan Waldenströms gata 25, SE-205 06 Malmö, Sweden.
(2)Krefting Research Centre, Institute of Medicine, Internal Medicine and
Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Box 424,
SE-405 30 Gothenburg, Sweden.
BACKGROUND: Health-care professionals have a responsibility to be attentive to

patients' adherence behavior but it could be difficult to identify poor adherence
in the context of clinical practice. Assessment of personality could be used to
identify individuals who are in need for support with their adherence behavior.
To our knowledge, existing adherence questionnaires are not based on individuals
reflecting asthmatics in the general population and there is limited research
describing adherence with asthma medication in relation to personal goals with
the treatment. The aim was to develop and validate an adherence questionnaire in
adult individuals with asthma from the general population and to assess adherence
in relation to personality traits and goals with the asthma medication using the
developed questionnaire.
METHODS: The study was conducted in three phases: 1. A preliminary postal 46-item
questionnaire was refined after psychometric testing (n = 157). 2. The
questionnaire was validated (n = 104). 3. The developed adherence questionnaire
was analyzed in relation to personality traits and achieved goals with the asthma
medication. Adult respondents with physician diagnosed asthma using asthma
medications were selected from the population-based West Sweden Asthma Study. The
respondents completed the Neuroticism, Extraversion and Openness to Experience
Five-Factor Inventory and the Medication Adherence Report Scale and stated their
goals with the asthma medication. Data were analyzed using t-tests, correlations,
multiple regression and principal component analysis.
RESULTS: A final questionnaire was developed consisting of ten items organized in
three subscales - "medication routines", "self-adjusting the medication" and
"concerns about side-effects". Two of the subscales - "medication routines" and
"self-adjusting the medication" - were associated with the Medication Adherence
Report Scale. The subscale "medication routines" was associated with the
personality traits - Conscientiousness and Neuroticism and unachieved goals with
the asthma medication.
CONCLUSIONS: The developed questionnaire appears to be useful for measuring
adherence to asthma medication in adult individuals with asthma. The study
suggests that both individual differences and personal treatment goals need to be
addressed in efforts to promote adherence to asthma medication treatment.
DOI: 10.1186/s40248-016-0078-8
PMCID: PMC5137217
PMID: 27980735
651. BMC Psychiatry. 2018 Jun 18;18(1):200. doi: 10.1186/s12888-018-1778-8.
Injuries prior and subsequent to index poisoning with medication among

adolescents: a national study based on Norwegian patient registry.
Qin P(1), Sun S(2), Bøe AS(3), Stanley B(3)(4), Mehlum L(3).
Author information:
(1)National Centre for Suicide Research and Prevention, Institute of Clinical
medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway.
ping.qin@medisin.uio.no.
(2)Department of Epidemiology, Shandong University School of Public Health and
Shandong University Center for Suicide Prevention Research, Jinan, China.
(3)National Centre for Suicide Research and Prevention, Institute of Clinical
medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway.
(4)Department of Psychiatry, Columbia University College of Physicians and
Surgeons, New York, NY, USA.
BACKGROUND: Adolescents treated for self-poisoning with medication have a high

prevalence of mental health problems and constitute a high-risk population for
self-harm repetition. However, little is known about whether this population is
also prone to injuries of other forms.
METHODS: Data were extracted from the Norwegian Patient Registry to include all
incidents of treated injuries in adolescents aged 10-19 years who were treated
for self-poisoning with medication during 2008-2011. This longitudinal approach
allowed for the inclusion of injuries of various forms both before and after the
index poisoning with medication. Gender differences and associations of injuries
with recorded deliberate self-harm or psychiatric comorbidity at index poisoning
were analysed. Forms of injury and psychiatric illnesses were coded according to
the ICD-10 system.
RESULTS: 1497 adolescents treated for self-poisoning with medication were
identified from the source database, including 1144 (76.4%) girls and 353 (23.6%)
boys. For these 1497 adolescents a total of 2545 injury incidents were recorded
in addition to the index poisoning incidents, consisting of 778 injury incidents
taking place before the index poisoning and 1767 incidents taking place
subsequently. Altogether 830 subjects (55.4%) had an injury treated either before
or after the index poisoning. Injuries to the hand and wrist as well as injuries
to the head, neck and throat were predominant in males. Females were more likely
to repeat poisoning with medication, particularly those with psychiatric
disorders.
CONCLUSION: Adolescents treated for poisoning with medication represent a
high-risk population prone to both prior and subsequent injuries of other forms,
and should be assessed for suicidal intent and psychiatric illness.
DOI: 10.1186/s12888-018-1778-8
PMCID: PMC6006963
652. Iran J Public Health. 2019 Apr;48(4):655-663.

Effects of Customized Long-Message Service and Phone-Based Health-Coaching on
Elderly People with Hypertension.
Kim M(1).
Author information:
(1)College of Nursing, Kangwon National University, Chuncheon-si, Gangwon-do,
Republic of Korea.
Background: We aimed to develop long-message services (LMS) and phone-based

health-coaching for community-dwelling seniors diagnosed with hypertension and
assess the effects of the programs implemented both separately and together.
These programs are easily applicable to seniors diagnosed with hypertension and
will help control their blood pressure (BP) in a practical manner.
Methods: We conducted a single-blinded, randomized, controlled pragmatic trial.
Individuals aged 65 years or older with hypertension at two senior welfare
centers in Seoul, South Korea, who were able to take phone calls and check text
messages were enrolled. The study included 124 participants: 31 in the control
group, 30 in the health-coaching group, 32 in the LMS group, and 31 in the
health-coaching-with-LMS group.
Results: Phone-based health-coaching with LMS was effective in improving
medication adherence, hypertension self-efficacy, and self-management behavior
and decreasing systolic BP as compared to LMS only. There were also improvements
in medication adherence, hypertension-related knowledge, hypertension
self-efficacy, self-management behavior, and systolic BP in the LMS group as
compared to the control group.
Conclusion: Using phone-based health-coaching with LMS was effective for managing
hypertension in community-dwelling seniors diagnosed with hypertension and could
become a useful intervention method.
PMCID: PMC6500537
PMID: 31110975
Conflict of interest statement: Conflict of interest The authors declare that

there is no conflict of interests.
653. J Ethnobiol Ethnomed. 2018 Nov 20;14(1):70. doi: 10.1186/s13002-018-0268-x.
Ethnopharmaceutical knowledge in Samogitia region of Lithuania: where old

traditions overlap with modern medicine.
Pranskuniene Z(1)(2), Dauliute R(3), Pranskunas A(4), Bernatoniene J(3)(5).
Author information:
(1)Department of Drug Technology and Social Pharmacy, Lithuanian University of
Health Sciences, Sukileliu pr. 13, Kaunas, Lithuania. z.pranskuniene@gmail.com.
(2)Institute of Pharmaceutical Technologies, Lithuanian University of Health
Sciences, Kaunas, Lithuania. z.pranskuniene@gmail.com.
Health Sciences, Sukileliu pr. 13, Kaunas, Lithuania.
(4)Department of Intensive Care, Lithuanian University of Health Sciences,
Kaunas, Lithuania.
(5)Institute of Pharmaceutical Technologies, Lithuanian University of Health
Sciences, Kaunas, Lithuania.
BACKGROUND: Modern ethnopharmaceutical studies are still quite unusual in

Northern Europe. Data regarding the medicinal use of plants, animals, and fungi
and also of spiritual rituals of healing is obtained mostly from ethnographic and
folkloric sources in Lithuania. The aim of this study was to assess the
ethnopharmaceutical knowledge regarding traditional use of natural substances for
medicinal purposes in the Samogitia region and compare with prior research
conducted 10 years prior in the same region.
METHODS: The study was performed during 2016-2017 in the Samogitia region
(Lithuania) using the conventional technique of ethnobotanical studies.
Twenty-eight respondents aged between 50 and 92 years were selected for the study
using snowball techniques. Information was collected using semi-structured and
structured interviews. The obtained information was recorded indicating local
names of plants, their preparation techniques, parts used, modes of
administration, and application for therapeutic purposes.
RESULTS: During the research, 125 records of raw materials of herbal origin
belonging to 55 families were made. The Asteraceae family had the highest number
of references, 147 (16.6%). It was stated that the most commonly used medicinal
plants were the raspberry (Rubus idaeus L.) (100%), marigold (Calendula
officinalis L.) (96.4%), camomile (Matricaria recutita L.) (92.9%), and small
linden tree (Tilia cordata Mill.) (92.9%). The most commonly used material of
animal origin was the toad (Bufo bufo) (89%). The most commonly used kind of
fungi was the common stinkhorn (Phallus impudicus) (71%), and the material of the
mineral origin was sand (50%). Comparative analysis of the two surveys in this
region showed similar results and produced a large amount of ethnopharmaceutical
information.
CONCLUSIONS: Lithuania belongs to the countries known for urban ethnobotany where
old traditions overlap with modern healing methods. Also, because modern medical
assistance is quite expensive, self-medication with home-made medicines is still
popular in Lithuania. It is important to collect and systematize this information
as soon as possible, to save it as a traditional Lithuanian heritage and also use
it for scientific investigations.
DOI: 10.1186/s13002-018-0268-x
PMCID: PMC6247776
654. Neuropsychopharmacology. 2018 Jan;43(1):80-102. doi: 10.1038/npp.2017.162.

Epub
2017 Jul 26.
Integrating Endocannabinoid Signaling and Cannabinoids into the Biology and

Treatment of Posttraumatic Stress Disorder.
Hill MN(1), Campolongo P(2), Yehuda R(3), Patel S(4)(5)(6)(7).
Author information:
(1)Departments of Cell Biology and Anatomy & Psychiatry, Hotchkiss Brain
Institute and Mathison Center for Mental Health Research and Education, Cumming
School of Medicine, University of Calgary, Calgary, AB, Canada.
(2)Department of Physiology and Pharmacology, Sapienza University of Rome, Rome,
Italy.
(3)Traumatic Stress Studies Division, Mount Sinai School of Medicine, James J
Peters VA Medical Center, Bronx, NY, USA.
(4)Department of Psychiatry and Behavioral Sciences, Nashville, TN, USA.
(5)Department of Pharmacology, Nashville, TN, USA.
(6)Department of Molecular Physiology & Biophysics, Nashville, TN, USA.
(7)The Vanderbilt Brain Institute, Vanderbilt University Medical Center,
Nashville, TN, USA.
Exposure to stress is an undeniable, but in most cases surmountable, part of

life. However, in certain individuals, exposure to severe or cumulative stressors
can lead to an array of pathological conditions including posttraumatic stress
disorder (PTSD), characterized by debilitating trauma-related intrusive thoughts,
avoidance behaviors, hyperarousal, as well as depressed mood and anxiety. In the
context of the rapidly changing political and legal landscape surrounding use of
cannabis products in the USA, there has been a surge of public and research
interest in the role of cannabinoids in the regulation of stress-related
biological processes and in their potential therapeutic application for
stress-related psychopathology. Here we review the current state of knowledge
regarding the effects of cannabis and cannabinoids in PTSD and the preclinical
and clinical literature on the effects of cannabinoids and endogenous cannabinoid
signaling systems in the regulation of biological processes related to the
pathogenesis of PTSD. Potential therapeutic implications of the reviewed
literature are also discussed. Finally, we propose that a state of
endocannabinoid deficiency could represent a stress susceptibility endophenotype
predisposing to the development of trauma-related psychopathology and provide
biologically plausible support for the self-medication hypotheses used to explain
high rates of cannabis use in patients with trauma-related disorders.
DOI: 10.1038/npp.2017.162
PMCID: PMC5719095
655. BMC Pregnancy Childbirth. 2016 Jun 14;16(1):141. doi: 10.1186/s12884-016-0888-

x.
Boosting antenatal care attendance and number of hospital deliveries among

pregnant women in rural communities: a community initiative in Ghana based on
mobile phones applications and portable ultrasound scans.
Amoah B(1)(2), Anto EA(1)(2), Osei PK(3)(2), Pieterson K(4), Crimi A(5)(6)(7).
Author information:
(1)ETH Zurich, Zurich, Switzerland.
(2)African Institute for Mathematical Sciences, P.O. Box DL 676, Cape Coast,
Ghana.
(3)University of Ghana, Accra, Ghana.
(4)Korle Bu Teaching Hospital, Accra, Ghana.
(5)ETH Zurich, Zurich, Switzerland. alessandro.crimi@iit.it.
(6)African Institute for Mathematical Sciences, P.O. Box DL 676, Cape Coast,
Ghana. alessandro.crimi@iit.it.
(7)Istituto Italiano di Tecnologia, Genoa, Italy. alessandro.crimi@iit.it.
BACKGROUND: The World Health Organization has recommended at least four antenatal
care (ANC) visits and skilled attendants at birth. Most pregnant women in rural
communities in low-income countries do not achieve the minimum recommended visits
and deliver without skilled attendants. With the aim of increasing number of ANC
visits, reducing home deliveries, and supplementing care given by ANC clinics, a
proposed system based on low-cost mobile phones and portable ultrasound scan
machines was piloted.
METHODS: A sample of 323 pregnant women from four rural communities in the
Central Region of Ghana were followed within a 11-month project. In each
community, at least one health worker was trained and equipped with a mobile
phone to promote ANC and hospital deliveries in her own community. If women
cannot attend ANC, technicians acquired scans by using portable ultrasound
machines in her community directly and sent them almost in real time to be
analyzed by a gynecologist in an urban hospital. A preliminary survey to assess
ANC status preceding the pilot study was conducted. During this, one hundred
women who had had pregnancies within five years prior to the study were
interviewed.
RESULTS: The preliminary survey showed that women who attended ANC were less
likely to have a miscarriage and more likely to have delivery at hospital or
clinic than those who did not, and women who attained at least four ANC visits
were less likely to practice self-medication. Among the women involved in the
project, 40 gave birth during the period of observation. The proposed prenatal
care approach showed that 62.5 % of pregnant women who gave birth during the
observation period included in the project (n=40) had their labor attended in
clinics or hospitals as against 37.5 % among the cases reported in the
pre-survey. One case of ectopic and two cases of breech pregnancies were detected
during the pilot through the proposed approach, and appropriate medical
interventions were sought.
CONCLUSION: Our results show that the proposed prenatal care approach can make
quality ANC accessible in rural communities where pregnant women have not been
able to access proper ANC.
DOI: 10.1186/s12884-016-0888-x
PMCID: PMC4906986
656. Reumatol Clin. 2017 Jan - Feb;13(1):4-9. doi: 10.1016/j.reuma.2016.02.007.

Epub
2016 Apr 5.
The activity of rheumatology nurses in Spain.
[Article in English, Spanish]
Fernández Sánchez SP(1), Rusiñol Badals M(2), Padró Blanch I(3), Paytubí Garí
C(4), Laiz Alonso A(5), Moragues Pastor C(6); Grupo de Trabajo de Enfermería de
la SER.
Author information:
(1)Unidad de Reumatología, Hospital de la Santa Creu i Sant Pau, Barcelona,
España. Electronic address: sfernandez@santpau.cat.
(2)Servicio de Reumatología, Hospital Mutua de Terrassa, Barcelona, España.
(3)Servicio de Reumatología, Hospital del Mar, Barcelona, España.
(4)Departamento de Medicina Interna y Urgencias, Parc Sanitari Sant Joan de Déu,
Barcelona, España.
España.
España; Servicio de Reumatología, Hospital Platón, Barcelona, España.
OBJECTIVE: Describe and analyze nursing activity in rheumatology.

MATERIAL AND METHODS: A cross-sectional study was performed in Spanish
rheumatology departments. Results were based on surveys administered to
rheumatology nurses. We included variables on socio-demographics, the setting and
available resources, and the activities they carried out. Each activity was
compared in terms of workplace, available resources and dedication exclusively to
one field.
RESULTS: Sixty-seven surveys were collected from 57 hospitals in 17 Spanish
autonomous communities. 97% of the nurses were women, with an average age of 48.9
years and an average nursing experience of 6 years. 56% of the professionals had
gained their experience in outpatient clinics, 35% in day hospitals and 9% in
inpatient and primary care. As for the availability of resources, 59% had their
own office, 77.3% had a phone listing and 60% scheduled and conducted patient
visits. Of the 19 activities included, those performed by the highest number of
nurses were managing, monitoring and coordinating the use of biological drugs
(90.9%), therapy monitoring (89.4%) and training patients in self-medication
(89.4%). The activity in which nurses most frequently collaborated with
physicians was the administration of local injections (51.5%). Other activities
were teaching (50%) and research (78.8%) in their departments and studies in the
nursing field (51.5%). Work in outpatient clinics versus day hospitals showed
statistically significant differences for health education, nutrition, splinting
and bandaging, and collaboration in ultrasound studies.
CONCLUSION: These professionals performed a greater number of activities when
they worked in outpatient clinics, had their own office and worked exclusively in
rheumatology.
Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y

Colegio Mexicano de Reumatología. All rights reserved.
DOI: 10.1016/j.reuma.2016.02.007
657. Neural Plast. 2016;2016:6526437. doi: 10.1155/2016/6526437. Epub 2016 Feb 25.
Mismatch Negativity and P50 Sensory Gating in Abstinent Former Cannabis Users.
Broyd SJ(1), Greenwood LM(1), van Hell HH(1), Croft RJ(2), Coyle H(3), Lee-Bates
B(3), Todd J(4), Johnstone SJ(3), Michie PT(4), Solowij N(5).
Author information:
(1)School of Psychology, University of Wollongong, Wollongong, NSW 2522,
Australia; Illawarra Health and Medical Research Institute, University of
Wollongong, Wollongong, NSW 2522, Australia.
Wollongong, Wollongong, NSW 2522, Australia; Centre for Health Initiatives,
University of Wollongong, Wollongong, NSW 2522, Australia.
Australia.
(4)School of Psychology and Priority Research Centre for Translational
Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW 2308,
Australia; Schizophrenia Research Institute, Sydney, NSW 2021, Australia.
Wollongong, Wollongong, NSW 2522, Australia; Schizophrenia Research Institute,
Sydney, NSW 2021, Australia.
Prolonged heavy exposure to cannabis is associated with impaired cognition and

brain functional and structural alterations. We recently reported attenuated
mismatch negativity (MMN) and altered P50 sensory gating in chronic cannabis
users. This study investigated the extent of brain functional recovery (indexed
by MMN and P50) in chronic users after cessation of use. Eighteen ex-users
(median 13.5 years prior regular use; median 3.5 years abstinence) and 18
nonusers completed (1) a multifeature oddball task with duration, frequency, and
intensity deviants and (2) a P50 paired-click paradigm. Trend level smaller
duration MMN amplitude and larger P50 ratios (indicative of poorer sensory
gating) were observed in ex-users compared to controls. Poorer P50 gating
correlated with prior duration of cannabis use. Duration of abstinence was
positively correlated with duration MMN amplitude, even after controlling for age
and duration of cannabis use. Impaired sensory gating and attenuated MMN
amplitude tended to persist in ex-users after prolonged cessation of use,
suggesting a lack of full recovery. An association with prolonged duration of
prior cannabis use may indicate persistent cannabis-related alterations to P50
sensory gating. Greater reductions in MMN amplitude with increasing abstinence
(positive correlation) may be related to either self-medication or an accelerated
aging process.
DOI: 10.1155/2016/6526437
PMCID: PMC4785272
658. J Caring Sci. 2018 Mar 1;7(1):1-8. doi: 10.15171/jcs.2018.001. eCollection

2018
Mar.
Using Social Cognitive Theory to Predict Medication Compliance Behavior in

Patients with Depression in Southern United States in 2016 in a Cross-Sectional
Study.
Bennett B(1), Sharma M(2), Bennett R(3), Mawson AR(4), Buxbaum SG(4), Sung JH(4).
Author information:
(1)Epidemiologist, STD/HIV Office, Mississippi State Department of Health,
Jackson, Mississippi.
(2)Department of Behavioral & Environmental Health, School of Public Health,
Jackson State University, Jackson, Mississippi.
(3)Department of Health Policy & Management, Jackson State University, Jackson,
Mississippi.
(4)Department of Epidemiology & Biostatistics, Jackson State University, Jackson,
Mississippi.
Introduction: Depression is a major public health issue. One of the concerns in

depression research and practice pertains to non-compliance to prescribed
medications. The purpose of the study was to predict compliance with medication
use for patients with depression using social cognitive theory (SCT). Based on
this study it was envisaged that recommendations for interventions to enhance
compliance for medication use could be developed for patients with depression.
Methods: The study was conducted using cross sectional design (n=148) in southern
United States with a convenience sample of clinic-based depression patients with
a 37-item valid and reliable questionnaire. Sample size was calculated to be 148
using G*Power (five predictors with a 0.80 power at the 0.05 alpha level and an
estimated effect size of 0.10 with an inflation by 10% for missing data). Social
cognitive theory constructs of expectations, self-efficacy and self-efficacy in
overcoming barriers, self-control, and environment were reified. Data were
analyzed using multiple linear regression and multiple logistic regression
analyses. Results: Self-control for taking medication for depression (P=0.04),
expectations for taking medication for depression (P=0.025), age (P<0.0001) and
race (P=0.04) were significantly related to intent for taking medication for
depression (Adjusted R2 = 0.183). In race, Blacks had lower intent to take
medication for depression. Conclusion: Social cognitive theory is weakly
predictive with low explained variance for taking medication for depression. It
needs to be bolstered by newer theories like integrative model or multi-theory
model of health behavior change for designing educational interventions aimed at
enhancing compliance to medication for depression.
DOI: 10.15171/jcs.2018.001
PMCID: PMC5889792
PMID: 29637050
659. Epilepsia Open. 2016 Sep 19;1(3-4):145-151. doi: 10.1002/epi4.12015.
eCollection
2016 Dec.
Cannabis in epilepsy: From clinical practice to basic research focusing on the

possible role of cannabidivarin.
Morano A(1), Cifelli P(2)(3), Nencini P(2), Antonilli L(2), Fattouch J(1),
Ruffolo G(2), Roseti C(4), Aronica E(5)(6), Limatola C(2), Di Bonaventura C(1),
Palma E(2)(4), Giallonardo AT(1).
Author information:
(1)Department of Neurology and Psychiatry Pasteur Institute-Cenci Bolognetti
Foundation University of Rome Sapienza Rome Italy.
(2)Department of Physiology and Pharmacology Pasteur Institute-Cenci Bolognetti
Foundation University of Rome Sapienza Rome Italy.
(3)Ri.MED Foundation Palermo Italy.
(4)IRCCS San Raffaele Pisana Rome Italy.
(5)Department of (Neuro) Pathology Academic Medical Center University of
Amsterdam Amsterdam the Netherlands.
(6)Stichting Epilepsie Instellingen Nederland (SEIN-Heemstede) Amsterdam the
Netherlands.
Cannabidivarin (CBDV) and cannabidiol (CBD) have recently emerged among

cannabinoids for their potential antiepileptic properties, as shown in several
animal models. We report the case of a patient affected by symptomatic partial
epilepsy who used cannabis as self-medication after the failure of countless
pharmacological/surgical treatments. Clinical and video electroencephalogram
(EEG) evaluations were periodically performed, and the serum levels of CBDV, CBD,
and Δ9-tetrahydrocannabinol were repeatedly measured. After cannabis
administration, a dramatic clinical improvement, in terms of both decrease in
seizure frequency and recovery of cognitive functions, was observed, which might
parallel high CBDV plasma concentrations. To widen the spectrum of CBDV possible
mechanisms of action, electrophysiological methods were applied to investigate
whether it could exert some effects on γ-aminobutyric acid (GABA)A receptors. Our
experiments showed that, in human hippocampal tissues of four patients affected
by drug-resistant temporal lobe epilepsy (TLE) transplanted in Xenopus oocytes,
there is decrease of current rundown (i.e., reduction of use-dependent GABAA
current) after prolonged exposure to CBDV. This result has been confirmed using a
single case of Rasmussen encephalitis (RE). Our patient's electroclinical
improvement supports the hypothesis that cannabis could actually represent an
effective, well-tolerated antiepileptic drug. Moreover, the experimental data
suggest that CBDV may greatly contribute to cannabis anticonvulsant effect
through its possible GABAergic action.
DOI: 10.1002/epi4.12015
PMCID: PMC5719834
PMID: 29588939
660. Alcohol Clin Exp Res. 2017 Dec;41(12):2185-2196. doi: 10.1111/acer.13512. Epub
2017 Nov 10.
The Prospective Association Between Internalizing Symptoms and Adolescent Alcohol

Involvement and the Moderating Role of Age and Externalizing Symptoms.
Colder CR(1), Shyhalla K(1), Frndak S(1), Read JP(1), Lengua LJ(2), Hawk LW
Jr(1), Wieczorek WF(3).
Author information:
(1)Department of Psychology, University at Buffalo, State University of New York,
Buffalo, New York.
(2)Department of Psychology, University of Washington, Seattle, Washington.
(3)Department of Epidemiology and Environmental Health, Buffalo State University,
Buffalo, New York.
BACKGROUND: As predicted by self-medication theories that drinking is motivated

by a desire to ameliorate emotional distress, some studies find internalizing
symptoms (e.g., anxiety, depression) increase risk of adolescent drinking;
however, such a risk effect has not been supported consistently. Our prior work
examined externalizing symptoms as a potential moderator of the association
between internalizing symptoms and adolescent alcohol use to explain some of the
inconsistencies in the literature. We found that internalizing symptoms were
protective against early adolescent alcohol use particularly for youth elevated
on externalizing symptoms (a 2-way interaction). Our sample has now been followed
for several additional assessments that extend into young adulthood, and the
current study tests whether the protective effect of internalizing symptoms may
change as youth age into young adulthood, and whether this age-moderating effect
varied across different clusters of internalizing symptoms (social anxiety,
generalized anxiety, and depression). Internalizing symptoms were hypothesized to
shift from a protective factor to a risk factor with age, particularly for youth
elevated on externalizing symptoms.
METHODS: A community sample of 387 adolescents was followed for 9 annual
assessments (mean age = 12.1 years at the first assessment and 55% female).
Multilevel cross-lagged 2-part zero-inflated Poisson models were used to test
hypotheses.
RESULTS: The most robust moderating effects were for levels of alcohol use, such
that the protective effect of all internalizing symptom clusters was most evident
in the context of moderate to high levels of externalizing problems. A risk
effect of internalizing symptoms was evident at low levels of externalizing
symptoms. With age, the risk and protective effects of internalizing symptoms
were evident at less extreme levels of externalizing behavior. With respect to
alcohol-related problems, findings did not support age moderation for generalized
anxiety or depression, but it was supported for social anxiety.
CONCLUSIONS: Findings highlight the importance of considering the role of
emotional distress from a developmental perspective and in the context of
externalizing behavior problems.
Copyright © 2017 by the Research Society on Alcoholism.
DOI: 10.1111/acer.13512
PMCID: PMC5711530
661. Schizophr Res. 2016 Mar;171(1-3):1-15. doi: 10.1016/j.schres.2016.01.020. Epub

2016 Jan 21.
nAChR dysfunction as a common substrate for schizophrenia and comorbid nicotine

addiction: Current trends and perspectives.
Parikh V(1), Kutlu MG(2), Gould TJ(2).
Author information:
(1)Department of Psychology and Neuroscience Program, Temple University,
Philadelphia, PA 19112, United States. Electronic address:
vinay.parikh@temple.edu.
(2)Department of Psychology and Neuroscience Program, Temple University,
Philadelphia, PA 19112, United States.
INTRODUCTION: The prevalence of tobacco use in the population with schizophrenia

is enormously high. Moreover, nicotine dependence is found to be associated with
symptom severity and poor outcome in patients with schizophrenia. The
neurobiological mechanisms that explain schizophrenia-nicotine dependence
comorbidity are not known. This study systematically reviews the evidence
highlighting the contribution of nicotinic acetylcholine receptors (nAChRs) to
nicotine abuse in schizophrenia.
METHODS: Electronic data bases (Medline, Google Scholar, and Web of Science) were
searched using the selected key words that match the aims set forth for this
review. A total of 276 articles were used for the qualitative synthesis of this
review.
RESULTS: Substantial evidence from preclinical and clinical studies indicated
that dysregulation of α7 and β2-subunit containing nAChRs account for the
cognitive and affective symptoms of schizophrenia and nicotine use may represent
a strategy to remediate these symptoms. Additionally, recent meta-analyses
proposed that early tobacco use may itself increase the risk of developing
schizophrenia. Genetic studies demonstrating that nAChR dysfunction that may act
as a shared vulnerability factor for comorbid tobacco dependence and
schizophrenia were found to support this view. The development of nAChR
modulators was considered an effective therapeutic strategy to ameliorate
psychiatric symptoms and to promote smoking cessation in schizophrenia patients.
CONCLUSIONS: The relationship between schizophrenia and smoking is complex. While
the debate for the self-medication versus addiction vulnerability hypothesis
continues, it is widely accepted that a dysfunction in the central nAChRs
represent a common substrate for various symptoms of schizophrenia and comorbid
nicotine dependence.
DOI: 10.1016/j.schres.2016.01.020
662. Pain Physician. 2017 Feb;20(2S):S93-S109.
Prescription Opioid Abuse in Chronic Pain: An Updated Review of Opioid Abuse

Predictors and Strategies to Curb Opioid Abuse: Part 1.
Kaye AD, Jones MR(1), Kaye AM, Ripoll JG(2), Galan V(3), Beakley BD(2), Calixto
F(2), Bolden JL(4), Urman RD, Manchikanti L.
Author information:
(1)Department of Anesthesiology, Louisiana State University Health New Orleans.
(2)Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
(3)Georgia Pain Care, Atlanta, GA.
(4)Louisiana State University.
Chronic pain and prescription opioid abuse are extremely prevalent both in this
country and worldwide. Consequences of opioid misuse can be life-threatening with
significant morbidity and mortality, exacting a heavy toll on patients,
physicians, and society. Individuals with chronic pain and co-occurring substance
use disorders and/or mental health disorders, are at a higher risk for misuse of
prescribed opioids. Opioid abuse and misuse occurs for a variety of reasons,
including self-medication, use for reward, compulsive use because of addiction,
and diversion for profit. There is a significant need for treatment approaches
that balance treating chronic pain; while minimizing risks for opioid abuse,
misuse, and diversion. The use of chronic opioid therapy for chronic non-cancer
pain has increased dramatically in the past 2 decades in conjunction with
associated increases in the abuse of prescribed opioids and accidental opioid
overdoses. Consequently, a validated screening instrument which provides an
effective and rational method of selecting patients for opioid therapy,
predicting risk, and identifying problems once they arise could be of enormous
benefit in clinical practice. Such an instrument could potentially curb the risk
of iatrogenic addiction. Although several screening instruments and strategies
have been introduced in recent years, there is no single test or instrument which
can reliably and accurately predict those patients not suitable for opioid
therapy or identify those who need increased vigilance or monitoring during
therapy. At present, screening for opioid abuse includes assessment of premorbid
and comorbid substance abuse; assessment of aberrant drug-related behaviors; risk
factor stratification; and utilization of opioid assessment screening tools.
Multiple opioid assessment screening tools and instruments have been developed by
various authors. In addition, urine drug testing, monitoring of prescribing
practices, prescription monitoring programs, opioid treatment agreements, and
utilization of universal precautions are essential. Presently, a combination of
strategies is recommended to stratify risk, to identify and understand aberrant
drug related behaviors, and to tailor treatments accordingly. This manuscript
builds on the 2012 opioid guidelines published in Pain Physician and the 2016
guidelines released by the Centers for Disease Control and Prevention. It reviews
the current state of knowledge regarding the growing problem of opioid abuse and
misuse; known risk factors; and methods of predicting, assessing, monitoring, and
addressing opioid abuse and misuse in patients with chronic non-cancer pain.Key
words: Opioids, misuse, abuse, chronic pain, prevalence, risk assessment, risk
management, drug monitoring, aberrant drug-related behavior.
663. Eur Ann Otorhinolaryngol Head Neck Dis. 2015 Sep;132(4):181-4. doi:
10.1016/j.anorl.2015.06.004. Epub 2015 Jun 29.
Cervicofacial cellulitis: The impact of non-steroidal anti-inflammatory drugs. A

study of 70 cases.
Bennani-Baïti AA(1), Benbouzid A(2), Essakalli-Hossyni L(3).
Author information:
(1)Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, faculté de
médecine et de pharmacie, hôpital des spécialités Rabat, 10000 Rabat, Morocco.
Electronic address: dr.a.bennani@gmail.com.
médecine et de pharmacie, hôpital des spécialités Rabat, 10000 Rabat, Morocco.
médecine et de pharmacie, hôpital des spécialités Rabat, 10000 Rabat, Morocco;
UFR d'ORL et de CMF, faculté de médecine et de pharmacie, université Mohmamed V,
Rabat, Morocco.
INTRODUCTION: Cervicofacial cellulitis (CFC) is a severe infection of the

subcutaneous cellular tissue, and is one of the most serious head and neck
infectious emergencies. In a series of 70 cases treated between 2007 and 2012, we
noticed a strong correlation between use of non-steroidal anti-inflammatory drugs
(NSAIDs) and evolution of head and neck infections toward CFC, including two
cases of necrotic CFC extending to the mediastinum, which were fatal.
MATERIAL AND METHODS: The cases included in the series comprised patients
admitted to emergency and requiring hospitalization due to the severity of
presenting symptoms. There were 70 such cases of CFC between 2007 and 2012; cases
managed on an outpatient basis were excluded, as were cases of orbital CFC, CFC
of sinus origin and mastoiditis.
RESULTS: Eighty percent of patients took NSAIDs, on self-medication or by
prescription (community physician, dentist, pharmacist). The most frequent
molecules were tiaprofenic acid and diclofenac. CFC extension was restricted in
most cases to the maxillary and/or ipsilateral subhyoid region, with 5 cases of
lower cervical extension and 2 of mediastinal involvement, which both proved
fatal.
CONCLUSION: CFC is a severe infection that can be life-threatening, and
represents a diagnostic and therapeutic emergency. Among other risk factors, use
of NSAIDs is frequently reported; these should therefore be used with caution if
at all in head and neck infection, especially of odonto-stomatological origin.
Copyright © 2015 Elsevier Masson SAS. All rights reserved.
DOI: 10.1016/j.anorl.2015.06.004
664. J Dual Diagn. 2015;11(2):107-17. doi: 10.1080/15504263.2015.1025013.
PTSD Symptoms, Emotion Dysregulation, and Alcohol-Related Consequences Among

College Students With a Trauma History.
Tripp JC, McDevitt-Murphy ME, Avery ML, Bracken KL.
OBJECTIVE: Posttraumatic stress disorder (PTSD), alcohol use, and alcohol-related

consequences have been linked to emotion dysregulation. Sex differences exist in
both emotion regulation dimensions and alcohol use patterns. This investigation
examined facets of emotion dysregulation as potential mediators of the
relationship between PTSD symptoms and alcohol-related consequences and whether
differences may exist across sexes.
METHODS: Participants were 240 college students with a trauma history who
reported using alcohol within the past three months and completed measures of
PTSD symptoms, emotion dysregulation, alcohol consumption, alcohol-related
consequences, and negative affect. The six facets of emotion dysregulation were
examined as mediators of the relationship between PTSD symptoms and
alcohol-related consequences in the full sample and by sex.
RESULTS: There were differences in sexes on several variables, with women
reporting higher PTSD scores and lack of emotional awareness. Men reported
significantly more drinks per week in a typical week and a heavy week. There were
significant associations between the variables for the full sample, with PTSD
showing associations with five facets of emotion dysregulation subscales: impulse
control difficulties when upset, difficulties engaging in goal-directed behavior,
nonacceptance of emotional responses, lack of emotional clarity, and limited
access to emotion regulation strategies. Alcohol-related consequences were
associated with four aspects of emotion dysregulation: impulse control
difficulties when upset, difficulties engaging in goal-directed behavior,
nonacceptance of emotional responses, and limited access to emotion regulation
strategies. Two aspects of emotion regulation, impulse control difficulties and
difficulties engaging in goal directed behavior, mediated the relationship
between PTSD symptoms and alcohol-related consequences in the full sample, even
after adjusting for the effects of negative affect. When examined separately by
gender, impulse control difficulties remained a mediator for men and difficulties
engaging in goal directed behavior for women.
CONCLUSIONS: These analyses shed light on processes that may underlie
"self-medication" of PTSD symptoms. Gender-specific interventions targeting
emotion dysregulation may be effective in reducing alcohol-related consequences
in individuals with PTSD. Women may possibly benefit from interventions that
focus on difficulties engaging in goal-directed behavior, while men may benefit
from interventions that target impulse control difficulties when upset.
DOI: 10.1080/15504263.2015.1025013
PMCID: PMC4437848

eCollection 2015.
Pro-arrhythmic potential of oral antihistamines (H1): combining adverse event

reports with drug utilization data across Europe.
Poluzzi E(1), Raschi E(1), Godman B(2), Koci A(1), Moretti U(3), Kalaba M(4),
Wettermark B(5), Sturkenboom M(6), De Ponti F(1).
Author information:
(1)Department of Medical and Surgical Sciences, Alma Mater Studiorum-University
of Bologna, Bologna, Italy.
(2)Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden;
Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde
University, Glasgow, United Kingdom.
(3)Clinical Pharmacology Unit, University of Verona, Verona, Italy.
(4)Republic Fund for Health Insurance, Belgrade, Serbia.
(5)Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden;
Centre for Pharmacoepidemiology, Karolinska University Hospital, Solna,
Stockholm, Sweden; Stockholm, County Council, Stockholm, Sweden.
(6)Erasmus University Medical Centre, Rotterdam, Netherlands.
BACKGROUND: There is appreciable utilisation of antihistamines (H1) in European

countries, either prescribed by physician and purchased by patients for
self-medication. Terfenadine and astemizole underwent regulatory restrictions in
'90 because of their cardiac toxicity, but only scarce clinical data are
available on other antihistamines.
AIM: To investigate the pro-arrhythmic potential of antihistamines by combining
safety reports of the FDA Adverse Event Reporting System (FAERS) with drug
utilization data from 13 European Countries.
METHODS: We identified signals of antihistamine arrhythmogenic potential by
analyzing FAERS database for all cases of Torsades de Pointes (TdP), QT
abnormalities (QTabn), ventricular arrhythmia (VA) and sudden cardiac
death/cardiac arrest (SCD/CA). Number of cases ≥3 and disproportionality were
used to define alert signals: TdP and QTabn identified stronger signals, whereas
SCD/CA identified weaker signals. Drug utilization data from 2005 to 2010 were
collected from administrative databases through health authorities and insurance.
RESULTS: Antihistamines were reported in 109 cases of TdP/QT prolongation, 278 VA
and 610 SCD/CA. Five agents resulted in stronger signals (cetirizine,
desloratadine, diphenhydramine, fexofenadine, loratadine) and 6 in weaker signals
(alimemazine, carbinoxamine, cyclizine, cyproeptadine, dexchlorpheniramine and
doxylamine). Exposure to antihistamines with stronger signal was markedly
different across European countries and was at least 40% in each Country.
Cetirizine was >29 Defined Daily Doses per 1000 inhabitants per day (DID) in
Norway, desloratadine >11 DID in France and loratadine >9 DID in Sweden and
Croatia. Drugs with weaker signals accounted for no more than 10% (in Sweden) and
in most European countries their use was negligible.
CONCLUSIONS: Some second-generation antihistamines are associated with signal of
torsadogenicity and largely used in most European countries. Although
confirmation by analytical studies is required, regulators and clinicians should
consider risk-minimisation activities. Also antihistamines without signal but
with peculiar use in a few Countries (e.g., levocetirizine) or with increasing
consumption (e.g., rupatadine) deserve careful surveillance.
PMCID: PMC4364720
666. Psychopharmacology (Berl). 2015 May;232(10):1681-92. doi:

10.1007/s00213-014-3800-2. Epub 2014 Nov 13.
Nicotine effects in adolescence and adulthood on cognition and α₄β₂-nicotinic

receptors in the neonatal ventral hippocampal lesion rat model of schizophrenia.
Berg SA(1), Sentir AM, Bell RL, Engleman EA, Chambers RA.
Author information:
(1)Laboratory for Translational Neuroscience of Dual Diagnosis & Development,
Suite 314D, 320 West 16th Street, Indianapolis, IN, 46202, USA,
berg.fieler@gmail.com.
RATIONAL: Nicotine use in schizophrenia has traditionally been explained as

"self-medication" of cognitive and/or nicotinic acetylcholinergic receptor
(nAChR) abnormalities.
OBJECTIVES: We test this hypothesis in a neurodevelopmental rat model of
schizophrenia that shows increased addiction behaviors including enhanced
nicotine reinforcement and drug-seeking.
METHODS: Nicotine transdermal patch (5 mg/kg/day vs. placebo × 10 days in
adolescence or adulthood) effects on subsequent radial-arm maze learning (15
sessions) and frontal-cortical-striatal nAChR densities (α4β2; [3H]-epibatidine
binding) were examined in neonatal ventral hippocampal lesion (NVHL) and
SHAM-operated rats.
RESULTS: NVHL cognitive deficits were not differentially affected by nicotine
history compared to SHAMs. Nicotine history produced minimal cognitive effects
while increasing food-reward consumption on the maze, compounding with
NVHL-induced overconsumption. Acute nicotine (0.5 mg/kg) delivered before the
final maze sessions produced modest improvements in maze performance in rats with
nicotine patch histories only, but not differentially so in NVHLs. Consistent
with in vivo neuroimaging of β2 nAChR binding in schizophrenia smokers vs.
non-smokers and healthy controls, adult NVHLs showed 12% reductions in nAChR
binding in MPFC (p < 0.05) but not ventral striatum (<5% changes, p > .40),
whereas nicotine history elevated nAChRs across both regions (>30%, p < 0.001)
without interacting with NVHLs. Adolescent vs. adult nicotine exposure did not
alter nAChRs differentially.
CONCLUSIONS: Although replicating nicotine-induced upregulation of nAChRs in
human smokers and demonstrating NVHL validity in terms of
schizophrenia-associated nAChR density patterns, these findings do not support
hypotheses explaining increased nicotine use in schizophrenia as reflecting
illness-specific effects of nicotine to therapeutically alter cognition or nAChR
densities.
DOI: 10.1007/s00213-014-3800-2
PMCID: PMC4412763
667. J Adolesc Health. 2014 Oct;55(4):549-55. doi:

10.1016/j.jadohealth.2014.04.004.
Epub 2014 May 21.
Association between nonmedical prescription drug use and health status among
young Swiss men.
N'Goran AA(1), Deline S(2), Henchoz Y(2), Baggio S(2), Studer J(2), Mohler-Kuo
M(3), Gmel G(4).
Author information:
(1)Alcohol Treatment Centre, Lausanne University Hospital CHUV, Lausanne,
Switzerland. Electronic address: Adjua-Alexandra.NGoran@chuv.ch.
Switzerland.
(3)Institute of Social and Preventive Medicine, University of Zurich, Zurich,
Switzerland.
Switzerland; Centre for Addiction and Mental Health, Toronto, Ontario, Canada;
University of the West of England, Frenchay Campus, Bristol, United Kingdom;
Addiction Switzerland, Lausanne, Switzerland.
PURPOSE: To examine the relationship between the nonmedical prescription drug use
(NMPDU) of six drug classes and health.
METHODS: Data on young adults males (mean age, 19.96 years) from the baseline and
follow-up of the Cohort Study on Substance Use Risk Factors (C-SURF) were used (n
= 4,958). Two sets of logistic regression models were fitted to examine the
associations between NMPDU of opioid analgesics, sedatives or sleeping pills,
anxiolytics, antidepressants, beta blockers and stimulants, and health status
(assessed using the Medical Outcomes Study 12-Item Short Form Survey Instrument
[SF-12 v2]). We first computed odds ratios between NMPDU at baseline and poor
mental and physical health at follow-up, adjusting for poor mental or physical
health at baseline. We then computed odds ratios between poor mental and physical
health at baseline and NMPDU at follow-up, adjusting for NMPDU at baseline.
RESULTS: Three key findings regarding mental health were (1) there was a
reciprocal risk between poor mental health and sedatives and anxiolytics; (2)
poor mental health increased NMPDU of opioid analgesics and antidepressants but
not vice versa; and (3) there were no associations with stimulants. Three key
findings regarding physical health were (1) poor physical health increased the
risk of NMPDU of anxiolytics; (2) the only reciprocal risk was between physical
health and NMPDU of opioid analgesics; and (3) there were no associations with
stimulants.
CONCLUSION: These results, among the first ever on reciprocal effects between
NMPDU and mental and physical health status, give unique information concerning
the adverse effects of NMPDU on health and vice versa. The study shows that NMPDU
is not only a sign of self-medication but may induce health problems.

DOI: 10.1016/j.jadohealth.2014.04.004
668. JMIR Res Protoc. 2019 Apr 30;8(4):e12447. doi: 10.2196/12447.
A Smart Home System for Information Sharing, Health Assessments, and Medication
Self-Management for Older People: Protocol for a Mixed-Methods Study.
Norell Pejner M(#)(1), Ourique de Morais W(#)(2), Lundström J(#)(2), Laurell

H(#)(3), Skärsäter I(#)(1).
Author information:
(1)Department of Health and Care, School of Health and Welfare, Halmstad
University, Halmstad, Sweden.
(2)Technical Science, School of Information Technology, Halmstad University,
Halmstad, Sweden.
(3)Innovation Science, School of Business, Engineering and Science, Halmstad
University, Halmstad, Sweden.
BACKGROUND: Older adults often want to stay in a familiar place, such as their
home, as they get older. This so-called aging in place, which may involve support
from relatives or care professionals, can promote older people's independence and
well-being. The combination of aging and disease, however, can lead to complex
medication regimes and difficulties for care providers in correctly assessing the
older person's health. In addition, the organization of health care is
fragmented, which makes it difficult for health professionals to encourage older
people to participate in their own care. It is also a challenge to perform
adequate health assessments and to engage in appropriate communication between
health care professionals.
OBJECTIVE: The purpose of this paper is to describe the design for an integrated
home-based system that can acquire and compile health-related evidence for
guidance and information-sharing among care providers and care receivers in order
to support and promote medication self-management among older people.
METHODS: The authors used a participatory design approach for this mixed-methods
project, which was divided into four phases. Phase I, Conceptualization, consists
of the conceptualization of a system to support medication self-management,
objective health assessments, and communication between health care
professionals. Phase II, Development of a System, consists of building and
bringing together the conceptualized systems from Phase I. Phase III, Pilot
Study, and Phase IV, Full-Scale Intervention, are described briefly.
RESULTS: Participants in Phase I were people who were involved in some way in the
care of older adults and included older adults themselves, relatives of older
adults, care professionals, and industrial partners. With input from Phase I
participants, we identified two relevant concepts for promoting medication
self-management, both of which related to systems that participants believed
could provide guidance for the older adults themselves, relatives of older
adults, and care professionals. The systems will also encourage
information-sharing between care providers and care receivers. The first is the
concept of the Intelligent Age-Friendly Home (IAFH), defined as an integrated
residential system that evolves to sense, reason, and act in response to
individuals' needs, preferences, and behaviors as these change over time. The
second concept is the Medication safety, Objective assessments of health-related
behaviors, and Personalized medication reminders (MedOP) system, a system that
would be supported by the IAFH, and which consists of three related components:
one that assesses health behaviors, another that communicates health data, and a
third that promotes medication self-management.
CONCLUSIONS: The participants in this project were older adults, relatives of
older adults, care professionals, and our industrial partners. With input from
the participants, we identified two main concepts that could comprise a system
for health assessment, communication, and medication self-management: the IAFH
and the MedOP system. These concepts will be tested in this study to determine
whether they can facilitate and promote medication self-management among older
people.
©Margaretha Norell Pejner, Wagner Ourique de Morais, Jens Lundström, Hélène

Laurell, Ingela Skärsäter. Originally published in JMIR Research Protocols
DOI: 10.2196/12447
PMCID: PMC6658282
PMID: 31038459
669. J Asthma. 2017 Mar;54(2):143-152. doi: 10.1080/02770903.2016.1201835. Epub

2016
Jun 23.
Perceptions and experiences underlying self-management and reporting of symptoms

in teens with asthma.
Mammen JR(1), Rhee H(1), Norton SA(1), Butz AM(2).
Author information:
(1)a University of Rochester School of Nursing , Rochester , NY , USA.
(2)b Johns Hopkins University, School of Medicine , Baltimore , MD , USA.
BACKGROUND: Teens often have inadequate asthma self-management and control.

However, little is known of their perceptions of or rationales for
self-management behaviors.
OBJECTIVES: To explore how teens self-manage asthma, including experiences,
perceptions, responses to and reporting of symptoms.
METHODS: A case-based, qualitative-descriptive design was used. Data were
collected from minority and non-minority teens with controlled and uncontrolled
asthma and their respective parents (N = 28). There were four data-collection
points, including: (1) a primary teen interview; (2) parent interview; (3) 2-week
self-management voice-diary; and (4) follow-up teen interview, incorporating
symptom-response card-sorting to map symptoms and associated self-management
responses. Seventy data sources were included in the analysis.
RESULTS: Teens thought of their asthma symptoms as normal or unusual relative to
their personal baseline symptom pattern; Those with uncontrolled asthma
normalized higher levels of asthma symptoms than their counterparts with
controlled asthma. Second, teens' decisions to treat symptoms of asthma with
rescue medication were based on perceived benefits, burdens and accessibility of
treatment balanced against perceived normalcy of symptoms. Teens with
uncontrolled asthma had substantially higher treatment thresholds and delayed
responses to symptoms compared to controlled peers. Third, teens never reported
perceived normal symptoms of asthma to parents or providers, who were thus only
aware of unusual or visible/audible symptoms.
CONCLUSIONS: Teen's perceptions of symptoms and understanding of what is normal
is the basis for self-management decisions. Improving self-management will likely
entail modifying perceptions of symptoms and benefits/burdens of treatment to
achieve healthier self-management patterns.
DOI: 10.1080/02770903.2016.1201835
PMCID: PMC5182183
670. J Pediatr Psychol. 2016 May;41(4):419-28. doi: 10.1093/jpepsy/jsv097. Epub

2015
Oct 24.
Predictors of Self-Reported Adherence to Antiretroviral Medication in a Multisite

Study of Ethnic and Racial Minority HIV-Positive Youth.
MacDonell KK(1), Jacques-Tiura AJ(2), Naar S(2), Fernandez MI(3); ATN 086/106
Protocol Team.
Author information:
(1)Wayne State University, kkolmodin@med.wayne.edu.
(2)Wayne State University.
(3)Nova Southeastern University, and.
OBJECTIVE: To test social cognitive predictors of medication adherence in

racial/ethnic minority youth living with HIV using a conceptual model.
METHODS: Youth were participants in two descriptive studies by the Adolescent
Trials Network for HIV/AIDS Interventions. Minority youth ages 16-24 years who
were prescribed antiretroviral medication were included (N = 956). Data were
collected through chart extraction and/or laboratory testing and by Audio
Computer-Assisted Self-Interview.
RESULTS: 39% of youth reported suboptimal adherence. Path analysis was used to
explore predictors of medication adherence. Higher self-efficacy predicted higher
readiness and adherence. Greater social support predicted higher self-efficacy.
Psychological symptoms and substance use were associated with several predictors
and lower adherence.
CONCLUSIONS: The model provided a plausible framework for understanding adherence
in this population. Culturally competent, but individually tailored,
interventions focused on increasing self-efficacy to take medication and reducing
risk behaviors (e.g., substance use) may be helpful for racial or ethnic minority
youth with HIV.
© The Author 2015. Published by Oxford University Press on behalf of the Society
of Pediatric Psychology. All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.
DOI: 10.1093/jpepsy/jsv097
PMCID: PMC6080484
671. J Gen Intern Med. 2015 Mar;30(3):346. doi: 10.1007/s11606-014-3122-4.
Capsule commentary on Aikens et al., integrating support persons into diabetes

telemonitoring to improve self-management and medication adherence.
Mohammad A(1).
Author information:
(1)VA Connecticut Healthcare System, Yale University School of Medicine, West
Haven, CT, 06516, USA, amir.mohammad@yale.edu.
Comment on
J Gen Intern Med. 2015 Mar;30(3):319-26.
DOI: 10.1007/s11606-014-3122-4
PMCID: PMC4351265
672. J Med Internet Res. 2016 Apr 17;18(5):e91. doi: 10.2196/jmir.5256.
A Remote Medication Monitoring System for Chronic Heart Failure Patients to

Reduce Readmissions: A Two-Arm Randomized Pilot Study.
Hale TM(1), Jethwani K, Kandola MS, Saldana F, Kvedar JC.
Author information:
(1)Partners Healthcare, Connected Health, Boston, MA, United States.
tmhale@mgh.harvard.edu.
Erratum in
J Med Internet Res. 2019 Feb 05;21(2):e13125.
BACKGROUND: Heart failure (HF) is a chronic condition affecting nearly 5.7

million Americans and is a leading cause of morbidity and mortality. With an
aging population, the cost associated with managing HF is expected to more than
double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates
for HF patients are high-25% are readmitted at 30 days and nearly 50% at 6
months. Low medication adherence contributes to poor HF management and higher
readmission rates. Remote telehealth monitoring programs aimed at improved
medication management and adherence may improve HF management and reduce
readmissions.
OBJECTIVE: The primary goal of this randomized controlled pilot study is to
compare the MedSentry remote medication monitoring system versus usual care in
older HF adult patients who recently completed a HF telemonitoring program. We
hypothesized that remote medication monitoring would be associated with fewer
unplanned hospitalizations and emergency department (ED) visits, increased
medication adherence, and improved health-related quality of life (HRQoL)
compared to usual care.
METHODS: Participants were randomized to usual care or use of the remote
medication monitoring system for 90 days. Twenty-nine participants were enrolled
and the final analytic sample consisted of 25 participants. Participants
completed questionnaires at enrollment and closeout to gather data on medication
adherence, health status, and HRQoL. Electronic medical records were reviewed for
data on baseline classification of heart function and the number of unplanned
hospitalizations and ED visits during the study period.
RESULTS: Use of the medication monitoring system was associated with an 80%
reduction in the risk of all-cause hospitalization and a significant decrease in
the number of all-cause hospitalization length of stay in the intervention arm
compared to usual care. Objective device data indicated high adherence rates
(95%-99%) among intervention group participants despite finding no significant
difference in self-reported adherence between study arms. The intervention group
had poorer heart function and HRQoL at baseline, and HRQoL declined significantly
in the intervention group compared to controls.
CONCLUSIONS: The MedSentry medication monitoring system is a promising technology
that merits continued development and evaluation. The MedSentry medication
monitoring system may be useful both as a standalone system for patients with
complex medication regimens or used to complement existing HF telemonitoring
interventions. We found significant reductions in risk of all-cause
hospitalization and the number of all-cause length of stay in the intervention
group compared to controls. Although HRQoL deteriorated significantly in the
intervention group, this may have been due to the poorer HF-functioning at
baseline in the intervention group compared to controls. Telehealth medication
adherence technologies, such as the MedSentry medication monitoring system, are a
promising method to improve patient self-management,the quality of patient care,
and reduce health care utilization and expenditure for patients with HF and other
chronic diseases that require complex medication regimens.
TRIAL REGISTRATION: ClinicalTrials.gov NCT01814696;
https://clinicaltrials.gov/ct2/show/study/NCT01814696 (Archived by WebCite® at
http://www.webcitation.org/6giqAVhno).
DOI: 10.2196/jmir.5256
PMCID: PMC4890732
673. Ethn Dis. 2017 Apr 20;27(2):155-160. doi: 10.18865/ed.27.2.155. eCollection

2017
Spring.
Impact of Distress Reduction on Behavioral Correlates and A1C in African American

Women with Uncontrolled Type 2 Diabetes: Results from EMPOWER.
Cummings DM(1), Lutes LD(2), Littlewood K(3), Solar C(4), Hambidge B(1), Gatlin
P(1).
Author information:
(1)Departments of Family Medicine and Public Health and Center for Health
Disparities, East Carolina University, Greenville, NC.
(2)Department of Psychology, University of British Columbia, Canada.
(3)School of Social Work, University of South Florida, Tampa, FL.
(4)Department of Psychology, East Carolina University, Greenville, NC.
OBJECTIVE: Symptoms of emotional distress related to diabetes have been

associated with inadequate self-care behaviors, medication non-adherence, and
poor glycemic control that may predispose patients to premature death. African
American women, in whom diabetes is more common and social support is often
insufficient, may be at particularly high risk. The objective of this study was
to examine the impact of lowering diabetes-related emotional distress on glycemic
control and associated behavioral correlates in rural African American women with
uncontrolled type 2 diabetes (T2D).
DESIGN: Post-hoc analysis of prospective, randomized, controlled trial.
SETTING: Rural communities in the southeastern United States.
PATIENTS: 129 rural middle-aged African American women with uncontrolled type 2
diabetes (T2D)(A1C ≥ 7.0).
PRIMARY INDEPENDENT VARIABLE: Diabetes-related distress.
MAIN OUTCOME MEASURES: Changes from baseline to 12-month follow-up in
diabetes-related distress, and associated changes in medication adherence,
self-care activities, self-efficacy, and glycemic control (A1C).
RESULTS: Patients with a reduction in diabetes-related distress (n=79) had
significantly greater improvement in A1C, medication adherence, self-care
activities, and self-efficacy compared with those in whom diabetes distress
worsened or was unchanged (n=50). Changes in distress were also significantly and
inversely correlated with improvements in medication adherence, self-care
activities, and self-efficacy.
CONCLUSIONS: Among rural African American women, reductions in diabetes-related
distress may be associated with lower A1C and improvements in self-efficacy,
self-care behaviors, and medication adherence.
DOI: 10.18865/ed.27.2.155
PMCID: PMC5398174
Conflict of interest statement: Competing Interests: None declared.
674. Pak J Med Sci. 2018 Jul-Aug;34(4):959-963. doi: 10.12669/pjms.344.14994.
Evaluation of medication adherence in hypertensive patients and influential

factors.
Boratas S(1), Kilic HF(2).

Author information:
(1)Selma Boratas, M.Sc. Staff Nurse, Akdogan Health Center, Famagusta, North
Cyprus, via Mersin 10 Turkey.
(2)Hulya Firat Kilic, PhD, RN. Assistant Professor, Department of Nursing,
Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, North
Cyprus, via Mersin 10 Turkey.
Objective: This study aims to evaluate medication adherence in hypertensive

patients and to identify the influential factors.
Methods: This descriptive, cross-sectional study included a total of 147
hypertensive patients who were admitted to Akdogan Health Center between December
2016 and February 2017. The Descriptive Data Form and Medication Adherence
Self-Efficacy Scale were used as the data collection tools.
Results: The mean Medication Adherence Self-Efficacy Scale score was found to be
70.29 ± 8.52. Age, duration of HT, the frequency of follow-up visit for HT, the
status of taking medication regularly, the frequency of blood pressure
measurement and the status of alternative method use were found to be effective
in medication adherence.
Conclusions: Our study results suggest that medication adherence is good in
patients with hypertension (HT). Factors which are effective in medication
adherence should be taken into consideration, when evaluating the medication
adherence in patients with HT.
DOI: 10.12669/pjms.344.14994
PMCID: PMC6115554
PMID: 30190761
675. Clin Epidemiol. 2018 Aug 16;10:981-989. doi: 10.2147/CLEP.S163037. eCollection

2018.
Concordance assessment of self-reported medication use in the Netherlands

three-generation Lifelines Cohort study with the pharmacy database iaDB.nl: The
PharmLines initiative.
Sediq R(1), van der Schans J(1), Dotinga A(2), Alingh RA(2), Wilffert B(1)(3),
Bos JH(1), Schuiling-Veninga CC(1), Hak E(1)(4).
Author information:
(1)Department of Pharmaco-Therapy, Epidemiology & Economics, University of
Groningen, Groningen Research Institute of Pharmacy, Groningen, the Netherlands,
e.hak@rug.nl.
(2)Lifelines Cohort Study, Lifelines Databeheer B.V., Groningen, the Netherlands.
(3)Department of Clinical Pharmacy and Pharmacology, University Medical Center
Groningen, Groningen, the Netherlands.
(4)Department of Epidemiology, University Medical Center Groningen, Groningen,
the Netherlands, e.hak@rug.nl.
Background: While self-reported data are commonly used as a source of medication

use for pharmaco-epidemiological studies, such information is prone to forms of
bias. Several previous studies showed that various factors like age, type of drug
and data collection method may influence accuracy. We aimed to assess the
concordance of the self-reported medication use that was documented at entry to
the Lifelines Cohort Study, a three-generation follow-up study in the Netherlands
that started in 2006 and included over 167,000 participants.
Materials and methods: As part of the PharmLines Initiative, we collected
medication data from the Lifelines participants encoded according to the
Anatomical Therapeutic Chemical (ATC) coding scheme and linked the data via
Statistics Netherlands to the widely used and representative pharmacy
prescription database of the University of Groningen, IADB.nl. Analyses were
conducted at second level of ATC coding for all recorded medications as well as a
top list of most used medications at drug-specific fifth level. Cohen's kappa
statistics were used to measure the concordance for all participants according to
sex and age.
Results: The level of concordance between the two data sources largely differed
according to the therapeutic class. Medication used for the cardiovascular system
and diabetes, thyroid therapy, bisphosphonates and anti-thrombotic drugs showed a
very good agreement (κ>0.75). Medication as needed or prone to stigmatization
bias showed a moderate agreement (κ=0.41-0.60), whereas medications used for
short periods of time showed a fair agreement (κ=0.0-0.4). Concordance was
similar for males and females, but younger adults tended to have lower
concordance rates than older adults.
Conclusion: The self-reported method was valid for capturing prevalent chronic
medication use at one moment in time, but invalid for medication used for short
periods of time. There is no effect of sex on the agreement, and more studies are
needed on the influence of age. Future pharmaco-epidemiological studies should
preferably combine the two data sources to achieve the highest accuracy of drug
exposure rates.
DOI: 10.2147/CLEP.S163037
PMCID: PMC6101003
PMID: 30147377

676. Ann Behav Med. 2016 Oct;50(5):642-652.
Predictors of Changes in Medication Adherence in Blacks with Hypertension: Moving

Beyond Cross-Sectional Data.
Schoenthaler AM(1), Butler M(2), Chaplin W(3), Tobin J(4)(5), Ogedegbe G(6).
Author information:
(1)Center for Healthful Behavior Change, Division of Health & Behavior,
Department of Population Health, New York University School of Medicine, 227 East
30th Street, 634, New York, NY, 10016, USA. antoinette.schoenthaler@nyumc.org.
30th Street, New York, NY, 10016, USA.
(3)Department of Psychology, St. John's University, Queens, NY, 11439, USA.
(4)Clinical Directors Network, Inc. (CDN), New York, NY, USA.
(5)The Rockefeller University, New York, NY, USA.
30th Street, 633, New York, NY, 10016, USA.
BACKGROUND: Many studies have examined the multiple correlates of non-adherence

in Blacks. However, they are largely cross-sectional; thus, these studies are
unable to examine their predictive value on long-term medication adherence.
PURPOSE: The purpose of this study is to examine the predictive role of key
psychosocial and interpersonal factors on changes in medication adherence over a
1-year period.
METHODS: Data were collected from 815 Black patients with hypertension followed
in community health centers. Hypothesized predictor variables included
self-efficacy, depressive symptoms, social support, and patient-provider
communication measured at baseline, 6, and 12 months. The dependent variable,
medication adherence was assessed at baseline, 6, and 12 months. Latent Growth
Modeling was used to evaluate the pathways between the latent predictor variables
RESULTS: Participants were mostly female, low-income, with high school education
or less, and mean age of 57 years. At baseline, high self-efficacy was associated
with low depressive symptoms (β = -0.22, p = 0.05), collaborative
patient-provider communication (β = 0.17, p = 0.006), and better medication
adherence (β = 1.04, p < 0.001). More social support and collaborative
patient-provider communication were associated with low depressive symptoms
(β = -0.08, p = 0.02; β = -0.18, p = 0.01). More social support was positively
associated with collaborative patient-provider communication (β = 0.32,
p < 0.001). In the longitudinal model, increasing self-efficacy over time
predicted improvements in medication adherence 1 year later (β = 1.76, p < 0.001;
CFI = 0.95; RMSEA = 0.04; SRMR = 0.04; Chi-Squared Index of Model Fit = 1128.54).
CONCLUSIONS: Self-efficacy is a key predictor of medication adherence over time
in Black patients with hypertension. Initial levels of self-efficacy are
influenced by the presence of depressive symptoms as well as the perceived
quality of patient-provider communication.
DOI: 10.1007/s12160-016-9791-y
PMCID: PMC5011034
677. Health Psychol. 2015 May;34(5):505-13. doi: 10.1037/hea0000131. Epub 2014 Aug
11.
Distress and type 2 diabetes-treatment adherence: A mediating role for perceived

control.
Gonzalez JS(1), Shreck E(2), Psaros C(3), Safren SA(3).
Author information:
(1)Ferkauf Graduate School of Psychology and Diabetes Research Center, Albert
Einstein College of Medicine, Yeshiva University.
(2)Ferkauf Graduate School of Psychology, Yeshiva University.
(3)Behavioral Medicine Service, Department of Psychiatry, Massachusetts General
Hospital.
OBJECTIVE: To better understand independent pathways linking emotional distress,

medication adherence, and glycemic control in adults with Type 2 diabetes, as
well as the potential mediating effects of perceived control over illness and
self-efficacy.
METHOD: Adults with Type 2 diabetes (N = 142) were recruited for an intervention
study evaluating cognitive-behavioral therapy for adherence and depression.
Depressive symptom severity was assessed via semistructured interview. Validated
self-reports assessed diabetes-related distress, perceived control over diabetes
(perceived control), self-efficacy for diabetes self-management, and medication
adherence. Glycemic control was evaluated by hemoglobin A1C. Only baseline data
were included in correlational and linear regression analyses.
RESULTS: Perceived control was an important mediator of emotional distress for
both medication adherence and A1C outcomes. Specifically, regression analyses
demonstrated that diabetes distress, but not depression severity, was
significantly related to medication adherence and A1C. Self-efficacy and
perceived control were also independently associated with medication adherence
and A1C. Mediation analyses demonstrated a significant indirect effect for
diabetes distress and medication adherence through perceived control and
self-efficacy. The relationship between distress and A1C was accounted for by an
indirect effect through perceived control.
CONCLUSION: Results demonstrated that diabetes-related emotional distress is
associated with poorer treatment adherence and glycemic control among adults with
Type 2 diabetes; these relationships were partially mediated through perceived
control over diabetes. Perceptions of one's personal ability to influence the
course of diabetes may be important in understanding the pathway between
emotional distress and poor diabetes-treatment outcomes.
DOI: 10.1037/hea0000131
PMCID: PMC4324372
678. Pediatr Rheumatol Online J. 2018 Mar 14;16(1):18. doi: 10.1186/s12969-018-

0232-2.
Improvement of medication adherence in adolescents and young adults with SLE

using web-based education with and without a social media intervention, a pilot
study.
Scalzi LV(1), Hollenbeak CS(2), Mascuilli E(2), Olsen N(2).
Author information:
(1)Pennsylvania State University, MC A480; 90 Hope Drive, Hershey, PA, 17033,
USA. lscalzi@pennstatehealth.psu.edu.
(2)Pennsylvania State University, MC A480; 90 Hope Drive, Hershey, PA, 17033,
USA.
Comment in
Nat Rev Rheumatol. 2018 Aug;14(8):445-446.
BACKGROUND: Self-management skills, including medication management, are vital to

the health of adolescents and young adults with systemic lupus erythematosus
(SLE). The purpose of this study was to assess the feasibility and preliminary
effects of an online educational program in a cohort of adolescent and young
adults with SLE with and without a social media (SM) experience.
METHODS: Adolescents and young adults with SLE participated weekly for 8 sessions
on a web-based educational program about SLE created specifically for this
project. Subjects were randomized to respond to questions at the end of each
weekly module in a journal or on a SM forum with other SLE subjects. Patients
were surveyed prior to initiating the study, (T0) and 6 weeks after completion of
the sessions (T1). Medication adherence for hydroxychloroquine, utilizing the
medication possession ratio (MPR), was compared for the 3 months preceding T0 and
for the 3 months following T1.
RESULTS: Twenty-seven of the 37 subjects (73%) enrolled completed the study,
including the two required sets of surveys. Reasons for being lost to follow up
included being too busy, forgetting, and/or not seeing email reminders.
Medication adherence improved in all subjects (p < 0.001). The percentage of the
SM intervention group that was adherent (MPR ≥ 80%) significantly improved from
50% to 92% (p = 0.03), while the control group did not. Secondary outcome
measures that improved, only in the SM group, included self-efficacy, sense of
agency (SOA), sense of community (SOC), and empowerment. There was a strong
correlation between empowerment with SOA and SOC and in turn a strong correlation
with SOA and SOC with MPR, providing a possible explanation for why social media
participation helped to improve medication adherence. Subjective reporting of
medication adherence was not reliably correlated to MPR.
CONCLUSIONS: This pilot study has demonstrated feasibility for the use of an
online educational SLE website, recruitment, and measurement of chosen outcome
measures. This study provides evidence for a larger multi-site trial which has
the potential to address an important service gap by delivering self-management
education and peer interactions in a format that is accessible, and engaging to
young people with SLE.
TRIAL REGISTRATION: Trial registration: NCT03218033 . Retrospectively registered
14 July 2017.
DOI: 10.1186/s12969-018-0232-2
PMCID: PMC5852975
679. Pharmacy (Basel). 2018 May 28;6(2). pii: E46. doi: 10.3390/pharmacy6020046.
One-Stop Dispensing: Hospital Costs and Patient Perspectives on Self-Management

of Medication.
Houlind MB(1)(2), McNulty HBØ(3), Treldal C(4)(5), Andersen SL(6), Huneck Haupt
T(7), Petersen J(8)(9), Andersen O(10)(11), Kjeldsen LJ(12).
Author information:
(1)Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre,
Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
morten.batlzer.houlind@regionh.dk.
(2)The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
morten.batlzer.houlind@regionh.dk.
helle.bach.oelgaard.mcnulty@regionh.dk.
charlotte.treldal.02@regionh.dk.
charlotte.treldal.02@regionh.dk.
signe.lindegaard.andersen@regionh.dk.
thomas.huneck.haupt.01@regionh.dk.
janne.petersen.01@regionh.dk.
(9)Section of Biostatistics, Department of Public Health, University of
Copenhagen, 1014 Copenhagen, Denmark. janne.petersen.01@regionh.dk.
ove.andersen@regionh.dk.
(11)Emergency Department, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
ove.andersen@regionh.dk.
(12)Amgros I/S, Dampfærgevej 27, 2100 Copenhagen, Denmark.
ljuelkjeldsen@gmail.com.
(1) Objective: To assess hospital medication costs and staff time between
One-Stop Dispensing (OSD) and the Traditional Medication System (TMS), and to
evaluate patient perspectives on OSD. (2) Methods: The study was conducted at
Hvidovre Hospital, University of Copenhagen, Denmark in an elective gastric
surgery and acute orthopedic surgery department. This study consists of three
sub-studies including adult patients able to self-manage medication. In Sub-study
1, staff time used to dispense and administer medication in TMS was assessed.
Medication cost and OSD staff time were collected in Sub-study 2, while patient
perspectives were assessed in Sub-study 3. Medication costs with two days of
discharge medication were compared between measured OSD cost and simulated TMS
cost for the same patients. Measured staff time in OSD was compared to simulated
staff time in TMS for the same patients. Patient satisfaction related to OSD was
evaluated by a questionnaire based on a five-point Likert scale ('very poor' (1)
to 'very good' (5)). (3) Results: In total, 78 elective and 70 acute OSD patients
were included. Overall, there was no significant difference between OSD and TMS
in medication cost per patient ($2.03 [95% CI -0.57⁻4.63]) (p = 0.131). Compared
with TMS, OSD significantly reduced staff time by an average of 12 min (p ≤
0.001) per patient per hospitalization. The patients' satisfaction for OSD was
high with an average score of 4.5 ± 0.7. (4) Conclusion: There were no
differences in medication costs, but staff time was significantly lower in OSD
and patients were overall satisfied with OSD.
DOI: 10.3390/pharmacy6020046
PMCID: PMC6025360
PMID: 29843357

report regarding the content of this study. We state the founding sponsor had no
role in the design of the study; in the collection, analyses, or interpretation
of data; in the writing of the manuscript, and in the decision to publish the
results.

eCollection 2015.
The development of the ProMAS: a Probabilistic Medication Adherence Scale.
Kleppe M(1), Lacroix J(2), Ham J(3), Midden C(3).
Author information:
(1)Human Technology Interaction, Eindhoven University of Technology, Eindhoven,
the Netherlands ; Behavior, Cognition and Perception, Philips Research,
Eindhoven, the Netherlands.
(2)Behavior, Cognition and Perception, Philips Research, Eindhoven, the
Netherlands.
(3)Human Technology Interaction, Eindhoven University of Technology, Eindhoven,
the Netherlands.
Current self-report medication adherence measures often provide heavily skewed

results with limited variance, suggesting that most participants are highly
adherent. This contrasts with findings from objective adherence measures. We
argue that one of the main limitations of these self-report measures is the
limited range covered by the behaviors assessed. That is, the items do not match
the adherence behaviors that people perform, resulting in a ceiling effect. In
this paper, we present a new self-reported medication adherence scale based on
the Rasch model approach (the ProMAS), which covers a wide range of adherence
behaviors. The ProMAS was tested with 370 elderly receiving medication for
chronic conditions. The results indicated that the ProMAS provided adherence
scores with sufficient fit to the Rasch model. Furthermore, the ProMAS covered a
wider range of adherence behaviors compared to the widely used Medication
Adherence Report Scale (MARS) instrument, resulting in more variance and less
skewness in adherence scores. We conclude that the ProMAS is more capable of
discriminating between people with different adherence rates than the MARS.
DOI: 10.2147/PPA.S76749
PMCID: PMC4356448
PMID: 25784791
681. BMJ Open. 2018 Aug 23;8(8):e020849. doi: 10.1136/bmjopen-2017-020849.
Links between blood pressure and medication intake, well-being, stress, physical
activity and symptoms reported via a mobile phone-based self-management support
system: a cohort study in primary care.
Taft C(1)(2), Hallberg I(2)(3), Bengtsson U(1)(2), Manhem K(4)(5), Kjellgren

K(1)(2).
Author information:
(1)Institute of Health and Care Sciences, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden.
(2)Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of
(3)Department of Medical and Health Sciences, Linköping University, Linköping,
Sweden.
(4)Department of Molecular and Clinical Medicine, Institute of Medicine,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
(5)Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg,
Sweden.
OBJECTIVES: To explore relationships between patients' self-monitoring of blood

pressure (BP) and their concurrent self-reports of medication intake, well-being,
stress, physical activity and symptoms.
DESIGN: This study is a secondary analysis of a prospective study exploring the
8-week effectiveness of a mobile phone-based self-management support system for
patients with hypertension.
SETTING: Four primary healthcare centres situated in urban and suburban
communities in Sweden.
PARTICIPANTS: 50 patients undergoing treatment for hypertension.
PRIMARY AND SECONDARY OUTCOME MEASURES: Associations between systolic (SBP) and
diastolic blood pressure (DBP) and 10 self-report lifestyle-related variables
were analysed using linear mixed effects modelling.
RESULTS: Medication intake, better well-being, less stress and greater physical
activity were associated variously with lower same-day SBP and DBP. The single
strongest association was found between medication intake and SBP, where failure
to take medications was associated with an estimated 7.44 mm Hg higher SBP. To a
lesser degree, medication intake was also associated with DBP, where DBP was
4.70 mm Hg higher in cases where medications were not taken. Well-being and
stress were consistently associated with SBP and DBP, whereas physical activity
was associated with only SBP. None of the symptoms-dizziness, headache,
restlessness, fatigue or palpitations-were significantly associated with BP.
CONCLUSIONS: Our findings that BP was associated with patients' BP management
behaviours and experiences of well-being and stress, but not symptoms suggest
that enabling persons with hypertension to monitor and track their BP in relation
to medication intake, physical activity, well-being, stress and symptoms may be a
fruitful way to help them gain first-hand understanding of the importance of
adherence and persistence to treatment recommendations.
TRIAL REGISTRATION NUMBER: NCT01510301; Pre-results.

DOI: 10.1136/bmjopen-2017-020849
PMCID: PMC6112389
PMID: 30139897
682. Patient Prefer Adherence. 2018 Dec 6;12:2605-2613. doi: 10.2147/PPA.S184166.

eCollection 2018.
Immunosuppressive therapy related adherence, beliefs and self-management in

kidney transplant outpatients.
Vankova B(1), Mala-Ladova K(1), Kubena AA(1), Maly J(1), Sulkova SD(2).
Author information:
Králové, Charles University, Hradec Králové, Czech Republic, malyj@faf.cuni.cz.
(2)Hemodialysis Centre, University Hospital, Hradec Králové, Czech Republic.
Purpose: Kidney transplant (KTx) recipients should strictly adhere to their

lifelong complex therapeutic regimen, and any barriers to medication adherence
can weaken correct patient behavior. This study aimed to determine the adherence
to immunosuppressive therapy (IS) in KTx adult outpatients in the Czech Republic,
and attempted to gain a greater insight into their attitudes toward IS and
self-management tasks.
Materials and methods: Pharmacist-led structured interviews were conducted to
assess self-reported adherence to IS using the Czech version of the Medication
Adherence Report Scale, in the context of attitudes toward IS in terms of
necessity and concern scale of the Beliefs about Medicines Questionnaire. A
specific questionnaire was developed to target IS self-management tasks.
Medication records were also reviewed for IS serum levels, reflecting direct
adherence measurement. Descriptive statistics were used to calculate adherence
and self-management variables, and were analyzed by univariate and multivariate
correlations, including the decision-tree method.
Results: The interview was completed by 211 (male 123; mean age 55.0±12.4 years,
mean time 6.6±5.9 years after KTx) of the total of 235 patients. Full adherence
to IS was reported by 173 (82.0%) patients. Most of them had IS serum levels
within the therapeutic range, however, cyclosporine was associated with the
highest variability (P<0.001). Non-adherence and concerns increased over time
after KTx (P<0.05). Despite the more common unintentional non-adherence
(P<0.001), relatively high concerns signified the risk of not taking IS as
prescribed. Concerns also correlated with the perception of impaired health
status (P<0.01), as well as the occurrence of IS-related adverse effects
(P<0.001). The patients' awareness of their therapy was insufficient, and main
gaps in self-management comprised inadequate sun protection, incorrect
administration of IS, and unfamiliarity with the IS name, or their indications.
Conclusion: Although self-reported adherence to IS therapy was satisfactory, the
comprehensive evaluation enabled the detection of greater concerns about IS, as
well as underestimated self-management tasks that posttransplant interventions
should target in the future.
DOI: 10.2147/PPA.S184166
PMCID: PMC6287542
PMID: 30584284

683. Drug Discov Ther. 2018;12(4):248-253. doi: 10.5582/ddt.2018.01043.
Criteria for the selection of switch OTC drugs based on patient benefits,
efficacy, and safety [II]: Comparing the physicochemical and pharmaceutical
properties of brand-name and switch OTC terbinafine hydrochloride cream.
Takata M(1), Wada Y(2), Iwasawa Y(3), Kumazawa M(4), Shimokawa KI(3), Ishii F(2).
Author information:
(1)Welcia Yakkyoku Co. Ltd.
(2)Department of Self-medication and Health Care Sciences, Meiji Pharmaceutical
University.
(4)Department of Mathematical Science, Meiji Pharmaceutical University.
The physicochemical properties (pH, yield value, and squeeze force) of a drug for
dermatomycosis, a terbinafine hydrochloride-containing cream (a brand-name
product), and 12 over-the-counter drugs (OTCs) were measured and compared to
ascertain the characteristics of each product. The pH of the brand-name product,
Lamisil, was 4.1, and that of the OTC products ranged from 4.2 to 7.6; Lamisil
Plus (7.6) had a significantly higher pH. Moreover, the yield value for Lamisil,
as an index of cream ductility, was 128 dyn/cm2, and that for the OTC products
ranged from 110 to 887 dyn/cm2. In particular, the OTC products Damalin (887
dyn/cm2), Barriact (512 dyn/cm2), and Exiv Deep (663 dyn/cm2) had a significantly
higher yield value. In addition, the squeeze force was measured by attaching a
HapLog® to the thumb and second finger. The squeeze force for Lamisil was 12.9 N,
and that for the OTC products ranged from 1.8 to 14.6 N. The OTC product Bilumon
(1.8 N) had a significantly lower squeeze force. These results indicated that
there were marked differences in the pharmaceutical properties of brand-name and
OTC products. External preparations are characterized by their feel during use.
Based on the current results, the pharmaceutical characteristics of drugs
resulted in differences in their feel during use, suggesting that products
appropriate for individual patients can be recommended.
DOI: 10.5582/ddt.2018.01043
684. Cochrane Database Syst Rev. 2016 Jan 28;1:CD009704. doi:

10.1002/14651858.CD009704.pub2.
Smoking cessation advice for people with serious mental illness.
Khanna P(1), Clifton AV, Banks D, Tosh GE.
Author information:
(1)Rehabilitation and Recovery, Adult Psychiatry, Northumberland, Tyne and Wear
NHS Foundation Trust, Newcastle, UK.
BACKGROUND: People with a serious mental illness are more likely to smoke more
and to be more dependent smokers than the general population. This may be due to
a wide range of factors that could include a common aetiology to both smoking and
the illness, self medication, smoking to alleviate adverse effects of
medications, boredom in the existing environment, or a combination of these
factors. It is important to undertake this review to facilitate improvements in
both the health and safety of people with serious mental illness who smoke, and
to reduce the overall burden of costs (both financial and health) to the smoker
and, eventually, to the taxpayer.
OBJECTIVES: To review the effects of smoking cessation advice for people with
serious mental illness.
SEARCH METHODS: We searched the Cochrane Schizophrenia Group Specialized Trials
Register up to 2 April 2015, which is based on regular searches of CENTRAL,
BIOSIS, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and trial registries. We also
undertook unsystematic searches of a sample of the component databases (BNI,
CINHAL, EMBASE, MEDLINE, and PsycINFO), up to 2 April 2015, and searched
references of all identified studies
SELECTION CRITERIA: We planned to include all randomised controlled trials (RCTs)
that focussed on smoking cessation advice versus standard care or comparing
smoking cessation advice with other more focussed methods of delivering care or
information.
DATA COLLECTION AND ANALYSIS: The review authors (PK, AC, and DB) independently
screened search results but did not identify any trials that fulfilled the
inclusion criteria of this review.
MAIN RESULTS: We did not identify any RCTs that evaluated advice regarding
smoking cessation for people with serious mental illness. The excluded studies
illustrate that randomisation of packages of care relevant to smokers with
serious mental illness is possible.
AUTHORS' CONCLUSIONS: People with serious mental illness are more likely to smoke
than the general population. Yet we could not find any high quality evidence to
guide the smoking cessation advice healthcare professionals pass onto service
users. This is an area where trials are possible and needed.
DOI: 10.1002/14651858.CD009704.pub2
PMCID: PMC6513396
685. BMC Fam Pract. 2016 Oct 4;17(1):140.
Safer drug use in primary care - a pilot intervention study to identify

improvement needs and make agreements for change in five Swedish primary care
units.
Modig S(1)(2), Lenander C(3), Viberg N(3)(4), Midlöv P(3).
Author information:
(1)Department of Clinical Sciences in Malmö/Family Medicine, Lund University, Jan
Waldenströms gata 35, SE-205 02, Malmö, Sweden. sara.modig@med.lu.se.
(2)Department of Medicines Management and Informatics in Skåne County, Malmö,
Sweden. sara.modig@med.lu.se.
(3)Department of Clinical Sciences in Malmö/Family Medicine, Lund University, Jan
Waldenströms gata 35, SE-205 02, Malmö, Sweden.
(4)Department for Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden.
BACKGROUND: There is an urgent need to improve patient safety in the area of

medication treatment among the elderly. The aim of this study was to explore
which improvement needs and strengths, relating to medication safety, arise from
a multi-professional intervention in primary care and further to describe and
follow up on the agreements for change that were established within the
intervention.
METHODS: The SÄKLÄK project was a multi-professional intervention in primary care
consisting of self-assessment, peer-review, feedback and written agreements for
change. Data were obtained from five primary care units randomised to the
intervention group. Reviewer feedback reports and agreements for change were
analysed using content analysis.
RESULTS: Strengths that were identified included a committed leadership, work
methods to enhance medication safety and access to consultants. Methods for
securing an accurate medication list, knowledge and methods of working of the
prescriber and patient's ability to contribute to medication safety were areas
that gave rise to three predesigned categories for improvement needs on a local
level. Another category became apparent during the analysis; namely learning from
mistakes and from results. In all categories, apparent shortcomings were
identified. These included inaccurate medication lists, lack of medication
reconciliation, lack of time for follow-up of elderly patients, need for further
education in geriatrics and pharmacotherapy and lack of information on indication
and maximum dosage. An increased number of medication reviews were among the most
common agreements for change seen.
CONCLUSIONS: This study identified substantial shortcomings, like poorly updated
medication lists, which affected medication safety in the participating Swedish
primary care units. Similar shortcomings are most likely present in other primary
care units in the country. Working together multi-professionally, including
performing medication reviews, could be one way of improving medication safety.
On the other hand, the individual physician must possess enough pharmaceutical
knowledge and the working conditions must allow time for follow-up of
prescriptions. Strengths of the primary care unit, such as successful methods of
working, must be taken advantage of. The culture in primary care may affect the
ability to successfully implement routines that improve patient safety and reduce
risk of medication errors.
DOI: 10.1186/s12875-016-0542-8
PMCID: PMC5050592
686. J Gerontol B Psychol Sci Soc Sci. 2016 Sep;71(5):902-13. doi:

10.1093/geronb/gbv091. Epub 2015 Nov 19.
Childhood Adversity and Men's Relationships in Adulthood: Life Course Processes

and Racial Disadvantage.
Umberson D(1), Thomeer MB(2), Williams K(3), Thomas PA(4), Liu H(5).
Author information:
(1)Department of Sociology and Population Research Center, The University of
Texas at Austin. umberson@prc.utexas.edu.
(2)Department of Sociology, University of Alabama at Birmingham.
(3)Department of Sociology, Ohio State University, Columbus.
(4)Department of Sociology and Center on Aging and the Life Course, Purdue
University, West Lafayette, Indiana.
(5)Department of Sociology, Michigan State University, East Lansing.
OBJECTIVES: Prior U.S. population studies have found that childhood adversity
influences the quality of relationships in adulthood, with emerging research
suggesting that this association might be especially strong for black men. We
theorize psychosocial and behavioral coping responses to early life adversity and
how these responses may link early life adversity to strain in men's
relationships with their indeterminate partners and children across the life
course, with attention to possible racial variation in these experiences and
implications for later life well-being.
METHOD: We analyze in-depth interviews with 15 black men and 15 white men. We use
qualitative analysis techniques to connect childhood experiences to psychosocial
processes in childhood and behavioral coping strategies associated with
relationship experiences throughout adulthood.
RESULTS: Black men describe much stronger and more persistent childhood adversity
than do white men. Findings further suggest that childhood adversity contributes
to psychosocial processes (e.g., diminished sense of mastery) that may lead to
ways of coping with adversity (e.g., self-medication) that are likely to
contribute to relationship difficulties throughout the life span.
DISCUSSION: A life course perspective directs attention to the early life origins
of cumulative patterns of social disadvantage, patterns that extend to later
life. Our findings suggest psychosocial and behavioral pathways through which
early life adversity may constrain and strain men's relationships, possibly
contributing to racial inequality in family relationships across the life span.
© The Author 2015. Published by Oxford University Press on behalf of The

Gerontological Society of America. All rights reserved. For permissions, please
e-mail: journals.permissions@oup.com.
DOI: 10.1093/geronb/gbv091
PMCID: PMC4982387
687. Public Health Res Pract. 2017 Oct 11;27(4). pii: 27341702. doi:
10.17061/phrp27341702.
Ascertainment of self-reported prescription medication use compared with

pharmaceutical claims data.
Gnjidic D(1), Du W(2), Pearson SA(3), Hilmer SN(4), Banks E(5).
Author information:
(1)Faculty of Pharmacy, University of Sydney, NSW, Australia,
danijela.gnjidic@sydney.edu.au.
(2)National Centre for Epidemiology and Population Health, Research School of
Population Health, Australian National University, Canberra, ACT.
(3)Faculty of Pharmacy, University of Sydney, NSW, Australia; Centre for Big Data
Research in Health, Faculty of Medicine, UNSW Sydney, Australia.
(4)Sydney Medical School, University of Sydney, NSW, Australia; Kolling
Institute, Sydney, NSW, Australia; Royal North Shore Hospital, Sydney, NSW,
Australia.
(5)National Centre for Epidemiology and Population Health, Research School of
Population Health, Australian National University, Canberra, ACT; Sax Institute,
Sydney, NSW, Australia.
BACKGROUND: Evidence on the comparative validity of self-reported medication use

in large-scale studies is limited. This study compared self-reported medication
use of prescription-only medications to gold standard pharmaceutical claims
(i.e. dispensing) data.
METHODS: We selected a random sample of 500 participants from the 45 and Up
Study, a large-scale Australian study, with complete ascertainment of
Pharmaceutical Benefits Scheme dispensing records. Self-reported medication use
was ascertained by questionnaire requesting data on medications used "for most of
the last 4 weeks". In the dispensing data, we determined exposure to specific
medications in the same 4-week window as the survey response if we observed a
dispensing record ≤90 days before the start of the window. We calculated
sensitivity and positive predictive values (PPVs) at the Anatomical Therapeutic
Chemical (ATC) classification 3- and 7-digit code levels.
RESULTS: PPVs were ≥75% for 79% of the medications examined at the 3-digit ATC
level. The sensitivity/PPV of self-reported versus claims data at the 3-digit
level were highest for chronic medications, including cardiovascular medications:
94.4%/96.9%, respectively, for lipid-lowering agents; 92.5%/97.5% for angiotensin
agents; 88.8%/93.1% for beta-blockers; and 88.0%/96.9% for calcium-channel
blockers. PPVs were ≥65% and sensitivity of self-reported data was 78.9% for
psychoanaleptics, 42.1% for analgesics, 26.0% for psycholeptics and 4.8% for
antibacterial agents. PPVs for individual medications were ≥75% for 81% of the
individual medications examined at the 7-digit level. The sensitivity/PPV for
self-reported versus claims data at the 7-digit level varied across individual
medications, with highest values being 96.9%/96.9% for warfarin, 94.5%/92.0% for
atorvastatin, 94.3%/84.6% for pantoprazole and 93.3%/95.5% for atenolol. The
lowest sensitivity of self-reported versus claims data for individual medications
was 16.7% for temazepam, 15.2% for perindopril, 11.5% for irbesartan, 11.1% for
oxazepam and 3.3% for amoxicillin.
CONCLUSIONS: Self-reported data of the type reported here are useful for
identifying exposure to prescription medications, particularly those for chronic
use. However, they are likely to be of lesser validity for ascertaining
short-term and/or intermittent medication exposure.
DOI: 10.17061/phrp27341702
Conflict of interest statement: None declared
688. J Pain Symptom Manage. 2014 Nov;48(5):784-96. doi:

Pain medication management processes used by oncology outpatients and family

caregivers part II: home and lifestyle contexts.
Schumacher KL(1), Plano Clark VL(2), West CM(3), Dodd MJ(3), Rabow MW(3),
Miaskowski C(3).
Author information:
(1)College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska,
USA. Electronic address: kschumacher@unmc.edu.
(2)University of Cincinnati, Cincinnati, Ohio, USA.
(3)University of California San Francisco, San Francisco, California, USA.
Comment in
J Pain Symptom Manage. 2014 Nov;48(5):760-1.
CONTEXT: Despite the increasing complexity of medication regimens for persistent

cancer pain, little is known about how oncology outpatients and their family
caregivers manage pain medications at home.
OBJECTIVES: To describe the day-to-day management of pain medications from the
perspectives of oncology outpatients and their family caregivers who participated
in a randomized clinical trial of a psychoeducational intervention called the
Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain
medication management in the context of highly individualized home environments
and lifestyles.
METHODS: This qualitative study was conducted as part of a randomized clinical
trial, in which an embedded mixed methods research design was used.
Audio-recorded dialogue among patients, family caregivers, and intervention
nurses was analyzed using qualitative research methods.
RESULTS: Home and lifestyle contexts for managing pain medications included
highly individualized home environments, work and recreational activities,
personal routines, and family characteristics. Pain medication management
processes particularly relevant in these contexts included understanding,
organizing, storing, scheduling, remembering, and taking the medications. With
the exception of their interactions with the intervention nurses, most study
participants had little involvement with clinicians as they worked through these
processes.
CONCLUSION: Pain medication management is an ongoing multidimensional process,
each step of which has to be mastered by patients and their family caregivers
when cancer treatment and supportive care are provided on an outpatient basis.
Realistic patient- and family-centered skill-building interventions are needed to
achieve effective and safe pain medication management in the contexts of
individual home environments and lifestyles.

PMCID: PMC4185301
689. J Clin Transl Endocrinol. 2017 Jul 26;9:48-54. doi:

10.1016/j.jcte.2017.07.003.
eCollection 2017 Sep.
Examining diabetes distress, medication adherence, diabetes self-care activities,

diabetes-specific quality of life and health-related quality of life among type 2
diabetes mellitus patients.
Jannoo Z(1), Wah YB(2), Lazim AM(2), Hassali MA(3).
Author information:
(1)University of Mauritius, Faculty of Social Studies and Humanities, Department
of Economics and Statistics, Réduit, Mauritius.
(2)Universiti Teknologi MARA, Faculty of Computer and Mathematical Sciences,
Centre of Statistical and Decision Science Studies, Sek 1, Shah Alam, Malaysia.
(3)Universiti Sains Malaysia, School of Pharmaceutical Sciences, Penang,
Malaysia.
AIMS: Health-Related Quality of Life (HRQoL) has been increasing attention in

health outcome studies. Factors that individually influence HRQoL, diabetes
self-care behaviors, and medication adherence have been widely investigated;
however, most previous studies have not tested an integrated association between
multiple health outcomes. The purpose of this study was to formulate a
hypothetical structural equation model linking HRQoL, diabetes distress, diabetes
self-care activities, medication adherence and diabetes-dependent QoL in patients
with Type 2 Diabetes Mellitus (T2DM).
METHODS: A cross-sectional study design was employed, and 497 patients with T2DM
were recruited from outpatient clinics in three public hospitals and one
government clinic. The patients completed a series of questionnaires. The
hypothetical model was tested using Structural Equation Modeling (SEM) analysis.
RESULTS: The values of the multiple fit indices indicated that the proposed model
provided a good fit to the data. SEM results showed that medication adherence
(MMAS) had a significant direct effect on diabetes distress (PAID)
(Beta = -0.20). The self-care activities (SDSCA) construct was significantly
related to PAID (Beta = -0.24). SDSCA was found to have a significant
relationship with HRQoL (SF-36) (Beta = 0.11). Additionally, diabetes distress
had a significant effect (Beta = -0.11) on HRQoL of patients. Finally, ADDQoL had
a significant effect on HRQoL (Beta = 0.12).
CONCLUSIONS: The various health outcome indicators such as self-care behaviors,
diabetes distress, medication adherence and diabetes-dependent QoL need to be
considered in clinical practice for enhancing HRQoL in those patients.
DOI: 10.1016/j.jcte.2017.07.003
PMCID: PMC5651286
PMID: 29067270
690. Aust Fam Physician. 2016 Sep;45(9):661-7.
Medication-related queries received for 'after hours GP helpline' - Comparison of

callers' intentions with GPs' advice.
Tariq A, Li L, Byrne M, Robinson M, Westbrook J, Baysari MT.
BACKGROUND: Limited studies have explored the actual usage of the 'after hours GP
helpline' (AGPH).
OBJECTIVE: The objectives of the article are to describe medication-related calls
to the AGPH and compare callers' original intentions versus the advice provided
by the general practitioner (GP).
METHODS: We performed a detailed descriptive statistical analysis of
medication-related queries received by the AGPH in 2014.
RESULTS: In 2014, 13,600 medication-related calls were made to the national AGPH.
For 86.56% of calls, GPs advised callers to either self-care only, or self-care
overnight and see their GP during business hours. Of the 1442 calls where the
caller had originally intended to visit the emergency department (ED), 76.70%
were advised by GPs to self-care, and only 5.48% were advised to call 000 or
visit an ED. Overall, less than 2.26% of callers were directed to the ED, despite
10.60% of people originally calling with this intention.
DISCUSSION: The availability of an after-hours service potentially prevented 1363
people from unnecessarily attending an ED and directed 228 people who had
originally underestimated the seriousness of their condition to an ED.
691. AIDS Behav. 2017 Jul;21(7):2005-2013. doi: 10.1007/s10461-017-1782-x.
Cannabis Use, Medication Management and Adherence Among Persons Living with HIV.
Vidot DC(1), Lerner B(2), Gonzalez R(2).
Author information:
(1)School of Nursing and Health Sciences, University of Miami, 5030 Brunson Ave,
Coral Gables, FL, 33146, USA. DVidot@miami.edu.
(2)Department of Psychology, Center for Children and Families, Florida
International University, Miami, FL, USA.
Cannabis is used to relieve nausea, trigger weight gain, and reduce pain among
adults living with HIV; however, the relationship between its use and medication
adherence and management is unclear. Participants (N = 107) were from an ongoing
cohort study of community-dwelling HIV+ adults, stratified by cannabis (CB) use:
HIV+/CB+ (n = 41) and HIV+/CB- (n = 66). CB+ participants either tested positive
in a urine toxicology screen for THC or had a self-reported history of regular
and recent use. HIV-status was provided by physician results and/or biomarker
assessment. Adherence was measured via the Morisky scale and medication
management was assessed via the Medication Management Test-Revised. After
adjusting for gender, we found no association between cannabis use group and
adherence nor medication management. The amount of cannabis used was also not
associated with measures of adherence and management. Preliminary findings
suggest that cannabis use may not adversely influence medication
adherence/management among adults living with HIV.
DOI: 10.1007/s10461-017-1782-x
PMCID: PMC5503453
692. Shanghai Arch Psychiatry. 2014 Dec;26(6):332-8. doi:

10.11919/j.issn.1002-0829.214076.
Effect of self-management training on adherence to medications among community

residents with chronic schizophrenia: a singleblind randomized controlled trial
in Shanghai, China.
Zhou B(1), Gu Y(1).
Author information:
(1)Pudong Yingbo Community Health Service Center, Shanghai, China.
BACKGROUND: Many community dwelling individuals with schizophrenia do not take

medications regularly and, thus, are prone to frequent relapses.
AIM: Evaluate the effectiveness of self-management training on adherence to
medications and relapse among individuals with chronic schizophrenia living in
the community.
METHODS: A total of 201 individuals with chronic schizophrenia living in the
urban and rural communities of Shanghai Municipality were randomized into a
treatment as usual control group (n=98) or a selfmanagement intervention group
(n=103) that received weekly self-management skills training for 6 months
followed by 24 months of monthly group booster sessions in which a community
health worker reviewed patients' self-management checklists. Two psychiatrists
blind to the treatment status of patients, assessed adherence to medications
using the Morisky Medication Adherence Scale and patients' insight into their
illness using the Scale to Assess Unawareness of Mental Disorders (SAUMD) at
baseline and 30 months after baseline. A total of 194 individuals (95.6%)
completed the study.
RESULTS: There were no differences between groups at baseline, but after 30
months the intervention group had significantly better medication compliance,
significantly greater insight into their illness, and (by self-report) were using
significantly higher dosages of antipsychotic medication. Only 2 (1.9%) of the
103 intervention group participants relapsed (i.e., experienced one or more
re-hospitalizations) over the 30 months of follow-up, but 14 (14.3%) of the 98
control group subjects relapsed (X (2)=8.83, p=0.003).
CONCLUSIONS: Given the large sample size, relatively long follow-up, randomized
design, and single-blind evaluation of outcomes the dramatic reduction in relapse
and improvements in medication adherence and insight identified in this study are
robust findings. These results extended our previous findings, which demonstrated
the benefit of self-management training on improving the symptoms and social
functioning of individuals with chronic schizophrenia living in the community.
Cost-benefit studies are now needed to assess the feasibility of up-scaling this
self-management intervention to a wide range of communities.
Publisher:
许多社区精神分裂症患者服药不规律因而很容易频繁复发。评估自我管理培训对社区慢性精神分裂症患者服药依
从性和复发情况的影响。共纳入上海市城市和农村的社区慢性精神分裂症
患者 201 例，随机分为常规治疗组（n=98）或自我管理干预组（n=103）。干预组接受为期 6 个月的每周一次自
我管理技能培训，之后参加每月一次的加强小组会议，由社区
卫生工作者检查患者的自我管理清单，共 24 个月。由两名单盲于患者治疗情况的精神科医生使用 Morisky 服药
依从性量表评估患者服药依从性并采用自知力评估量表（Scal
e to Assess Unawareness of Mental
Disorders，SAUMD）了解基线时和 30 个月后患者的自知力。总共 194 人（95.6％）完成研究。基线时两组间
无显著差异，但在 30 个月后，干预组服药依从性比
常规治疗组好，对疾病的自知力提高，自我报告使用抗精神病药物的剂量相对高。在随访 30 个月里，干预组 103
例患者中只有 2 例（1.9％）复发（即一次或多次住院），然而对
照组 98 例患者中有 14 例（14.3％）复发（X2=8.83,
p=0.003）。本研究样本量大、随访时间相对长、随机设计并采用单盲法评估，研究结果的说服力相对强。本研
究发现自我管理干预后患者复发显著减少、服药依从性改善以及自
知力提高。这些结果拓展了我们先前的研究发现，显示自我管理训练可以有效改善社区慢性精神分裂症患者的症
状和社会功能。今后需要纳入成本效益分析研究，评估将自我管理干预扩
大到其他更多社区的可行性。
DOI: 10.11919/j.issn.1002-0829.214076
PMCID: PMC4311106
PMID: 25642107
693. J Gerontol A Biol Sci Med Sci. 2018 Jun 19. doi: 10.1093/gerona/gly104. [Epub
ahead of print]
Is Who you Ask Important? Concordance Between Survey and Registry Data on
Medication Use Among Self- and Proxy-Respondents in the Longitudinal Study of
Aging Danish Twins and the Danish 1905-Cohort Study.
Oksuzyan A(1), Sauer T(1)(2), Gampe J(1), Höhn A(1)(3), Wod M(3)(4), Christensen
K(3)(4), Wastesson JW(5).
Author information:
(1)Max Planck Institute for Demographic Research, Rostock, Germany.
(2)Institute for Sociology and Demography, University of Rostock, Germany.
(3)Department of Epidemiology, Biostatistics and Biodemography, Institute of
Public Health, University of Southern Denmark, Odense.
(4)Danish Aging Research Center, Institute of Public Health, University of
Southern Denmark, Odense.
(5)Aging Research Center, Department of Neurobiology, Care Sciences and Society,
Karolinska Institute and Stockholm University, Sweden.
Background: This study investigates the accuracy of the reporting of medication

use by proxy- and self-respondents, and it compares the prognostic value of the
number of medications from survey and registry data for predicting mortality
across self- and proxy-respondents.
Methods: The study is based on the linkage of the Longitudinal Study of Aging
Danish Twins and the Danish 1905-Cohort Study with the Danish National
Prescription Registry. We investigated the concordance between survey and
registry data, and the prognostic value of medication use when assessed using
survey and registry data, to predict mortality for self- and proxy-respondents at
intake surveys.
Results: Among self-respondents, the agreement was moderate (κ = 0.52-0.58) for
most therapeutic groups, whereas among proxy-respondents, the agreement was low
to moderate (κ = 0.36-0.60). The magnitude of the relative differences was,
generally, greater among proxies than among self-respondents. Each additional
increase in the total number of medications was associated with 7%-8% mortality
increase among self- and 4%-6% mortality increase among proxy-respondents in both
the survey and registry data. The predictive value of the total number of
medications estimated from either data source was lower among proxies
(c-statistic = 0.56-0.58) than among self-respondents (c-statistic = 0.74).
Conclusions: The concordance between survey and registry data regarding
medication use and the predictive value of the number of medications for
mortality were lower among proxy- than among self-respondents.
DOI: 10.1093/gerona/gly104
PMCID: PMC6477639
PMID: 29924318
694. Pharmacoepidemiol Drug Saf. 2016 Jul;25(7):827-35. doi: 10.1002/pds.3970. Epub
2016 Jan 29.
Agreement between Medicare pharmacy claims, self-report, and medication inventory

for assessing lipid-lowering medication use.
Colantonio LD(1), Kent ST(1), Kilgore ML(2), Delzell E(1), Curtis JR(1)(3),
Howard G(4), Safford MM(3), Muntner P(1)(3).
Author information:
(1)Department of Epidemiology, University of Alabama at Birmingham, Birmingham,
AL, USA.
(2)Department of Health Care Organization and Policy, University of Alabama at
Birmingham, Birmingham, AL, USA.
(3)Department of Medicine, University of Alabama at Birmingham, Birmingham, AL,
USA.
(4)Department of Biostatistics, University of Alabama at Birmingham, Birmingham,
AL, USA.
Comment in
Pharmacoepidemiol Drug Saf. 2016 Jul;25(7):844-6.
BACKGROUND: Medicare claims have been used to study lipid-lowering medication

(LLM) use among US adults.
METHODS: We analyzed the agreement between Medicare claims for LLM and LLM use
indicated by self-report during a telephone interview and, separately, by a
medication inventory performed during an in-home study visit upon enrollment into
the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. We
included REGARDS participants ≥65 years enrolled in 2006-2007 with Medicare
pharmacy benefits (Part D) from 120 days before their telephone interview through
their medication inventory (n = 899).
RESULTS: Overall, 39.2% and 39.5% of participants had a Medicare claim for an LLM
within 120 days prior to their interview and medication inventory, respectively.
Also, 42.7% of participants self-reported using LLMs, and 41.8% had an LLM in
their medication inventory. The Kappa statistic (95% confidence interval [CI])
for agreement of Medicare claims with self-report and medication inventory was
0.68 (0.63-0.73) and 0.72 (0.68-0.77), respectively. No Medicare claims for LLMs
were present for 22.1% (95%CI: 18.1-26.6%) of participants who self-reported
taking LLMs and 18.9% (15.1-23.3%) with LLMs in their medication inventory.
Agreement between Medicare claims and self-report was lower among Black male
individuals (Kappa = 0.34 [95%CI: 0.14-0.54]) compared with Black female
individuals (0.70 [0.61-0.79]), White male individuals (0.65 [0.56-0.75]), and
White female individuals (0.79 [0.72-0.86]). Agreement between Medicare claims
and the medication inventory was also low among Black male individuals
(Kappa = 0.48 [95%CI: 0.29-0.66]).
CONCLUSIONS: Although substantial agreement exists, many Medicare beneficiaries
who self-report LLM use or have LLMs in a medication inventory have no claims for
these medications. Copyright © 2016 John Wiley & Sons, Ltd.
Copyright © 2016 John Wiley & Sons, Ltd.
DOI: 10.1002/pds.3970
PMCID: PMC5039944

eCollection 2017.
Economic costs and health-related quality of life for hand, foot and mouth
disease (HFMD) patients in China.
Zheng Y(1), Jit M(2)(3), Wu JT(4), Yang J(1), Leung K(4), Liao Q(1), Yu H(5).
Author information:
(1)Key Laboratory of Surveillance and Early-warning on Infectious Disease,
Division of Infectious Disease, Chinese Center for Disease Control and
Prevention, Beijing, China.
(2)Modelling and Economics Unit, Public Health England, London, United Kingdom.
(3)Department of Infectious Disease Epidemiology, London School of Hygiene &
(4)WHO Collaborating Centre for Infectious Disease Epidemiology and Control,
School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong
Kong, Hong Kong Special Administrative Region, China.
(5)School of Public Health, Fudan University, Key Laboratory of Public Health
Safety, Ministry of Education, Shanghai, China.
BACKGROUND: Hand, foot and mouth disease (HFMD) is a common illness in China that
mainly affects infants and children. The objective of this study is to assess the
economic cost and health-related quality of life associated with HFMD in China.
METHOD: A telephone survey of caregivers were conducted in 31 provinces across
China. Caregivers of laboratory-confirmed HFMD patients who were registered in
the national HFMD enhanced surveillance database during 2012-2013 were invited to
participate in the survey. Total costs included direct medical costs (outpatient
care, inpatient care and self-medication), direct non-medical costs
(transportation, nutrition, accommodation and nursery), and indirect costs for
lost income associated with caregiving. Health utility weights elicited using
EuroQol EQ-5D-3L and EQ-Visual Analogue Scale (VAS) were used to calculate
associated loss in quality adjusted life years (QALYs).
RESULTS: The subjects comprised 1136 mild outpatients, 1124 mild inpatients, 1170
severe cases and 61 fatal cases. The mean total costs for mild outpatients, mild
inpatients, severe cases and fatal cases were $201 (95%CI $187, $215), $1072
(95%CI $999, $1144), $3051 (95%CI $2905, $3197) and $2819 (95%CI $2068, $3571)
respectively. The mean QALY losses per HFMD episode for mild outpatients, mild
inpatients and severe cases were 3.6 (95%CI 3.4, 3,9), 6.9 (95%CI 6.4, 7.4) and
13.7 (95%CI 12.9, 14.5) per 1000 persons. Cases who were diagnosed with EV-A71
infection and had longer duration of illness were associated with higher total
cost and QALY loss.
CONCLUSION: HFMD poses a high economic and health burden in China. Our results
provide economic and health utility data for cost-effectiveness analysis for HFMD
vaccination in China.
PMCID: PMC5608208
696. Malar J. 2018 Dec 18;17(1):476. doi: 10.1186/s12936-018-2630-9.
Caregiver responses and association with delayed care-seeking in children with

uncomplicated and severe malaria.
Mpimbaza A(1), Katahoire A(2), Rosenthal PJ(3), Karamagi C(4)(5), Ndeezi G(4).
Author information:
(1)Child Health and Development Centre, Makerere University, College of Health
Sciences, Kampala, Uganda. arthurwakg@yahoo.com.
(2)Child Health and Development Centre, Makerere University, College of Health
Sciences, Kampala, Uganda.
(3)Department of Medicine, University of California, San Francisco, USA.
(4)Department of Pediatrics and Child Health, Makerere University, College of
Health Sciences, Kampala, Uganda.
(5)Clinical Epidemiology Unit, Department of Medicine, Makerere University,
College of Health Sciences, Kampala, Uganda.
BACKGROUND: Gaps remain in understanding the role of caregiver responses on time

to seek appropriate care. The objective of this study was to describe caregiver
responses to illness and the impact of these responses on time to seek
appropriate care among children with malaria.
METHODS: A case-control study of 325 children with severe (cases) and 325
children with uncomplicated (controls) malaria was conducted in Jinja, Uganda.
Caregivers' responses to their children's illnesses and time to seek appropriate
care were documented. Responses included staying at home, seeking care at drug
shops, and seeking care at public health facilities classified into two types:
(1) health facilities where caregiver initially sought care before enrollment,
and (2) health facilities where children were provided appropriate care and
enrolled in the study. Weighted Cox regression was used to determine risk factors
for delays in time to seek appropriate care within 24 h of illness onset.
RESULTS: Children staying home on self-medication was the most common initial
response to illness among caregivers of controls (57.5%) and cases (42.4%,
p < 0.001), followed by staying at home without medication (25.2%) and seeking
care at drug shops (32.0%) for caregivers of controls and cases, respectively.
Seeking care at drug shops was more common among caregivers of cases than of
controls (32.0% vs. 12.3%; p < 0.001). However, compared to public health
facilities, drug shops offered sub-optimal services with children less likely to
have been examined (50.0% vs. 82.9%; p < 0.001) or referred to another facility
(12.5% vs. 61.4%; p < 0.001). Upon adjustment for known risk factors for delay,
initially seeking care at a drug shop (HR 0.37, p = 0.036) was associated with
delay in seeking care at a health facility where appropriate care was provided.
In contrast, those initially seeking care at public health facility before
enrollment were more likely to subsequently seek care at another public health
facility where appropriate care was provided (HR 5.55, p < 0.001).
CONCLUSION: Caregivers should be educated on the importance of promptly seeking
care at a health facility where appropriate care can be provided. The role of
drug shops in providing appropriate care to children with malaria needs to be
reviewed.
DOI: 10.1186/s12936-018-2630-9
PMCID: PMC6299589
697. Open Rheumatol J. 2016 Sep 30;10:60-70. eCollection 2016.
Medication-related Self-management Behaviors among Arthritis Patients: Does

Attentional Coping Style Matter?
Geryk LL(1), Blalock SJ(1), DeVellis RF(2), Jordan JM(3), Han PK(4), Carpenter
DM(1).
Author information:
(1)University of North Carolina, UNC Eshelman School of Pharmacy, Division of
Pharmaceutical Outcomes and Policy, Chapel Hill, NC, USA.
(2)University of North Carolina, Gillings School of Global Public Health,
Department of Health Behavior, University of North Carolina, Chapel Hill, USA.
(3)Thurston Arthritis Research Center, University of North Carolina, Chapel Hill,
USA.
(4)Maine Medical Center, Center for Outcomes Research and Evaluation, Portland,
ME, USA.
OBJECTIVE: The aim of this study was to investigate the relationship between the
attentional coping styles (monitoring and blunting) of rheumatoid arthritis (RA)
and osteoarthritis (OA) patients and: (a) receipt of medication information; (b)
receipt of conflicting medication information; (c) ambiguity aversion; (d)
medication-related discussions with doctors and spouse/partners; and (e)
medication adherence.
METHOD: A sample of 328 adults with a self-reported diagnosis of arthritis (RA
n=159; OA n=149) completed an Internet-based survey. Coping style was assessed
using the validated short version of the Miller Behavioral Style Scale. Measures
related to aspects of medication information receipt and discussion and validated
measures of ambiguity aversion and medication adherence (Vasculitis
Self-Management Survey) were collected. Pearson correlation coefficients, ANOVA,
independent samples t-tests and multiple regression models were used to assess
associations between coping style and the other variables of interest.
RESULTS: Arthritis patients in our sample were more likely to be high monitors
(50%) than high blunters (36%). Among RA patients, increased information-receipt
was significantly associated with decreased monitoring (b = -1.06, p = .001).
Among OA patients, increased information-receipt was significantly associated
with increased blunting (b = .60, p = .02).
CONCLUSION: In our sample of patients with arthritis, attentional coping style is
not in accordance with the characteristic patterns outlined in the acute and
chronic disease coping literature.
DOI: 10.2174/1874312901610010060
PMCID: PMC5080870
PMID: 27843510
698. J Med Internet Res. 2016 Jun 22;18(6):e116. doi: 10.2196/jmir.5429.
The Influence of Wireless Self-Monitoring Program on the Relationship Between

Patient Activation and Health Behaviors, Medication Adherence, and Blood Pressure
Levels in Hypertensive Patients: A Substudy of a Randomized Controlled Trial.
Kim JY(1), Wineinger NE, Steinhubl SR.
Author information:
(1)Digital medicine, Scripps Translational Science Institute, La Jolla, CA,
United States.
BACKGROUND: Active engagement in the management of hypertension is important in

improving self-management behaviors and clinical outcomes. Mobile phone
technology using wireless monitoring tools are now widely available to help
individuals monitor their blood pressure, but little is known about the
conditions under which such technology can effect positive behavior changes or
clinical outcomes.
OBJECTIVE: To study the influence of wireless self-monitoring program and patient
activation measures on health behaviors, medication adherence, and blood pressure
levels as well as control of blood pressure in hypertensive patients.
METHODS: We examined a subset of 95 hypertensive participants from a 6-month
randomized controlled trial designed to determine the utility of a wireless
self-monitoring program (n=52 monitoring program, n=43 control), which consisted
of a blood pressure monitoring device connected with a mobile phone, reminders
for self-monitoring, a Web-based disease management program, and a mobile app for
monitoring and education, compared with the control group receiving a standard
disease management program. Study participants provided measures of patient
activation, health behaviors including smoking, drinking, and exercise,
medication adherence, and blood pressure levels. We assessed the influence of
wireless self-monitoring as a moderator of the relationship between patient
activation and health behaviors, medication adherence, and control of blood
pressure.
RESULTS: Improvements in patient activation were associated with improvements in
cigarette smoking (beta=-0.46, P<.001) and blood pressure control (beta=0.04,
P=.02). This relationship was further strengthened in reducing cigarettes
(beta=-0.60, P<.001), alcohol drinking (beta=-0.26, P=.01), and systolic
(beta=-0.27, P=.02) and diastolic blood pressure (beta=-0.34, P=.007) at 6 months
among individuals participating in the wireless self-monitoring program. No
differences were observed with respect to medication adherence.
CONCLUSIONS: Participation in a wireless self-monitoring program provides
individuals motivated to improve their health management with an added benefit
above and beyond that of motivation alone. Hypertensive individuals eager to
change health behaviors are excellent candidates for mobile health
self-monitoring..
TRIAL REGISTRATION: ClinicalTrials.gov NCT01975428,
https://clinicaltrials.gov/ct2/show/NCT01975428 (Archived by WebCite at
http://www.webcitation.org/6iSO5OgOG).
DOI: 10.2196/jmir.5429
PMCID: PMC4935792
699. Optom Vis Sci. 2016 Jul;93(7):731-7. doi: 10.1097/OPX.0000000000000856.
Communication Predicts Medication Self-Efficacy in Glaucoma Patients.
Carpenter DM(1), Blalock SJ, Sayner R, Muir KW, Robin AL, Hartnett ME,
Giangiacomo AL, Tudor GE, Sleath BL.
Author information:
(1)*PhD, MSPH †PhD, MPH ‡PharmD §MD ∥PhD Division of Pharmaceutical Outcomes and
Policy (DMC), University of North Carolina at Chapel Hill, Asheville Satellite
Campus, Asheville, North Carolina; Division of Pharmaceutical Outcomes and Policy
(SJB, BLS), University of North Carolina at Chapel Hill, Chapel Hill, North
Carolina; School of Medicine (RS), Stanford University, Stanford, California;
Duke University School of Medicine & Durham VA Medical Center (KWM), Durham,
North Carolina; Wilmer Institute and Bloomberg School of Public Health (ALR),
Johns Hopkins University, Baltimore, Maryland; Department of Ophthalmology (ALR),
University of Maryland, College Park, Maryland; John A. Moran Eye Center (MEH),
University of Utah, Salt Lake City, Utah; School of Medicine (ALG), Emory
University, Atlanta, Georgia; and Department of Mathematics and Statistics (GET),
Husson University, Bangor, Maine.
PURPOSE: Medication self-efficacy, or patients' confidence that they can perform

medication-related behaviors, is associated with better glaucoma medication
adherence. Little is known about how to enhance glaucoma patients' medication
self-efficacy. Our purpose is to examine whether patient-provider communication
increases glaucoma patients' medication self-efficacy.
METHODS: During an 8-month cohort study of 279 glaucoma patients and 15
providers, two office visits were videotape-recorded, transcribed, and coded for
six patient-provider communication behaviors. A validated scale was used at
baseline and 8-month follow-up to assess patients' confidence in overcoming
adherence barriers (adherence barriers self-efficacy) and carrying out tasks to
use eye drops correctly (eye drop task self-efficacy). We ran two generalized
estimating equations to examine whether more frequent patient-provider
communication during office visits predicted increased patient adherence barriers
self-efficacy and eye drop task self-efficacy at 8-month follow-up.
RESULTS: For each additional topic providers educated about, patients reported an
average increase of 0.35 in self-efficacy in overcoming adherence barriers (p <
0.001). Patients also reported an average increase of 1.01 points in eye drop
task self-efficacy when providers asked about patients' views of glaucoma and its
treatment versus not (p < 0.001). Patients who asked more medication questions (p
< 0.001) and African-American patients (p < 0.05) reported lower adherence
barriers self-efficacy by 0.30 and 2.15 points, respectively. Women had a 0.63
lower eye drop task self-efficacy than men (p < 0.05).
CONCLUSIONS: When providers educate glaucoma patients and assess patient views
about glaucoma and its treatment, patients report higher medication
self-efficacy. Providers should be aware that patients who ask more medication
questions may have less confidence in their ability to overcome barriers to
adherence.
DOI: 10.1097/OPX.0000000000000856
PMCID: PMC4915983
700. Oncology. 2016;91(4):231-236. Epub 2016 Aug 3.
Errors and Nonadherence in Pediatric Oral Chemotherapy Use.
Walsh K(1), Ryan J, Daraiseh N, Pai A.
Author information:
(1)James M. Anderson Center, Cincinnati Children's Hospital, Cincinnati, Ohio,
USA.
BACKGROUND: Nonadherence and medication error both limit the effectiveness of

oral chemotherapy. The overlap between nonadherence and medication error is not
well studied in children, and interventions strategies differ for each. Our
objective was to describe nonadherence and errors in children with cancer to
inform future interventions.
METHODS: Nonadherence was measured using two self-report tools. Medication error
was measured using medication review and observation of administration at home.
Two clinicians made judgments about whether each error also represented an
episode of nonadherence.
RESULTS: Of 72 errors detected in 92 home visits, 27 were also instances of
nonadherence. For example, parents gave a child 1 tablet of mercaptopurine every
day rather than the prescribed 1 tablet 5 days a week and ½ tablet on weekends.
Clinician reviewers judged that family interventions and health system
interventions would be most effective in preventing the errors and nonadherence
identified in this population of children with cancer.
DISCUSSION: The relationship between medication errors and nonadherence is not
well described in the literature. Our data indicate that medication error and
nonadherence coexist in the same population and in the same patient.
Interventions should address both to most effectively support self-management.
© 2016 S. Karger AG, Basel.
DOI: 10.1159/000447700
PMCID: PMC5063697
Conflict of interest statement: None of the authors have conflicts of interest

701. Fam Pract. 2015 Jun;32(3):311-6. doi: 10.1093/fampra/cmv002. Epub 2015 Feb 24.
Does patient experience of multimorbidity predict self-management and health

outcomes in a prospective study in primary care?
Kenning C(1), Coventry PA(2), Gibbons C(3), Bee P(4), Fisher L(3), Bower P(5).
Author information:
(1)Institute of Population Health, NIHR School for Primary Care Research, Centre
for Primary Care, Manchester Academic Health Science Centre (MAHSC),
Cassandra.kenning@manchester.ac.uk.
(2)Institute of Population Health, NIHR Collaboration for Applied Health Research
and Care, Greater Manchester (GM-CLAHRC), Manchester Academic Health Science
Centre (MAHSC).
(3)Institute of Population Health, NIHR School for Primary Care Research, Centre
for Primary Care, Manchester Academic Health Science Centre (MAHSC).
(4)Institute of Population Health, School of Nursing, Midwifery and Social Work
and.
(5)Institute of Population Health, NIHR Greater Manchester Primary Care Patient
Safety Translational Research Centre, Centre for Primary Care, Manchester
Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
BACKGROUND: There is a need to better understand the mechanisms which lead to

poor outcomes in patients with multimorbidity, especially those factors that
might be amenable to intervention.
OBJECTIVE: This research aims to explore what factors predict self-management
behaviour and health outcomes in patients with multimorbidity in primary care in
the UK.
METHODS: A prospective study design was used. Questionnaires were mailed out to
1460 patients with multimorbidity. Patients were asked to complete a range of
self-report measures including measures of multimorbidity, measures of their
experience of multimorbidity and service delivery and outcomes (three measures of
self-management: behaviours, Self-monitoring and Insight and medication
adherence; and a measure of self-reported health).
RESULTS: In total, 36% (n = 499) of patients responded to the baseline survey and
80% of those respondents completed follow-up. Self-management behaviour at 4
months was predicted by illness perceptions around the consequences of individual
conditions. Self-monitoring and Insight at 4 months was predicted by patient
experience of 'Hassles' in health services. Self-reported medication adherence at
4 months was predicted by health status, Self-monitoring and Insight and
'Hassles' in health services. Perceived health status at 4 months was predicted
by age and patient experience of multimorbidity.
CONCLUSIONS: This research shows that different factors, particularly around
patients' experiences of health care and control over their treatment, impact on
various types of self-management. Patient experience of multimorbidity was not a
critical predictor of self-management but did predict health status in the short
term. The findings can help to develop and target interventions that might
improve outcomes in patients with multimorbidity.
© The Author 2015. Published by Oxford University Press.
DOI: 10.1093/fampra/cmv002
PMCID: PMC4445135
702. Cultur Divers Ethnic Minor Psychol. 2018 Jan;24(1):15-25. doi:

10.1037/cdp0000165. Epub 2017 Jun 12.
Still I rise: The need for self-validation and self-care in the midst of
adversities faced by Black women with HIV.
Dale SK(1), Pierre-Louis C(1), Bogart LM(2), O'Cleirigh C(1), Safren SA(3).
Author information:
(1)Department of Psychiatry, Massachusetts General Hospital.
(2)RAND Health, RAND Corporation.
(3)Psychology Department, University of Miami.
OBJECTIVES: Psychosocial factors of trauma and abuse, racial discrimination, HIV

stigma, and gender-related stressors (e.g., prioritizing others' needs) have been
associated with antiretroviral treatment (ART) nonadherence and poor viral
suppression among Black women living with HIV (BWLWH). To inform the development
of an intervention addressing these psychosocial factors to improve ART
adherence, the authors sought the insight of BWLWH.
METHOD: Qualitative semistructured interviews were conducted with 30 BWLWH to
gather information on their experiences with trauma, racism, HIV stigma,
gender-related stressors, ART adherence, and coping strategies, and their
insights on the proposed intervention. Participants' interviews were
audio-recorded, transcribed, and coded using thematic content analysis and
grounded theory.
RESULTS: Participants shared (a) their experiences with trauma/abuse, racism,
HIV-stigma, gender-related stress, and medication adherence; (b) coping
strategies they use (e.g., social support, awareness [acknowledging systemic
racism], assertiveness, selective disclosure of HIV status, and prioritizing the
self); (c) how each of these adversities relate to their medication adherence and
how they found ways to self-validate and practice self-primacy and self-care,
including medication adherence in spite of adversities; and (d) enthusiasm for
the proposed intervention.
CONCLUSIONS: Culturally adapted interventions are needed to improve the health of
BWLWH by enhancing coping strategies for the multiple adversities they face and
promoting self-validation, self-primacy, and self-care in spite of adversities.
(PsycINFO Database Record
DOI: 10.1037/cdp0000165
PMCID: PMC5726949
703. J Patient Exp. 2017 Dec;4(4):169-176. doi: 10.1177/2374373517714452. Epub 2017

Jun 20.
A Description of Patient and Provider Experience and Clinical Outcomes After

Heart Failure Shared Medical Appointment.
Cohen LB(1)(2), Parent M(1), Taveira TH(1)(2)(3), Dev S(4), Wu WC(1)(3).
Author information:
(1)Department of Veterans Affairs, Providence VA Medical Center, Providence, RI,
USA.
(2)Department of Pharmacy Practice, University of Rhode Island, Kingston, RI,
USA.
(3)Department of Medicine, Alpert Medical School, Brown University, Providence,
RI, USA.
(4)Phoenix VA Healthcare System, Phoenix, AZ, USA.
Background: Shared medical appointments (SMAs) are clinical visits in which

several patients meet with 1 or more providers at the same time.
Objective: To describe the outcomes of an interdisciplinary SMA for veterans
recently discharged for heart failure (HF).
Methods: A retrospective chart review for patients' readmission rates, survival,
medication adherence, and medication-related problems. For qualitative outcomes,
we performed semistructured interviews on 12 patients who had undergone HF SMAs
and their respective caregivers focusing on care satisfaction, HF knowledge,
disease self-care, medication reconciliation, and peer support.
Results: The cohort comprised 70 patients-49% had left ventricular function <40%
and 50% were prescribed >10 medications. Medication-related problems occurred in
60% of patients. Interviews revealed overall satisfaction with HF-SMA, but
patients felt overwhelmed with HF instructions, perceived lack of peer support
and self-efficacy, and feelings of hopelessness related to HF.
Conclusion: Shared medical appointments are well-perceived. Medication problems
and need for medication management are prevalent along with patient's lack of
self-efficacy in HF care. Multiple HF-SMA visits may be needed to reinforce
concepts, reduce confusion, and garner peer support.
DOI: 10.1177/2374373517714452
PMCID: PMC5734515
PMID: 29276763
Conflict of interest statement: Declaration of Conflicting Interests: The

704. AMIA Annu Symp Proc. 2017 Feb 10;2016:984-993. eCollection 2016.
Using Natural Language Processing and Network Analysis to Develop a Conceptual

Framework for Medication Therapy Management Research.
Ogallo W(1), Kanter AS(1).
Author information:
(1)department of Biomedical Informatics, Columbia University, New York.
This paper describes a theory derivation process used to develop a conceptual

framework for medication therapy management (MTM) research. The MTM service model
and chronic care model were selected as parent theories. Review article abstracts
targeting medication therapy management in chronic disease care were retrieved
from Ovid Medline (2000-2016). Unique concepts in each abstract were extracted
using MetaMap and their pairwise cooccurrence determined. The information was
used to construct a network graph of concept co-occurrence that was analyzed to
identify content for the new conceptual model. 142 abstracts were analyzed.
Medication adherence is the most studied drug therapy problem and co-occurred
with concepts related to patient-centered interventions targeting
self-management. The enhanced model consists of 65 concepts clustered into 14
constructs. The framework requires additional refinement and evaluation to
determine its relevance and applicability across a broad audience including
underserved settings.
PMCID: PMC5333323
705. Kidney Int. 2017 Oct;92(4):972-978. doi: 10.1016/j.kint.2017.03.018. Epub 2017
May 18.
The Perceived Medical Condition Self-Management Scale can be applied to patients

with chronic kidney disease.
Wild MG(1), Wallston KA(1), Green JA(2), Beach LB(3), Umeukeje E(3), Wright Nunes
JA(4), Ikizler TA(3), Steed J(5), Cavanaugh KL(6).
Author information:
(1)Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt University
Medical Center, Nashville, Tennessee, USA; Vanderbilt Center for Kidney Disease,
Nashville, Tennessee, USA.
(2)Geisinger Health System, Danville, Pennsylvania, USA.
(3)Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt
Center for Kidney Disease, Nashville, Tennessee, USA.
(4)University of Michigan, Ann Arbor, Michigan, USA.
(5)Vanderbilt University, Nashville, Tennessee, USA.
(6)Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt
Center for Kidney Disease, Nashville, Tennessee, USA. Electronic address:
kerri.cavanaugh@vanderbilt.edu.
Chronic Kidney Disease (CKD) is a major burden on patients and the health care
system. Treatment of CKD requires dedicated involvement from both caretakers and
patients. Self-efficacy, also known as perceived competence, contributes to
successful maintenance of patient's CKD self-management behaviors such as
medication adherence and dietary regulations. Despite a clear association between
self-efficacy and improved CKD outcomes, there remains a lack of validated
self-report measures of CKD self-efficacy. To address this gap, the Perceived
Kidney/Dialysis Self-Management Scale (PKDSMS) was adapted from the previously
validated Perceived Medical Condition Self-Management Scale. We then sought to
validate this using data from two separate cohorts: a cross-sectional
investigation of 146 patients with end-stage renal disease receiving maintenance
hemodialysis and a longitudinal study of 237 patients with CKD not receiving
dialysis. The PKDSMS was found to be positively and significantly correlated with
self-management behaviors and medication adherence in both patient cohorts. The
PKDSMS had acceptable reliability, was internally consistent, and exhibited
predictive validity between baseline PKDSMS scores and self-management behaviors
across multiple time points. Thus, the PKDSMS is a valid and reliable measure of
CKD patient self-efficacy and supports the development of interventions enhancing
perceived competence to improve CKD self-management.
Copyright © 2017 International Society of Nephrology. Published by Elsevier Inc.

All rights reserved.
DOI: 10.1016/j.kint.2017.03.018
PMCID: PMC5610608
706. Fam Pract. 2018 Mar 27;35(2):142-150. doi: 10.1093/fampra/cmx088.
Medication-taking experiences in attention deficit hyperactivity disorder: a

systematic review.
Rashid MA(1), Lovick S(2), Llanwarne NR(3).
Author information:
(1)UCL Medical School, London, UK.
(2)School of Clinical Medicine, University of Cambridge, Cambridge, UK.
(3)Department of Public Health and Primary Care, University of Cambridge,
Cambridge, UK.
Background: Although attention deficit hyperactivity disorder (ADHD) is a common

condition for which pharmacotherapy is considered an effective treatment,
guidelines on the treatment of ADHD have been challenging to implement.
Considering the views of patients and caregivers involved in medication-taking
could help shed light on these challenges.
Objective: This review combines the findings of individual studies of
medication-taking experiences in ADHD in order to guide clinicians to effectively
share decisions about treatment.
Methods: Five databases (MEDLINE, Embase, PsycINFO, SCOPUS and CINAHL) were
systematically searched for relevant published research articles. Articles were
assessed for quality using a Critical Appraisal Skills Programme checklist, and
synthesis was performed using meta-ethnography.
Results: Thirty-one articles were included in the final synthesis, comprising
studies of caregivers, paediatric patients and adult patients across seven
countries. Findings were categorized into five different constructs, including
coming to terms with ADHD, anticipated concerns about medication, experiences of
the effects of medication, external influences and the development of
self-management. The synthesis demonstrates that decisions surrounding
medication-taking for ADHD evolve as the child patient enters adulthood and moves
towards autonomy and self-management. In all parts of this journey, decisions are
shaped by a series of 'trade-offs', where potential benefits and harms of
medication are weighed up.
Conclusions: This review offers a comprehensive insight into medication-taking
experiences in ADHD. By considering the shifting locus of decision-making over
time and the need for individuals and families to reconcile a variety of external
influences, primary care and mental health clinicians can engage in holistic
conversations with their patients to share decisions effectively.
DOI: 10.1093/fampra/cmx088
PMCID: PMC5892172
707. J Pediatr Health Care. 2017 Jan - Feb;31(1):29-36. doi:

10.1016/j.pedhc.2016.01.003. Epub 2016 Feb 6.
Self-Management Strategies in Emerging Adults With Type 1 Diabetes.
Majumder E, Cogen FR, Monaghan M.
INTRODUCTION: We examined changes in self-management behaviors after high school

graduation in a cohort of emerging adults with type 1 diabetes.
METHODS: Sixty-four emerging adults reported on diabetes self-management
behaviors at three time points over a 1-year period. Glycemic control and blood
glucose monitoring frequency data were collected from the medical chart.
RESULTS: Collaboration with parents decreased, diabetes problem-solving and
communication increased, and glycemic control worsened during the first year
after high school (p < .05). Problem solving appeared to be protective against
worsening glycemic control; higher baseline diabetes problem solving
significantly predicted better glycemic control at the 1-year follow-up.
DISCUSSION: Emerging adults demonstrate increased independence in diabetes
problem solving and communication with health care providers in the year after
high school. Problem-solving skills may help emerging adults adapt type 1
diabetes self-care in response to unpredictable schedules after high-school, and
promoting these skills may prevent deteriorations in glycemic control during this
risky period.
Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published

DOI: 10.1016/j.pedhc.2016.01.003
PMCID: PMC4976043
708. J Clin Epidemiol. 2018 Feb;94:132-142. doi: 10.1016/j.jclinepi.2017.10.013.

Epub
2017 Oct 31.
Self-reported medication use validated through record linkage to national

prescribing data.
Hafferty JD(1), Campbell AI(2), Navrady LB(3), Adams MJ(3), MacIntyre D(3),
Lawrie SM(3), Nicodemus K(4), Porteous DJ(5), McIntosh AM(6).
Author information:
(1)Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh,
Edinburgh EH10 5HF, UK. Electronic address: jonathan.hafferty@ed.ac.uk.
(2)Generation Scotland, Centre for Genomics and Experimental Medicine, Institute
for Genetics and Molecular Medicine, Western General Hospital, University of
Edinburgh, Edinburgh EH4 2XU, UK.
Edinburgh EH10 5HF, UK.
Edinburgh, Edinburgh EH4 2XU, UK; Institute for Genetics and Molecular Medicine,
Western General Hospital, University of Edinburgh1, Edinburgh EH4 2XU, UK.
Edinburgh, Edinburgh EH4 2XU, UK; Institute for Genetics and Molecular Medicine,
Western General Hospital, University of Edinburgh1, Edinburgh EH4 2XU, UK; Centre
for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, 7
George Square, EH8 9JZ, UK.
Edinburgh EH10 5HF, UK; Centre for Cognitive Ageing and Cognitive Epidemiology,
University of Edinburgh, 7 George Square, EH8 9JZ, UK.
OBJECTIVES: Researchers need to be confident about the reliability of

epidemiologic studies that quantify medication use through self-report. Some
evidence suggests that psychiatric medications are systemically under-reported.
Modern record linkage enables validation of self-report with national prescribing
data as gold standard. Here, we investigated the validity of medication
self-report for multiple medication types.
STUDY DESIGN AND SETTING: Participants in the Generation Scotland
population-based cohort (N = 10,244) recruited 2009-2011 self-reported regular
usage of several commonly prescribed medication classes. This was matched against
Scottish NHS prescriptions data using 3- and 6-month fixed time windows.
Potential predictors of discordant self-report, including general intelligence
and psychological distress, were studied via multivariable logistic regression.
RESULTS: Antidepressants self-report showed very good agreement (κ = 0.85, [95%
confidence interval (CI) 0.84-0.87]), comparable to antihypertensives (κ = 0.90
[CI 0.89-0.91]). Self-report of mood stabilizers showed moderate-poor agreement
(κ = 0.42 [CI 0.33-0.50]). Relevant past medical history was the strongest
predictor of self-report sensitivity, whereas general intelligence was not
predictive.
CONCLUSION: In this large population-based study, we found self-report validity
varied among medication classes, with no simple relationship between psychiatric
medication and under-reporting. History of indicated illness predicted more
accurate self-report, for both psychiatric and nonpsychiatric medications.
Although other patient-level factors influenced self-report for some medications,
none predicted greater accuracy across all medications studied.
DOI: 10.1016/j.jclinepi.2017.10.013
PMCID: PMC5808931
PMID: 29097340
709. Br J Health Psychol. 2016 Feb;21(1):11-30. doi: 10.1111/bjhp.12152. Epub 2015

Aug
12.
Is the intention-behaviour gap greater amongst the more deprived? A meta-analysis

of five studies on physical activity, diet, and medication adherence in smoking
cessation.
Vasiljevic M(1), Ng YL(1), Griffin SJ(1)(2), Sutton S(1)(3), Marteau TM(1).
Author information:
(1)Behaviour and Health Research Unit, University of Cambridge, UK.
(2)Primary Care Unit, Department of Public Health and Primary Care, University of
Cambridge, UK.
(3)Behavioural Science Group, University of Cambridge, UK.
OBJECTIVES: Unhealthy behaviour is more common amongst the deprived, thereby

contributing to health inequalities. The evidence that the gap between intention
and behaviour is greater amongst the more deprived is limited and inconsistent.
We tested this hypothesis using objective and self-report measures of three
behaviours, both individual- and area-level indices of socio-economic status, and
pooling data from five studies.
DESIGN: Secondary data analysis.
METHODS: Multiple linear regressions and meta-analyses of data on physical
activity, diet, and medication adherence in smoking cessation from 2,511
participants.
RESULTS: Across five studies, we found no evidence for an interaction between
deprivation and intention in predicting objective or self-report measures of
behaviour. Using objectively measured behaviour and area-level deprivation,
meta-analyses suggested that the gap between self-efficacy and behaviour was
greater amongst the more deprived (B = .17 [95% CI = 0.02, 0.31]).
CONCLUSIONS: We find no compelling evidence to support the hypothesis that the
intention-behaviour gap is greater amongst the more deprived.
STATEMENT OF CONTRIBUTION: What is already known on this subject? Unhealthy
behaviour is more common in those who are more deprived. This may reflect a
larger gap between intentions and behaviour amongst the more deprived. The
limited evidence to date testing this hypothesis is mixed. What does this study
add? In the most robust study to date, combining results from five trials, we
found no evidence for this explanation. The gap between intentions and behaviour
did not vary with deprivation for the following: diet, physical activity, or
medication adherence in smoking cessation. We did, however, find a larger gap
between perceived control over behaviour (self-efficacy) and behaviour in those
more deprived. These findings add to existing evidence to suggest that higher
rates of unhealthier behaviour in more deprived groups may be reduced by the
following: ◦ Strengthening behavioural control mechanisms (such as executive
function and non-conscious processes) or ◦ Behaviour change interventions that
bypass behavioural control mechanisms.
© 2015 The Authors. British Journal of Health Psychology published by John Wiley
& Sons Ltd on behalf of the British Psychological Society.
DOI: 10.1111/bjhp.12152
PMCID: PMC5014219
710. Clin Transplant. 2016 Oct;30(10):1294-1305. doi: 10.1111/ctr.12821. Epub 2016

Aug
29.
Medication understanding, non-adherence, and clinical outcomes among adult kidney

transplant recipients.
Patzer RE(1)(2), Serper M(3), Reese PP(4), Przytula K(5), Koval R(6), Ladner
DP(7), Levitsky JM(7), Abecassis MM(7), Wolf MS(8).
Author information:
(1)Division of Transplantation, Department of Surgery, Emory University School of
Medicine, Atlanta, GA, USA. rpatzer@emory.edu.
(2)Department of Epidemiology, Rollins School of Public Health, Emory University
School of Medicine, Atlanta, GA, USA. rpatzer@emory.edu.
(3)Division of Gastroenterology and Hepatology, Department of Medicine, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
(4)Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman
School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
(5)Health Literacy and Learning Program, Division of General Internal Medicine,
Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
(6)Division of Transplantation, Department of Surgery, Emory University School of
Medicine, Atlanta, GA, USA.
(7)Comprehensive Transplant Center (CTC), Northwestern University Transplant
Outcomes Research Collaborative (NUTORC), Northwestern University Feinberg School
of Medicine, Chicago, IL, USA.
(8)Division of General Internal Medicine and Geriatrics, Department of Medicine,
Northwestern University School of Medicine, Chicago, IL, USA.
We sought to evaluate the prevalence of medication understanding and

non-adherence of entire drug regimens among kidney transplantation (KT)
recipients and to examine associations of these exposures with clinical outcomes.
Structured, in-person interviews were conducted with 99 adult KT recipients
between 2011 and 2012 at two transplant centers in Chicago, IL; and Atlanta, GA.
Nearly, one-quarter (24%) of participants had limited literacy as measured by the
Rapid Estimate of Adult Literacy in Medicine test; patients took a mean of 10
(SD=4) medications and 32% had a medication change within the last month. On
average, patients knew what 91% of their medications were for (self-report) and
demonstrated proper dosing (via observed demonstration) for 83% of medications.
Overall, 35% were non-adherent based on either self-report or tacrolimus level.
In multivariable analyses, fewer months since transplant and limited literacy
were associated with non-adherence (all P<.05). Patients with minority race, a
higher number of medications, and mild cognitive impairment had significantly
lower treatment knowledge scores. Non-white race and lower income were associated
with higher rates of hospitalization within a year following the interview. The
identification of factors that predispose KT recipients to medication
misunderstanding, non-adherence, and hospitalization could help target
appropriate self-care interventions.
DOI: 10.1111/ctr.12821
PMCID: PMC5061615
711. Indian J Pharmacol. 2015 Nov-Dec;47(6):668-71. doi: 10.4103/0253-7613.169597.
Evaluation of adherence to therapy in patients of chronic kidney disease.
Sontakke S(1), Budania R(1), Bajait C(1), Jaiswal K(1), Pimpalkhute S(1).
Author information:
(1)Department of Pharmacology, Government Medical College, Nagpur, Maharashtra,
India.
OBJECTIVE: To evaluate adherence to medication and study factors associated with

non-adherence in chronic kidney disease (CKD) patients.
METHODS: A prospective, cross-sectional, questionnaire based study was conducted
in Nephrology department of a super specialty hospital. Patients above 18 years
of age, suffering from CKD from six months or more were interviewed using
self-designed, semi-structured questionnaire to get information about adherence
to medication, diet restriction and lifestyle modification (n = 150). Morisky
medication adherence questionnaire was used to calculate overall adherence. In
this higher score indicates poor adherence. Main outcome measures included
prevalence of non-adherence and factors associated with the same.
RESULTS: Average number of medicines taken by each patient was 8.0+1.612
(mean+SD) per day. Non-adherence to medication schedule was reported in 34%
patients. Common causes of non-adherence were high cost (21.3%), complex dosing
schedule (20%), fear of adverse effects (16%). Sixty-eight% patients were not
aware about importance of taking each medicine. Sixteen% stopped taking medicines
due to high cost. Forty-two% suggested that government should adopt measures to
provide free medicines to poor patients. In Morisky medication adherence
questionnaire high, medium and low adherence was reported in 7.3%, 55.3% and
37.3% of patients, respectively. Moderately positive correlation was observed
between poor adherence and number of concurrent illnesses and number of medicines
taken.
CONCLUSION: Since majority of patients were not aware about importance of taking
each medicine, creating awareness about the same is essential for improving
adherence to therapy. Measures to provide free medicines to non-affording
patients need to be implemented since high cost was other major cause of
non-adherence.
DOI: 10.4103/0253-7613.169597
PMCID: PMC4689023
712. Patient Prefer Adherence. 2016 Sep 29;10:1979-1989. eCollection 2016.
Factors related to intentional and unintentional medication nonadherence in

elderly patients with hypertension in rural community.
Bae SG(1), Kam S(2), Park KS(3), Kim KY(2), Hong NS(2), Kim KS(2), Lee YM(2), Lee
WK(2), Choe MS(4).
Author information:
(1)Department of Preventive Medicine, Regional Cardiocerebrovascular Disease
Center, Kyungpook National University Hospital.
(2)Department of Preventive Medicine, Kyungpook National University School of
Medicine, Daegu.
(3)Department of Preventive Medicine and Institute of Health Sciences, Gyeongsang
National University School of Medicine; Department of Preventive Medicine,
Regional Cardiocerebrovascular Disease Center, Gyeongsang National University
Hospital, Jinju.
(4)Department of Emergency Medicine, CHA Gumi Medical Center, CHA University,
Gumi, Korea.
PURPOSE: We assessed medication nonadherence, categorized as intentional or

unintentional, and related factors in elderly patients with hypertension,
correlating the data with measurement of blood pressure as the final target of
medication adherence and other possible influencing factors, such as lifestyle.
PATIENTS AND METHODS: Subjects were aged ≥65 years, resided in a rural area, and
were taking antihypertensive drugs. The survey was conducted in July 2014.
Participants were divided into the following three groups: "Adherence",
"Unintentional nonadherence", and "Intentional nonadherence". Individual
cognitive components, such as necessity and concern as well as self-efficacy and
other related factors, were compared according to adherence groups. The
interrelationships between those factors and nonadherence were tested using
structural equation modeling analysis.
RESULTS: Of the 401 subjects, 182 (45.6%) were in the adherence group, 107
(26.7%) in the unintentional nonadherence group, and 112 (27.9%) in the
intentional nonadherence group. Necessity and self-efficacy were found to have a
significant direct influence on unintentional nonadherence behaviors (necessity
β=-0.171, P=0.019; self-efficacy β=-0.433, P<0.001); concern was not
statistically significant (β=-0.009, P=0.909). Necessity was found to have
significant direct and indirect impact on intentional nonadherence (direct
β=-0.275, P=0.002; indirect β=-0.113, P=0.036). Self-efficacy had no significant
direct effect on intentional nonadherence though it had the only significant
indirect effect on intentional nonadherence (direct β=-0.055, P=0.515; indirect
β=-0.286, P<0.001). Concern had no significant influence on intentional or on
unintentional nonadherence (direct β=0.132 0.132, P=0.151; indirect β=-0.006,
P=0.909).
CONCLUSION: Unintentional nonadherence should be regularly monitored and managed
because of its potential prognostic significance. Interventions addressing
cognitive factors, such as beliefs about medicine or self-efficacy, are
relatively difficult to implement, but are essential to improve medication
adherence.
DOI: 10.2147/PPA.S114529
PMCID: PMC5047725
PMID: 27729776

eCollection 2019.
Analgesic use among the Brazilian population: Results from the National Survey on
Access, Use and Promotion of Rational Use of Medicines (PNAUM).
da Silva Dal Pizzol T(1)(2), Turmina Fontanella A(2), Cardoso Ferreira MB(3),
Dâmaso Bertoldi A(4), Boff Borges R(2), Serrate Mengue S(2).
Author information:
(1)Department of Production and Control of Medicines, School of Pharmacy, Federal
University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
(2)Graduate Program in Epidemiology, School of Medicine, Federal University of
Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
(3)Department of Pharmacology, Institute for Basic Health Sciences, Federal
University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
(4)Graduate Program in Epidemiology, Federal University of Pelotas (UFPEL),
Pelotas, Rio Grande do Sul, Brazil.
Erratum in
PLoS One. 2019 Apr 18;14(4):e0216005.
PURPOSE: To estimate the prevalence of use of analgesics in Brazil; and to

characterize this use, according to sociodemographic and health-related
characteristics.
METHODS: A cross-sectional population-based study (National Survey on Access, Use
and Promotion of Rational Use of Medicines, PNAUM) was conducted between
September 2013 and February 2014. A total of 41,433 people of all ages in
Brazilian urban households were interviewed. Occasional use (within the last 15
days) and continuous use of non-opioid analgesics, opioid analgesics and
non-steroidal anti-inflammatory drugs were investigated, regardless of whether
this use occurred through prescription or self-medication. The main outcome was
the use of at least one analgesic.
RESULTS: The majority of the individuals were female (52.8%), aged between 20 and
59 years (57.2%), with 1 to 8 years of schooling (45.6%). The overall prevalence
of analgesic use was 22.8% [95% CI: 21.4-24.2]. The use of analgesics was
significantly higher among women, adults and elderly (20 years or more), highly
educated individuals and respondents who referred: diagnosis of one or more
chronic diseases, using three or more medications, possession of health insurance
and with one or more emergency care admittances or hospitalizations within the
last year. Non-opioid analgesics were the agents most used (18.5% of the sample),
followed by non-steroidal anti-inflammatory drugs (6.9%) and opioid analgesics
(0.5%). The most commonly used drugs were metamizole (37.8% of all analgesics),
paracetamol (25.3%) and diclofenac (10.7%). These drugs were used mainly to
manage occasional health conditions, particularly pain.
CONCLUSION: One in five Brazilians used some analgesic, especially non-opioid
analgesics, to manage acute health problems such as painful conditions.
PMCID: PMC6428399
PMID: 30897156

interests exist.
714. BMJ Sex Reprod Health. 2018 Jul 18. pii: bmjsrh-2018-200102. doi:
10.1136/bmjsrh-2018-200102. [Epub ahead of print]
Second-trimester medication abortion outside the clinic setting: an analysis of

electronic client records from a safe abortion hotline in Indonesia.
Gerdts C(1), Jayaweera RT(1), Baum SE(1), Hudaya I(2).
Author information:
(1)Ibis Reproductive Health, Oakland, California, USA.
(2)The Institute for the Study of Human Rights, Columbia University, New York
City, New York, USA.
INTRODUCTION: Unsafe abortion past the first trimester disproportionately

accounts for the majority of global abortion-related morbidity and mortality;
research that documents the safety, feasibility and acceptability of existing
models for providing information and support to women who self-manage outside of
formal clinic settings is needed.
METHODS: This study is a retrospective analysis of anonymised electronic client
records from callers to a safe abortion hotline in Indonesia. Between July 2012
and October 2016, a total of 96 women contacted the hotline for information on
medication abortion beyond 12 weeks' gestation and are included in this study.
Descriptive statistics were calculated regarding pregnancy termination status,
client experience with warning signs of potential complications, and medical care
seeking and treatment.
RESULTS: Ninety-six women with pregnancies beyond the first trimester called the
hotline for information on medication abortion; 91 women received counselling
support from the hotline. Eighty-three women (91.2%) successfully terminated
their pregnancies using medication and did not seek medical care. Five women
exhibited warning signs of potential complications and sought medical care; one
woman sought care after a failed abortion. Two women were lost to follow-up and
the outcomes of their pregnancies are unknown.
CONCLUSIONS: Evidence from our analysis suggests that a model of remote provision
of support for abortions later in pregnancy by non-medically trained, skilled
abortion counsellors could be a safe alternative for women in need of abortions
beyond 12 weeks' gestation in a legally restrictive context. Further examination
and documentation of the model is warranted.

DOI: 10.1136/bmjsrh-2018-200102
PMCID: PMC6225793
PMID: 30021794
715. Int J Nurs Pract. 2018 Feb;24(1). doi: 10.1111/ijn.12616. Epub 2017 Dec 5.
Evaluation of factors related to glycaemic control among South Korean patients

with type 2 diabetes.
Choi WH(1), Seo YM(2), Ha Y(3).
Author information:
(1)Department of Nursing, Kyungsung University, Busan, South Korea.
(2)Department of Nursing, Gyeongnam National University of Science and
Technology, Jinju, South Korea.
(3)College of Nursing, Institute of Health Science, Gyeongsang National
University, Jinju, South Korea.
AIMS: To examine specific self-care behaviours, depression, and diabetes-related

stress among South Korean patients with type 2 diabetes and to evaluate whether
these factors are related to glycaemic control.
METHODS: This cross-sectional study included 171 patients with type 2 diabetes
who visited an endocrinology clinic. A structured questionnaire and electronic
medical records were used to collect data regarding self-care behaviours,
depression, diabetes-related distress, and glycaemic control between May 2015 and
July 2015.
RESULTS: Compared with the group with good glycaemic control, the group with poor
glycaemic control had significantly lower values for medication adherence and
significantly greater values for regimen-related distress. Depression was not
significantly associated with glycaemic control. In logistic regression analysis,
only medication adherence was independently associated with glycaemic control.
CONCLUSIONS: Medication adherence should be continuously emphasized and monitored
in clinical practice to effectively manage glycaemic control among patients with
type 2 diabetes. Furthermore, consideration of diabetes-related distress may help
improve glycaemic control among patients with type 2 diabetes.
© 2017 The Authors. International Journal of Nursing Practice Published by John

Wiley & Sons Australia, Ltd.
DOI: 10.1111/ijn.12616
PMCID: PMC5814914
716. PLoS Negl Trop Dis. 2019 Apr 9;13(4):e0007321. doi:

10.1371/journal.pntd.0007321.
Epidemiological features of a recent zoonotic cutaneous leishmaniasis outbreak in

Zagora province, southern Morocco.
El Hamouchi A(1), Daoui O(1)(2), Ait Kbaich M(1)(2), Mhaidi I(1)(2), El Kacem
S(1)(3), Guizani I(4), Sarih M(1), Lemrani M(1).
Author information:
(1)Laboratory of Parasitology and Vector-Borne-Diseases, Institut Pasteur du
Maroc, Casablanca, Morocco.
(2)Molecular Genetics and Immunophysiopathology Research Team, Health and
Environment Laboratory, Hassan II University of Casablanca, Aïn Chock Faculty of
Sciences, Morocco.
(3)Laboratory of Biology and Health, Faculty of Sciences Ben M'Sik, Hassan II
University, Casablanca, Morocco.
(4)Molecular Epidemiology and Experimental Pathology (MEEP)/ LR16IPT04, Institut
Pasteur de Tunis, Université de Tunis El Manar, Tunisia.
BACKGROUND: Leishmania major is an endemic vector-borne disease in Morocco that

causes zoonotic cutaneous leishmaniasis (ZCL), especially in arid pre-Saharan
regions where its unique vector and reservoir are Phlebotomus papatasi and
Meriones shawi, respectively, and may cause epidemics. In late 2017, the Zagora
province, an endemic focus for ZCL in southern Morocco, had CL outbreak. The main
objective of our investigation was to analyze the epidemiological features of
this latest ZCL outbreak.
METHODOLOGY/PRINCIPAL FINDINGS: We analyzed epidemiological features of this
latest ZCL outbreak. The Regional Delegation of Health, Zagora, recorded 4,402 CL
patients between October 2017 and end of March 2018. Our findings showed that 24
municipalities were affected and majority (55.1%) of infected cases belonged to
the Tinzouline rural municipality. Majority of patients were females (57.2%).
While all age group patients were affected, those aged <10 years were the most
affected (42.1%). During this outbreak over 5 days in December 2017, we conducted
a survey in Tinzouline and recruited and sampled 114 CL patients to confirm CL
diagnosis by parasitological (direct examination and culture) and molecular
(ITS1-PCR) methods and identify the etiological agent of infection using
ITS1-PCR-RFLP and sequencing. We completed a detailed questionnaire including
clinical and epidemiological data for each patient and found 72.8% of patients
presenting multiple lesions (≥2), with an average number of lesions of 5.16 ±
0.5. Lesions were more prevalent in the upper limbs, with the most common type
being the ulcerocrusted lesion (60.5%). We detected no associations between
lesion type and patients' sex or age.
CONCLUSIONS/SIGNIFICANCE: Among 114 clinically diagnosed CL patients, we
confirmed 90.35% and identified L. major as the species responsible for this
outbreak. Self-medication using various products caused superinfection and
inflammation of lesions and complicated the diagnosis and treatment. Thus, ZCL
remains a major public health problem in the Zagora province, and commitment of
all stakeholders is urgently required to implement a sustainable regional control
program.
PMCID: PMC6474635

interests exist.
717. Pain Physician. 2017 Feb;20(2S):S111-S133.
Prescription Opioid Abuse in Chronic Pain: An Updated Review of Opioid Abuse

Predictors and Strategies to Curb Opioid Abuse (Part 2).
Kaye AD, Jones MR(1), Kaye AM, Ripoll JG(2), Jones DE(3), Galan V(4), Beakley
BD(2), Calixto F(2), Bolden JL(5), Urman RD, Manchikanti L.
Author information:
(1)Department of Anesthesiology, Louisiana State University Health New Orleans.
(2)Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA.
(3)Dept. of Anesthesiology, Louisiana State University Health.
(4)Georgia Pain Care, Atlanta, GA.
(5)Louisiana State University.
Chronic pain and prescription opioid abuse are extremely prevalent in the United
States and worldwide. The consequences of opioid misuse can be life-threatening
with significant morbidity and mortality, exacting a heavy toll on patients,
physicians, and society. The risk for misuse of prescribed opioids is much higher
in patients with chronic pain, especially those with concurrent substance use and
/or mental health disorders. Several reasons can account for the occurrence of
opioid abuse and misuse, including self-medication, use for reward, compulsive
use related to addiction, and diversion for profit. There is a need, therefore,
for therapeutic approaches that balance treating chronic pain, while minimizing
risks for opioid abuse, misuse, and diversion. Chronic opioid therapy for chronic
non-cancer pain has seen a dramatic increase throughout the past 2 decades in
conjunction with associated increases in the abuse of prescribed opioids and
accidental opioid overdoses. Consequently, a validated screening instrument that
provides an effective and rational method for selecting patients for opioid
therapy, predicting risk, and identifying problems once they have arisen, could
be of enormous benefit in clinical practice. An instrument as such has the
potential to attenuate the risk of iatrogenic addiction. Despite the recent
introduction of various screening strategies and instruments, no single test or
instrument can reliably and accurately predict those patients unsuitable for
opioid therapy or pinpoint those requiring heightened degrees of surveillance and
monitoring throughout their therapy. Current opioid abuse screening tactics
include assessing premorbid and comorbid substance abuse; assessing aberrant
drug-related behaviors; stratification of risk factors; and utilizing opioid
assessment screening tools. Several authors have contributed numerous screening
tools and instruments to aid the assessment of appropriate opioid therapy.
Additional essential measures include urine drug testing, prescription practice
monitoring programs, opioid treatment agreements, and implementing universal
precautions. Presently accepted recommendations consist of a combination of
strategies designed to stratify risk, to identify and to understand aberrant
drug-related behaviors, and to tailor treatments accordingly. This manuscript,
Part 2 of a 2 part update, builds on the 2012 opioid guidelines published in Pain
Physician, and the 2016 guidelines released by the Centers for Disease Control
and Prevention. It reviews screening, monitoring, and addressing opioid abuse and
misuse in patients with chronic non-cancer pain. Opioids, misuse, abuse, chronic
pain, prevalence, risk assessment, risk management, drug monitoring, aberrant
drug-related behavior.
718. Anaesthesia. 2016 May;71(5):535-43. doi: 10.1111/anae.13406. Epub 2016 Mar 2.
Patient-controlled oral analgesia versus nurse-controlled parenteral analgesia

after caesarean section: a randomised controlled trial.
Bonnal A(1), Dehon A(1), Nagot N(2), Macioce V(2), Nogue E(2), Morau E(1).
Author information:
(1)Department of Anaesthesiology, Arnaud de Villeneuve University Hospital,
Montpellier, France.
(2)Clinical Research and Epidemiology Unit, Medical Information Department,
Montpellier University Hospital, Montpellier, France.
We assessed the effectiveness of early patient-controlled oral analgesia compared

with parenteral analgesia in a randomised controlled non-inferiority trial of
women undergoing elective caesarean section under regional anaesthesia.
Seventy-seven women received multimodal paracetamol, ketoprofen and morphine
analgesia. The woman having patient-controlled oral analgesia were administered
four pillboxes on the postnatal ward containing tablets and instructions for
self-medication, the first at 7 h after the spinal injection and then three more
at 12-hourly intervals. Pain at rest and on movement was evaluated using an
11-point verbal rating scale at 2 h and then at 6-hourly intervals for 48 h. The
pre-defined non-inferiority limit for the difference in mean pain scores
(patient-controlled oral analgesia minus parenteral) was one. The one-sided 95%
CI of the difference in mean pain scores was significantly lower than one at all
time-points at rest and on movement, demonstrating non-inferiority of
patient-controlled oral analgesia. More women used morphine in the
patient-controlled oral analgesia group (22 (58%)) than in the parenteral group
(9 (23%); p = 0.002). The median (IQR [range]) number of morphine doses in the
patient-controlled oral analgesia group was 2 (1-3 [1-7]) compared with 1 (1-1
[1-2]); p = 0.006) in the parenteral group. Minor drug errors or omissions were
identified in five (13%) women receiving patient-controlled oral analgesia.
Pruritus was more frequent in the patient-controlled oral analgesia group (14
(37%) vs 6 (15%) respectively; p = 0.03), but no differences were noted for other
adverse events and maternal satisfaction. After elective caesarean section, early
patient-controlled oral analgesia is non-inferior to standard parenteral
analgesia for pain management, and can be one of the steps of an enhanced
recovery process.
© 2016 The Association of Anaesthetists of Great Britain and Ireland.
DOI: 10.1111/anae.13406
719. BMJ Open Respir Res. 2015 Jun 23;2(1):e000078. doi: 10.1136/bmjresp-2014-
000078.
eCollection 2015.
Perceptions of medical students towards antibiotic prescribing for upper

respiratory tract infections in Saudi Arabia.
Harakeh S(1), Almatrafi M(2), Ungapen H(3), Hammad R(4), Olayan F(5), Hakim R(6),
Ayoub M(7), Bakhsh N(5), Almasaudi SB(8), Barbour E(9), Bahijri S(10), Azhar
E(1), Damanhouri G(10), Qari Y(11), Kumosani T(12), Harakeh Z(13), Ahmad MS(14),
Cals JW.
Author information:
(1)Special Infectious Agents Unit , King Fahd Medical Research Center, King
Abdulaziz University , Jeddah , Saudi Arabia.
(2)Obstetrics and Gynecology Department, King Abdulaziz Medical City, National
Guard Health Affair, Riyadh , Saudi Arabia.
(3)Manchester , UK.
(4)Department of Pediatric , King Fahad Armed Forces Hospital , Jeddah , Saudi
Arabia.
(5)Medical School, Umm Alqura University, Makkah , Saudi Arabia.
(6)Department of Family Medicine, National Guard Hospital , Jeddah , Saudi
Arabia.
(7)Department of Pediatric, National Guard Hospital, Jeddah, Saudi Arabia.
(8)Biology Department, King Abdulaziz University , Jeddah , Saudi Arabia.
(9)Department of Animal and Veterinary Sciences, American University of Beirut,
Lebanon; Adjunct to Biochemistry Department, Faculty of Science and Production of
Bioproducts for Industrial Application Research Group, King Abdulaziz Univeristy,
Jeddah , Saudi Arabia.
(10)King Fahd Medical Research Center , Jeddah , Saudi Arabia.
(11)Department of Gastroenterology, Faculty of Medicine, King Abdulaziz
University, Jeddah, Saudi Arabia.
(12)Biochemistry Department, Faculty of Science and Experimental Biochemistry
Unit, King Fahd Medical Research Center , Jeddah , Saudi Arabia.
(13)Department of Interdisciplinary Social Science, Utrecht University, Utrecht,
The Netherlands.
(14)Drug Metabolism Unit, King Fahd Medical Research Center, Jeddah, Saudi
Arabia.
(15)Department of Family Medicine, School of Primary Care and Public Health
(CAPHRI), Maastricht University, Maastricht, The Netherlands.
Erratum in
BMJ Open Respir Res. 2015;2(1). pii: bmjresp-2014-000078corr1. doi:
10.1136/bmjresp-2014-000078corr1. Cals, JochenW L [corrected to Cals, Jochen W
L].
INTRODUCTION: This survey evaluates knowledge, attitudes and practices of medical

students towards use of antibiotics for upper respiratory infections (URTIs).
METHODOLOGY: Cross-sectional questionnaire study among 1042 randomly selected
medical students in Saudi Arabia.
RESULTS: Respondents were mostly Saudis (97.5%), had previous knowledge of
antibiotics (99.7%) and their usage (98.3%) against bacterial infections (93.7%).
18.1% thought that they could be used for viral infections. Nearly all students
(97.2%) used antibiotics themselves during the previous year and self-medication
without a prescription was high at 49% of cases. Most antibiotics were taken for
URTI symptoms (61.8%). Female medical students had better knowledge on antibiotic
effectiveness against bacteria and viruses, and overall knowledge increased with
study year. Health seeking behaviour rates for symptoms of RTI and associated
estimated necessity for antibiotics varied but were highest for cough with
yellow/green phlegm.
CONCLUSIONS: The depth of knowledge that healthcare professionals have in
relation to the proper use of antibiotics is essential in spreading the right
message within communities. This is the first large study among medical students
in Saudi Arabia, shedding important light on areas for improvement in the medical
curriculum as well as antibiotic practices of medical students themselves.
DOI: 10.1136/bmjresp-2014-000078
PMCID: PMC4488607
PMID: 26175907
720. J Pediatr Gastroenterol Nutr. 2016 Nov;63(5):494-499.
Are Expectations Too High for Transitioning Adolescents With Inflammatory Bowel
Disease? Examining Adult Medication Knowledge and Self-Management Skills.
Fishman LN(1), Mitchell PD, Lakin PR, Masciarelli L, Flier SN.
Author information:
(1)*Division of Gastroenterology and Nutrition, Boston Children's Hospital,
Harvard Medical School †Clinical Research Center, Boston Children's Hospital
‡Bouve School of Health Sciences, Northeastern University §Division of
Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School,
Boston, MA.
Comment in
J Pediatr Gastroenterol Nutr. 2016 Nov;63(5):451-452.
OBJECTIVE: Transition readiness assessment has focused attention on adolescent

knowledge and skills, but data-driven benchmarks have not been established.
METHODS: Patients with inflammatory bowel disease (IBD), ages 25 to 50 years,
attending an outpatient gastroenterology clinic, were recruited to complete a
voluntary, confidential survey asking patients to recall medications and
potential side effects, and to rate their degree of independence performing
health maintenance tasks.
RESULTS: The 141 respondents (48% response rate) had mean age of 36 years with
median disease duration of 11 years. They were 60% female, 54% had Crohn disease,
and 23% were diagnosed before age 18. Nearly all patients were fully independent
answering doctor's questions during the visit (93%) and scheduling office visits
(92%). Excluding pharmacy pick up, full independence seen in only 57%, whereas
16% significantly delegated tasks. No differences by sex, disease type,
medication class, age at disease onset, or disease duration were found across
levels of self-management. Almost all (97%) respondents could recall medication
name, whereas fewer were able to recall dose (63%) or frequency (65%). Side
effect knowledge was poor; among 81 patients on a biologic or immunomodulator,
only 17 (21%) cited cancer and 22 (27%) cited infection.
CONCLUSIONS: Adolescent IBD transition programs now have empirical data from the
present study about adult benchmarks for independence in self-management skills.
Further research can establish which skills correlate with medication adherence
and active collaboration with the medical team. The present study also exposes
important gaps in medication risk knowledge and may allow improved patient
education for subgroups of adult patients with IBD.
DOI: 10.1097/MPG.0000000000001299
PMCID: PMC5331613
721. SSM Popul Health. 2017 Dec 9;4:144-152. doi: 10.1016/j.ssmph.2017.11.010.
Is self-rated health in adolescence a predictor of prescribed medication in

adulthood? Findings from the Nord Trøndelag Health Study and the Norwegian
Prescription Database.
Vie TL(1), Hufthammer KO(2), Holmen TL(3), Meland E(4), Breidablik HJ(1).
Author information:
(1)Helse Førde HF/Førde Health Trust, postboks 1000, 6807 Førde, Norway.
(2)Centre for Clinical Research, Haukeland University Hospital, Norway.
(3)HUNT Research Centre, Department of Public health and General Practice,
Faculty of Medicine, Norwegian University of Science and Technology, Norway.
(4)Department of Global Public Health and Primary Care, University of Bergen,
Norway.
Self-rated health (SRH) is a commonly used health indicator predicting morbidity

and mortality in a range of populations. However, the relationship between SRH
and medication is not well established. The aim of this study was to examine
adolescent SRH as a predictor for prescribed medication later in young adulthood.
Eighteen years' prospective data from the Nord-Trøndelag Health Study (HUNT) and
the Norwegian Prescription Database (NorPD) were analyzed. Baseline data,
gathered from 8982 adolescents (mean age 16.0 years) in the Young-HUNT I survey
(1995-1997), were linked to individual data from NorPD, including information on
all medications prescribed in 2013-2014. Gender-stratified negative binomial
regression models were used to investigate the association between SRH and
medication, also adjusted for age, baseline self-reported medicine use, physical
and mental disability, smoking, and physical activity. Based on the Anatomical
Therapeutic Chemical (ATC) Classification System, total consumption and
consumption related to various ATC groups were examined. The adjusted analyses
showed a dose-response relationship for females, with poorer SRH predicting
higher average medication for both total consumption and for the ATC groups
"Musculoskeletal system" (M), "Nervous system" (N; Analgesics (N02), Opioids
(N02A)) and "Respiratiory system" (R). The predictive power of SRH, as well as
the role of the adjustment factors, varies by gender and drug groups. This
knowledge is important in order to identify risks for later disease and to
capture pathological changes before and beyond the disease diagnosis, potentially
preventing morbidity in the adult population.
DOI: 10.1016/j.ssmph.2017.11.010
PMCID: PMC5769112
PMID: 29349283
722. J Card Fail. 2017 Apr;23(4):345-349. doi: 10.1016/j.cardfail.2016.11.001. Epub

2016 Nov 3.
Telemonitoring Adherence to Medications in Heart Failure Patients (TEAM-HF): A

Pilot Randomized Clinical Trial.
Gallagher BD(1), Moise N(1), Haerizadeh M(1), Ye S(1), Medina V(1), Kronish
IM(2).
Author information:
(1)Center for Behavioral Cardiovascular Health, Columbia University Medical
Center, New York, New York.
(2)Center for Behavioral Cardiovascular Health, Columbia University Medical
Center, New York, New York. Electronic address: ik2293@columbia.edu.
BACKGROUND: Medication nonadherence contributes to hospitalizations in recently

discharged patients with heart failure (HF). We aimed to test the feasibility of
telemonitoring medication adherence in patients with HF.
METHODS AND RESULTS: We randomized 40 patients (1:1) hospitalized for HF to 30
days of loop diuretic adherence monitoring with telephonic support or to passive
adherence monitoring alone. Eighty-three percent of eligible patients agreed to
participate. The median age of patients was 64 years, 25% were female, and 45%
were Hispanic. Overall, 67% of patients were nonadherent (percentage of days that
the correct number of doses were taken <88%). There were no differences between
intervention and passive monitoring group patients, respectively, in adherence
(median correct dosing adherence 82% vs 73%; P = .41) or in the proportion
readmitted within 30 days (30% vs 20%; P = .72). Eighty-eight percent of patients
rated the wireless electronic adherence device as somewhat or very easy to use,
and 88% agreed to use it again.
CONCLUSIONS: Adherence telemonitoring was acceptable to most patients with HF.
Diuretic nonadherence was common even when patients knew they were being
monitored. Future studies should assess whether adherence telemonitoring can
improve adherence and reduce readmissions among patients with HF.
DOI: 10.1016/j.cardfail.2016.11.001
PMCID: PMC5380538

eCollection 2018.
Smartphone apps for improving medication adherence in hypertension: patients'

perspectives.
Morrissey EC(1)(2), Casey M(3), Glynn LG(4), Walsh JC(2), Molloy GJ(1).
Author information:
(1)Medication Adherence Across the Lifespan Research Group, School of Psychology,
National University of Ireland Galway, Galway, Ireland.
(2)mHealth Research Group, School of Psychology, National University of Ireland
Galway, Galway, Ireland.
(3)School of Medicine, National University of Ireland Galway, Galway, Ireland.
(4)Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
Purpose: Digital interventions, such as smartphone applications (apps), are

becoming an increasingly common way to support medication adherence and
self-management in chronic conditions. It is important to investigate how
patients feel about and engage with these technologies. The aim of this study was
to explore patients' perspectives on smartphone apps to improve medication
adherence in hypertension.
Methods: This was a qualitative study based in the West of Ireland. Twenty-four
patients with hypertension were purposively sampled and engaged in focus groups.
Thematic analysis on the data was carried out.
Results: Participants ranged in age from 50 to 83 years (M=65 years) with an
equal split between men and women. Three major themes were identified in relation
to patients' perspectives on smartphone apps to improve medication adherence in
hypertension: "development of digital competence," "rules of engagement," and
"sustainability" of these technologies.
Conclusion: These data showed that patients can identify the benefits of a
medication reminder and recognize that self-monitoring their blood pressure could
be empowering in terms of their understanding of the condition and interactions
with their general practitioners. However, the data also revealed that there are
concerns about increasing health-related anxiety and doubts about the
sustainability of this technology over time. This suggests that the current
patient perspective of smartphone apps might be best characterized by
"ambivalence."
DOI: 10.2147/PPA.S145647
PMCID: PMC5957057
PMID: 29785096

724. AIDS Behav. 2016 Nov;20(11):2700-2708.
Validation of a New Three-Item Self-Report Measure for Medication Adherence.
Wilson IB(1), Lee Y(2), Michaud J(2), Fowler FJ Jr(3), Rogers WH(4).
Author information:
(1)Department of Health Services, Policy & Practice, Brown University School of
Public Health, Box G-121-7, 121 South Main St., Providence, RI, 02912, USA.
ira_wilson@brown.edu.
(2)Department of Health Services, Policy & Practice, Brown University School of
Public Health, Box G-121-7, 121 South Main St., Providence, RI, 02912, USA.
(3)Center for Survey Research, University of Massachusetts, Boston, MA, USA.
(4)Center for Health Solutions, Tufts Medical Center, Boston, MA, USA.
Few self-report measures of medication adherence have been rigorously developed

and validated against electronic drug monitoring (EDM). Assess the validity of
the 3-item self-report scale by comparing it with a contemporaneous EDM measure.
We conducted an observational study in which adherence assessments were done
monthly for up to 4 months for 81 patients with HIV who were taking
antiretroviral medications. We report results for both HIV antiretroviral
medications, and also for other, non-HIV-related medications. Raw and calibrated
self-report adherence measures, electronic drug monitoring adherence measures,
and sociodemographic variables. The mean age of patients was 46 years, 37 % were
female, 49 % had some education beyond high school, 22 % were Black, and 22 %
were Hispanic. Cronbach's alphas for the 3-item scale for HIV and non-HIV
medications were 0.83 and 0.87, respectively. The mean differences
(raw/uncalibrated self-report scale minus EDM) for HIV and non-HIV medications
were 7.5 and 5.2 points on a 100-point scale (p < 0.05 for both). Pearson
correlation coefficients between the calibrated 3-item scale and the EDM for HIV
and non-HIV medications were 0.47 and 0.59, respectively. The c-statistics for
the ROC curves for the calibrated scale, using cut-offs of 0.8 and 0.9 for the
EDM gold standard measure to define non-adherence, were between 0.74 and 0.76 for
HIV and non-HIV medications. This 3-item adherence self-report scale showed good
psychometric characteristics and good construct validity when compared with an
EDM standard, for both HIV and non-HIV medications. In clinical care it can be a
useful first-stage screener for non-adherence. In clinical research and quality
improvement settings it can be a useful tool when more complex and expensive
methods such as EDM or pharmacy claims are impractical or unavailable.
DOI: 10.1007/s10461-016-1406-x
PMCID: PMC5071118
725. JMIR Mhealth Uhealth. 2015 Dec 31;3(4):e108. doi: 10.2196/mhealth.4292.
Let Visuals Tell the Story: Medication Adherence in Patients with Type II
Diabetes Captured by a Novel Ingestion Sensor Platform.
Browne SH(1), Behzadi Y, Littlewort G.
Author information:
(1)University of California, San Diego, School of Medicine, La Jolla, CA, United
States. shbrowne@ucsd.edu.
BACKGROUND: Chronic diseases such as diabetes require high levels of medication

adherence and patient self-management for optimal health outcomes. A novel
sensing platform, Digital Health Feedback System (Proteus Digital Health, Redwood
City, CA), can for the first time detect medication ingestion events and
physiological measures simultaneously, using an edible sensor, personal monitor
patch, and paired mobile device. The Digital Health Feedback System (DHFS)
generates a large amount of data. Visual analytics of this rich dataset may
provide insights into longitudinal patterns of medication adherence in the
natural setting and potential relationships between medication adherence and
physiological measures that were previously unknown.
OBJECTIVE: Our aim was to use modern methods of visual analytics to represent
continuous and discrete data from the DHFS, plotting multiple different data
types simultaneously to evaluate the potential of the DHFS to capture
longitudinal patterns of medication-taking behavior and self-management in
individual patients with type II diabetes.
METHODS: Visualizations were generated using time domain methods of oral
metformin medication adherence and physiological data obtained by the DHFS use in
5 patients with type II diabetes over 37-42 days. The DHFS captured at-home
metformin adherence, heart rate, activity, and sleep/rest. A mobile glucose
monitor captured glucose testing and level (mg/dl). Algorithms were developed to
analyze data over varying time periods: across the entire study, daily, and
weekly. Following visualization analysis, correlations between sleep/rest and
medication ingestion were calculated across all subjects.
RESULTS: A total of 197 subject days, encompassing 141,840 data events were
analyzed. Individual continuous patch use varied between 87-98%. On average, the
cohort took 78% (SD 12) of prescribed medication and took 77% (SD 26) within the
prescribed ±2-hour time window. Average activity levels per subjects ranged from
4000-12,000 steps per day. The combination of activity level and heart rate
indicated different levels of cardiovascular fitness between subjects.
Visualizations over the entire study captured the longitudinal pattern of missed
doses (the majority of which took place in the evening), the timing of ingestions
in individual subjects, and the range of medication ingestion timing, which
varied from 1.5-2.4 hours (Subject 3) to 11 hours (Subject 2). Individual morning
self-management patterns over the study period were obtained by combining the
times of waking, metformin ingestion, and glucose measurement. Visualizations
combining multiple data streams over a 24-hour period captured patterns of broad
daily events: when subjects rose in the morning, tested their blood glucose, took
their medications, went to bed, hours of sleep/rest, and level of activity during
the day. Visualizations identified highly consistent daily patterns in Subject 3,
the most adherent participant. Erratic daily patterns including sleep/rest were
demonstrated in Subject 2, the least adherent subject. Correlation between sleep
/rest and medication ingestion in each individual subject was evaluated. Subjects
2 and 4 showed correlation between amount of sleep/rest over a 24-hour period and
medication-taking the following day (Subject 2: r=.47, P<.02; Subject 4: r=.35,
P<.05). With Subject 2, sleep/rest disruptions during the night were highly
correlated (r=.47, P<.009) with missing doses the following day.
CONCLUSIONS: Visualizations integrating medication ingestion and physiological
data from the DHFS over varying time intervals captured detailed individual
longitudinal patterns of medication adherence and self-management in the natural
setting. Visualizing multiple data streams simultaneously, providing a data-rich
representation, revealed information that would not have been shown by plotting
data streams individually. Such analyses provided data far beyond traditional
adherence summary statistics and may form the foundation of future personalized
predictive interventions to drive longitudinal adherence and support optimal
self-management in chronic diseases such as diabetes.
DOI: 10.2196/mhealth.4292
PMCID: PMC4713908
PMID: 26721413
726. J Child Health Care. 2018 Jun;22(2):238-250. doi: 10.1177/1367493517753082.

Epub
2018 Jan 11.
Adolescent and caregivers' experiences of electronic adherence assessment in

paediatric problematic severe asthma.
Stewart AC(1), Gannon KN(2), Beresford F(3), Fleming L(3).
Author information:
(1)1 Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London,
UK.
(2)2 School of Psychology, University of East London, London, UK.
(3)3 Respiratory Paediatrics, Royal Brompton Hospital, London, UK.
This study explored the experiences of adolescents and their caregivers regarding
adherence to inhaled corticosteroids which are assessed through an electronic
monitoring device (EMD). These devices are increasingly being used for assessing
medication adherence, yet there is little information about patient's experience
of these tools. Semi-structured interviews were conducted with eight adolescents
with severe asthma, aged 11-15 years, who were electronically monitored as part
of their care, along with their caregivers. Interviews were analysed using
thematic analysis. Three themes were identified: 'they were trying to help me get
better', 'checking up and catching out' and 'who is responsible?' The themes
highlighted differences in priorities between participant groups, the impact of
monitoring on the healthcare relationship and the dilemma of transferring
responsibility for asthma management to adolescents. The findings suggest it is
important for healthcare professionals to engage with patient's preferences and
priorities when introducing EMDs.
DOI: 10.1177/1367493517753082
727. Brain Sci. 2019 Jul 16;9(7). pii: E166. doi: 10.3390/brainsci9070166.
Marijuana Use among African American Older Adults in Economically Challenged

Areas of South Los Angeles.
Cobb S(1), Bazargan M(2)(3)(4), Smith J(2), Del Pino HE(5)(6), Dorrah K(3),
Assari S(7).
Author information:
(1)School of Nursing, Charles R Drew University of Medicine and Science, Los
Angeles, CA 90059, USA.
(2)Department of Family Medicine, College of Medicine, Charles R Drew University
of Medicine and Science, Los Angeles, CA 90059, USA.
(3)Department of Public Health, Charles R Drew University of Medicine and
Science, Los Angeles, CA 90059, USA.
(4)Department of Family Medicine, University of California, Los Angeles (UCLA),
Los Angeles, CA 90095, USA.
(5)Department of Psychiatry and Human Behavior, College of Medicine, Charles R
Drew University of Medicine and Science, Los Angeles, CA 90059, USA.
(6)Department of Psychiatry and Biobehavioral Sciences, University of California,
Los Angeles (UCLA), Los Angeles, CA 90095, USA.
(7)Department of Family Medicine, College of Medicine, Charles R Drew University
of Medicine and Science, Los Angeles, CA 90059, USA. shervinassari@cdrewu.edu.
Purpose: This study explored demographic, social, behavioral, and health factors
associated with current marijuana use (MU) among African American older adults
who were residing in economically challenged areas of south Los Angeles. Methods:
This community-based study recruited a consecutive sample of African American
older adults (n = 340), age ≥ 55 years, residing in economically challenged areas
of South Los Angeles. Interviews were conducted to collect data. Demographics
(age and gender), socioeconomic status (educational attainment, income, and
financial strain), marital status, living alone, health behaviors (alcohol
drinking and cigarette smoking), health status (number of chronic medical
conditions, body mass index, depression, and chronic pain), and current MU were
collected. Logistic regression was used to analyze the data. Results: Thirty
(9.1%) participants reported current MU. Age, educational attainment, chronic
medical conditions, and obesity were negatively associated with current MU.
Gender, income, financial strain, living alone, marital status, smoking
cigarettes, drinking alcohol, depression, and pain did not correlate with MU.
Conclusion: Current MU is more common in younger, healthier, less obese, less
educated African American older adults. It does not seem that African American
older adults use marijuana for the self-medication of chronic disease, pain, or
depression. For African American older adults, MU also does not co-occur with
cigarette smoking and alcohol drinking. These results may help clinicians who
provide services for older African Americans in economically challenged urban
areas.
DOI: 10.3390/brainsci9070166
PMCID: PMC6681052
PMID: 31315249
728. J Allergy Clin Immunol Pract. 2017 May - Jun;5(3):764-770. doi:

10.1016/j.jaip.2016.09.046. Epub 2016 Nov 30.
What Really Happens in the Home: The Medication Environment of Urban, Minority
Youth.
Pappalardo AA(1), Karavolos K(2), Martin MA(3).
Author information:
(1)Asthma and Allergy Center, Bloomingdale, Ill; Department of Pediatrics,
University of Illinois at Chicago, Chicago, Ill. Electronic address:
pappalardo.andrea@gmail.com.
(2)Department of Preventative Medicine, Rush University Medical Center, Chicago,
Ill.
(3)Department of Pediatrics, University of Illinois at Chicago, Chicago, Ill.
BACKGROUND: Asthma disproportionately affects minority youth. Understanding the
home medication environment and its relation to medication adherence can shape
interventions to improve health outcomes.
OBJECTIVE: The objective of this study was to describe the asthma medication
environment in the homes of urban minority youth and to determine predictors of
medication use and technique in this population.
METHODS: Baseline data from 2 cohorts of minority youth with asthma in Chicago
were combined for cross-sectional analysis. Bilingual research assistants (RAs)
collected data in the home. RAs asked caregivers and children to self-report
medications using pictures and observed children's asthma medications and inhaler
technique.
RESULTS: The sample contained 175 mainly Latino youth (85.6%) ranging from 5 to
18 years old. Most were on public insurance (80%) and had uncontrolled asthma by
self-report (89.7%). Only 27.4% had a spacer, 74.9% had a quick relief medicine,
and 48.6% had any controller medicine. RA observations of controllers agreed with
children (36%) and parental self-report (42.3%) but did not match the specific
observed controllers. Children reported less parental help with medications (43%)
than their parents (58.1%). One child was able to properly demonstrate 100% of
the inhaler steps and 35.6% achieved >70% of inhaler steps. A better medication
technique was associated with having a controller (b = 12.2, SE = 3.0,
P < .0001), quick reliever (b = 8.05, SE = 3.5, P = .023), and a spacer (b = 9.3,
SE = 3.54, P = .009).
CONCLUSIONS: This rigorous evaluation of the home medication environment of
high-risk youth demonstrated that many families lack critical medications,
devices, and a technique for proper management of asthma.
Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by

DOI: 10.1016/j.jaip.2016.09.046
PMCID: PMC5423821
729. BMC Public Health. 2018 Apr 6;18(1):460. doi: 10.1186/s12889-018-5357-1.
Connecting the dots between breast cancer, obesity and alcohol consumption in
middle-aged women: ecological and case control studies.
Miller ER(1), Wilson C(2)(3), Chapman J(2), Flight I(2), Nguyen AM(4), Fletcher
C(2), Ramsey I(2).
Author information:
(1)College of Medicine and Public Health, Flinders University, Adelaide,
Australia. emma.miller@flinders.edu.au.
(2)Flinders Centre for Innovation in Cancer, Flinders University , Adelaide,
Australia.
(3)Cancer Council of South Australia, Adelaide, Australia.
(4)College of Medicine and Public Health, Flinders University, Adelaide,
Australia.
BACKGROUND: Breast cancer (BC) incidence in Australian women aged 45 to 64 years

('middle-aged') has tripled in the past 50 years, along with increasing alcohol
consumption and obesity in middle-age women. Alcohol and obesity have been
individually associated with BC but little is known about how these factors might
interact. Chronic psychological stress has been associated with, but not causally
linked to, BC. Here, alcohol could represent the 'missing link' - reflecting
self-medication. Using an exploratory cross-sectional design, we investigated
inter-correlations of alcohol intake and overweight/obesity and their association
with BC incidence in middle-aged women. We also explored the role of stress and
various lifestyle factors in these relationships.
METHODS: We analysed population data on BC incidence, alcohol consumption,
overweight/obesity, and psychological stress. A case control study was conducted
using an online survey. Cases (n = 80) were diagnosed with BC and controls
(n = 235) were women in the same age range with no BC history. Participants
reported lifestyle data (including alcohol consumption, weight history) over
consecutive 10-year life periods. Data were analysed using a range of bivariate
and multivariate techniques including correlation matrices, multivariate binomial
regressions and multilevel logistic regression.
RESULTS: Ecological inter-correlations were found between BC and alcohol
consumption and between BC and obesity but not between other variables in the
matrix. Strong pairwise correlations were found between stress and alcohol and
between stress and obesity. BMI tended to be higher in cases relative to controls
across reported life history. Alcohol consumption was not associated with
case-control status. Few correlations were found between lifestyle factors and
stress, although smoking and alcohol consumption were correlated in some periods.
Obesity occurring during the ages of 31 to 40 years emerged as an independent
predictor of BC (OR 3.5 95% CI: 1.3-9.4).
CONCLUSIONS: This study provides ecological evidence correlating obesity and
alcohol consumption with BC incidence. Case-control findings suggest lifetime BMI
may be important with particular risk associated with obesity prior to 40 years
of age. Stress was ecologically linked to alcohol and obesity but not to BC
incidence and was differentially correlated with alcohol and smoking among cases
and controls. Our findings support prevention efforts targeting weight in women
below 40 years of age and, potentially, lifelong alcohol consumption to reduce BC
risk in middle-aged women.
DOI: 10.1186/s12889-018-5357-1
PMCID: PMC5889566
730. Biomed Res Int. 2015;2015:968786. doi: 10.1155/2015/968786. Epub 2015 Nov 10.
Following "the Roots" of Kratom (Mitragyna speciosa): The Evolution of an

Enhancer from a Traditional Use to Increase Work and Productivity in Southeast
Asia to a Recreational Psychoactive Drug in Western Countries.
Cinosi E(1), Martinotti G(1), Simonato P(2), Singh D(3), Demetrovics Z(4),
Roman-Urrestarazu A(5), Bersani FS(6), Vicknasingam B(3), Piazzon G(2), Li JH(7),
Yu WJ(7), Kapitány-Fövény M(8), Farkas J(9), Di Giannantonio M(10), Corazza O(6).
Author information:
Sciences, University of Hertfordshire, College Lane Campus, Hatfield, Herts AL10
9AB, UK ; Department of Neuroscience, Imaging and Clinical Sciences, Gabriele
D'Annunzio University, Chieti, Italy.
9AB, UK.
(3)Centre for Drug Research, Universiti Sains, Penang, Malaysia.
(4)Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
(5)London School of Economics and Political Science, LSE Health and Social Care,
London, UK ; Department of Psychiatry, University of Cambridge, Cambridge, UK.
9AB, UK ; Department of Neurology and Psychiatry, Sapienza University of Rome,
Rome, Italy.
(7)School of Pharmacy and Ph.D. Program in Toxicology, Kaohsiung Medical
University, Kaohsiung, Taiwan.
(8)Institute of Psychology, Eötvös Loránd University, Budapest, Hungary ; Faculty
of Health Sciences, Semmelweis University, Budapest, Hungary ; Nyírő Gyula
Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary.
(9)Institute of Psychology, Eötvös Loránd University, Budapest, Hungary ; Nyírő
Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest,
Hungary.
(10)Department of Neuroscience, Imaging and Clinical Sciences, Gabriele
D'Annunzio University, Chieti, Italy.
The use of substances to enhance human abilities is a constant and cross-cultural

feature in the evolution of humanity. Although much has changed over time, the
availability on the Internet, often supported by misleading marketing strategies,
has made their use even more likely and risky. This paper will explore the case
of Mitragyna speciosa Korth. (kratom), a tropical tree used traditionally to
combat fatigue and improve work productivity among farm populations in Southeast
Asia, which has recently become popular as novel psychoactive substance in
Western countries. Specifically, it (i) reviews the state of the art on kratom
pharmacology and identification; (ii) provides a comprehensive overview of kratom
use cross-culturally; (iii) explores the subjective experiences of users; (iv)
identifies potential risks and side-effects related to its consumption. Finally,
it concludes that the use of kratom is not negligible, especially for
self-medication, and more clinical, pharmacological, and socioanthropological
studies as well as a better international collaboration are needed to tackle this
marginally explored phenomenon.
DOI: 10.1155/2015/968786
PMCID: PMC4657101
731. J Pediatr Psychol. 2015 Sep;40(8):790-803. doi: 10.1093/jpepsy/jsv044. Epub

2015
May 22.
Condition Self-Management in Pediatric Spina Bifida: A Longitudinal Investigation

of Medical Adherence, Responsibility-Sharing, and Independence Skills.
Psihogios AM(1), Kolbuck V(1), Holmbeck GN(2).
Author information:
(1)Loyola University Chicago.
(2)Loyola University Chicago gholmbe@luc.edu.
OBJECTIVE: This study aimed to evaluate rates of medical adherence,

responsibility, and independence skills across late childhood and adolescence in
youth with spina bifida (SB) and to explore associations among these disease
self-management variables.
METHOD: 111 youth with SB, their parents, and a health professional participated
at two time points. Informants completed questionnaires regarding medical
adherence, responsibility-sharing, and child independence skills.
RESULTS: Youth gained more responsibility and independence skills across time,
although adherence rates did not follow a similar trajectory. Increased child
medical responsibility was related to poorer adherence, and father-reported
independence skills were associated with increased child responsibility.
CONCLUSIONS: This study highlights medical domains that are the most difficult
for families to manage (e.g., skin checks). Although youth appear to gain more
autonomy across time, ongoing parental involvement in medical care may be
necessary to achieve optimal adherence across adolescence.
DOI: 10.1093/jpepsy/jsv044
PMCID: PMC4626750

eCollection 2016.
Connection between self-stigma, adherence to treatment, and discontinuation of

medication.
Kamaradova D(1), Latalova K(1), Prasko J(1), Kubinek R(1), Vrbova K(1), Mainerova
B(1), Cinculova A(1), Ociskova M(1), Holubova M(2), Smoldasova J(1), Tichackova
A(1).
Author information:
(1)Department of Psychiatry, University Hospital Olomouc.
(2)Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech
Republic.
INTRODUCTION: Self-stigma plays a role in many areas of the patient's life.

Furthermore, it also discourages therapy. The aim of our study was to examine
associations between self-stigma and adherence to treatment and discontinuation
of medication in patients from various diagnostic groups.
METHODS: This cross-sectional study involved outpatients attending the Department
of Psychiatry, University Hospital Olomouc, Czech Republic. The level of
self-stigma was measured with the Internalized Stigma of Mental Illness and
adherence with the Drug Attitude Inventory. The patients also anonymously filled
out a demographic questionnaire which included a question asking whether they had
discontinued their medication in the past.
RESULTS: We examined data from 332 patients from six basic diagnostic categories
(substance abuse disorders, schizophrenia, bipolar disorders, depressive
disorders, anxiety disorders, and personality disorders). The study showed a
statistically significant negative correlation between self-stigma and adherence
to treatment in all diagnostic groups. Self-stigma correlated positively and
adherence negatively with the severity of disorders. Another important factor
affecting both variables was partnership. Self-stigma positively correlated with
doses of antidepressants and adherence with doses of anxiolytics. Self-stigma
also negatively correlated with education, and positively with a number of
hospitalizations and number of psychiatrists visited. Adherence was further
positively correlated with age and age of onset of disorders. Regression analysis
showed that self-stigma was an important factor negatively influencing adherence
to treatment and significantly contributing to voluntary discontinuation of
drugs. The level of self-stigma did not differ between diagnostic categories.
Patients suffering from schizophrenia had the lowest adherence to treatment.
CONCLUSION: The study showed a significant correlation between self-stigma and
adherence to treatment. High levels of self-stigma are associated with
discontinuation of medications without a psychiatrist's recommendation. This
connection was present in all diagnostic groups.
DOI: 10.2147/PPA.S99136
PMCID: PMC4966500
PMID: 27524884
733. Ci Ji Yi Xue Za Zhi. 2019 Apr-Jun;31(2):73-80. doi: 10.4103/tcmj.tcmj_177_18.
Improving the assessment of medication adherence: Challenges and considerations

with a focus on low-resource settings.
Basu S(1), Garg S(1), Sharma N(1), Singh MM(1).
Author information:
(1)Department of Community Medicine, Maulana Azad Medical College, New Delhi,
India.
Improving patient survival and quality of life in chronic diseases requires

prolonged and often lifelong medication intake. Less than half of patients with
chronic diseases globally are adherent to their prescribed medications which
preclude the full benefit of treatment, worsens therapeutic outcomes, accelerates
disease progression, and causes enormous economic losses. The accurate assessment
of medication adherence is pivotal for both researchers and clinicians.
Medication adherence can be assessed through both direct and indirect measures.
Indirect measures include both subjective (self-report measures such as
questionnaire and interview) and objective (pill count and secondary database
analysis) measures and constitute the mainstay of assessing medication adherence.
However, the lack of an inexpensive, ubiquitous, universal gold standard for
assessment of medication adherence emphasizes the need to utilize a combination
of measures to differentiate adherent and nonadherent patients. The global
heterogeneity in health systems precludes the development of a universal
guideline for evaluating medication adherence. Methods based on the secondary
database analysis are mostly ineffectual in low-resource settings lacking
electronic pharmacy and insurance databases and allowing refills without updated,
valid prescriptions from private pharmacies. This significantly restricts the
choices for assessing adherence until digitization of medical data takes root in
much of the developing world. Nevertheless, there is ample scope for improving
self-report measures of adherence. Effective interview techniques, especially
accounting for suboptimal patient health literacy, validation of adherence
questionnaires, and avoiding conceptual fallacies in reporting adherence can
improve the assessment of medication adherence and promote understanding of its
causal factors.
DOI: 10.4103/tcmj.tcmj_177_18
PMCID: PMC6450154
PMID: 31007485

eCollection 2016.
Might ART Adherence Estimates Be Improved by Combining Biomarker and Self-Report

Data?
Rhead R(1), Masimirembwa C(2), Cooke G(3), Takaruza A(4), Nyamukapa C(4),
Mutsimhi C(2), Gregson S(1).
Author information:
(1)Imperial College London, Department of Infectious Disease Epidemiology,
London, United Kingdom.
(2)African Institute of Biomedical Research and Technology, Harare, Zimbabwe.
(3)Imperial College London, Department of Medicine, London, United Kingdom.
(4)Biomedical Research and Training Institute, Harare, Zimbabwe.
BACKGROUND: As we endeavour to examine rates of viral suppression in PLHIV,

reliable data on ART adherence are needed to distinguish between the respective
contributions of poor adherence and treatment failure on high viral load.
Self-reported data are susceptible to response bias and although biomarker data
on drug presence and concentration can provide a superior, alternative method of
measurement, complications due to drug-drug interactions and genetic variations
can cause some inaccuracies. We investigate the feasibility of combining both
biomarker and self-report data to produce a potentially more accurate measure of
ART adherence.
METHODS: Data were taken from a large general-population survey in the Manicaland
province, Zimbabwe, conducted in 2009-2011. HIV-infected adults who had initiated
ART (N = 560) provided self-report data on adherence and dried blood spot samples
that were analysed for traces of ART medication. A new three-category measure of
ART adherence was constructed, based on biomarker data but using self-report data
to adjust for cases with abnormally low and high drug concentrations due to
possible drug-drug interactions and genetic factors, and was assessed for
plausibility using survey data on socio-demographic correlates.
RESULTS: 94.3% (528/560) and 92.7% (519/560) of the sample reported faithful
adherence to their medication and had traces of ART medication, respectively. The
combined measure estimated good evidence of ART adherence at 69% and excellent
evidence of adherence at 53%. The regression analysis results showed plausible
patterns of ART adherence by socio-demographic status with men and younger
participants being more likely to adhere poorly to medication, and higher
socio-economic status individuals and those living in more urban locations being
more likely to adhere well.
CONCLUSION: Biomarker and self-reported measures of adherence can be combined in
a meaningful way to produce a potentially more accurate measure of ART adherence.
Results indicate that ART adherence in Manicaland is at best 69%, which not only
allows for considerable room for improvement but also suggests that the area may
be falling short of the UNAIDS' 90% target regarding viral suppression. Increased
efforts are needed to improve ART adherence particularly amongst the young male
population in rural areas of east Zimbabwe.
PMCID: PMC5156419

interests exist.
735. J Am Geriatr Soc. 2016 Mar;64(3):561-8. doi: 10.1111/jgs.14032.
Multifaceted Prospective Memory Intervention to Improve Medication Adherence.
Insel KC(1), Einstein GO(2), Morrow DG(3), Koerner KM(1), Hepworth JT(1).
Author information:
(1)College of Nursing, University of Arizona, Tucson, Arizona.
(2)Department of Psychology, Furman University, Greenville, South Carolina.
(3)Department of Educational Psychology, University of Illinois, Urbana,
Illinois.
OBJECTIVES: To test whether a multifaceted prospective memory intervention

improved adherence to antihypertensive medications and to assess whether
executive function and working memory processes moderated the intervention
effects.
DESIGN: Two-group longitudinal randomized control trial.
SETTING: Community.
PARTICIPANTS: Individuals aged 65 and older without signs of dementia or symptoms
of severe depression who were self-managing prescribed medication.
MEASUREMENTS: After 4 weeks of initial adherence monitoring using a medication
event monitoring system, individuals with 90% or less adherence were randomly
assigned to groups.
INTERVENTION: The prospective memory intervention was designed to provide
strategies that switch older adults from relying on executive function and
working memory processes (that show effects of cognitive aging) to mostly
automatic associative processes (that are relatively spared with normal aging)
for remembering to take medications. Strategies included establishing a routine,
establishing cues strongly associated with medication taking actions, performing
the action immediately upon thinking about it, using a medication organizer, and
imagining medication taking to enhance encoding and improve cuing.
RESULTS: There was significant improvement in adherence in the intervention group
(57% at baseline to 78% after the intervention), but most of these gains were
lost after 5 months. The control condition started at 68% and was stable during
the intervention, but dropped to 62%. Executive function and working memory
moderated the intervention effect, with the intervention producing greater
benefit for those with lower executive function and working memory.
CONCLUSION: The intervention improved adherence, but the benefits were not
sustained. Further research is needed to determine how to sustain the substantial
initial benefits.
© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics
Society.
DOI: 10.1111/jgs.14032
736. West J Nurs Res. 2014 Oct;36(9):1091-110. doi: 10.1177/0193945914524639. Epub

2014 Feb 25.
Stressors may compromise medication adherence among adults with diabetes and low
socioeconomic status.
Osborn CY(1), Mayberry LS(2), Wagner JA(3), Welch GW(4).
Author information:
(1)Vanderbilt University Medical Center, Nashville, TN, USA
chandra.osborn@vanderbilt.edu.
(2)Vanderbilt University Medical Center, Nashville, TN, USA.
(3)University of Connecticut Health Center, Farmington, CT, USA.
(4)Tufts University School of Medicine, Boston, MA, USA Baystate Medical Center,
Springfield, MA, USA.
Studies examining the impact of stressors on diabetes self-care have focused on a

single stressor or have been largely qualitative. Therefore, we assessed the
stressors experienced by a high-risk population with type 2 diabetes, and tested
whether having more stressors was associated with less adherence to multiple
self-care behaviors. Participants were recruited from a Federally Qualified
Health Center and 192 completed a stressors checklist. Experiencing more
stressors was associated with less adherence to diet recommendations and
medications among participants who were trying to be adherent, but was not
associated with adherence to other self-care behaviors. Because having more
stressors was also associated with more depressive symptoms, we further adjusted
for depressive symptoms. Stressors remained associated with less adherence to
medications, but not to diet recommendations. For adults engaged in adherence,
experiencing an accumulation of stressors presents barriers to adherence that are
distinct from associated depressive symptoms.
DOI: 10.1177/0193945914524639
PMCID: PMC4143498
737. AIDS Behav. 2017 Jun;21(6):1655-1664. doi: 10.1007/s10461-016-1500-0.
Effects of Depression Alleviation on ART Adherence and HIV Clinic Attendance in

Uganda, and the Mediating Roles of Self-Efficacy and Motivation.
Wagner GJ(1), Ghosh-Dastidar B(2), Robinson E(2), Ngo VK(2), Glick P(2), Mukasa
B(3), Musisi S(4), Akena D(4).
Author information:
(1)RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
gwagner@rand.org.
(2)RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
(3)Mildmay Uganda, Kampala, Uganda.
(4)Department of Psychiatry, Makerere University, Kampala, Uganda.
With depression known to impede HIV care adherence and retention, we examined
whether depression alleviation improves these disease management behaviors. A
sample of 1028 depressed HIV clients in Uganda enrolled in a cluster randomized
controlled trial of two depression care models, and were surveyed over 12 months.
Serial regression analyses examined whether depression alleviation was associated
with self-reported antiretroviral therapy (ART) adherence and clinic attendance
at month 12, and whether these relationships were mediated by self-efficacy and
motivation. Among those with major depression, depression alleviation was
associated with better ART adherence and clinic attendance at month 12; these
relationships were fully mediated by self-efficacy at month 12, while adherence
motivation partially mediated the relationship between depression alleviation and
ART adherence. When both mediators were entered simultaneously, only
self-efficacy was a significant predictor and still fully mediated the
relationship between depression alleviation and adherence. These findings suggest
that depression alleviation benefits both ART adherence and clinic attendance, in
large part through improved confidence and motivation to engage in these disease
management behaviors.
DOI: 10.1007/s10461-016-1500-0
PMCID: PMC5250618
738. J Clin Pharm Ther. 2016 Jun;41(3):256-9. doi: 10.1111/jcpt.12360. Epub 2016
Mar
4.
Medication adherence may be more important than other behaviours for optimizing
glycaemic control among low-income adults.
Osborn CY(1), Mayberry LS(1), Kim JM(2).

Author information:
(1)Vanderbilt University Medical Center, Nashville, TN, USA.
(2)Texas A&M Health Science Center, Bryan, TX, USA.
WHAT IS KNOWN: Patients with type 2 diabetes mellitus (T2DM) are required to
perform multiple self-care behaviours to achieve and maintain optimal glycaemic
control (HbA1c), which prevents complications and premature mortality. Patients
with T2DM and low socioeconomic status (SES) are more likely to have suboptimal
HbA1c, often due to being less adherent to recommended self-care activities than
their higher-SES counterparts.
OBJECTIVE: Although studies support performing certain diabetes self-care
behaviours for optimizing glycaemic control, there is limited research on the
relative importance of each behaviour for this purpose. Identifying what
behaviours are most important for HbA1c among low-SES patients with T2DM would be
particularly useful for informing policy and intervention efforts for this
high-risk group.
METHODS: In a cross-sectional study of 314 adults with T2DM and low SES, we used
the Summary of Diabetes Self-Care Activities to assess self-care behaviours and
multivariate models to test which behaviours were associated with lower HbA1c.
RESULTS AND DISCUSSION: Only medication adherence was significantly associated
with lower HbA1c after adjusting for the other self-care behaviours (β = -0·14, P
= 0·028) and further adjusting for demographic and diabetes characteristics (β =
-0·16, P = 0·024).
WHAT IS NEW: Medication adherence may be the most important self-care behaviour
for glycaemic control among adults with T2DM and low SES.
CONCLUSION: Focused efforts to improve medication adherence among low-SES patient
populations may improve glycaemic control.
DOI: 10.1111/jcpt.12360
PMCID: PMC4871756
739. J Rheumatol. 2018 Dec;45(12):1636-1642. doi: 10.3899/jrheum.171339. Epub 2018

Sep
15.
Association of Medication Beliefs, Self-efficacy, and Adherence in a Diverse

Cohort of Adults with Rheumatoid Arthritis.
McCulley C(1)(2), Katz P(1)(2), Trupin L(1)(2), Yelin EH(1)(2), Barton JL(3)(4).
Author information:
(1)From the University of California, San Francisco, San Francisco, California;
Oregon Health & Science University; VA Portland Health Care System, Portland,
Oregon, USA.
(2)C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P.
Katz, PhD, Professor, Division of Rheumatology, University of California, San
Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University
of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of
Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate
Professor, Division of Rheumatology, Oregon Health & Science University, and VA
Portland Health Care System.
(3)From the University of California, San Francisco, San Francisco, California;
Oregon Health & Science University; VA Portland Health Care System, Portland,
Oregon, USA. bartoje@ohsu.edu.
(4)C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P.
Katz, PhD, Professor, Division of Rheumatology, University of California, San
Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University
of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of
Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate
Professor, Division of Rheumatology, Oregon Health & Science University, and VA
Portland Health Care System. bartoje@ohsu.edu.
OBJECTIVE: Rheumatoid arthritis (RA) patients' adherence to disease-modifying

antirheumatic drugs (DMARD) is often suboptimal. We examined associations among
medication beliefs, self-efficacy, and adherence to medications in RA.
METHODS: Data were from a longitudinal observational cohort of persons with RA.
Subjects completed telephone interviews on self-reported adherence,
self-efficacy, demographics, and the Beliefs about Medicines Questionnaire (BMQ),
which assesses beliefs in necessity and beliefs about taking medication.
Bivariate and multivariate logistic regression identified correlates of poor
adherence to synthetic DMARD and prednisone as well as to biologic therapy,
including medication concerns and necessity.
RESULTS: There were 362 patients who reported taking a synthetic DMARD and/or
prednisone. Of these, 14% and 21% reported poor adherence to oral DMARD or
prednisone, and biologics, respectively. There were 64% who reported concern
about taking medicines, 81% about longterm effects, and 47% about becoming too
dependent on medicines. In multivariate analyses, the BMQ necessity score was
independently associated with better adherence to oral DMARD or prednisone
(adjusted OR 0.61, 95% CI 0.41-0.91), while self-efficacy was associated with
greater odds of poor adherence to oral medications (adjusted OR 1.23, 95% CI
1.01-1.59). Beliefs in medicines and self-efficacy were not associated with
adherence to biologics.
CONCLUSION: In a diverse cohort of patients with RA, stronger beliefs in the
necessity of medication were associated with better adherence to oral DMARD or
prednisone, while higher self-efficacy was associated with poor adherence.
Providers can play important roles in eliciting patient beliefs about medications
to improve adherence and ultimately health outcomes.
DOI: 10.3899/jrheum.171339
PMCID: PMC6364826
PMID: 30219761
740. J Gen Intern Med. 2015 Mar;30(3):319-26. doi: 10.1007/s11606-014-3101-9. Epub

2014 Nov 25.
Integrating support persons into diabetes telemonitoring to improve

self-management and medication adherence.
Aikens JE(1), Trivedi R, Aron DC, Piette JD.
Author information:
(1)Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann
Arbor, MI, 48104-1213, USA, aikensj@umich.edu.
Comment in
J Gen Intern Med. 2015 Mar;30(3):346.
OBJECTIVE: The purpose of this study was to investigate the potential benefits
for medication adherence of integrating a patient-selected support person into an
automated diabetes telemonitoring and self-management program, and to determine
whether these benefits vary by patients' baseline level of psychological
distress.
STUDY DESIGN: The study was a quasi-experimental patient preference trial.
METHODS: The study included patients with type 2 diabetes who participated in
three to six months of weekly automated telemonitoring via interactive voice
response (IVR) calls, with the option of designating a supportive relative or
friend to receive automated updates on the patient's health and self-management,
along with guidance regarding potential patient assistance. We measured long-term
medication adherence using the four-point Morisky Medication Adherence Scale
(MMAS-4, possible range 0-4), weekly adherence with an IVR item, and
psychological distress at baseline with the Mental Composite Summary (MCS) of the
SF-12.
RESULTS: Of 98 initially nonadherent patients, 42% opted to involve a support
person. Participants with a support person demonstrated significantly greater
improvement in long-term adherence than those who participated alone (linear
regression slopes: -1.17 vs. -0.57, respectively, p =0.001). Among distressed
patients in particular, the odds of weekly nonadherence tended to decrease 25%
per week for those with a support person (p =0.030), yet remained high for those
who participated alone (p =0.820).
CONCLUSIONS: Despite their multiple challenges in illness self-management,
patients with diabetes who are both nonadherent and psychologically distressed
may benefit by the incorporation of a support person when they receive assistance
via automated telemonitoring.
DOI: 10.1007/s11606-014-3101-9
PMCID: PMC4351288
741. Transl Behav Med. 2015 Dec;5(4):470-82. doi: 10.1007/s13142-015-0315-2. Epub

2015
Jul 9.
Self-report measures of medication adherence behavior: recommendations on optimal

use.
Stirratt MJ(1), Dunbar-Jacob J(2), Crane HM(3), Simoni JM(4), Czajkowski S(5),
Hilliard ME(6), Aikens JE(7), Hunter CM(8), Velligan DI(9), Huntley K(10),
Ogedegbe G(11), Rand CS(12), Schron E(13), Nilsen WJ(14).
Author information:
(1)NIH/National Institute of Mental Health Division of AIDS Research, Bethesda,
MD USA.
(2)School of Nursing, University of Pittsburgh, Pittsburgh, PA USA.
(3)Division of Infectious Diseases, University of Washington, Seattle, WA USA.
(4)Department of Psychology, University of Washington, Seattle, WA USA.
(5)NIH/National Heart, Lung and Blood Institute, Bethesda, MD USA.
(6)Department of Pediatrics, Baylor College of Medicine, Houston, TX USA.
(7)Department of Family Medicine, University of Michigan, Ann Arbor, MI USA.
(8)NIH/National Institute of Diabetes and Digestive and Kidney Diseases,
Bethesda, MD USA.
(9)Health Science Center, University of Texas, San Antonio, TX USA.
(10)NIH/National Institute on Drug Abuse, Bethesda, MD USA.
(11)School of Medicine, New York University, New York, NY USA.
(12)School of Medicine, Johns Hopkins University, Baltimore, MD USA.
(13)NIH/National Eye Institute, Bethesda, MD USA.
(14)National Science Foundation, Arlington, VA USA.
Medication adherence plays an important role in optimizing the outcomes of many

treatment and preventive regimens in chronic illness. Self-report is the most
common method for assessing adherence behavior in research and clinical care, but
there are questions about its validity and precision. The NIH Adherence Network
assembled a panel of adherence research experts working across various chronic
illnesses to review self-report medication adherence measures and research on
their validity. Self-report medication adherence measures vary substantially in
their question phrasing, recall periods, and response items. Self-reports tend to
overestimate adherence behavior compared with other assessment methods and
generally have high specificity but low sensitivity. Most evidence indicates that
self-report adherence measures show moderate correspondence to other adherence
measures and can significantly predict clinical outcomes. The quality of
self-report adherence measures may be enhanced through efforts to use validated
scales, assess the proper construct, improve estimation, facilitate recall,
reduce social desirability bias, and employ technologic delivery. Self-report
medication adherence measures can provide actionable information despite their
limitations. They are preferred when speed, efficiency, and low-cost measures are
required, as is often the case in clinical care.
DOI: 10.1007/s13142-015-0315-2
PMCID: PMC4656225
PMID: 26622919
742. Am J Epidemiol. 2016 Aug 1;184(3):233-8. doi: 10.1093/aje/kwv446. Epub 2016

Jul
7.
Validity of Self-Reported Medication Use Compared With Pharmacy Records in a

Cohort of Older Women: Findings From the Women's Health Initiative.
Drieling RL, LaCroix AZ, Beresford SA, Boudreau DM, Kooperberg C, Heckbert SR.
Inaccurate self-reported data on medication exposure lead to less reliable study

findings. From 2013 to 2015, we assessed the validity of information on
medication use collected via a mailed medication inventory among 223 Women's
Health Initiative participants who were members of a health-care delivery system.
Self-reported information on medication use was compared with pharmacy records
for statins, calcium channel blockers, β-blockers, and bisphosphonates. We
assessed sensitivity, specificity, and positive predictive value (PPV) for
current medication use. We assessed agreement on duration of use (<2, 2, 3, 4, or
≥5 years) by means of the weighted κ statistic. The mean age of participants was
77 years. Statins, β-blockers, and calcium channel blockers were each reported by
over 15% of women, and bisphosphonates were reported by 4.5%. Compared with
pharmacy records, the sensitivity, specificity, and PPV for self-reported use of
statins, β-blockers, and calcium channel blockers were all 95% or greater. The
sensitivity and PPV for bisphosphonate use were both 80% (95% confidence
interval: 44, 97), and specificity was 99% (95% confidence interval: 97, 100).
The κ statistic for duration of use was 0.87 or greater for all 4 medication
classes. Compared with pharmacy records, self-reported information on current
medication use and duration of use collected via mailed medication inventory
among older women had almost perfect agreement for use of statins, β-blockers,
and calcium channel blockers.
© The Author 2016. Published by Oxford University Press on behalf of the Johns
Hopkins Bloomberg School of Public Health. All rights reserved. For permissions,
please e-mail: journals.permissions@oup.com.
DOI: 10.1093/aje/kwv446
PMCID: PMC4967595
743. Transl Behav Med. 2016 Sep;6(3):457-68. doi: 10.1007/s13142-015-0348-6.
The effect of a locally adapted, secondary stroke risk factor self-management

program on medication adherence among veterans with stroke/TIA.
Damush TM(1), Myers L(2), Anderson JA(3), Yu Z(2), Ofner S(2), Nicholas G(2),
Kimmel B(2), Schmid AA(2), Kent T(3), Williams LS(2).
Author information:
(1)VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of
Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA. tdamush@iupui.edu.
(2)VA HSRD QUERI Center and HSRD CHIC Center, Indiana University School of
Medicine, Regenstrief Institute, Inc, Indianapolis, IN, USA.
(3)VA HSRD Coin Center, Michael DeBakey VAMC, Baylor College of Medicine,
Houston, TX, USA.
Erratum in
Transl Behav Med. 2016 Sep;6(3):469.
We targeted stroke/transient ischemic attack (TIA) survivors to engage in

self-management practices to manage secondary stroke risk factors. We conducted a
randomized, regional pilot trial of a locally adapted, secondary stroke
prevention program. We implemented the program at two Veterans Administration
Medical Centers. Program sessions targeted stroke risk factor self-management.
Specifically, we evaluated the effect of the program on the reach,
implementation, and effectiveness on patient self-efficacy; stroke-specific,
health-related quality of life; and medication adherence for the prevalent stroke
risk factors: (1) diabetes, (2) hypertension, and (3) hyperlipidemia. Medication
possession ratios were calculated to evaluate medication adherence using VA
pharmacy benefits data pre (6 months prior) and post (6 months after) the
stroke/TIA event. Based upon the literature standard of 80 % compliance rate, we
dichotomized compliance and modeled the data using logistical regression. Final
sample included 174 veterans with an acute stroke or TIA who were randomized to
receive either the intervention (n = 87) or attention control program (n = 87).
Patient self-efficacy and stroke-specific, health-related quality of life at
6 months did not significantly differ between groups. We found improvements in
medication adherence within the intervention group. In the intervention group,
the odds of compliance with diabetes medications post-stroke were significantly
larger than the odds of compliance prior to the stroke (odds ratio = 3.45 (95 %
CI = 1.08-10.96). For compliance to hypertension medications, the intervention
group showed significantly greater odds of compliance post intervention than pre
intervention (odds ratio = 3. 68 (95 % CI = 1.81-7.48). The control group showed
no difference in compliance rates from baseline to follow-up. For adherence to
hypercholesterolemia medications, both the intervention (odds ratio = 5.98 (95 %
CI = 2.81-12.76) and control groups (odds ratio = 3.83 (95 % CI = 1.83-8.01), had
significant increases in the odds of compliance to statin medications; however,
the comparison of changes in log odds of compliance between these two groups
showed that the increases were not significantly different. We observed within
group improvements in medication adherence among those receiving a post-stroke
risk factor self-management program suggesting that a self-management format may
be feasible to enable adherence to prescribed medications to reduce secondary
stroke risk after stroke in concordance with guideline care. Additional research
is needed to enhance intervention components to improve effectiveness outcomes.
DOI: 10.1007/s13142-015-0348-6
PMCID: PMC4987603
744. Schizophr Bull. 2015 May;41(3):584-96. doi: 10.1093/schbul/sbv015. Epub 2015
Mar
5.
Modeling determinants of medication attitudes and poor adherence in early

nonaffective psychosis: implications for intervention.
Drake RJ(1), Nordentoft M(2), Haddock G(3), Arango C(4), Fleischhacker WW(5),
Glenthøj B(6), Leboyer M(7), Leucht S(8), Leweke M(9), McGuire P(10),
Meyer-Lindenberg A(9), Rujescu D(11), Sommer IE(12), Kahn RS(12), Lewis SW(13).
Author information:
(1)Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour &
Mental Health, University of Manchester, Manchester, UK; Manchester Academic
Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust,
Manchester, UK; richard.drake@manchester.ac.uk.
(2)Mental Health Centre Copenhagen, Faculty of Health and Medical Sciences,
University of Copenhagen, Copenhagen NV, Denmark;
(3)Manchester Academic Health Sciences Centre, Manchester Mental Health & Social
Care NHS Trust, Manchester, UK; Manchester Academic Health Sciences Centre,
School of Psychological Sciences, University of Manchester, Manchester, UK;
(4)Department of Child and Adolescent Psychiatry, Hospital General Universitario
Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de
Madrid, Madrid, Spain;
(5)Department of Psychiatry and Psychotherapy, Medical University Innsbruck,
Innsbruck, Austria;
(6)Center for Neuropsychiatric Schizophrenia Research and Center for Clinical
Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Hospital
Center Glostrup, Faculty of Health and Medical Sciences, University of
Copenhagen, Glostrup, Denmark;
(7)INSERM U955, Laboratoire Psychopathologie et génétique des maladies mentales,
et AP-HP, DHU Pe-PSY, Pole de Psychiatrie et d'addictologie des Hôpitaux
Universitaires Henri Mondor, Université Paris-Est, Créteil, France;
(8)Department of Psychiatry and Psychotherapy, Technische Universität München,
München, Germany;
(9)Central Institute of Mental Health, Mannheim, Germany;
(10)King's College London, Institute of Psychiatry, London, UK;
(11)Psychiatry, Molecular and Clinical Neurobiology, Ludwig-Maximilians
University, München, München, Germany; Department of Psychiatry, University of
Halle, Halle, Germany;
(12)Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht,
The Netherlands.
(13)Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour &
Mental Health, University of Manchester, Manchester, UK; Manchester Academic
Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust,
Manchester, UK;
We aimed to design a multimodal intervention to improve adherence following first

episode psychosis, consistent with current evidence. Existing literature
identified medication attitudes, insight, and characteristics of support as
important determinants of adherence to medication: we examined medication
attitudes, self-esteem, and insight in an early psychosis cohort better to
understand their relationships. Existing longitudinal data from 309 patients with
early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
nonaffective psychosis (83% first episode) were analyzed to test the hypothesis
that medication attitudes, while meaningfully different from "insight,"
correlated with insight and self-esteem, and change in each influenced the
others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and
Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and
3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were
rated from 6 weeks onward. Structural equation models of their relationships were
compared. Insight measures' and DAI's predictive validity were compared against
relapse, readmission, and remission. Analysis found five latent constructs best
fitted the data: medication attitudes, self-esteem, accepting need for treatment,
self-rated insight, and objective insight. All were related and each affected the
others as it changed, except self-esteem and medication attitudes. Low
self-reported insight at presentation predicted readmission. Good 6-week insight
(unlike drug attitudes) predicted remission. Literature review and data modeling
indicated that a multimodal intervention using motivational interviewing, online
psychoeducation, and SMS text medication reminders to enhance adherence without
damaging self-concept was feasible and appropriate.
© The Author 2015. Published by Oxford University Press on behalf of the Maryland
Psychiatric Research Center. All rights reserved. For permissions, please email:
DOI: 10.1093/schbul/sbv015
PMCID: PMC4393703
745. AIDS Care. 2016;28(3):370-5. doi: 10.1080/09540121.2015.1090538. Epub 2015 Oct

8.
Comparing the unmatched count technique and direct self-report for sensitive
health-risk behaviors in HIV+ adults.
Arentoft A(1)(2), Van Dyk K(2), Thames AD(2), Sayegh P(2), Thaler N(2), Schonfeld
D(3), LaBrie J(4), Hinkin CH(2)(3).
Author information:
(1)a Department of Psychology , California State University , Northridge , CA ,
USA.
(2)b Department of Psychiatry & Biobehavioral Sciences , University of
California-Los Angeles , Los Angeles , CA , USA.
(3)c Department of Psychology , West Los Angeles VA Healthcare Center , Los
Angeles , CA , USA.
(4)d Department of Psychology , Loyola Marymount University , CA , USA.
Researchers often rely on self-report measures to assess sensitive health-risk

behaviors in HIV+ individuals, yet the accuracy of self-report has been
questioned, particularly when inquiring about behaviors that may be embarrassing,
risky, and/or taboo. We compared an anonymous reporting method - the unmatched
count technique (UCT) - to direct self-report (DSR) in order to assess reporting
differences for several health-risk behaviors related to medication adherence and
sexual risk. Contrary to hypotheses, the UCT only produced a significantly higher
estimated base rate for one sensitive behavior: reporting medication adherence to
one's physician, which may have been contextually primed by our study design. Our
results suggest that anonymous reporting methods may not increase disclosure
compared to DSR when assessing several health-risk behaviors in HIV+ research
volunteers. However, our results also suggest that contextual factors should be
considered and investigated further, as they may influence perception of
sensitive behavior.
DOI: 10.1080/09540121.2015.1090538
PMCID: PMC5209753
746. Patient Prefer Adherence. 2015 Oct 27;9:1505-15. doi: 10.2147/PPA.S85408.
eCollection 2015.
A mixed-methods study of the implementation of medication adherence policy

solutions: how do European countries compare?
Clyne W(1), McLachlan S(2).
Author information:
(1)Faculty of Health and Life Sciences, Coventry University, Priory Street,
Coventry, UK.
(2)Primary Care and Health Sciences, Keele University, Staffordshire, UK.
OBJECTIVES: We describe a key informant study that invited national medicines

policy leads for the European Union member states to self-assess the level of
implementation of medicines adherence initiatives in their country and the
adequacy of that implementation. Interviews with medicines policy leads enabled
in-depth understanding of the variation in adherence support across nations and
the ways in which different nations prioritize, plan, and implement medicines
adherence systems and services.
METHODS: Ten national policy leads (Bulgaria, Denmark, Estonia, Finland, Germany,
Ireland, Latvia, Lithuania, Malta, and the Netherlands) completed a
self-assessment survey, and seven (Estonia, Finland, Germany, Ireland, Lithuania,
Malta, and the Netherlands) engaged in a follow-up interview.
KEY FINDINGS: Policy leads varied in the level of implementation of medication
adherence solutions that they reported in their nations; most initiatives were
aimed directly at patients with few initiatives at government or health care
commissioner levels of action. Policy leads reported insufficient implementation
of medication adherence initiatives across all potential domains. Barriers to
implementation included lack of resources, strategic planning, evidence to
support action, the "hidden" nature of medication adherence within policy work,
and dispersed responsibility for medication adherence as a policy and practice
theme.
CONCLUSION: This study has international significance and summarizes the emergent
characteristics of nations with and without coordinated medication adherence
activity. We highlight the importance of sharing good practice in policy
formulation and implementation for medication adherence.
DOI: 10.2147/PPA.S85408
PMCID: PMC4629975
PMID: 26604703
747. Paediatr Child Health. 2017 Aug;22(5):255-258. doi: 10.1093/pch/pxx055. Epub

2017
May 17.
Adherence to antimuscarinics in children with overactive bladder.
Fortin A(1), Morin V(1), Ramsay S(2), Gervais P(1), Bolduc S(2).
Author information:
(1)Department of Pediatrics, CHU de Québec - Université Laval, Québec, Québec.
(2)Division of Urology, CRCHU de Québec - Université Laval, Québec, Québec.
Objectives: Adherence to antimuscarinics for the treatment of overactive bladder

is known to be low in adults but there is scarce data on adherence in paediatric
patients. Our objectives were to evaluate the adherence of children to
antimuscarinics and to identify influencing factors.
Methods: Children aged 5 to 18 years and treated with an antimuscarinic agent for
at least 6 months were recruited at a routine visit and had to fill out a
questionnaire. Their pharmacists were then contacted to inquire about
prescription renewals since the beginning of treatment. The medication possession
ratio was calculated and grouped by time blocks of 1, 3, 6 and 12 months. The
pharmacists were contacted again 6 months after the recruitment visit. A
medication possession ratio ≥ 80% was considered as good adherence.
Results: Seventy-two patients were recruited with a mean age of 10.1 years. The
self-reported adherence was 93%. Prior to the questionnaire, the medication
possession ratio was ≥ 80% in 36%, 57%, 64% and 74% of cases in blocks of 1, 3, 6
and 12 months, respectively. After the questionnaire, the medication possession
ratio improved to 53%, 65% and 71% for blocks of 1, 3 and 6 months, respectively.
No influencing factors were identified.
Conclusions: Measured adherence to antimuscarinics in children with overactive
bladder is higher than in adults but significantly lower than the self-reported
adherence. Good self-reported adherence must be questioned to avoid unnecessary
dose escalation or change of medication. Strategies to increase medication
adherence are required to improve treatment efficacy.
DOI: 10.1093/pch/pxx055
PMCID: PMC5804706
PMID: 29479229

eCollection 2017.
Relationship between depression and medication adherence in cardiovascular

disease: the perfect challenge for the integrated care team.
Goldstein CM(1), Gathright EC(2), Garcia S(3).
Author information:
(1)Department of Psychiatry and Human Behavior, Warren Alpert Medical School of
Brown University; Weight Control and Diabetes Research Center, The Miriam
Hospital, Providence, RI.
(2)Department of Psychiatry and Human Behavior, Warren Alpert Medical School of
Brown University; Department of Psychological Sciences, Kent State University,
Kent, OH.
(3)Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann
Arbor, MI, USA.
Many individuals with cardiovascular disease (CVD) experience depression that is

associated with poor health outcomes, which may be because of medication
nonadherence. Several factors influence medication adherence and likely influence
the relationship between depression and medication adherence in CVD patients.
This comprehensive study reviews the existing literature on depression and
medication adherence in CVD patients, addresses the methods of and problems with
measuring medication adherence, and explains why the integrated care team is
uniquely situated to improve the outcomes in depressed CVD patients. This paper
also explores how the team can collaboratively target depressive symptoms and
medication-taking behavior in routine clinical care. Finally, it suggests the
limitations to the integrated care approach, identifies targets for future
research, and discusses the implications for CVD patients and their families.
DOI: 10.2147/PPA.S127277
PMCID: PMC5359120
PMID: 28352161

749. J Affect Disord. 2015 Mar 15;174:241-9. doi: 10.1016/j.jad.2014.11.055. Epub

2014
Dec 5.
Managing bipolar moods without medication: a qualitative investigation.
Cappleman R(1), Smith I(2), Lobban F(3).
Author information:
(1)South West Yorkshire Partnership NHS Foundation Trust, United Kingdom.
Electronic address: reed.cappleman@swyt.nhs.uk.
(2)Division of Health Research, Lancaster University, United Kingdom.
(3)Spectrum Centre for Mental Health Research, Lancaster University, United
Kingdom.
OBJECTIVES: Although many diagnosed with Bipolar Disorder (BD) choose to manage
their moods without medication at some point, their experiences of doing so are
not well understood. This paper aims to explore the processes by which people
manage bipolar moods without medication.
METHODS: Ten people diagnosed with BD who do not use medication were interviewed.
Analysing their accounts using grounded theory methods led to developing a model
of how they perceive the processes involved in managing moods without medication.
RESULTS: Participants engaged in repeated evaluative processes around their
strategies for managing moods. Some participants decided not to influence
elevated moods due to their perceived advantages. Participants‫ ׳‬intentions and
actions were influenced by their perceptions of themselves and by the meanings
they attached to bipolar moods, which were in turn influenced by feedback from
others.
CONCLUSIONS: The complexity of the processes described by participants suggests
that traditional models of explaining non-adherence may over-simplify some
individuals‫ ׳‬experiences. Future research could focus on identifying factors
predictive of successful attempts to manage moods without medication.
Professionals should place more emphasis on non-medication approaches in order to
increase engagement with people who do not use medication. This may involve
focussing on individual‫׳‬s longer-term goals rather than on modifying moods in
shorter-term. Conclusions are based on participants who had experienced
significant bipolar moods, but who largely seemed satisfied living without
medication.
LIMITATIONS: Future research should ascertain whether such processes apply to a
wider group of individuals who do not use medication for bipolar moods.
DOI: 10.1016/j.jad.2014.11.055
750. Value Health. 2014 Dec;17(8):863-76. doi: 10.1016/j.jval.2014.08.2671.
Predicting adherence to medications using health psychology theories: a

systematic review of 20 years of empirical research.
Holmes EA(1), Hughes DA(2), Morrison VL(3).

Author information:
(1)Centre for Health Economics & Medicines Evaluation. Electronic address:
e.holmes@bangor.ac.uk.
(2)Centre for Health Economics & Medicines Evaluation.
(3)School of Psychology, Bangor University, Bangor, Gwynedd, UK.
OBJECTIVES: This review sought to identify the empirical evidence for the
application of models from sociocognitive theory, self-regulation theory, and
social support theory at predicting patient adherence to medications.
METHODS: A systematic review of the published literature (1990-2010) using
MEDLINE, EMBASE, Cochrane Library, CINAHL, and PsychINFO identified studies
examining the application of health psychology theory to adherence to medication
in adult patients. Two independent reviewers extracted data on medication,
indication, study population, adherence measure, theory, model, survey
instruments, and results. Heterogeneity in theoretical model specification and
empirical investigation precluded a meta-analysis of data.
RESULTS: Of 1756 unique records, 67 articles were included (sociocognitive = 35,
self-regulation = 21, social support = 11). Adherence was most commonly measured
by self-report (50 of 67). Synthesis of studies highlighted the significance (P ≤
0.05) of self-efficacy (17 of 19), perceived barriers (11 of 17), perceived
susceptibility (3 of 6), necessity beliefs (8 of 9), and medication concerns (7
of 8).
CONCLUSIONS: The results of this review provide a foundation for the development
of theory-led adherence-enhancing interventions that could promote sustainable
behavior change in clinical practice.
Copyright © 2014 International Society for Pharmacoeconomics and Outcomes

Research (ISPOR). Published by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.jval.2014.08.2671
751. Pragmat Obs Res. 2014 Oct 1;5:35-41. eCollection 2014.
Effects on hypertensive patients' satisfaction with information about their

medication after nurses' consultation training.
Drevenhorn E(1), Bengtson A(2), Nyberg P(1), Kjellgren KI(3).
Author information:
(1)Department of Health Sciences, Faculty of Medicine, Lund University, Lund,
Sweden.
(2)Institute of Health and Care Sciences, The Sahlgrenska Academy, University of
(3)Institute of Health and Care Sciences, The Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden; Department of Medical and Health Sciences,
Linköping University, Linköping, Sweden.
BACKGROUND: There is a well-known problem in hypertension care with patients'

adherence to treatment. Patients who score high in answering the instrument
Satisfaction with Information about Medicine Scale are reported to have greater
adherence to their medication.
AIM: To explore how hypertensive patients' satisfaction with information about
their medicines was affected by nurses' education in Motivational Interviewing.
MATERIAL AND METHODS: The Stages of Change model and Motivational Interviewing
was the theoretical base for consultation training for nurses. Nineteen nurses
attended 3 days of video-recorded consultation training with simulated patients.
They were updated in hypertensive medication and were trained in motivating
patients to improve their self-management as well as adherence to lifestyle
changes and medication. The satisfaction with information instrument identifies
patients' satisfaction with information about the action and usage of medication
as well as potential problems with it. The instrument was used to assess how well
the needs of individual patients for medicine information were met at baseline
and 2 years after the training. The 19 trained nurses in the intervention group
worked with 137 patients, and a control group of 16 nurses, who gave normal care,
worked with 51 patients.
RESULTS: There was a difference between the intervention and control group in
total score (P=0.028) 2 years after the intervention. Patients in the
intervention group perceived higher satisfaction with the action and usage of
their medication (P=0.001) and a lower degree of potential problems with their
medication (P=0.001). Patients in the control group also perceived a lower degree
of potential problems with their medication (P=0.028).
CONCLUSION: We suggest that consultation training for nurses with the aim of
motivating patients to be more self-directed in their self-care improves
satisfaction with information about medication.
DOI: 10.2147/POR.S58352
PMCID: PMC5045019
PMID: 27774027
752. J Educ Health Promot. 2017 Oct 4;6:83. doi: 10.4103/jehp.jehp_64_16.

eCollection
2017.
Development and study of self-efficacy scale in medication adherence among

Iranian patients with hypertension.
Najimi A(1), Mostafavi F(2), Sharifirad G(3), Golshiri P(4).
Author information:
(1)Department of Medical Education, Medical Education Research Center, Isfahan
(2)Department of Health Education and Health Promotion, School of Health, Isfahan
(3)Department of Public Health, Faculty of Health, Qom University of Medical
Sciences, Qom, Iran.
(4)Department of Community Medicine, School of Medicine, Isfahan University of
BACKGROUND: This study was aimed at developing and studying the scale of
self-efficacy in adherence to treatment in Iranian patients with hypertension.
METHODS: A mix-method study was conducted on the two stages: in the first phase,
a qualitative study was done using content analysis through deep and
semi-structured interviews. After data analysis, the draft of tool was prepared.
Items in the draft were selected based on the extracted concepts. In the second
phase, validity and reliability of the instrument were implemented using a
quantitative study. The prepared instrument in the first phase was studied among
612 participants. To test the construct validity and internal consistency,
exploratory factor analysis and Cronbach's alpha were used, respectively. To
study the validity of the final scale, the average score of self-efficacy in
patients with controlled hypertension were compared with patients with
uncontrolled hypertension.
RESULTS: In overall, 16 patients were interviewed. Twenty-six items were
developed to assess different concepts of self-efficacy. Concept-related items
were extracted from interviews to study the face validity of the tool from
patient's point of view. Four items were deleted because scored 0.79 in content
validity. The mean of questionnaire content validity was 0.85. Items were
collected in two factors with an eigenvalue >1. Four items were deleted with load
factor <0.4. Reliability was 0.84 for the entire instrument.
CONCLUSION: Self-efficacy scale in patients with hypertension is a valid and
reliable instrument that can effectively evaluate the self-efficacy in medication
adherence in the management of hypertension.
DOI: 10.4103/jehp.jehp_64_16
PMCID: PMC5651667
PMID: 29114551
753. Curr Epidemiol Rep. 2018;5(4):357-369. doi: 10.1007/s40471-018-0176-6. Epub

2018
Sep 28.
Assessment of Medication Safety Using Only Dispensing Data.
Pratt N(1), Roughead E(1).
Author information:
(1)Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and
Medical Science, University of South Australia, Adelaide, Australia.
Purpose of Review: The purpose of this review is to provide an overview of the

published studies that have been used to generate evidence on the safety of
medicine use when only medication dispensing data are available.
Recent Findings: Medication dispensing databases are increasingly available for
research on large populations, particularly in countries that provide universal
coverage for medicines. These data are often used for drug utilisation studies to
identify inappropriate medicine use at the population level that may be
associated with known safety issues. Lack of coded diagnoses, to identify
outcomes, and lack of data on confounders can limit use of these data in practice
for medication safety assessment. To overcome these issues, studies have
exploited the fact that symptoms of adverse effects of medications can be treated
with other medications, for example antidepressants to treat depression or
oxybutynin to treat urinary incontinence. The challenge of unmeasured confounding
has been addressed by implementing self-controlled study designs that use
within-person comparisons and provide inherent control for confounding.
Prescription sequence symmetry analysis (SSA) is a within-person study design
that has been demonstrated as a useful tool for safety signal generation in
dispensing data.
Summary: Using medicine initiation as a proxy for the development of adverse
events can help to generate evidence of the safety of medicines when only
medication dispensing data are available. Careful consideration, however, should
be given to the sensitivity and specificity of the proxy medicine for the adverse
event and potential for time-varying confounding due to trends in medicine
utilisation. Data-mining approaches using dispensing data have the potential to
improve safety assessments; however, the challenge of unmeasured confounding with
these methods remains to be investigated.
DOI: 10.1007/s40471-018-0176-6
PMCID: PMC6290698
PMID: 30596002
Conflict of interest statement: The authors declare that they have no conflicts
of interest.This article does not contain any studies with human or animal
subjects performed by any of the authors.
754. Int J Chron Obstruct Pulmon Dis. 2018 Jul 3;13:2065-2074. doi:
10.2147/COPD.S159726. eCollection 2018.
Community pharmacists' knowledge of COPD, and practices and perceptions of

medication counseling of COPD patients.
Heikkilä JM(1)(2), Parkkamäki S(3), Salimäki J(4), Westermarck S(5),

Pohjanoksa-Mäntylä M(1).
Author information:
(1)Faculty of Pharmacy, Division of Pharmacology and Pharmacotherapy, University
of Helsinki, Helsinki, Finland, juha.markus.heikkila@gmail.com.
(2)Hartola Pharmacy, Hartola, Finland, juha.markus.heikkila@gmail.com.
(3)Hyvinkää Willan Kehrä Pharmacy, Hyvinkää, Finland.
(4)The Association of Finnish Pharmacies, Helsinki, Finland.
(5)Tammela Pharmacy, Tammela, Finland.
Background and purpose: COPD is one of the leading causes of morbidity and
mortality worldwide. Although medication counseling interventions by pharmacists
have been found to support the management of COPD, little is known about
pharmacists' knowledge concerning COPD and regular practices and perceptions
concerning medication counseling of COPD patients. The purpose of this study was
to research these topics among Finnish community pharmacists.
Materials and methods: In January 2017, an electronic survey was e-mailed to
Finnish community pharmacies (n=741) via the Association of the Finnish
Pharmacies. One pharmacist from each pharmacy, preferably a specialist in asthma,
was invited to answer the survey.
Results: Completed responses were received from 263 pharmacists (response rate
=35%), of whom 196 pharmacists were specialists in asthma. Response rate among
asthma pharmacists was 42%. Pharmacists were positive about their role in
medication counseling and in support of the self-management of COPD patients.
COPD-related knowledge was self-assessed as being good and was on a good level in
respect of basic facts. However, almost half (46%) of the pharmacists did not
know that COPD is considered a national public health issue, and ~50% of the
pharmacists were not familiar with the current care guideline on COPD. Medication
counseling was found to be more medicinal product-driven and less advisory
concerning lifestyle changes such as smoking cessation and physical exercise.
Conclusion: Although the pharmacists' knowledge of COPD was good on general
topics, there were some gaps in their knowledge on the current care guideline and
status of the disease. Pharmacists should more systematically individually target
medication counseling according to patients' needs. In addition, lifestyle
treatments, including smoking cessation and physical exercise, should be part of
the medication counseling.
DOI: 10.2147/COPD.S159726
PMCID: PMC6037276

755. Patient Prefer Adherence. 2019 Apr 18;13:549-559. doi: 10.2147/PPA.S195446.

eCollection 2019.
Impact of multimodal interventions on medication nonadherence among elderly
hypertensives: a randomized controlled study.
Sheilini M(1), Hande HM(2), Prabhu MM(2), Pai MS(3), George A(4).
Author information:
(1)Department of Medical Surgical Nursing, Manipal College of Nursing Manipal,
MAHE, Manipal, Udupi District, Karnataka, India.
(2)Department of Medicine, Kasturba Hospital, MAHE, Manipal, Udupi District,
Karnataka, India.
(3)Department of Child Health Nursing, Manipal College of Nursing Manipal, MAHE,
Manipal, Udupi District, Karnataka, India.
(4)Department of Child Health Nursing, Manipal College of Nursing Manipal,
Manipal MAHE, Manipal, Udupi District, Karnataka, India.
Purpose: The study was conducted to investigate the effects of multimodal

interventions on medication nonadherence, quality of life (QoL), hypertension
(HTN), self-efficacy, and clinical outcome in terms of blood pressure (BP) among
elderly people with HTN. Methods: An experimental design using a randomized
controlled trial was adopted (N=80+80). The experimental group received
multimodal interventions and the control group received routine care. Both groups
were followed up at baseline and at 3 and 6 months. The data collection tools of
demographic and clinical proforma, structured knowledge questionnaire on HTN
(r=0.84), Revised Medication Adherence Self-Efficacy Scale (r=0.94), Morisky
Medication Adherence Scale (r=0.83), World Health Organization Quality of
Life-BREF scale (r=0.87), and digital BP apparatus were used. Necessary
administrative permission was obtained for the study. Results: The study results
proved that nurse-led multimodal interventions led to an improvement in
medication adherence [F(1.75,214.30)=774.18, p<0.001], knowledge on HTN
[F(2,244)=43.83, p<0.001], and self-efficacy [F(1,122)=3.99, p=0.04] of elderly
people on antihypertensives over a period of 6 months. Overall QoL did not
exhibit any statistically significant improvement, and no statistically
significant reductions in the systolic BP (SBP) and diastolic BP (DBP) scores
were obtained (p>0.05) in the experimental group over a period of 6 months.
However, the clinical significance of multimodal interventions for improvements
in medication adherence, QoL, knowledge on HTN, and self-efficacy was more
favorable compared with the reduction in SBP and DBP scores. Conclusion: Nurses
play a crucial role in improving medication adherence among elderly people with
HTN. Trial details: Ethical clearance was obtained (IEC no. KH IEC 253/2012) from
the Institutional Ethical Committee of Manipal University, Manipal, and the study
was conducted in accordance with the Declaration of Helsinki. The study is
registered under Clinical Trials Registry of India (CTRI/2017/04/008405).
Informed consent was obtained from participants, and the confidentiality of
information was assured.
DOI: 10.2147/PPA.S195446
PMCID: PMC6489579
PMID: 31114169

this work.
756. J Acquir Immune Defic Syndr. 2017 Jan 1;74(1):e18-e22.
Brief Report: Interpersonal and Intrapersonal Factors as Parallel Independent

Mediators in the Association Between Internalized HIV Stigma and ART Adherence.
Seghatol-Eslami VC(1), Dark HE, Raper JL, Mugavero MJ, Turan JM, Turan B.
Author information:
(1)Departments of *Psychology;†Medicine, University of Alabama at Birmingham,
Birmingham, AL; and‡Department of Health Care Organization and Policy, School of
Public Health, University of Alabama at Birmingham, Birmingham, AL.
INTRODUCTION: People living with HIV (PLWH) need to adhere to antiretroviral

therapy (ART) to achieve optimal health. One reason for ART nonadherence is
HIV-related stigma.
OBJECTIVES: We aimed to examine whether HIV treatment self-efficacy (an
intrapersonal mechanism) mediates the stigma-adherence association. We also
examined whether self-efficacy and the concern about being seen while taking HIV
medication (an interpersonal mechanism) are parallel mediators independent of
each other.
METHODS: A total of 180 people living with HIV self-reported internalized HIV
stigma, ART adherence, HIV treatment self-efficacy, and concerns about being seen
while taking HIV medication. We calculated bias-corrected 95% confidence
intervals for indirect effects using bootstrapping to conduct mediation analyses.
RESULTS: Adherence self-efficacy mediated the relationship between internalized
stigma and ART adherence. Additionally, self-efficacy and concern about being
seen while taking HIV medication uniquely mediated and explained almost all the
stigma-adherence association in independent paths (parallel mediation).
CONCLUSION: These results can inform intervention strategies to promote ART
adherence.
DOI: 10.1097/QAI.0000000000001177
PMCID: PMC5147512
Conflict of interest statement: The authors declared that no conflicts of

interest exist.
757. J Pediatr. 2018 Feb;193:128-133.e2. doi: 10.1016/j.jpeds.2017.09.069. Epub

2017
Nov 20.
Self-Management Measurement and Prediction of Clinical Outcomes in Pediatric

Transplant.
Annunziato RA(1), Bucuvalas JC(2), Yin W(3), Arnand R(3), Alonso EM(4),
Mazariegos GV(5), Venick RS(6), Stuber ML(7), Shneider BL(8), Shemesh E(9).
Author information:
(1)Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York,
NY; Department of Psychology, Fordham University, Bronx, NY. Electronic address:
annunziato@fordham.edu.
(2)Department of Pediatrics, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH.
(3)The Emmes Corporation, Rockville, MD.
(4)Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of
Chicago, Chicago, IL.
(5)Department of Surgery and Critical Care, Hillman Center for Pediatric
Transplantation Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
(6)Department of Pediatrics, Mattel Children's Hospital at UCLA, Los Angeles, CA.
(7)Department of Psychiatry, David Geffen School of Medicine at UCLA, Los
Angeles, CA.
(8)Texas Children's Hospital, Houston, TX.
(9)Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York,
NY.
Comment in
J Pediatr. 2018 Apr;195:307-308.
J Pediatr. 2018 Apr;195:307.
OBJECTIVE: To further refine a measure of self-management, the Responsibility and

Familiarity with Illness Survey (REFILS), and to determine if this score predicts
medication adherence and, thus, fewer instances of allograft rejection among
pediatric liver transplant recipients.
STUDY DESIGN: Participants were 400 liver transplant recipients and their parents
recruited for the Medication Adherence in Children Who Had a Liver Transplant
study, from 5 US pediatric transplant centers. The REFILS was administered to
participants (ages 9-17 years) and their parents at enrollment (n = 213 completed
dyads). The REFILS scores, and a discrepancy score calculated between patient and
parent report of the patient's self-management, were used to predict Medication
Level Variability Index (MLVI), a measure of medication adherence (higher
MLVI = more variability in medication levels) and central pathologist-diagnosed
rejection over a 2-year follow-up.
RESULTS: When patients reported greater self-management, their adherence was
lower (higher MLVI, r = 0.26, P < .01). Discrepancies between patient and parent
report (patients endorsing higher levels than parents) were associated with lower
adherence (r = 0.20, P < .01). Greater patient-reported self-management and
higher discrepancy scores also predicted rejection.
CONCLUSIONS: We found that when patients endorse more responsibility for their
care, clinical outcomes are worse, indicating that indiscriminate promotion of
self-management by adolescents may not be advisable. A discrepancy between
patient and parent perception of self-management emerged as a novel strategy to
gauge the degree of risk involved in transitioning care responsibilities to the
child.
DOI: 10.1016/j.jpeds.2017.09.069
PMCID: PMC5889102
758. Clin Ther. 2015 Sep 1;37(9):1975-85. doi: 10.1016/j.clinthera.2015.06.008.

Epub
2015 Jul 9.
Accuracy of Patient-reported Adherence to Glaucoma Medications on a Visual Analog

Scale Compared With Electronic Monitors.
Sayner R(1), Carpenter DM(2), Blalock SJ(2), Robin AL(3), Muir KW(4), Hartnett
ME(5), Giangiacomo AL(6), Tudor G(7), Sleath B(8).
Author information:
Pharmacy, Chapel Hill, North Carolina. Electronic address: sayner@unc.edu.
Pharmacy, Chapel Hill, North Carolina.
(3)Department of Ophthalmology and Visual Sciences, University of Maryland,
Baltimore, Maryland; Department of Ophthalmology and Department of International
Health, Johns Hopkins University, Baltimore, Maryland.
(4)Department of Ophthalmology, School of Medicine, Duke University, Durham,
North Carolina; Durham VA Medical Center, Health Services Research and
Development, Durham, North Carolina.
(5)Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center,
University of Utah, Salt Lake City, Utah.
(6)Ophthalmology Department, Emory University School of Medicine, Atlanta,
Georgia.
(7)Department of Science and Mathematics, Husson University, Bangor, Maine.
Pharmacy, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services
Research, University of North Carolina at Chapel Hill, Chapel Hill, North
Carolina.
PURPOSE: Glaucoma medications can improve clinical outcomes when patients adhere
to their medication regimen. Providers often ask patients with glaucoma to
self-report their adherence, but the accuracy of self-reporting has received
little scientific attention. The purpose of this article was to compare a
self-reported medication adherence measure with adherence data collected from
Medication Event Monitoring Systems (MEMS) electronic monitors. An additional
goal was to identify which patient characteristics were associated with
overreporting adherence on the self-reported measure.
METHODS: English-speaking adult patients with glaucoma were recruited from 6
ophthalmology practices for this observational cohort study. Patients were
interviewed after their initial visit and were given MEMS contains, which
recorded adherence over a 60-day period. MEMS percent adherence measured the
percentage of the prescribed number of doses taken. MEMS-measured timing
adherence assessed the percent doses taken on time. Patients self-reported
adherence to their glaucoma medications on a visual analog scale (VAS) ~60 days
after the baseline visit. Bivariate analyses and logistic regressions were used
to analyze the data. Self-reported medication adherence on the VAS was plotted
against MEMS adherence to illustrate the discrepancy between self-reported and
electronically monitored adherence.
FINDINGS: The analyses included 240 patients who returned their MEMS containers
and self-reported medication adherence at the 60-day follow-up visit. Compared
with MEMS-measured percent adherence, 31% of patients (n = 75) overestimated
their adherence on the VAS. Compared with MEMS-measured timing adherence, 74% (n
= 177) of patients overestimated their adherence. For the MEMS-measured percent
adherence, logistic regression revealed that patients who were newly prescribed
glaucoma medications were significantly more likely to overreport adherence on
the VAS (odds ratio, 3.07 [95% CI, 1.22-7.75]). For the MEMS-measured timing
adherence, being male (χ(2) test, 6.78; P = 0.009) and being prescribed glaucoma
medications dosed multiple times daily (χ(2) test, 4.02; P = 0.045) were
significantly associated with patients overreporting adherence. However, only
male sex remained a significant predictor of overreporting adherence in the
logistic regression (odds ratio, 4.05 [95% CI, 1.73-9.47]).
IMPLICATIONS: Many patients with glaucoma, especially those newly diagnosed,
overestimated their medication adherence. Because patients were likely to
overreport the percent doses taken and timing adherence, providers may want to
ask patients additional questions about when they take their glaucoma medications
to potentially detect issues with taking these medications on time.
Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.
DOI: 10.1016/j.clinthera.2015.06.008
PMCID: PMC4568126
759. J Affect Disord. 2016 May 15;196:234-42. doi: 10.1016/j.jad.2016.02.048. Epub

2016 Feb 22.
Examination of the dynamic interplay between posttraumatic stress symptoms and

alcohol misuse among combat-exposed Operation Enduring Freedom (OEF)/Operation
Iraqi Freedom (OIF) Veterans.
Langdon KJ(1), Fox AB(2), King LA(3), King DW(4), Eisen S(5), Vogt D(6).
Author information:
(1)National Center for PTSD, Women's Health Sciences Division, VA Boston
Healthcare System, United States; Department of Psychiatry, Boston University
School of Medicine, United States. Electronic address: kirstenjlangdon@gmail.com.
Healthcare System, United States.
School of Medicine, United States; Department of Psychology, Boston University
School of Medicine, United States.
(4)Department of Psychiatry, Boston University School of Medicine, United States;
Department of Psychology, Boston University School of Medicine, United States;
National Center for PTSD, Behavioral Sciences Division, VA Boston Healthcare
System, United States.
(5)Center for Healthcare Organization and Implementation Research, Edith Nourse
Rogers Memorial Veterans Hospital, United States; Department of Health Policy and
Management, Boston University School of Public Health, United States.
BACKGROUND: Although alcohol misuse co-occurs with PTSD symptoms at a strikingly

high rate (i.e., nearly 52% of men and 28% of women with PTSD also meet
diagnostic criteria for an Alcohol Use Disorder), the functional associations
between these symptom types remain unclear.
METHODS: The current study sought to clarify the nature of posttraumatic
stress-alcohol misuse relations by employing a prospective longitudinal
methodology-the latent difference score approach-to examine dynamic change in
posttraumatic stress symptoms and alcohol misuse among 478 combat-exposed
Veterans completing a longitudinal survey of post-deployment mental and physical
health. This study builds on the existing literature, as most prior research has
been limited to cross-sectional studies and has not explored prospective
relations between specific PTSD symptom clusters and alcohol misuse.
RESULTS: Consistent with the self-medication model, results indicated that PTSD
symptoms demonstrate a prospective and proximal association with alcohol misuse
during the assessment period; however, alcohol misuse did not appear to be a
unique contributor to overall PTSD symptom exacerbation over time. Examination of
individual PTSD symptom clusters revealed that more severe symptoms of intrusion
and numbing, but not avoidance and hyperarousal, predicted greater alcohol misuse
at subsequent time intervals.
LIMITATIONS: The constructs examined within this investigation relied on
self-report data; diagnostic criteria for PTSD and/or Alcohol Use Disorders were
not assessed. Future work may benefit from replicating these findings in clinical
populations formally diagnosed with PTSD via clinician-administered structured
interviews.
CONCLUSIONS: Findings underscore the importance of addressing PTSD symptoms in
the context of alcohol treatment to facilitate improved drinking outcomes.
DOI: 10.1016/j.jad.2016.02.048
PMCID: PMC4808402
760. Patient. 2016 Apr;9(2):171-80. doi: 10.1007/s40271-015-0136-x.
Patient Preferences for Injectable Treatments for Multiple Sclerosis in the

United States: A Discrete-Choice Experiment.
Poulos C(1), Kinter E(2), Yang JC(3), Bridges JF(4), Posner J(5), Reder AT(6).
Author information:
(1)RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, PO Box
12194, Durham, NC, 27709, USA. cpoulos@rti.org.
(2)Biogen, Cambridge, MA, USA.
(3)Pacific Economic Research, LLC, Bellevue, WA, USA.
(4)Johns Hopkins University, Baltimore, MD, USA.
(5)RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, PO Box
12194, Durham, NC, 27709, USA.
(6)University of Chicago Medicine, Chicago, IL, USA.
BACKGROUND AND OBJECTIVE: Patients' perceptions and experiences of medication

efficacy, medication adverse events, dosing frequency, and dosing complexity have
been found to influence adherence to injectable disease-modifying treatments
(DMTs) in patients with multiple sclerosis (MS). The aim of this study was to
quantify patient preferences for features of injectable DMTs for MS.
METHODS: Adult patients in the United States (US) with a self-reported diagnosis
of MS completed an online discrete-choice experiment survey to assess preference
for a number of features of a hypothetical injectable DMT. Patients chose
hypothetical treatments in paired comparisons, where each treatment was described
by features or attributes, including the number of years until disability
progression, the number of relapses in the next 4 years, injection time, the
frequency of injections, the occurrence of flu-like symptoms (FLS), and severity
of injection-site reactions. Random-parameters logit regression parameters were
used to calculate preference weights of attribute levels and the relative
importance of changes in treatment features.
RESULTS: Of the 205 patients who completed the survey, 192 provided sufficient
data for analysis. The results indicated a broad range of tradeoffs that patients
would be willing to make. With regard to this, the relative importance of an
improvement in the number of years until disability progression from 1 to 2
(i.e., vertical distance between preference weights for these attribute levels)
was 0.9 [95% confidence interval (CI) 0.5-1.2], the relative importance of this
change was approximately equivalent to that of an improvement from 12 injections
per month to two (mean 0.8, 95% CI 0.4-1.2), or approximately equivalent to a
decrease from four to one relapses in the next 4 years (mean 0.8, 95% CI
0.5-1.2), or FLS 3 days after every injection to 3 days after some injections
(mean 1.0, 95% CI 0.6-1.4).
CONCLUSIONS: These results suggest that an improvement in treatment efficacy may
be as important as a reduction in injection frequency or a reduction in some
adverse events for patients who self-administer injectable DMTs for MS.
Understanding the preferences of patients who use injectable treatments will
inform the development of such treatments, which may in turn improve patient
medication adherence and well-being.
DOI: 10.1007/s40271-015-0136-x
PMCID: PMC4796329
761. Curr Clin Pharmacol. 2015;10(3):213-21.
Ability of older people with dementia or cognitive impairment to manage medicine

regimens: a narrative review.
Elliott RA, Goeman D(1), Beanland C, Koch S.
Author information:
(1)Royal District Nursing Service, 31 Alma Rd, St Kilda, Victoria 3182,
Australia. dgoeman@rdns.com.au.
Impaired cognition has a significant impact on a person's ability to manage their

medicines. The aim of this paper is to provide a narrative review of contemporary
literature on medicines management by people with dementia or cognitive
impairment living in the community, methods for assessing their capacity to
safely manage medicines, and strategies for supporting independent medicines
management. Studies and reviews addressing medicines management by people with
dementia or cognitive impairment published between 2003 and 2013 were identified
via searches of Medline and other databases. The literature indicates that as
cognitive impairment progresses, the ability to plan, organise, and execute
medicine management tasks is impaired, leading to increased risk of unintentional
non-adherence, medication errors, preventable medication-related hospital
admissions and dependence on family carers or community nursing services to
assist with medicines management. Impaired functional capacity may not be
detected by health professionals in routine clinical encounters. Assessment of
patients' (or carers') ability to safely manage medicines is not undertaken
routinely, and when it is there is variability in the methods used. Self-report
and informant report may be helpful, but can be unreliable or prone to bias.
Measures of cognitive function are useful, but may lack sensitivity and
specificity. Direct observation, using a structured, standardised
performance-based tool, may help to determine whether a person is able to manage
their medicines and identify barriers to adherence such as inability to open
medicine packaging. A range of strategies have been used to support independent
medicines management in people with cognitive impairment, but there is little
high-quality research underpinning these strategies. Further studies are needed
to develop and evaluate approaches to facilitate safe medicines management by
older people with cognitive impairment and their carers.
PMCID: PMC5396255
762. Oncol Nurs Forum. 2018 Jan 1;45(1):69-76. doi: 10.1188/18.ONF.69-76.
Use of a Smartphone Application for Prompting Oral Medication Adherence Among

Adolescents and Young Adults With Cancer
Wu YP(1), Linder LA(2), Kanokvimankul P(1), Fowler B(1), Parsons BG(1),

Macpherson CF(3), Johnson RH(4).
Author information:
(1)University of Utah.
(2)College of Nursing, University of Utah.
(3)Seattle Children's Hospital.
(4)Mary Bridge Children's Hospital and Health Center/MultiCare Health System.
OBJECTIVES: To explore the feasibility and acceptability of use of a smartphone

medication reminder application to promote adherence to oral medications among
adolescents and young adults (AYAs) with cancer..
SAMPLE &AMP; SETTING: 23 AYAs with cancer from a Children's Oncology
Group-affiliated children's hospital and a National Cancer Institute-designated
comprehensive cancer center in Salt Lake City, UT..
METHODS &AMP; VARIABLES: Participants were asked to use the application for eight
weeks. Data on application usage were obtained from a cloud-based server hosted
by the application developers. Weekly self-report questionnaires were completed.
Feasibility was assessed through participants' usage and responses. Acceptability
was assessed through participants' perceived ease of use and usefulness..
RESULTS: Almost all participants used the application at least once. More than
half reported that they took their medications immediately when they received
reminders. Participants also reported that the application was easy to set up and
use, and that it was useful for prompting medication taking..
IMPLICATIONS FOR NURSING: Nurses could continue to test the efficacy of
integrating e-health modalities, such as smartphone applications, into efforts to
promote medication adherence.
DOI: 10.1188/18.ONF.69-76
PMCID: PMC5927589
763. Ann Med Health Sci Res. 2014 Nov;4(6):922-7. doi: 10.4103/2141-9248.144914.
Determinants of Patient's Adherence to Hypertension Medications: Application of

Health Belief Model Among Rural Patients.
Kamran A(1), Sadeghieh Ahari S(2), Biria M(2), Malepour A(2), Heydari H(3).
Author information:
(1)Department of Public Health, School of Health, Ardabil University of Medical
Sciences, Ardabil, Iran.
(2)Department of Community Medicine, School of Medicine, Ardabil University of
Medical Sciences, Ardabil, Iran.
(3)Department of Community Health, School of Nursing and Midwifery, Tehran
University of Medical Sciences, Tehran, Iran.
BACKGROUND: Hypertension is a major health problem in developing and developed

countries, and its increasing epidemy is a serious warning to take more attention
to this silent disease.
AIM: This study was aimed to determine the factors of adherence to hypertension
medication based on health belief model (HBM).
SUBJECTS AND METHODS: A cross-sectional study was conducted in a rural area of
the Ardabil city in 2013. This study was carried out using a pre-structured and
validated questionnaire. The questionnaire included information on demographic
characteristics, lifestyle habits, HBM constructs and adherence to hypertension
medication (Morisky 4-Item Self-Report Measure of Medication-taking Behavior
[Morisky Medication Adherence Scale]). Data were analyzed with the use of SPSS
version 18. P < 0.05 was considered as statistically significant.
RESULTS: A total of 671 hypertensive patients participated in the study (169 were
males and 502 were females). The prevalence of adherence was 24% (161/671)% in
the study population. Respondents with regular physical activity and nonsmokers
were more adherent to hypertension medication when compared to respondents with
sedentary lifestyle and smoking (P < 0.01). Based on HBM constructs, the
respondents who perceived high susceptibility, severity, benefit had better
adherence compared to moderate and low susceptibility, severity, and benefit.
CONCLUSION: The prevalence of adherence to hypertension management was low in
study population, this due to inadequate perceived susceptibility, perceived,
severity, perceived benefit and poor lifestyle factors. Improving adherence in
hypertension patients need to recognize the value and importance of patient
perceptions medications.
DOI: 10.4103/2141-9248.144914
PMCID: PMC4250992
PMID: 25506487
764. BMJ Open Diabetes Res Care. 2016 May 9;4(1):e000201. doi:
10.1136/bmjdrc-2016-000201. eCollection 2016.
Integrative health coaching: a behavior skills approach that improves HbA1c and
pharmacy claims-derived medication adherence.
Wolever RQ(1), Dreusicke MH(2).
Author information:
(1)Department of Physical Medicine and Rehabilitation, Osher Center for
Integrative Medicine, Vanderbilt Schools of Medicine & Nursing, Nashville,
Tennessee, USA; Duke Integrative Medicine, Duke University School of Medicine,
Durham, North Carolina, USA.
(2)Duke Integrative Medicine , Duke University School of Medicine , Durham, North
Carolina , USA.
OBJECTIVE: Medication adherence requires underlying behavior skills and a

supporting mindset that may not be addressed with education or reminders. Founded
in the study of internal motivation and health psychology, integrative health
coaching (IHC) helps patients gain insight into their behaviors and make
long-term, sustainable lifestyle changes. The purpose of the study is to
determine whether IHC improves oral medication adherence, glycated hemoglobin
(HbA1c), and psychosocial measures, and to assess whether adherence changes are
sustained after the intervention.
METHODS: Using a prospective observational design, participants (n=56) received
14 coaching calls by telephone over 6 months. Medication possession ratio (MPR)
was calculated for time intervals before, during, and after the intervention.
HbA1c and patient-reported psychosocial outcomes were obtained to test
interactions with MPR.
RESULTS: Medication adherence (MPR) increased from 0.74±0.197 to 0.85±0.155
during coaching, and was sustained at 0.82±0.175 during a 6-month period after
the study. Better adherence correlated with a greater decrease in HbA1c. HbA1c
decreased from 8.0±1.92% to 7.7±1.70% over the 6-month intervention. All
psychosocial measures showed significant improvement. In addition to discussing
medication adherence strategies with their coach, patients discussed nutrition
and exercise (86.9% of calls), stress management (39.8%), and social support and
relationships (15.4%).
CONCLUSIONS: IHC targets internal motivation and supports behavior change by
facilitating patients' insight into their own behaviors, and it uses this insight
to foster self-efficacy. This approach may yield sustainable results for
medication adherence and warrants further exploration for health-related behavior
change.
DOI: 10.1136/bmjdrc-2016-000201
PMCID: PMC4873948
PMID: 27239318
765. Acta Neuropathol. 2017 Mar;133(3):463-483. doi: 10.1007/s00401-016-1658-6.

Epub
2016 Dec 20.
Paradoxical antidepressant effects of alcohol are related to acid

sphingomyelinase and its control of sphingolipid homeostasis.
Müller CP(1), Kalinichenko LS(2), Tiesel J(2), Witt M(3), Stöckl T(2), Sprenger
E(2), Fuchser J(3), Beckmann J(3), Praetner M(2), Huber SE(2), Amato D(2), Mühle
C(2), Büttner C(4), Ekici AB(4), Smaga I(5), Pomierny-Chamiolo L(5), Pomierny
B(5), Filip M(6), Eulenburg V(7), Gulbins E(8)(9), Lourdusamy A(10), Reichel
M(2)(11), Kornhuber J(2).
Author information:
(1)Department of Psychiatry and Psychotherapy, University Clinic,
Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054,
Erlangen, Germany. Christian.Mueller@uk-erlangen.de.
(2)Department of Psychiatry and Psychotherapy, University Clinic,
Friedrich-Alexander-University of Erlangen-Nuremberg, Schwabachanlage 6, 91054,
Erlangen, Germany.
(3)Bruker Daltonik GmbH, Bremen, Germany.
(4)Institute of Human Genetics, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany.
(5)Chair of Toxicology, Faculty of Pharmacy, Jagiellonian University Medical
College, Krakow, Poland.
(6)Institute of Pharmacology, Polish Academy of Sciences, Laboratory of Drug
Addiction Pharmacology, 12 Smetna, Krakow, 31-343, Poland.
(7)Institute of Biochemistry, Friedrich-Alexander-University of
Erlangen-Nuremberg, 91054, Erlangen, Germany.
(8)Department of Molecular Biology, University of Duisburg-Essen, Essen, Germany.
(9)Department of Surgery, College of Medicine, University of Cincinnati, 231
Albert Sabin Way, Cincinnati, OH, 45267-0558, USA.
(10)Division of Child Health, Obstetrics and Gynaecology, School of Medicine,
University of Nottingham, Nottingham, NG7 2UH, UK.
(11)Department of Nephrology and Hypertension, Friedrich-Alexander-University
Erlangen-Nuremberg, Schwabachanlage 12, 91054, Erlangen, Germany.
Alcohol is a widely consumed drug that can lead to addiction and severe brain
damage. However, alcohol is also used as self-medication for psychiatric
problems, such as depression, frequently resulting in depression-alcoholism
comorbidity. Here, we identify the first molecular mechanism for alcohol use with
the goal to self-medicate and ameliorate the behavioral symptoms of a genetically
induced innate depression. An induced over-expression of acid sphingomyelinase
(ASM), as was observed in depressed patients, enhanced the consumption of alcohol
in a mouse model of depression. ASM hyperactivity facilitates the establishment
of the conditioned behavioral effects of alcohol, and thus drug memories.
Opposite effects on drinking and alcohol reward learning were observed in animals
with reduced ASM function. Importantly, free-choice alcohol drinking-but not
forced alcohol exposure-reduces depression-like behavior selectively in depressed
animals through the normalization of brain ASM activity. No such effects were
observed in normal mice. ASM hyperactivity caused sphingolipid and subsequent
monoamine transmitter hypo-activity in the brain. Free-choice alcohol drinking
restores nucleus accumbens sphingolipid- and monoamine homeostasis selectively in
depressed mice. A gene expression analysis suggested strong control of ASM on the
expression of genes related to the regulation of pH, ion transmembrane transport,
behavioral fear response, neuroprotection and neuropeptide signaling pathways.
These findings suggest that the paradoxical antidepressant effects of alcohol in
depressed organisms are mediated by ASM and its control of sphingolipid
homeostasis. Both emerge as a new treatment target specifically for
depression-induced alcoholism.
DOI: 10.1007/s00401-016-1658-6
PMCID: PMC5325869
766. Int J Clin Pharm. 2019 Feb;41(1):113-121. doi: 10.1007/s11096-018-0756-z. Epub
2018 Nov 26.
The treatment-related experiences of parents, children and young people with

regular prescribed medication.
Aston J(1)(2), Wilson KA(3), Terry DRP(3).
Author information:
(1)Aston Pharmacy School, Aston University, Birmingham, UK. jeff.aston@nhs.net.
(2)Pharmacy Department, Birmingham Women's and Children's NHS Foundation Trust,
Birmingham, UK. jeff.aston@nhs.net.
(3)Aston Pharmacy School, Aston University, Birmingham, UK.
Background Taking regular medication has been shown to have an impact on the
daily lives of patients and their families. Objective To explore the
medication-related experiences of patients and their families when a child or
young person is prescribed regular medication. Setting A specialist U.K.
paediatric hospital. Method Semi-structured face-to-face interviews of 24
parents/carers, children or young people, who had been taking two or more
medications for 6 weeks or longer. The themes explored included the medication
regimen, formulation, supplies, social aspects and adverse effects. The data was
analysed using NVIVO version 11. Main outcome measure The experiences of
patients, and their parents/carers, when a child/young person takes regular
medication. Results Participants described a range of experiences associated with
taking regular medication. Medication-related challenges were experienced around
the timing of administration which was managed over 24 h rather than waking
hours. Updating medication doses for administration at school was often delayed.
Unintended nonadherence was cited as the biggest challenge with a range of
strategies employed to manage this. The internet was commonly used as a source of
additional information accessed for reassurance and adverse effects but there
were varying experiences of using patient forums/help groups. Other challenges
included the adequacy of information, travelling with medication, formulation
issues, arranging supplies and adverse effects. Conclusion Patients and parents
experience many challenges with children's medication. Individualised treatment
options should be considered. Further research is required to determine how these
experiences may be managed including the role of paediatric medication review.
DOI: 10.1007/s11096-018-0756-z
PMCID: PMC6394506
767. Am J Manag Care. 2014 Dec 1;20(12):e547-55.
Improving medication understanding among Latinos through illustrated medication

lists.
Mohan A(1), Riley B, Schmotzer B, Boyington DR, Kripalani S.
Author information:
(1)Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322.
E-mail: arun.mohan@emory.edu.
OBJECTIVES: Strategies are needed to improve medication management among

vulnerable populations. We tested the effect of providing illustrated,
plain-language medication lists on medication understanding, adherence, and
satisfaction among Latino patients with diabetes in a safety net clinic.
STUDY DESIGN: Randomized controlled trial.
METHODS: Intervention patients received a PictureRx illustrated medication list
that depicted the medication, indication, and dosing instructions, accompanied by
plain language bilingual text. Usual care patients received a written list of
their medications in their preferred language, with indication but no images.
Outcomes were assessed by telephone approximately 1 week later. The Medication
Understanding Questionnaire measured patients' ability to report the indication,
strength, dosing, and frequency for their medication regimen. Self-reported
adherence and satisfaction were secondary outcomes. Analysis was performed by
intention to treat.
RESULTS: Of 200 enrolled participants, 197 (98.5%) completed follow-up. Most
(71%) had not graduated high school, and 59% had low health literacy. Patients
randomized to illustrated medication instructions had better overall
understanding of their medications (P<.001), including greater ability to report
the drug indication (P<.01), strength (P<.05), dosing (P<.01), and frequency of
administration (P<.001). Self-reported adherence did not differ significantly
between study groups. Patients who received illustrated medication lists were
very satisfied with them.
CONCLUSIONS: In this randomized controlled trial, patients who received
illustrated, plain-language medication lists demonstrated significantly greater
understanding of their medication regimen. Such tools have the potential to
improve medication use and chronic disease control, as well as reduce health
disparities-although this requires further study.
768. Can Respir J. 2018 Jun 21;2018:3238546. doi: 10.1155/2018/3238546. eCollection

2018.
Asthma and Asthma Medication Are Common among Recreational Athletes Participating
in Endurance Sport Competitions.
Näsman A(1), Irewall T(1), Hållmarker U(2), Lindberg A(3), Stenfors N(1).
Author information:
(1)Department of Public Health and Clinical Medicine, Unit of Medicine-Östersund,
Umeå University, 90187 Umeå, Sweden.
(2)Department of Internal Medicine, Mora Hospital, 79285 Mora, Sweden.
(3)Department of Public Health and Clinical Medicine, Unit of Medicine-Sunderbyn,
Umeå University, 90187 Umeå, Sweden.
Background: Asthma prevalence is high among elite endurance athletes, but little
is known about its prevalence among competitive recreational athletes. The aim of
this study was to determine the prevalence of self-reported asthma and asthma
medication use among competitive recreational endurance athletes and their
association with training.
Methods: A web survey on asthma and medication was conducted among 38,603 adult
participants of three Swedish endurance competitions (cross-country running,
cross-country skiing, and swimming).
Results: The overall response rate was 29%. The prevalence of self-reported
asthma (physician-diagnosed asthma and use of asthma medication in the last 12
months) was 12%. Among those reporting asthma, 23% used inhaled corticosteroids
and long-acting beta-agonists daily. We found no association between training
volume and daily use of asthma medication, except a trend in relation to
short-acting beta-agonists. Independent predictors of self-reported asthma were
female sex, allergic rhinitis, previous eczema, family history of asthma,
cycling, and training for >5 h 50 min/week.
Conclusions: The prevalence of self-reported asthma among Swedish competitive
recreational endurance athletes appears to be higher than that in the general
Swedish population. A large proportion of recreational athletes were reported
with asthma use medications, indicating an association between high physical
activity and self-reported asthma among competitive recreational athletes.
DOI: 10.1155/2018/3238546
PMCID: PMC6032657
769. COPD. 2015 Apr;12(2):151-64. doi: 10.3109/15412555.2014.922067. Epub 2014 Jun

24.
Chronic Obstructive Pulmonary Disease Illness and Medication Beliefs are

Associated with Medication Adherence.
Krauskopf K(1), Federman AD, Kale MS, Sigel KM, Martynenko M, O'Conor R, Wolf MS,
Leventhal H, Wisnivesky JP.
Author information:
(1)1Division of General Internal Medicine, Icahn School of Medicine at Mount
Sinai , New York, NY , USA.
Almost half of patients with COPD do not adhere to their medications. Illness and
medication beliefs are important determinants of adherence in other chronic
diseases. Using the framework of the Common Sense Model of Self-Regulation (CSM),
we determined associations between potentially modifiable beliefs and adherence
to COPD medications in a cohort of English- and Spanish-speaking adults with COPD
from New York and Chicago. Medication adherence was assessed using the Medication
Adherence Report Scale. Illness and medication beliefs along CSM domains were
evaluated using the Brief Illness Perception Questionnaire (B-IPQ) and the
Beliefs about Medications Questionnaire (BMQ). Unadjusted analysis (with Cohen's
d effect sizes) and multiple logistic regression were used to assess the
relationship between illness and medication beliefs with adherence. The study
included 188 participants (47% Black, 13% Hispanics); 109 (58%) were
non-adherent. Non-adherent participants were younger (p < 0.001), more likely to
be Black or Hispanic (p = 0.001), to have reported low income (p = 0.02), and had
fewer years of formal education (p = 0.002). In unadjusted comparisons,
non-adherent participants reported being more concerned about their COPD (p =
0.011; Cohen's d = 0.43), more emotionally affected by the disease (p = 0.001;
Cohen's d = 0.54), and had greater concerns about COPD medications (p < 0.001,
Cohen's d = 0.81). In adjusted analyses, concerns about COPD medications
independently predicted non-adherence (odds ratio: 0.52, 95% confidence interval:
0.36-0.75). In this cohort of urban minority adults, concerns about medications
were associated with non-adherence. Future work should explore interventions to
influence patient adherence by addressing concerns about the safety profile and
long-term effects of COPD medications.
DOI: 10.3109/15412555.2014.922067
PMCID: PMC4305045

eCollection 2019.
Associations of different adherences in patients with type 2 diabetes mellitus.

Klinovszky A(1), Kiss IM(1), Papp-Zipernovszky O(2), Lengyel C(3), Buzás N(1).
Author information:
(1)Department of Health Economics, University of Szeged, Szeged, Hungary,
buzas.norbert@med.u-szeged.hu.
(2)Department of Psychology, University of Szeged, Szeged, Hungary.
(3)1st Department of Internal Medicine, University of Szeged, Szeged, Hungary.
Purpose: The objective of our cross-sectional study is to explore the adherence

behavior of patients with type 2 diabetes mellitus (T2DM) by examining the
association between the various types of adherence. The success of diabetic
therapy partly relies on patient motivation, psych-odemographic variables
(self-efficacy, health literacy, and health locus of control [HLOC]), and
adherence. The aim of our research was to explore the attitudes of T2DM patients
toward medication and lifestyle therapy, thus gaining a deeper insight into the
role of adherence-determining parameters in disease management.
Patients and methods: The sample for the present study consisted of 113 T2DM
inpatients (75 women and 38 men) with a mean age of 60.56 years (SD=12.94, range:
20-85 years) diagnosed with T2DM for an average of 13 years (SD=8.23).
Participants completed the Diabetes Adherence Questionnaire conceptualized by the
research team in accordance with the mapping of psychological and psychosocial
parameters. We examined the associations between variables using Spearman's rank
correlation. Multivariate regression analysis was used to examine predictive
variables for adherent behavior. In addition, we attempted to examine factors
with a negative effect on adherence using factor analysis.
Results: Based on our results, a high level of medication adherence negatively
correlated with lifestyle adherence. Multivariate regression analysis showed that
blood glucose monitoring adherence is mostly predicted by social-external HLOC,
diabetes self-efficacy, and internal HLOC, while dietary adherence is predicted
by the patient's self-efficacy and duration of the illness. Additionally,
understanding and following the diabetes treatment were significantly associated
with dietary adherence and high levels of patient self-efficacy, while health
literacy was mostly predicted by internal HLOC.
Conclusion: Adherence to medication, diet, glucose monitoring, and physical
exercise showed different levels in T2DM patients and were in association with
psychodemographic factors.
DOI: 10.2147/PPA.S187080
PMCID: PMC6422420
PMID: 30936685

771. Patient Educ Couns. 2016 Feb;99(2):220-6. doi: 10.1016/j.pec.2015.09.001. Epub

2015 Sep 3.
Clinician empathy is associated with differences in patient-clinician

communication behaviors and higher medication self-efficacy in HIV care.
Flickinger TE(1), Saha S(2), Roter D(3), Korthuis PT(4), Sharp V(5), Cohn J(6),
Eggly S(6), Moore RD(3), Beach MC(3).
Author information:
(1)University of Virginia School of Medicine, Charlottesville, VA, USA.
Electronic address: TES3J@hscmail.mcc.virginia.edu.
(2)Portland VA Medical Center, Portland, OR, USA; Oregon Health and Science
University, Portland, OR, USA.
(3)Johns Hopkins University, Baltimore, MD, USA.
(4)Oregon Health and Science University, Portland, OR, USA.
(5)St Luke's Roosevelt, New York, NY, USA.
(6)Wayne State University, Detroit, MI, USA.
Comment in
Patient Educ Couns. 2016 Feb;99(2):171-2.
OBJECTIVE: We examined associations of clinicians' empathy with patient-clinician

communication behaviors, patients' rating of care, and medication self-efficacy.
METHODS: We analyzed 435 adult patients and 45 clinicians at four outpatient HIV
care sites in the United States. Negative binomial regressions investigated
associations between clinician empathy and patient-clinician communication,
assessed using the Roter Interaction Analysis System (RIAS). Logistic regressions
investigated associations between clinician empathy and patient ratings of
clinician communication, overall satisfaction, and medication self-efficacy.
RESULTS: Clinicians in the highest vs. lowest empathy tertile engaged in less
explicitly emotional talk (IRR 0.79, p<0.05), while clinicians in the middle vs.
lowest engaged in more positive talk (IRR 1.31, p<0.05), more questions (IRR
1.42, p<0.05), and more patient activating talk (IRR 1.43, p<0.05). Patients of
higher empathy clinicians disclosed more psychosocial and biomedical information.
Patients of clinicians in both the middle and highest (vs. lowest) empathy
tertiles had greater odds of reporting highest medication self-efficacy (OR 1.80,
95% CI 1.16-2.80; OR 2.13, 95% CI 1.37-3.32).
CONCLUSIONS: Clinician empathy may be expressed through addressing patient
engagement in care, by fostering cognitive, rather than primarily emotional,
processing.
PRACTICE IMPLICATIONS: Clinicians should consider enhancing their own empathic
capacity, which may encourage patients' self-efficacy in medication adherence.
DOI: 10.1016/j.pec.2015.09.001
PMCID: PMC5610904
772. Med Care. 2017 May;55(5):500-505. doi: 10.1097/MLR.0000000000000701.
A Comparison of Self-reported Medication Adherence to Concordance Between Part D

Claims and Medication Possession.
Savitz ST(1), Stearns SC, Zhou L, Thudium E, Alburikan KA, Tran R, Rodgers JE.
Author information:
(1)*Department of Health Policy & Management †Cecil G. Sheps Center for Health
Services Research, The University of North Carolina at Chapel Hill ‡UNC Eshelman
School of Pharmacy, Chapel Hill, NC §College of Pharmacy, King Saud University,
Riyadh, Kingdom of Saudi Arabia.
OBJECTIVE: Medicare Part D claims indicate medication purchased, but people who
are not fully adherent may extend prescription use beyond the interval
prescribed. This study assessed concordance between Part D claims and medication
possession at a study visit in relation to self-reported medication adherence.
MATERIALS AND METHODS: We matched Part D claims for 6 common medications to
medications brought to a study visit in 2011-2013 for the Atherosclerosis Risk in
Communities study. The combined data consisted of 3027 medication events (claims,
medications possessed, or both) for 2099 Atherosclerosis Risk in Communities
study participants. Multinomial logistic regression estimated the association of
concordance (visit only, Part D only, or both) with self-reported medication
adherence while controlling for sociodemographic characteristics, veteran status,
and availability under Generic Drug Discount Programs.
RESULTS: Relative to participants with high adherence, medication events for
participants with low adherence were approximately 25 percentage points less
likely to match and more likely to be visit only (P<0.001). The results were
similar but smaller in magnitude (approximately 2-3 percentage points) for
participants with medium adherence. Compared with females, medication events for
male veterans were approximately 11 percentage points less likely to match and
more likely to be visit only. Events for medications available through Generic
Drug Discount Programs were 3 percentage points more likely to be visit only.
CONCLUSIONS: Part D claims were substantially less likely to be concordant with
medications possessed at study visit for participants with low self-reported
adherence. This result supports the construction of adherence proxies such as
proportion days covered using Part D claims.
DOI: 10.1097/MLR.0000000000000701
PMCID: PMC5391286
773. Blood Press. 2014 Oct;23(5):296-306. doi: 10.3109/08037051.2014.901009. Epub

2014
May 1.
Developing an interactive mobile phone self-report system for self-management of

hypertension. Part 2: content validity and usability.
Bengtsson U(1), Kjellgren K, Höfer S, Taft C, Ring L.
Author information:
Gothenburg , Sweden.
Self-management support tools using technology may improve adherence to

hypertension treatment. There is a need for user-friendly tools facilitating
patients' understanding of the interconnections between blood pressure, wellbeing
and lifestyle. This study aimed to examine comprehension, comprehensiveness and
relevance of items, and further to evaluate the usability and reliability of an
interactive hypertension-specific mobile phone self-report system. Areas
important in supporting self-management and candidate items were derived from
five focus group interviews with patients and healthcare professionals (n = 27),
supplemented by a literature review. Items and response formats were drafted to
meet specifications for mobile phone administration and were integrated into a
mobile phone data-capture system. Content validity and usability were assessed
iteratively in four rounds of cognitive interviews with patients (n = 21) and
healthcare professionals (n = 4). Reliability was examined using a test-retest.
Focus group analyses yielded six areas covered by 16 items. The cognitive
interviews showed satisfactory item comprehension, relevance and coverage;
however, one item was added. The mobile phone self-report system was reliable and
perceived easy to use. The mobile phone self-report system appears efficiently to
capture information relevant in patients' self-management of hypertension. Future
studies need to evaluate the effectiveness of this tool in improving
self-management of hypertension in clinical practice.
DOI: 10.3109/08037051.2014.901009
PMCID: PMC4196575
Validity assessment of self-reported medication use by comparing to pharmacy

insurance claims.
Fujita M(1), Sato Y(2), Nagashima K(2), Takahashi S(3), Hata A(1).
Author information:
(1)Department of Public Health, Chiba University, Chiba, Japan.
(2)Department of Global Clinical Research, Chiba University, Chiba, Japan Chiba
University Hospital, Clinical Research Center, Chiba, Japan.
(3)Chiba University Hospital, Clinical Research Center, Chiba, Japan.
OBJECTIVES: In Japan, an annual health check-up and health promotion guidance

programme was established in 2008 in accordance with the Act on Assurance of
Medical Care for the Elderly. A self-reported questionnaire on medication use is
a required item in this programme and has been used widely, but its validity has
not been assessed. The aim of this study was to evaluate the validity of this
questionnaire by comparing self-reported usage to pharmacy insurance claims.
SETTING: This is a population-based validation study. Self-reported medication
use for hypertension, diabetes and dyslipidaemia is the evaluated measurement.
Data on pharmacy insurance claims are used as a reference standard.
PARTICIPANTS: Participants were 54,712 beneficiaries of the National Health
Insurance of Chiba City.
PRIMARY AND SECONDARY OUTCOME MEASURES: Sensitivity, specificity and κ statistics
of the self-reported medication-use questionnaire for predicting actual
prescriptions during 1 month (that of the check-up) and 3 months (that of the
check-up and the previous 2 months) were calculated.
RESULTS: Sensitivity and specificity scores of questionnaire data for predicting
insurance claims covering 3 months were, respectively, 92.4% (95% CI 91.9 to
92.8) and 86.4% (95% CI 86.0 to 86.7) for hypertension, 82.6% (95% CI 81.1 to
84.0) and 98.5% (95% CI 98.4 to 98.6) for diabetes, and 86.2% (95% CI 85.5 to
86.8) and 91.0% (95% CI 90.8 to 91.3) for dyslipidaemia. Corresponding κ
statistics were 70.9% (95% CI 70.1 to 71.7), 77.1% (95% CI 76.2 to 77.9) and
69.8% (95% CI 68.9 to 70.6). The specificity was significantly higher for
questionnaire data covering 3 months compared with data covering 1 month for all
3 conditions.
CONCLUSIONS: Self-reported questionnaire data on medication use had sufficiently
high validity for further analyses. Item responses showed close agreement with
actual prescriptions, particularly those covering 3 months.
http://www.bmj.com/company/products-services/rights-and-licensing/
DOI: 10.1136/bmjopen-2015-009490
PMCID: PMC4654279
775. Atherosclerosis. 2015 Oct;242(2):625-9. doi:

10.1016/j.atherosclerosis.2015.08.026. Epub 2015 Aug 20.
Validity of self-report of lipid medication use: the Atherosclerosis Risk in

Communities (ARIC) Study.
Bhaskara S(1), Whitsel EA(2), Ballantyne CM(3), Folsom AR(4).

Author information:
(1)Division of Epidemiology and Community Health, School of Public Health,
University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN
55454-1015, USA. Electronic address: bhask007@umn.edu.
(2)Cardiovascular Disease Program, Departments of Epidemiology and Medicine,
University of North Carolina at Chapel Hill, Bank of America Center, Suite 301-B,
137 East Franklin Street, Chapel Hill, NC 27514, USA. Electronic address:
eric_whitsel@unc.edu.
(3)Department of Medicine, Baylor College of Medicine, 6565 Fannin Street, Suite
A656, MS A601, Houston, TX 77030, USA. Electronic address: cmb@bcm.tmc.edu.
(4)Division of Epidemiology and Community Health, School of Public Health,
University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN
55454-1015, USA. Electronic address: folso001@umn.edu.
OBJECTIVE: To evaluate the validity of self-reported lipid medication use in an

epidemiological study.
METHODS: We studied medication self-reports compared with inventoried lipid
medication containers at the fifth visit of the Atherosclerosis Risk in
Communities (ARIC) Study in 2011-2013 (n = 6370). To assess the validity of
self-reports, we computed sensitivity, specificity, positive and negative
predictive values. We used multiple logistic regression to determine whether
validity varied by participant characteristics. Comparisons were made with visit
4 (n = 11,531), to determine if there was a change in validity as the pattern and
types of lipid medication used changed over time.
RESULTS: The prevalence of lipid medication use, according to medication
containers was higher at visit 5 (56%) than visit 4 (14.3%). Statins were
increasingly used. The percentage of participants reporting use/non-use
accurately was 91.8% at visit 5, lower than visit 4 (97.3%). The unadjusted kappa
coefficient of agreement was 0.83 (95% CI - 0.82 to 0.85) at visit 5 and 0.89
(95% CI - 0.88 to 0.90) at visit 4. Agreement was higher, compared with their
counterparts, for women, younger and more educated participants, and those using
fewer total medications.
CONCLUSION: In this population sample, self-reported lipid medication use was
highly accurate and therefore likely would be for similar epidemiological studies
or clinical settings collecting this information.
DOI: 10.1016/j.atherosclerosis.2015.08.026
PMCID: PMC4575898
Factors predicting self-reported medication low adherence in a large sample of

adults in the US general population: a cross-sectional study.
Feehan M(1)(2), Morrison MA(2), Tak C(1), Morisky DE(3), DeAngelis MM(2), Munger
MA(1).
Author information:
(1)The Department of Pharmacotherapy, College of Pharmacy, University of Utah,
Salt Lake City, Utah, USA.
(2)The Moran Eye Center, Department of Ophthalmology and Visual Sciences, Moran
Eye Centre, University of Utah School of Medicine, Salt Lake City, Utah, USA.
(3)Department of Community Health Sciences, UCLA Fielding School of Public
Health, Los Angeles, California, USA.
Erratum in
BMJ Open. 2017 Sep 1;7(8):e014435corr1.
OBJECTIVES: The study objective was to determine the level and correlates of
self-reported medication low adherence in the US general population.
SETTING: A 30 min cross-sectional online survey was conducted with a national
sample of adults.
PARTICIPANTS: 9202 adults (aged 18+) who had filled at least three or more
prescriptions at a community pharmacy in the past 12 months.
PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported medication adherence was
measured with the 8-item Morisky Medication Adherence Scale.
RESULTS: Low adherence was reported by 42.0%, 29.4% had medium adherence and
28.6% had high adherence. Low adherence was significantly associated with: lower
age, being of Hispanic origin or African-American, having difficulty with
healthcare, medication or transportation costs, needing the support of others to
access primary care, health limiting activity, using multiple providers,
infrequent visits to primary care providers and visiting an emergency department
>3 times in last 12 months.
CONCLUSIONS: A very high level of low medication adherence is seen in the general
population, particularly for ethnic minorities, those who use multiple healthcare
providers and those who experience barriers to access for regular primary care.
As clinical, patient education and counselling, and healthcare policy initiatives
are directed to tracking the problem of low medication adherence, these should be
priority populations for research and interventions.
DOI: 10.1136/bmjopen-2016-014435
PMCID: PMC5623408
777. J Manag Care Spec Pharm. 2018 Nov;24(11):1184-1196. doi:

10.18553/jmcp.2018.24.11.1184.
Effects of an Asthma Self-Management Support Service Provided by Community

Pharmacists: A Systematic Review and Meta-Analysis.
Dokbua S(1), Dilokthornsakul P(2), Chaiyakunapruk N(3), Saini B(4), Krass I(4),
Dhippayom T(1).
Author information:
(1)1 Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok,
Thailand.
(2)2 Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice,
Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
(3)3 Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice,
Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand;
School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; School of
Pharmacy, University of Wisconsin, Madison; and Asian Centre for Evidence
Synthesis in Population, Implementation and Clinical Outcomes, Health and
Well-being Cluster, Global Asia in the 21st Century Platform, Monash University
Malaysia, Selangor.
(4)4 Faculty of Pharmacy, the University of Sydney, Australia.
BACKGROUND: Current evidence of the effects of pharmacy services on asthma
outcomes are not conclusive, since most pharmacy services comprise a variety of
interventions.
OBJECTIVE: To assess the effect of a service containing self-management support
delivered by community pharmacists to patients with asthma.
METHODS: A systematic search was performed in the following databases from
inception to January 2017: PubMed, Embase, Cochrane Library's Central Register of
Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health
Literature) Plus, International Pharmaceutical Abstracts, and PsycInfo. Original
studies were selected if they met the following criteria: (a) provided by
community pharmacists; (b) the intervention service included the essential
components of asthma self-management; (c) included a usual care group; and (d)
measured control/severity of asthma symptoms, health-related quality of life
(HRQOL), or medication adherence.
RESULTS: Of the 639 articles screened, 12 studies involving 2,121 asthma patients
were included. Six studies were randomized trials, and the other 6 were
nonrandomized trials. Patients with asthma who received a self-management support
service by community pharmacists had better symptom control/lower severity
compared with those receiving usual care (standardized mean difference [SMD] =
0.46; 95% CI = 0.09-0.82) with high heterogeneity (I2=82.6%; P = 0.000). The
overall improvement in HRQOL and medication adherence among patients in the
asthma self-management support group was greater than for those in the usual care
group with SMD of 0.23 (95% CI = 0.12-0.34) and 0.44 (95% CI = 0.27-0.61),
respectively. Evidence of heterogeneity was not observed in these 2 outcomes.
CONCLUSIONS: Self-management support service provided by community pharmacists
can help improve symptom control, quality of life, and medication adherence in
patients with asthma.
DISCLOSURES: This study received financial support from Naresuan University's
Faculty of Pharmaceutical Sciences Research Fund. Two authors, Saini and Krass,
have studies that were included in this review. However, they were not involved
in the processes that could bias outcomes of the present study, that is, quality
assessment and meta-analysis. The remaining authors have declared no conflicts of
interest.
DOI: 10.18553/jmcp.2018.24.11.1184
778. Oncol Nurs Forum. 2018 Jul 2;45(4):508-526. doi: 10.1188/18.ONF.508-526.
Factors Associated With Medication Beliefs in Patients With Cancer: An

Integrative Review.
Marshall VK(1), Given BA(1).
Author information:
(1)Michigan State University.
PROBLEM IDENTIFICATION: Medication beliefs are linked to medication adherence in

cancer treatment. Oral cancer treatments are increasing, making patients
responsible for self-managing medication at home.
LITERATURE SEARCH: A literature search was performed using CINAHL®, PubMed, and
PsycINFO. Included studies were published in English from 2000-2017 and examined
medication beliefs among participants aged 18 years or older who were prescribed
cancer medication.
DATA EVALUATION: Articles were organized by study design, how medication beliefs
were measured, and whether psychometric testing was evaluated. Articles were
scored to indicate rigor of medication belief measurements. Themes of factors
associated with medication beliefs were compiled.
SYNTHESIS: The review represented several cancer and cancer medication types.
Various methods were used to elicit medication beliefs. Medication beliefs
influence decisions to initiate or continue cancer medications, and those beliefs
are multifaceted. Nurses have a critical role in evaluating and supporting
facilitative medication beliefs.
IMPLICATIONS FOR RESEARCH: Nurses can address medication beliefs and clarify
treatment misconceptions. Understanding factors influencing medication beliefs
can inform future interventions to improve adherence and symptom management.
DOI: 10.1188/18.ONF.508-526
779. JMIR Res Protoc. 2017 May 15;6(5):e87. doi: 10.2196/resprot.7223.
EpxMedTracking: Feasibility Evaluation of an SMS-Based Medication Adherence

Tracking System in Community Practice.
Tricarico C(1), Peters R(1), Som A(1)(2), Javaherian K(1), Ross W(1).
Author information:
(1)Washington University in St. Louis School of Medicine, St. Louis, MO, United
States.
(2)Epharmix Research Center, St. Louis, MO, United States.
BACKGROUND: Medication adherence remains a difficult problem to both assess and

improve in patients. It is a multifactorial problem that goes beyond the commonly
cited reason of forgetfulness. To date, eHealth (also known as mHealth and
telehealth) interventions to improve medication adherence have largely been
successful in improving adherence. However, interventions to date have used time-
and cost-intensive strategies or focused solely on medication reminding, leaving
much room for improvement in using a modality as flexible as eHealth.
OBJECTIVE: Our objective was to develop and implement a fully automated short
message service (SMS)-based medication adherence system, EpxMedTracking, that
reminds patients to take their medications, explores reasons for missed doses,
and alerts providers to help address problems of medication adherence in real
time.
METHODS: EpxMedTracking is a fully automated bidirectional SMS-based messaging
system with provider involvement that was developed and implemented through
Epharmix, Inc. Researchers analyzed 11 weeks of de-identified data from patients
cared for by multiple provider groups in routine community practice for
feasibility and functionality. Patients included were those in the care of a
provider purchasing the EpxMedTracking tool from Epharmix and were enrolled from
a clinic by their providers. The primary outcomes assessed were the rate of
engagement with the system, reasons for missing doses, and self-reported
RESULTS: Of the 25 patients studied over the 11 weeks, 3 never responded and
subsequently opted out or were deleted by their provider. No other patients opted
out or were deleted during the study period. Across the 11 weeks of the study
period, the overall weekly engagement rate was 85.9%. There were 109 total
reported missed doses including "I forgot" at 33 events (30.3%), "I felt better"
at 29 events (26.6%), "out of meds" at 20 events (18.4%), "I felt sick" at 19
events (17.4%), and "other" at 3 events (2.8%). We also noted an increase in
self-reported medication adherence in patients using the EpxMedTracking system.
CONCLUSIONS: EpxMedTracking is an effective tool for tracking self-reported
medication adherence over time. It uniquely identifies actionable reasons for
missing doses for subsequent provider intervention in real time based on patient
feedback. Patients enrolled on EpxMedTracking also self-report higher rates of
medication adherence over time while on the system.
©Christopher Tricarico, Robert Peters, Avik Som, Kavon Javaherian, Will Ross.
Originally published in JMIR Research Protocols
PMCID: PMC5447823
PMID: 28506954
780. J Hypertens. 2015 Feb;33(2):412-20. doi: 10.1097/HJH.0000000000000382.
Differences in cardiovascular disease risk when antihypertensive medication

adherence is assessed by pharmacy fill versus self-report: the Cohort Study of
Medication Adherence among Older Adults (CoSMO).
Krousel-Wood M(1), Holt E, Joyce C, Ruiz R, Dornelles A, Webber LS, Morisky DE,
Frohlich ED, Re RN, He J, Whelton PK, Muntner P.
Author information:
(1)aDepartment of Medicine, Tulane University School of Medicine bCenter for
Health Research, Ochsner Clinic Foundation cDepartment of Epidemiology, Tulane
University School of Public Health and Tropical Medicine dDepartment of
Biostatistics and Bioinformatics, Tulane University School of Public Health and
Tropical Medicine eOffice of Medical Education, Tulane University School of
Medicine, New Orleans, Louisiana (work done while at the Center for Health
Research, Ochsner Clinic Foundation) fDepartment of Community Health Sciences,
UCLA Fielding School of Public Health, Los Angeles, California gDepartment of
Cardiology-Hypertension Section, Ochsner Clinic Foundation, New Orleans,
Louisiana hDepartment of Epidemiology, University of Alabama at Birmingham,
Birmingham, Alabama, USA.
BACKGROUND: Pharmacy refill adherence assesses the medication-filling behaviors,

whereas self-report adherence assesses the medication-taking behaviors. We
contrasted the association of pharmacy refill and self-reported antihypertensive
medication adherence with blood pressure (BP) control and cardiovascular disease
(CVD) incidence.
METHODS AND RESULTS: Adults (n = 2075) from the prospective Cohort Study of
Medication Adherence among Older Adults recruited between August 2006 and
September 2007 were included. Antihypertensive medication adherence was
determined using a pharmacy refill measure, medication possession ratio (MPR;
low, medium, and high MPR: <0.5, 0.5 to <0.8, and ≥0.8, respectively) and a
self-reported measure, eight-item Morisky Medication Adherence Scale (MMAS-8;
low, medium, and high MMAS-8: <6, 6 to <8, and 8, respectively). Incident CVD
events (stroke, myocardial infarction, congestive heart failure, or CVD death)
through February 2011 were identified and adjudicated. The prevalence of low,
medium, and high adherence was 4.5, 23.7, and 71.8% for MPR and 14.0, 34.3, and
51.8% for MMAS-8, respectively. During a median of 3.8 years' follow-up, 240
(11.5%) people had a CVD event. Low MPR and low MMAS-8 were associated with
uncontrolled BP at baseline and during follow up. After multivariable adjustment
and compared to those with high MPR, the hazard ratios for CVD associated with
medium and low MPR were 1.17 [95% confidence interval (CI) 0.87-1.56)] and 1.87
(95% CI: 1.06-3.30), respectively. Compared to those with high MMAS-8, the hazard
ratios (95% CI) for MMAS-8 for medium and low MMAS-8 were 1.04 (0.79-1.38) and
0.89 (0.58-1.35), respectively.
CONCLUSION: While both adherence measures were associated with BP control,
pharmacy refill but not self-report antihypertensive medication adherence was
associated with incident CVD. The differences in these associations may be
because of the distinctions in what each adherence measure assesses.
DOI: 10.1097/HJH.0000000000000382
PMCID: PMC4514519
781. EBioMedicine. 2017 Dec;26:146-151. doi: 10.1016/j.ebiom.2017.10.023. Epub 2017

Nov 9.
Paracetamol Medication During Pregnancy: Insights on Intake Frequencies, Dosages

and Effects on Hematopoietic Stem Cell Populations in Cord Blood From a
Longitudinal Prospective Pregnancy Cohort.
Bremer L(1), Goletzke J(2), Wiessner C(3), Pagenkemper M(4), Gehbauer C(5),
Becher H(6), Tolosa E(7), Hecher K(8), Arck PC(9), Diemert A(10), Tiegs G(11).
Author information:
(1)Institute of Experimental Immunology and Hepatology, University Medical Center
Hamburg Eppendorf, Martinistrasse 52, Hamburg 20246, Germany. Electronic address:
La.Bremer@uke.de.
(2)Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg
Eppendorf, Martinistrasse 52, Hamburg 20246, Germany. Electronic address:
J.Goletzke@uke.de.
(3)Institute of Medical Biometry and Epidemiology, University Medical Center
C.Wiessner@uke.de.
M.Pagenkemper@uke.de.
(5)Department of Immunology, University Medical Center Hamburg Eppendorf,
Martinistrasse 52, Hamburg 20246, Germany. Electronic address: C.Gehbauer@uke.de.
(6)Institute of Medical Biometry and Epidemiology, University Medical Center
H.Becher@uke.de.
(7)Department of Immunology, University Medical Center Hamburg Eppendorf,
Martinistrasse 52, Hamburg 20246, Germany. Electronic address: E.Tolosa@uke.de.
K.Hecher@uke.de.
P.Arck@uke.de.
(10)Department of Obstetrics and Fetal Medicine, University Medical Center
A.Diemert@uke.de.
(11)Institute of Experimental Immunology and Hepatology, University Medical
Center Hamburg Eppendorf, Martinistrasse 52, Hamburg 20246, Germany. Electronic
address: G.Tiegs@uke.de.
BACKGROUND: Paracetamol is the first choice for antipyretic or analgesic

treatment throughout pregnancy. Products with Paracetamol are readily available
over the counter and therefore easily accessible for self-medication.
Epidemiological data on Paracetamol intake pattern during pregnancy and its
potential immunological effects are sparse. We aimed to analyze a possible
association between Paracetamol medication and numbers of hematopoietic stem
cells (HSC) in cord blood.
METHODS: The objective was addressed in the PRINCE (PRENATAL DETERMINANTS OF
CHILDREN'S HEALTH) study, a population-based prospective pregnancy cohort study
initiated in 2011 at the University Medical Center in Hamburg, Germany. 518
healthy pregnant women with singleton pregnancies were recruited during the first
trimester. Three examinations were scheduled at the end of the 1st (gestational
week 12-14), the 2nd (gestational week 22-24) and the 3rd trimester (gestational
week 34-36). For 146 of these women, cord blood flow cytometry data were
available. Paracetamol intake was assessed for each trimester of pregnancy.
FINDINGS: Among the 518 enrolled women, 40% took Paracetamol as main analgesic
treatment during pregnancy. The intake frequency and dosage of Paracetamol varied
between the women and was overall low with a tendency towards higher frequencies
and higher dosages in the third trimester. Paracetamol intake, particularly
during the third trimester, resulted in decreased relative numbers of HSCs in
cord blood, independent of maternal age, first-trimester BMI, parity, gestational
age and birth weight (-0.286 (95% CI -0.592, 0.021), p=0.068).
INTERPRETATION: Prenatal Paracetamol intake, especially during the third
trimester, may be causally involved in decreasing HSCs in cord blood.
Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.
DOI: 10.1016/j.ebiom.2017.10.023
PMCID: PMC5832562
782. Drug Discov Ther. 2019 Jul 22;13(3):150-156. doi: 10.5582/ddt.2019.01035. Epub
2019 Jun 28.
Generic selection criteria for safety and patient benefit [VIII]: Comparing the
physicochemical and pharmaceutical properties of brand-name and generic
diclofenac sodium tapes.
Nozawa M(1), Goto M(1), Wada Y(2), Yotsukura K(3), Gannichida A(3), Ishii F(2),
Shimokawa KI(3).
Author information:
(1)Triad Japan Co. Ltd.
University.
With respect to diclofenac sodium-containing tape preparations of nonsteroidal

antiphlogistic drug, we compared the pharmaceutical properties (pH,
elongatedness, water-vapor permeability, adhesive force, and peeling-force) of 11
medicinal drugs (2 brand-name and 9 generic drugs) to obtain evidence for product
selection in line with the needs of the patient. The elongatedness of the generic
drugs Teikoku (1.39), Yutoku (1.40), and Nippon-zoki (1.43) were significantly
higher than the brand-name drug Voltaren® (1.22). The adhesive force was measured
using the probe tack test and the inclined ball tack test. The probe tack test
results of Naboal® (6.8 N/cm2), Teikoku (6.1 N/cm2), Yutoku (5.9 N/cm2),
Nippon-zoki (6.2 N/cm2), and Rakool (6.2 N/cm2) were higher than that of Voltaren
(2.0 N/cm2). The inclined ball tack test results of Naboal (18.0), Teikoku
(24.0), Yutoku (21.5), and Nippon-zoki (22.7) were also higher than that of
Voltaren (7.2). Concerning peeling-force measurement, the 90° peeling-forces of
Naboal (0.95 N), Teikoku (0.96 N), Yutoku (0.94 N), and Nippon-zoki (1.01 N) were
higher than that of Voltaren (0.68 N). These results show that there were marked
differences in the feeling of use of each product between the brand-name and
generic drugs. The pharmacist indicates the basis for selection of a preparation
according to the feeling of use desired by each patient. It has become possible
to recommend products suitable for each patient, which will allow pharmacists to
provide products according to the needs of each patient when a brand-name drug is
changed to a generic one.
DOI: 10.5582/ddt.2019.01035
PMID: 31257355

eCollection 2018.
Medication adherence in chronic illness: do beliefs about medications play a

role?
Lemay J(1), Waheedi M(2), Al-Sharqawi S(1), Bayoud T(2).
Author information:
(1)Department of Pharmacology and Therapeutics, j.lemay@hsc.edu.kw.
Safat, Kuwait.
Background: Several medicines are prescribed for chronic disease management;

however, adherence to long-term therapy remains poor. Culture influences beliefs
about medications and, ultimately, adherence to treatment. There is a paucity of
data with regard to beliefs about medications in the Middle East region, and it
remains to be determined how these beliefs would impact treatment adherence.
Objectives: To investigate the relationship between patients' beliefs about
medications with self-reported adherence to treatment among a chronically ill
multicultural patient population.
Methods: A prospective cross-sectional study was conducted among patients treated
for chronic illnesses in the Ministry of Health primary care clinics in Kuwait.
Patients completed a questionnaire that consisted of questions to collect
information about their health status and demographics using validated
instruments: the Beliefs about Medication, Sensitive Soma Assessment Scale, and
Medication Adherence Report Scale-5 items. The main outcome measures were
self-reported adherence to medications, beliefs, and perceived sensitivity toward
medications.
Results: Of the 1,150 questionnaires distributed, 783 were collected - giving a
response rate of 68.1%. Of the 783 patients, 56.7% were male, 73.7% were married,
53.3% were non-Kuwaitis, and 49.4% had low income (<1,000 KD/3,350 USD monthly).
Patients self-reported having a cardiovascular illness (80.2%), diabetes mellitus
(67.7%), respiratory disease (24.3%), or mood disorder (28.6%). Participants had
a mean of two comorbid illnesses and indicated taking an average of four
prescription medicines to treat them. A structural equation model analysis showed
adherence to medications was negatively impacted by higher negative beliefs
toward medications (beta = -0.46). Factors associated with negative beliefs
toward medications included marital status (being unmarried; beta = -0.14),
nationality (being Kuwaiti; beta = 0.15), having lower education level (beta =
-0.14), and higher illness severity (beta = 0.15). Younger age (beta = 0.10) and
higher illness severity (beta = -0.9) were independently associated with lower
medication adherence. Income and gender did not influence medication adherence or
beliefs about medications. The combined effect of variables tested in the model
explained 24% of the variance in medication adherence.
Conclusion: Medication adherence is a complex, multifaceted issue and patient
beliefs about medications contribute significantly, although partially, to
adherence among a multicultural Middle Eastern patient population.
DOI: 10.2147/PPA.S169236
PMCID: PMC6130270
PMID: 30233149

784. Am J Kidney Dis. 2015 Oct;66(4):621-9. doi: 10.1053/j.ajkd.2015.03.026. Epub

2015
May 13.
Self-reported Medication Adherence and Adverse Patient Safety Events in CKD.
Hsu KL(1), Fink JC(2), Ginsberg JS(1), Yoffe M(1), Zhan M(3), Fink W(1), Woods
CM(4), Diamantidis CJ(5).
Author information:
(1)Department of Medicine, University of Maryland School of Medicine, Baltimore,
MD.
(2)Department of Medicine, University of Maryland School of Medicine, Baltimore,
MD; Department of Epidemiology and Public Health, University of Maryland School
of Medicine, Baltimore, MD; Department of Medicine, Veterans Affairs Maryland
Health Care System, Baltimore, MD.
(3)Department of Epidemiology and Public Health, University of Maryland School of
Medicine, Baltimore, MD.
(4)University of Maryland School of Pharmacy, Baltimore, MD.
(5)Department of Medicine, Duke University School of Medicine, Durham, NC;
Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC.
Electronic address: clarissa.diamantidis@duke.edu.
BACKGROUND: Promoting medication adherence is a recognized challenge for

prescribers. In this study, we examine whether lower medication adherence is
associated with adverse safety events in individuals with decreased estimated
glomerular filtration rates (eGFRs).
STUDY DESIGN: Cross-sectional baseline analysis of prospective cohort.
SETTING & PARTICIPANTS: Baseline analysis of the Safe Kidney Care (SKC) Cohort
Study, a prospective study of individuals with eGFRs<60 mL/min/1.73 m(2) intended
to assess the incidence of disease-specific safety events. Kidney transplant
recipients were excluded.
PREDICTOR: Self-reported medication adherence based on responses to 3 questions
ascertaining degree of medication regimen adherence.
OUTCOMES: Adverse safety events were self-reported at baseline (class I events),
such as hypoglycemia or fall thought to be related to a medication, or detected
incidentally during the baseline visit (class II events), for example,
hypotension or hyperkalemia. Potential drug-related problems (DRPs) were
determined by analyzing participants' medications with respect to dosing
guidelines based on their screening eGFRs at the time of medication reporting.
MEASUREMENTS: Relationship between medication adherence and disease-specific
patient safety events.
RESULTS: Of 293 SKC participants, 154 (53%) were classified as having lower
medication adherence. After multivariable adjustment, lower medication adherence
was significantly associated with a class I or II safety event (prevalence ratio
[PR], 1.21; 95% CI, 1.04-1.41) and potential DRPs (PR, 1.29; 95% CI, 1.02-1.63).
Lower medication adherence was also significantly associated with multiple (≥2)
class I events (PR, 1.71; 95% CI, 1.18-2.49), multiple class I or II events (PR,
1.35; 95% CI, 1.04-1.76), and multiple potential DRPs (PR, 2.11; 95% CI,
1.08-2.69) compared with those with higher medication adherence.
LIMITATIONS: Use of self-reported medication adherence rather than pharmacy
records. Clinical relevance of detected safety events is unclear.
CONCLUSIONS: Lower medication adherence is associated with adverse safety events
in individuals with eGFRs<60 mL/min/1.73 m(2).
Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All
rights reserved.
DOI: 10.1053/j.ajkd.2015.03.026
PMCID: PMC4586079
785. Respiration. 2016;92(1):9-15. doi: 10.1159/000447244. Epub 2016 Jun 28.
Enrolment in an Asthma Management Program during Pregnancy and Adherence with

Inhaled Corticosteroids: The 'Management of Asthma during Pregnancy' Program.
Baarnes CB(1), Hansen AV, Ulrik CS.
Author information:
(1)Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark.
BACKGROUND: Poor adherence with inhaled corticosteroids (ICS) is a major problem

in asthma and according to previous studies not least during pregnancy.
OBJECTIVE: Our aim was to assess if enrolment in an asthma management program,
and by that close monitoring, can improve self-reported and documented adherence
with ICS in pregnant women with asthma.
METHODS: Pregnant women with doctor-diagnosed asthma, currently being prescribed
ICS, referred during a 12-month period to the outpatient respiratory clinic, were
consecutively included in the study. They had follow-up visits every 4 weeks
during pregnancy. Asthma control was assessed according to GINA guidelines.
Self-reported adherence was compared to documented adherence, defined as medical
possession rate (MPR), calculated on the basis of filled prescriptions (data from
each individuals' medication profile at www.fmk-online.dk).
RESULTS: A total of 130 women fulfilled the inclusion criteria, but at the
initial visit, 16 women reported no current use of ICS, and the analyses are
therefore based on 114 patients. Self-reported adherence to ICS was significantly
higher during pregnancy than before pregnancy (73 and 52%, respectively,
reporting good adherence; p < 0.001). The actual adherence, i.e. MPR, was also
higher during pregnancy than before (46 vs. 28%, p < 0.0001). In keeping with
this, an overall improvement was also observed in asthma control. Of the women
with a low pre-pregnancy MPR, 71% had moderate or good adherence (MPR) during
pregnancy. Self-reported adherence was significantly correlated with MPR during
pregnancy (p = 0.004) but not before pregnancy (p = 0.46). At the 3-month
postpartum visit, adherence was close to the pre-pregnancy level.
CONCLUSION: Enrolment in an asthma management program during pregnancy seems to
improve adherence with controller medication, but self-reported adherence is not
a valid measure for actual adherence in patients with asthma.
DOI: 10.1159/000447244
786. BMC Health Serv Res. 2017 Jul 6;17(1):464. doi: 10.1186/s12913-017-2418-6.
Understanding the impact of supervision on reducing medication risks: an

interview study in long-term elderly care.
Vermeulen JA(1)(2), Kleefstra SM(3), Zijp EM(4), Kool RB(5).
Author information:
(1)Dutch Health Care Inspectorate (IGZ), Department Nursing and Long-Term Care,
Utrecht, the Netherlands. ja.vermeulen@igz.nl.
(2)Dutch Health Care Inspectorate (IGZ), PO Box 2518, 6401, DA, Heerlen, the
Netherlands. ja.vermeulen@igz.nl.
(3)Dutch Health Care Inspectorate (IGZ), Department Risk Identification and
Development, Utrecht, the Netherlands.
(4)Dutch Health Care Inspectorate (IGZ), Department Nursing and Long-Term Care,
Utrecht, the Netherlands.
(5)Radboud University Medical Center, Radboud Institute for Health Sciences, IQ
Healthcare, Nijmegen, the Netherlands.
BACKGROUND: In 2009, the Dutch Health Care Inspectorate (IGZ) observed several
serious risks to safety involving medication within elderly care facilities.
However, by 2011, high risks had been reduced in almost all the organisations we
visited. And yet the IGZ analysed too the alarming increase in the number of
incidents arising in the self-reported national indicator of medication safety
between 2009 and 2010. The aim of this study was to understand the factors that
can explain this contradiction between the increase in self-reported medication
incidents and the observation of the IGZ in reducing the risks to medication
safety through supervision.
METHODS: We interviewed health care professionals of ten care facilities, visited
by the IGZ, who were involved in, or responsible for, the improvement of
medication safety in their institutions. As outcome measures we used the rate of
medication safety risk per facility; the perceptions of the participant with
regard to the reports of medication incidents; the level of medication safety of
the facility; the measures used to improve medication safety; and the supervision
of medication safety. This was a mixed methods study, qualitative in that we used
semi-structured interviews, and quantitative, by calculating risks for the
different organisations we visited. The findings from both study methods resulted
in a comprehensive view and an in-depth understanding of this contradiction.
RESULTS: The contradiction between the increase in self-reported medication
incidents and the observation of reduced risks was explained by three themes:
activities designed to improve medication safety, the reporting of medication
incidents, and, lastly, the impact of supervision. The focus of the IGZ on issues
of medication safety stimulated most elderly care facilities to reduce medication
risks. Also, a change in the culture of reporting incidents caused an increase in
the number of reported incidents.
CONCLUSIONS: Supervision contributed to an improvement in actions geared towards
reducing the risks associated with the safety of medication. It also increased a
willingness to report such incidents. The more incidents reported are therefore
not necessarily a sign of an increase in the risks, but can also be considered as
a sign of a safer culture.
DOI: 10.1186/s12913-017-2418-6
PMCID: PMC5501537

4863.220037.
Prevalence of self-care practices and assessment of their sociodemographic risk

factors among diabetes in the urban slums of Bengaluru.
Dasappa H(1), Prasad S(2), Sirisha M(1), Ratna Prasanna SVN(1), Naik S(3).
Author information:
(1)Department of Family Medicine, St. Philomena Hospital, Bengaluru, Karnataka,
India.
(2)Medical Superintendent, St. Philomenas Hospital, Bengaluru, Karnataka, India.
(3)Lecturer, St. Philomena's Nursing College, Bengaluru, Karnataka, India.
Objective: The objective of this study was to determine the prevalence of

self-care practices in the urban slums of Bengaluru among diabetes and also to
assess their sociodemographic risk factors.
Materials and Methods: A cross-sectional study was done in the two slums of
Bengaluru comprising 163 diabetes patients. The prevalence of self-care practices
and their sociodemographic risk was analyzed.
Results: Maximum adherence was seen for blood sugar testing (77.91%), and least
adherence was seen for diet (12.26%). Adherence to exercise was 30.67%, adherence
to foot care was 48.46%, and adherence to medication was 60.73%. Some of the
sociodemographic factors associated with good self-care practices are young age,
gender, formal education, occupation, and religion. Good adherence to medication
is associated with better control of blood sugars.
Conclusion: A clinician should be able to identify these risk factors and give
special attention to these groups of patients and make realistic recommendations
for self-care activities.
DOI: 10.4103/2249-4863.220037
PMCID: PMC5749060
PMID: 29302521
788. Neuropsychiatr Dis Treat. 2018 Jan 26;14:383-392. doi: 10.2147/NDT.S152208.

eCollection 2018.
Self-stigma and treatment effectiveness in patients with anxiety disorders - a

mediation analysis.
Ociskova M(1), Prasko J(1), Vrbova K(1), Kasalova P(1), Holubova M(1), Grambal
A(1), Machu K(2).
Author information:
(1)Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky
University, University Hospital, Olomouc.
(2)Department of Psychology, Faculty of Arts, University of Ostrava, Ostrava, The
Czech Republic.
Goal: The goal of this study was to explore the impact of self-stigma on the
treatment outcomes in patients with anxiety disorders and to find possible
mediators of this relationship.
Method: Two hundred and nine patients with anxiety disorders, who were
hospitalized in a psychotherapeutic department, attended the study. The average
age was 39.2±12.4 years; two-thirds were women. Most of the patients used a
long-term medication. The participants underwent either cognitive behavioral
therapy (CBT) or short psychodynamic therapy. The selection to the psychotherapy
was not randomized. All individuals completed several scales - Beck Depression
Inventory, the second edition (BDI-II), Beck Anxiety Inventory (BAI),
Dissociative Experience Scale (DES), Sheehan Disability Scale (SDS), subjective
Clinical Global Impression (subjCGI), and The Internalized Stigma of Mental
Illness Scale (ISMI). A senior psychiatrist filled out the objective CGI
(objCGI).
Results: The patients significantly improved in the severity of anxiety (BAI),
depression (BDI-II), and overall severity of the mental disorder (objCGI). The
self-stigma predicted a lower change of the objCGI, but not a change of the
anxiety and depressive symptoms severity. Anxiety, depressive symptoms,
dissociation, and disability were assessed as possible mediators of the
relationship between the self-stigma and the treatment change. None of them were
significant.
Conclusion: Self-stigma lowers the effectiveness of the combined treatment of
anxiety disorders. Future research should explore other possible mediators
influencing this relationship.
DOI: 10.2147/NDT.S152208
PMCID: PMC5790087
PMID: 29416340

789. J Med Internet Res. 2018 Dec 18;20(12):e294. doi: 10.2196/jmir.9284.
The Use and Effects of Electronic Health Tools for Patient Self-Monitoring and
Reporting of Outcomes Following Medication Use: Systematic Review.
Lancaster K(#)(1), Abuzour A(2), Khaira M(2)(3), Mathers A(2), Chan A(4), Bui
V(5), Lok A(6), Thabane L(4), Dolovich L(1)(2).
Author information:
(1)Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
(2)Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
(3)School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
(4)Department of Health Research Methods, Evidence, and Impact, McMaster
University, Hamilton, ON, Canada.
(5)Pharmacy Department, Sunnybrook Health Sciences, Toronto, ON, Canada.
(6)Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON,
Canada.
BACKGROUND: Electronic health (eHealth) tools are becoming increasingly popular

for helping patients' self-manage chronic conditions. Little research, however,
has examined the effect of patients using eHealth tools to self-report their
medication management and use. Similarly, there is little evidence showing how
eHealth tools might prompt patients and health care providers to make appropriate
changes to medication use.
OBJECTIVE: The objective of this systematic review was to determine the impact of
patients' use of eHealth tools on self-reporting adverse effects and symptoms
that promote changes to medication use. Related secondary outcomes were also
evaluated.
METHODS: MEDLINE, EMBASE, and CINAHL were searched from January 1, 2000, to April
25, 2018. Reference lists of relevant systematic reviews and included articles
from the literature search were also screened to identify relevant studies.
Title, abstract, and full-text review as well as data extraction and risk of bias
assessment were performed independently by 2 reviewers. Due to high
heterogeneity, results were not meta-analyzed and instead presented as a
narrative synthesis.
RESULTS: A total of 14 studies, including 13 randomized controlled trials (RCTs)
and 1 open-label intervention, were included, from which 11 unique eHealth tools
were identified. In addition, 14 RCTs found statistically significant increases
in positive medication changes as a result of using eHealth tools, as did the
single open-label study. Moreover, 8 RCTs found improvement in patient symptoms
following eHealth tool use, especially in adolescent asthma patients.
Furthermore, 3 RCTs showed that eHealth tools might improve patient self-efficacy
and self-management of chronic disease. Little or no evidence was found to
support the effectiveness of eHealth tools at improving medication
recommendations and reconciliation by clinicians, medication-use behavior, health
service utilization, adverse effects, quality of life, or patient satisfaction.
eHealth tools with multifaceted functionalities and those allowing direct
patient-provider communication may be more effective at improving patient
self-management and self-efficacy.
CONCLUSIONS: Evidence suggests that the use of eHealth tools may improve patient
symptoms and lead to medication changes. Patients generally found eHealth tools
useful in improving communication with health care providers. Moreover,
health-related outcomes among frequent eHealth tool users improved in comparison
with individuals who did not use eHealth tools frequently. Implementation issues
such as poor patient engagement and poor clinician workflow integration were
identified. More high-quality research is needed to explore how eHealth tools can
be used to effectively manage use of medications to improve medication management
and patient outcomes.
©Karla Lancaster, Aseel Abuzour, Manmeet Khaira, Annalise Mathers, April Chan,
Vivian Bui, Annie Lok, Lehana Thabane, Lisa Dolovich. Originally published in the
Journal of Medical Internet Research (http://www.jmir.org), 18.12.2018.
DOI: 10.2196/jmir.9284
PMCID: PMC6315271
PMID: 30563822
790. Pain. 2017 Mar;158(3):457-462. doi: 10.1097/j.pain.0000000000000780.
A mouse model for chronic pain-induced increase in ethanol consumption.
Butler RK(1), Knapp DJ, Ulici V, Longobardi L, Loeser RF, Breese GR.
Author information:
(1)aBowles Center for Alcohol Studies, The University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA bDepartment of Psychiatry, The University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA cThurston Arthritis Research
Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
dDivision of Rheumatology, Allergy and Immunology, The University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA, Department of Medicine eDepartment
of Pharmacology, The University of North Carolina at Chapel Hill, Chapel Hill,
NC, USA fCurriculum in Neurobiology, The University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA gThe UNC Neuroscience Center, The University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA.
Chronic pain conditions are often comorbid with alcohol abuse. "Self-medication"
with alcohol introduces a host of problems associated with the abuse of alcohol
which over time has the potential of exacerbating the painful condition. Despite
the prevalence of chronic pain being associated with alcohol abuse, rodent models
which mimic the comorbid conditions are lacking. In this study, we model
osteoarthritis (OA) in C57BL/6J mice by surgically destabilizing the medial
meniscus (DMM). Sham-operated mice served as controls. Thirteen weeks after
surgery, DMM but not sham-operated mice exhibited pronounced incapacitance of the
surgically manipulated hind limb compared with the nonsurgically manipulated hind
limb. At this time, the mice were exposed to the 2-bottle ethanol choice,
beginning with 2.5% with a gradual increasing to 20%. Compared with sham
controls, DMM mice consumed more EtOH and preferred EtOH over water at the 20%
EtOH concentration. Histological analysis verified that the DMM mice exhibited
significant damage to the articular cartilage and osteophyte growth compared with
sham controls and these measures of the severity of OA correlated with the amount
of ethanol intake. Thus, the combination of the DMM model of OA with the enhanced
two-bottle ethanol choice is a potential preclinical approach in mice by which
the basis of the comorbid association of alcohol abuse and chronic pain
conditions can be explored.
DOI: 10.1097/j.pain.0000000000000780
PMCID: PMC5303149
Conflict of interest statement: Declaration of interest The authors report no

conflicts of interest. The authors alone are responsible for the content and
writing of the paper.
791. J Am Med Inform Assoc. 2016 May;23(3):449-55. doi: 10.1093/jamia/ocv158. Epub

2015 Dec 11.
The feasibility of text reminders to improve medication adherence in adolescents

with asthma.
Johnson KB(1), Patterson BL(2), Ho YX(3), Chen Q(4), Nian H(5), Davison CL(3),
Slagle J(6), Mulvaney SA(7).
Author information:
(1)Department of Biomedical Informatics at Vanderbilt University School of
Medicine, Nashville, TN, USA Department of Pediatrics at Vanderbilt University
School of Medicine, Nashville, TN, USA kevin.johnson@vanderbilt.edu.
(2)Department of Pediatrics at Vanderbilt University School of Medicine,
Nashville, TN, USA.
Medicine, Nashville, TN, USA.
Medicine, Nashville, TN, USA Department of Biostatistics at Vanderbilt University
School of Medicine, Nashville, TN, USA.
(5)Department of Biostatistics at Vanderbilt University School of Medicine,
Nashville, TN, USA.
(6)Department of Anesthesiology at Vanderbilt University School of Medicine,
Nashville, TN, USA.
Medicine, Nashville, TN, USA School of Nursing at Vanderbilt University School of
Medicine, Nashville, TN, USA.
OBJECTIVE: Personal health applications have the potential to help patients with
chronic disease by improving medication adherence, self-efficacy, and quality of
life. The goal of this study was to assess the impact of MyMediHealth (MMH) - a
website and a short messaging service (SMS)-based reminder system - on medication
adherence and perceived self-efficacy in adolescents with asthma.
METHODS: We conducted a block-randomized controlled study in academic pediatric
outpatient settings. There were 98 adolescents enrolled. Subjects who were
randomized to use MMH were asked to create a medication schedule and receive SMS
reminders at designated medication administration times for 3 weeks. Control
subjects received action lists as a part of their usual care. Primary outcome
measures included MMH usage patterns and self-reports of system usability,
medication adherence, asthma control, self-efficacy, and quality of life.
RESULTS: Eighty-nine subjects completed the study, of whom 46 were randomized to
the intervention arm. Compared to controls, we found improvements in
self-reported medication adherence (P = .011), quality of life (P = .037), and
self-efficacy (P = .016). Subjects reported high satisfaction with MMH; however,
the level of system usage varied widely, with lower use among African American
patients.
CONCLUSIONS: MMH was associated with improved medication adherence, perceived
quality of life, and self-efficacy.Trial Registration This project was registered
under http://clinicaltrials.gov/ identifier NCT01730235.
© The Author 2015. Published by Oxford University Press on behalf of the American
Medical Informatics Association. All rights reserved. For Permissions, please
email: journals.permissions@oup.com.
DOI: 10.1093/jamia/ocv158
PMCID: PMC4901375
792. J Acquir Immune Defic Syndr. 2017 Nov 1;76(3):e87-e89. doi:

10.1097/QAI.0000000000001501.
Association Between Self-Reported Adherence and HIV Viral Load Suppression Among
Older Children and Adolescents.
Dziva Chikwari C(1), Ferrand RA, Simms V.
Author information:
(1)*Biomedical Research and Training Institute, Harare, Zimbabwe †London School
of Hygiene and Tropical Medicine, London, United Kingdom.
DOI: 10.1097/QAI.0000000000001501
PMCID: PMC5638017
793. J Res Health Sci. 2016 Spring;16(2):72-5.
Predictors of Adherence to Type2 Diabetes Medication.
Pirdehghan A(1), Poortalebi N(2).
Author information:
(1)Department of Community and Preventive Medicine, School Of Medicine, Hamadan
University of Medical Sciences, Hamadan, Iran. pirdehghan93@gmail.com.
(2)Department of Community and Preventive Medicine, School Of Medicine,
University of Shahid Sadoughi, Yazd, Iran.
BACKGROUND: Despite the effectiveness of drug therapy in diabetes management high

rates of poor adherence persist. The purpose of this study was to determine the
factors influencing the medication adherence and dietary regiment in type2
diabetic patients.
METHODS: This cross sectional study was conducted on 300 type2 diabetic patients
referred to General Internal Medicine Clinic, Yazd Shohdaye Kargar Hospital,Yazd
City, central Iran between September and December 2013. Each consented
participant was interviewed by a trained study member using a questionnaire in
three sections: Socio-demographic questions, self-reported Morisky medication
adherence scale and Disease and medication beliefs Patient's questionnaire.
Multivariable logistic regression model was developed to identify independent
predictors of poor adherence. P<0.05 was considered statistically significant.
RESULTS: Patients had diabetes for an average of 8.87 (SD: 6.0) yr with a mean
age of 58.22 (SD: 10.27) yr. Totally, 101(33.7%) of the patients reported poor
adherence with their diabetes medication. In multivariate analyses, good familial
support (OR=0.11; 0.03, 0.37), and tendency to consume sweets (OR=1.21; 1.05,
1.39), belief about medication (OR=0.02; 0.018, 0.07) and tendency to consume
vegetables (OR=0.75; 0.65, 0.88) were considered as predictive factors for poor
adherence.
CONCLUSIONS: Familial support, belief about medication, tendency to consume
sweets and vegetables are logical goals for educational interventions to modify
diabetes self-management.
794. Front Pharmacol. 2018 Sep 26;9:1057. doi: 10.3389/fphar.2018.01057.

eCollection
2018.
Effectiveness of a Patient-Tailored, Pharmacist-Led Intervention Program to

Enhance Adherence to Antihypertensive Medication: The CATI Study.
van der Laan DM(1), Elders PJM(2), Boons CCLM(1), Nijpels G(2), van Dijk L(3),
Hugtenburg JG(1).
Author information:
(1)Department of Clinical Pharmacology and Pharmacy and the Amsterdam Public
Health Research Institute, VU University Medical Center, Amsterdam, Netherlands.
(2)Department of General Practice and Elderly Care Medicine and the Amsterdam
Public Health Research Institute, VU University Medical Center, Amsterdam,
Netherlands.
(3)Netherlands Institute for Health Services Research, Utrecht, Netherlands.
Introduction: Non-adherence to medication is a complex health care problem. In

spite of substantial efforts, up till now little progress has been made to
effectively tackle the problem with adherence-enhancing interventions. The aim of
this study was to investigate the effectiveness of a patient-tailored,
pharmacist-led and theory-driven intervention program aimed to enhance
self-reported adherence to antihypertensive medication. Materials and Methods: A
parallel-group randomized controlled trial in 20 community pharmacies with nine
months follow-up was conducted. Patients (45-75 years) using antihypertensive
medication and considered non-adherent based on both pharmacy dispensing data and
a self-report questionnaire were eligible to participate. The intervention
program consisted of two consultations with the pharmacist to identify
participants' barriers to adhere to medication and to counsel participants in
overcoming these barriers. The primary outcome was self-reported medication
adherence. Secondary outcomes were beliefs about medicines, illness perceptions,
quality of life and blood pressure. Mixed-model and generalized estimating
equation (GEE) analyses were used to assess overall effects of the intervention
program and effects per time point. Results: 170 patients were included. No
significant differences between intervention and control groups were found in
self-reported adherence, quality of life, illness perceptions, beliefs about
medicines (concern scale), and blood pressure. After nine months, intervention
participants had significantly stronger beliefs about the necessity of using
their medicines as compared to control participants (mean difference 1.25 [95%
CI: 0.27 to 2.24], p = 0.012). Discussion: We do not recommend to implement the
intervention program in the current form for this study population. Future
studies should focus on how to select eligible patient groups with appropriate
measures in order to effectively target adherence-enhancing interventions. Trial
Register: NTR5017 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5017.
DOI: 10.3389/fphar.2018.01057
PMCID: PMC6169131
PMID: 30319409
795. Drug Discov Ther. 2018 Mar 19;12(1):16-20. doi: 10.5582/ddt.2017.01073. Epub
2018
Feb 25.
Generic selection criteria for safety and patient benefit [VII]: Comparing the
physicochemical and pharmaceutical properties of brand-name and generic
terbinafine hydrochloride cream.
Nozawa M(1), Goto M(1), Wada Y(2), Kumazawa M(3), Shimokawa KI(4), Ishii F(2).
Author information:
(1)Triad Japan Co., Ltd.
University.
(3)Department of Mathematical Science, Meiji Pharmaceutical University.
We measured and compared the physicochemical properties (pH, yield value, and
squeeze force) of a drug for dermatomycosis, terbinafine hydrochloride-containing
cream (brand-name product), and 12 generic products to clarify the
characteristics of each product. On pH measurement, the pH value of the
brand-name product, Lamisil, was 4.8, and those of the generic products ranged
from 4.3 to 5.5, showing no marked difference. Furthermore, the yield value of
Lamisil, as an index of cream ductility, was 122.2 dyn/cm2, and those of the
generic products ranged from 42.1 to 1,621.5 dyn/cm2. In particular, the value of
a generic product, Taiyo (42.1 dyn/cm2), was significantly lower, whereas that of
another one, Viras (1,621.0 dyn/cm2), was significantly higher. In addition, the
squeeze force was measured by attaching a HapLog® to the thumb and second finger.
The value of Lamisil was 12.9 N, and those of the generic products ranged from
8.0 to 15.4 N. The values of generic products, Mylan (8.6 N), Tebinaceil (9.0 N),
and Kelger (8.0 N), were significantly lower, whereas that of another one, Viras
(15.4 N), was significantly higher. These results showed that there were marked
differences in the pharmaceutical properties between the generic and brand-name
products. The above pharmaceutical characteristics of drugs facilitated the
presentation of reasons for differences in the sense of use, which characterizes
external preparations, suggesting that products appropriate for individual
patients can be recommended.
DOI: 10.5582/ddt.2017.01073
796. Hematol Transfus Cell Ther. 2018 Jul-Sep;40(3):207-212. doi:

10.1016/j.htct.2017.11.009. Epub 2018 Feb 17.
Barriers experienced in self-care practice by young people with sickle cell

disease.
Cecilio SG(1), Pereira SADS(1), Pinto VDS(1), Torres HC(1).
Author information:
(1)Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
Objective: To identify barriers to the self-care practice of young people with

sickle cell disease.
Method: This qualitative study was conducted with 17 individuals with sickle cell
disease aged between 13 and 24 years in Belo Horizonte, MG, Brazil in March and
April 2017. An interview investigated the barriers to self-care practice and the
feelings associated with sickle cell disease. Data were transcribed and analyzed
according to Bardin's perspective using the following steps: (1) pre-analysis,
(2) exploration of the material, and (3) treatment of the results (inference and
interpretation).
Results: Five thematic categories emerged: (1) feelings: anger, sadness, and
fear; (2) bullying and stigmatization: challenges regarding walking, speaking, or
behaving, as well as patient labels; (3) cognitive factors: doubts related to
medication, hydration, heredity and maternity; (4) medication compliance: fear of
the side effects suffered and anger triggered by the obligation to use the
medication; (5) family issues: complaints of not earning the mothers' trust to
live independently.
Conclusion: The barriers to self-care in young people with sickle cell disease
indicate difficulties related to emotional, behavioral, and environmental
aspects. Understanding these factors will favor a better adaptation of youths to
the context of sickle cell disease.
DOI: 10.1016/j.htct.2017.11.009
PMCID: PMC6098173
PMID: 30128428
797. J Am Heart Assoc. 2015 Apr 13;4(4). pii: e001561. doi:

10.1161/JAHA.114.001561.
Racial differences in clinical treatment and self-care behaviors of adults with

chronic heart failure.
Dickson VV(1), Knafl GJ(2), Wald J(3), Riegel B(4).
Author information:
(1)New York University College of Nursing, New York, NY (V.V.D.).
(2)University of North Carolina School of Nursing, Chapel Hill, NC (G.J.K.).
(3)Heart FailureTransplant Program, University of Pennsylvania, Philadelphia, PA
(J.W.).
(4)University of Pennsylvania School of Nursing, Philadelphia, PA (B.R.).
BACKGROUND: In the United States, the highest prevalence of heart failure (HF) is
in blacks followed by whites. Compared with whites, blacks have a higher risk of
HF-related morbidity and mortality and HF-related hospitalization. Little
research has focused on explaining the reasons for these disparities. The purpose
of this study was to examine racial differences in demographic and clinical
characteristics in blacks and whites with HF and to determine if these
characteristics influenced treatment, or together with treatment, influenced
self-care behaviors.
METHODS AND RESULTS: This was a secondary analysis of existing data collected
from adults (n=272) with chronic HF enrolled from outpatient sites in the
northeastern United States and followed for 6 months. After adjusting for
sociodemographic and clinical characteristics within reduced (HFrEF) and
preserved ejection fraction (HFpEF) groups, there were 2 significant racial
differences in clinical treatment. Blacks with HFrEF were prescribed ACE
inhibitors and hydralazine and isosorbide dinitrate (H-ISDN) more often than
whites. In the HFpEF group, blacks were taking more medications and were
prescribed digoxin and a diuretic when symptomatic. Deficits in HF knowledge and
decreased medication adherence, objectively measured, were more prominent in
blacks. These racial differences were not explained by sociodemographic or
clinical characteristics or clinical treatment variables. Premorbid intellect and
the quality of support received contributed to clinical treatment and self-care.
CONCLUSION: Although few differences in clinical treatment could be attributed
solely to race, knowledge about HF and medication adherence is lower in blacks
than whites. Further research is needed to explain these observations, which may
be targets for future intervention research.
© 2015 The Authors. Published on behalf of the American Heart Association, Inc.,
by Wiley Blackwell.
DOI: 10.1161/JAHA.114.001561
PMCID: PMC4579928
798. Ther Adv Drug Saf. 2018 Mar;9(3):179-192. doi: 10.1177/2042098617746053. Epub
2017 Dec 22.
Likelihood of reporting medication errors in hospitalized children: a survey of

nurses and physicians.
Rishoej RM(1), Hallas J(2), Juel Kjeldsen L(3), Thybo Christesen H(4),
Almarsdóttir AB(5).
Author information:
(1)Clinical Pharmacology and Pharmacy, Department of Public Health, University of
Southern Denmark, J. B. Winsløws Vej 19, 2., 5000 Odense C, Denmark.
(2)Clinical Pharmacology and Pharmacy, Department of Public Health, University of
Southern Denmark, Odense, Denmark.
(3)Amgros I/S, Copenhagen, Denmark.
(4)Hans Christian Andersen Children's Hospital, Odense University Hospital,
Odense, Denmark Department of Clinical Research, University of Southern Denmark,
Odense, Denmark.
(5)Social and Clinical Pharmacy, Department of Pharmacy, University of
Copenhagen, Copenhagen, Denmark.
Background: Hospitalized children are at risk of medication errors (MEs) due to

complex dosage calculations and preparations. Incident reporting systems may
facilitate prevention of MEs but underreporting potentially undermines this
system. We aimed to examine whether scenarios involving medications should be
reported to a national mandatory incident reporting system and the likelihood of
self- and peer-reporting these scenarios among paediatric nurses and physicians.
Methods: Participants' reporting of MEs was explored through a questionnaire
involving 20 medication scenarios. The scenarios represented different steps in
the medication process, types of error, patient outcomes and medications.
Reporting rates and odds ratios with 95% confidence interval [OR, (95% CI)] were
calculated. Barriers to and enablers of reporting were identified through content
analysis of participants' comments.
Results: The response rate was 42% (291/689). Overall, 61% of participants
reported that scenarios should be reported. The likelihood of reporting was 60%
for self-reporting and 37% for peer-reporting. Nurses versus physicians, and
healthcare professionals with versus without patient safety responsibilities
assessed to a larger extent that the scenarios should be reported [OR = 1.34
(1.05-1.70) and OR = 1.41 (1.12-1.78), respectively]; were more likely to
self-report, [OR = 2.81 (1.71-4.62) and OR = 2.93 (1.47-5.84), respectively]; and
were more likely to peer-report [OR = 1.89 (1.36-2.63) and OR = 3.61 (2.57-5.06),
respectively].Healthcare professionals with versus without management
responsibilities were more likely to peer-report [OR = 5.16 (3.44-7.72)].
Participants reported that scenarios resulting in actual injury or incidents
considered to have a learning potential should be reported.
Conclusion: The likelihood of underreporting scenarios was high among paediatric
nurses and physicians. Nurses and staff with patient safety responsibilities were
more likely to assess that scenarios should be reported and to report. Incidents
with actual injury or learning potential were more likely to be reported. The
potential for improving reporting rates involving MEs seems high.
DOI: 10.1177/2042098617746053
PMCID: PMC5810853
PMID: 29492247

799. Neurourol Urodyn. 2016 Aug;35(6):738-42. doi: 10.1002/nau.22798. Epub 2015 May
20.
Is self-reported adherence associated with clinical outcomes in women treated

with anticholinergic medication for overactive bladder?
Andy UU, Arya LA(1), Smith AL(2), Propert KJ(3), Bogner HR(4), Colavita K(1),
Harvie HS(1).
Author information:
(1)Division of Urogynecology, Department of Obstetrics and Gynecology, University
of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
(2)Division of Urology, Department of Surgery, University of Pennsylvania School
of Medicine, Philadelphia, Pennsylvania.
(3)Department of Biostatistics and Epidemiology, University of Pennsylvania
School of Medicine, Philadelphia, Pennsylvania.
(4)Department of Family Medicine and Community Health, University of Pennsylvania
Comment in
Neurourol Urodyn. 2016 Sep;35(7):856.
J Urol. 2017 Jun;197(6):1525-1526.
AIM: To determine the association between self-reported adherence to

anticholinergic medication and clinical outcomes in women with overactive bladder
(OAB).
METHODS: A prospective study of women with OAB treated with fesoterodine for 8
weeks. Adherence to medication was measured using the Medication Adherence
Self-report Inventory (MASRI). A self reported adherence rate of ≥80% was
considered adherent. The association between self-reported adherence and clinical
outcomes (Global Index of Improvement, Global impression of Severity, urinary
symptom and quality of life scores) was examined. We hypothesized that adherent
women would have greater improvement in urinary symptoms and quality of life than
non-adherent women.
RESULTS: Based on the MASRI, 115 (62.5%) women were adherent and 69 (37.5%) were
non-adherent to anticholinergic medication at 8weeks. Adherent women were more
likely to report overall improvement in their symptoms compared to non-adherent
women (84% vs. 24%, P < 0.001). Significantly more non-adherent women described
their bladder symptoms as "moderate" or "severe" at 8 weeks compared to adherent
women (74% vs. 44%, P = 0.03). At 8 weeks, adherent women reported significantly
greater improvement (change) in urinary symptoms from baseline to 8 weeks than
non-adherent women (-13.3 ± 25.8 vs. 2.5 ± 14.4, P = 0.04). Similarly, adherent
women reported greater improvement in quality of life scores than non-adherent
women (- 7.9 ± 24.0 vs. -1.8 ± 11.9, P = 0.003).
CONCLUSION: Self-reported non-adherence, as measured by the MASRI, is associated
with clinically meaningful outcomes in women with OAB. This further validates the
MASRI as a clinically useful tool for measuring adherence to anticholinergic
medications in women with OAB. Neurourol. Urodynam. 35:738-742, 2016. © 2015
Wiley Periodicals, Inc.
DOI: 10.1002/nau.22798
PMCID: PMC4654718
800. J Pharm Health Care Sci. 2018 Jul 3;4:16. doi: 10.1186/s40780-018-0112-4.
eCollection 2018.
Possible associations of personality traits representing harm avoidance and

self-directedness with medication adherence in Japanese patients with type 2
diabetes.
Tominaga Y(1), Aomori T(2), Hayakawa T(2), Kijima N(3), Morisky DE(4), Takahashi
K(5), Mochizuki M(1)(2).
Author information:
(1)1Division of Hospital Pharmacy Science, Graduate School of Pharmaceutical
Sciences, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512 Japan.
(2)2Division of Hospital Pharmacy Science, Faculty of Pharmacy, Keio University,
1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512 Japan.
(3)3Psychological Laboratory, Keio University, 4-1-1 Hiyoshi, Kohoku-ku,
Yokohama, 223-8521 Japan.
(4)4Department of Community Health Sciences, UCLA Fielding School of Public
Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772 USA.
(5)5Department of Clinical Epidemiology and Biostatistics, Graduate School of
Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan.
Background: Insufficient medication adherence in diabetes patients, of which

numbers continue to increase globally, remains a critical issue. Medication
adherence is multifactorial and determined by interactions among factors
including socioeconomic status, health care team and system, condition, therapy,
and patient-specific factors. On the other hand, personality traits have been
studied in adherence other than to medication. Using the instruments of
Temperament and Character Inventory (TCI), Harm Avoidance (TCI-HA) and
Self-directedness (TCI-SD) showed distinguishing associations with adherence of
health-related programs. However, few studies have been performed to elucidate
psychometric properties related to medication adherence. We investigated how
TCI-HA and TCI-SD of patients with diabetes are related to medication adherence.
Method: A cross-sectional survey 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). Personality traits were assessed using the established scales of TCI-HA
and TCI-SD. Univariate and multivariate regression analyses of the MMAS-8 scores
were performed in addition to assessing demographic and disease characteristics
and TCI-HA and TCI-SD.
Results: A total of 358 responses were analyzed. Multivariate regression analysis
of MMAS-8 scores revealed that higher TCI-SD was related to better adherence and
experiencing drug-related side effects was related to poor adherence. Aging was
significantly associated with better medication adherence in univariate
regression analysis but became insignificant in multivariate regression.
Conclusions: In diabetes patients, the anxiety reflected in TCI-HA tends to lower
and the self-control reflected in TCI-SD tends to promote medication adherence.
TCI-SD has a greater effect than TCI-HA.
DOI: 10.1186/s40780-018-0112-4
PMCID: PMC6029079
PMID: 29988655
Conflict of interest statement: The Ethics and Research Board of the Faculty of
Pharmacy, Keio University, approved this study protocol (approval nos. 161215–1
and 170120–1). The study objective and methods were explained to the participants
using written documents to obtain their signed consent after confirming their
sufficient understanding and agreement.DEM is the developer/owner of the
copyrighted MMAS diagnosed adherence assessment instrument and receives
royalities. He was not involved in the data analysis. The other authors declare
that they have no competing interests.Springer Nature remains neutral with regard
to jurisdictional claims in published maps and institutional affiliations.
801. Scand J Public Health. 2017 Aug;45(6):569-583. doi: 10.1177/1403494817701565.

Epub 2017 Jul 14.
The impact of a social network based intervention on self-management behaviours

among patients with type 2 diabetes living in socioeconomically deprived
neighbourhoods: a mixed methods approach.
Vissenberg C(1), Nierkens V(1), van Valkengoed I(1), Nijpels G(2), Uitewaal P(3),
Middelkoop B(4), Stronks K(1).
Author information:
(1)1 Department of Public Health, Academic Medical Centre, University of
Amsterdam, Amsterdam, The Netherlands.
(2)4 VU University Medical Centre, Amsterdam, The Netherlands.
(3)2 The Hague's Public Health Department, The Hague, The Netherlands.
(4)3 Leiden University Medical Centre, Leiden, The Netherlands.
AIMS: This paper aims to explore the effect of the social network based
intervention Powerful Together with Diabetes on diabetes self-management among
socioeconomically deprived patients. This 10-month group intervention targeting
patients and significant others aimed to improve self-management by stimulating
social support and diminishing social influences that hinder self-management.
METHODS: This intervention was evaluated in a quasi-experimental study using a
mixed methods approach. Of 131 socioeconomically deprived patients with
suboptimal glycaemic control, 69 were assigned to the intervention group and 62
to the control group (standard diabetes education). 27 qualitative in-depth
interviews with the participants and 24 with their group leaders were held to
study the subjective impact of the intervention. Further, self-management
behaviours (medication adherence, diet and physical activity) were assessed at
baseline, 10 and 16 months. Data were analysed using framework analyses and a
linear mixture model.
RESULTS: Qualitative data showed that the intervention group had a better
understanding of the way self-management influences diabetes. The intervention
group showed more complex self-management behaviours, such as planning ahead,
seeking adequate food and physical activity alternatives, and consistently taking
their diabetes into consideration when making choices. In participants with
complete follow-up data, we found a significant increase in physical activity in
the intervention group (3.78 vs. 4.83 days) and no changes in medication
adherence and diet.
CONCLUSIONS: This study indicates that an intensive support group and
simultaneously involving significant others might improve diabetes
self-management behaviours among socioeconomically deprived patients. More
studies are needed to justify further implementation of the intervention. This
study is registered in the Dutch Trial Register NTR1886.
http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1886.
DOI: 10.1177/1403494817701565
PMCID: PMC5544123

eCollection 2016.
Marked Rise in the Prevalence of Asymptomatic Plasmodium falciparum Infection in

Rural Gabon.
Pegha Moukandja I(1)(2), Biteghe Bi Essone JC(1)(2), Sagara I(3), Kassa Kassa
RF(1), Ondzaga J(1), Lékana Douki JB(1)(2)(4), Bouyou Akotet M(4), Nkoghe Mba
D(1), Touré Ndouo FS(1).
Author information:
(1)Centre International de Recherches Médicales de Franceville (CIRMF) B.P. 769
Franceville, Gabon.
(2)Ecole Doctorale Régionale (EDR) en Infectiologie Tropicale, BP: 876
Franceville, Gabon.
(3)Département d'Epidémiologie et des Affections Parasitaires, MRTC, Faculté de
Médecine et d'Odontostomatologie, Université de Bamako, BP 1805 Bamako, Mali.
(4)Département de Parasitologie-Mycologie Médecine Tropicale, Faculté de
Médecine, Université des Sciences de la Santé, B.P. 4009 Libreville, Gabon.
Control strategies implemented a decade ago led to a marked reduction in the

prevalence of malaria in many countries. In Dienga, southeastern Gabon, the
prevalence of microscopic P. falciparum infection was 7% in 2003, close to the
pre-elimination threshold of 5%. The aim of this work was to determine the
prevalence of P. falciparum infection in the same community a decade later. A
cohort of 370 individuals aged from 3 to 85 years living in Dienga was
investigated for P. falciparum infection; during six passages (P) in 15-month
period. Demographic data were collected, along with behaviors and attitudes
towards malaria. Plasmodium infection was diagnosed by microscopy (ME), followed
by PCR to detect submicroscopic infection. The prevalence of P. falciparum
infection in P1, P2, P3, P4, P5 and P6 was respectively 43.5% (25.1% ME+, 18.4%
PCR+); 40.9% (27.0% ME+, 13.9% PCR+), 52.7% (26.1% ME+, 26.6% PCR+); 34.1% (14.1%
ME+, 20% PCR+), 57.7% (25.4.% ME+, 32.3% PCR+); and 46.2% (21.4% ME+, 24.8% PCR+)
with an overall average of 45.9% (95%CI [37.0-54.7], 23.2% ME+ and 22.7% PCR+).
P4 and P5 prevalences were statically different throughout the six passages.
Microscopic prevalence was significantly higher than that observed ten years ago
(23% [n = 370] vs 7% [n = 323], p < 0.001). Asymptomatic infections were the most
frequent (96%). Gametocytes were detected in levels ranging from 5.9% to 13.9%.
Insecticide-treated nets, indoor residual insecticides, and self-medication were
used by respectively 33.2% (95%CI [29.0-37.4]), 17.7% (95%CI [15.5-19.9]) and
12.1% (95%CI [10.6-13.6]) of the study population. A near-threefold increase in
P. falciparum infection has been observed in a rural area of southeastern Gabon
during a 10-year period. Most infections were asymptomatic, but these subjects
likely represent a parasite reservoir. These findings call for urgent
reinforcement of preventive measures.
PMCID: PMC4881998
803. Trop Med Health. 2017 Dec 4;45:31. doi: 10.1186/s41182-017-0070-9. eCollection
2017.
Awareness of malaria and treatment-seeking behaviour among persons with acute
undifferentiated fever in the endemic regions of Myanmar.
Naing PA(1), Maung TM(1), Tripathy JP(2), Oo T(1), Wai KT(1), Thi A(3).
Author information:
(1)Department of Medical Research, Ministry of Health and Sports, No. 5, Ziwaka
Road Dagon Township, Yangon, 11191 Myanmar.
(2)International Union Against Tuberculosis and Lung Disease, The Union
South-East Asia Regional Office, New Delhi, India.
(3)National Malaria Control Program, Ministry of Health and Sports, Naypyitaw,
Myanmar.
Background: Myanmar has a high burden of malaria with two-third of the population
at risk of malaria. One of the basic elements of the Roll Back Malaria Initiative
to fight against malaria is early diagnosis and treatment within 24 h of fever.
Public awareness about malaria is a key factor in malaria prevention and control
and in improving treatment-seeking behaviour.
Methods: A large community-based survey was carried out in 27 townships of
malaria endemic regions in Myanmar in 2015 which reported on the knowledge,
behaviour and practices around malaria in the general population. We used the
data already collected in this survey to assess (i) general public awareness of
malaria and (ii) treatment-seeking behaviour and associated factors among persons
with acute undifferentiated fever.
Results: A total of 6597 respondents from 6625 households were interviewed
(response rate of 99.5%). About 85% of the respondents were aware that mosquito
bite was the mode of transmission of malaria and 90% mentioned that malaria was
preventable. However, only 16% of the respondents knew about anti-malaria drug
resistance. There were certain misconceptions about the transmission of malaria
such as dirty water, same blood group, sharing shelter, sleeping/eating together
and poor hygiene. Health facility staff were the most common source of
information about malaria (80%). Nearly one-fourth (23%) of the respondents with
fever resorted to self-medication. Around 28% of the respondents with fever
underwent blood testing, less than half of whom (44%) were tested within 24 h.
Elderly age group, females, those with poor knowledge about malaria and those
residing in non-Regional Artemisinin Resistance Initiative townships were
associated with poor treatment-seeking behaviour in case of fever.
Conclusion: Although there is fair knowledge on mosquito bite as a mode of
transmission and prevention of malaria, there are some misconceptions about
transmission of malaria. Those having poor knowledge about malaria have poor
treatment-seeking behaviour. A considerable number of respondents seek care from
informal care providers and seek care late. Thus, there is a need to promote
awareness about the role of early diagnosis and appropriate treatment and address
misconceptions about transmission of malaria.
DOI: 10.1186/s41182-017-0070-9
PMCID: PMC5713003
PMID: 29213208
804. Front Pharmacol. 2016 Aug 10;7:233. doi: 10.3389/fphar.2016.00233. eCollection

2016.
Disentangling Rheumatoid Arthritis Patients' Implicit and Explicit Attitudes

toward Methotrexate.
Linn AJ(1), Vandeberg L(1), Wennekers AM(2), Vervloet M(3), van Dijk L(3), van
den Bemt BJ(4).
Author information:
(1)Amsterdam School of Communication Research, University of Amsterdam Amsterdam,
Netherlands.
(2)Amsterdam School of Communication Research, University of AmsterdamAmsterdam,
Netherlands; The Netherlands Institute for Social ResearchDen Haag, Netherlands.
(3)Netherlands Institute for Health Services Research Utrecht, Netherlands.
(4)Department of Pharmacy and Department of Rheumatology, Sint
MaartenskliniekNijmegen, Netherlands; Department of Pharmacy, Radboud University
Medical CenterNijmegen, Netherlands.
Medication non-adherence is a major public health problem that has been termed an
'invisible epidemic.' Non-adherence is not only associated with negative clinical
consequences but can also result in substantial healthcare costs. Up to now,
effective adherence interventions are scarce and a more comprehensive model of
adherence determinants is required to target the determinants for not taking the
medication as prescribed. Current approaches only included explicit attitudes
such as self-reported evaluations of medication as determinants, neglecting the
role of associative processes that shape implicit attitudes. Implicit processes
can predict daily behavior more accurately than explicit attitudes. Our aim is to
assess explicit and implicit attitudes toward medication and explore the relation
with beliefs, adherence and clinical (laboratory) outcomes in chronically ill
patients. Fifty two Rheumatic Arthritis (RA) patients' attitudes toward
Methotrexate (MTX) were explicitly (self-reported) and implicitly
(Single-Category Implicit Association Test) assessed and related to the Beliefs
about Medicine Questionnaire, the Compliance Questionnaire on Rheumatology and
laboratory parameters [Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein
(CRP)]. Results show that explicit attitudes were positive and health-related.
Implicit attitudes were, however, negative and sickness-related. Half of the
patients displayed explicitly positive but implicitly negative attitudes.
Explicit attitudes were positively related to ESR. A positive relationship
between implicit attitudes and disease duration was observed. In this study, we
have obtained evidence suggesting that the measurement of implicit attitudes and
associations provides different information than explicit, self-reported
attitudes toward medication. Since patients' implicit attitudes deviated from
explicit attitudes, we can conclude that the relationship between implicit
attitudes and medication adherence is worthwhile to be further explored. With
this information we can improve our understanding of the subconscious, automatic
processes underlying adherence and we can develop interventions that target these
implicit attitudes.
DOI: 10.3389/fphar.2016.00233
PMCID: PMC4978711
PMID: 27559311
805. Medicine (Baltimore). 2019 May;98(18):e15188. doi:

10.1097/MD.0000000000015188.
Assessment of inter-rater agreement between physicians and their patients

regarding medication adherence in a clinical questionnaire study.
Otsu Y(1)(2), Kai M(1), Suematsu Y(3), Kiyomi F(4), Saku K(3), Kamimura H(1)(2),
Miura SI(3).
Author information:
(1)Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences.
(2)Division of Pharmacy.
(3)Department of Cardiology, Faculty of Medicine.
(4)Academia, Industry and Government Collaborative Research Institute of
Translational Medicine for Life Innovation, Fukuoka University, Fukuoka, Japan.
While it is important to treat lifestyle-related diseases for the primary and

secondary prevention of cardiovascular diseases, medication adherence is still
poor. Although various causes of poor adherence have been reported, the
differences between physicians and their patients regarding the recognition of
medication adherence have not been well-investigated.We administered a
questionnaire about medication adherence to 300 outpatients and their 23
cardiologists at the Department of Cardiology, Fukuoka University Hospital. The
questionnaires for patients and physicians included acceptable total number of
drug doses and dosing schedule, forgetting to take the medicine, and
dose-reduction or -increase based on self-judgement. The patients were
70.6 ± 12.3 years old and 61.0% (n = 183) were male. Patients reported that it
was acceptable to receive 0-5 doses twice daily. The patients were divided into
two groups: an agreement group, in which physicians and their patients had the
same answer to the question regarding forgetting medication (203 cases; 67.7%),
and a disagreement group (97 cases; 32.3%). Overall, the inter-rater agreement
between physicians and patients with regard to forgetting medication was
significant, but slight (κ coefficient = 0.12). In a multivariate analysis,
absence of hypertension [odds ratio (OR): 0.21, 95% confidence interval (CI):
0.09-0.50, P < .001), β-blocker usage (OR: 1.86, 95% CI: 1.11-3.12, P = .02), and
biguanide usage (OR: 4.04, 95% CI: 1.43-11.41, P = .01) were independent
predictors of disagreement with regard to forgetting medication.The inter-rater
agreement between physicians and patients with regard to medication adherence was
slight. An increase in inter-rater agreement should improve medication adherence.
DOI: 10.1097/MD.0000000000015188
PMCID: PMC6504264
806. Syst Rev. 2016 May 4;5:83. doi: 10.1186/s13643-016-0255-z.
Identifying configurations of behavior change techniques in effective medication

adherence interventions: a qualitative comparative analysis.
Kahwati L(1), Viswanathan M(2), Golin CE(3), Kane H(2), Lewis M(2), Jacobs S(2).
Author information:
(1)RTI International, Research Triangle Park, NC, USA. lkahwati@rti.org.
(2)RTI International, Research Triangle Park, NC, USA.
(3)Departments of Medicine and Health Behavior, University of North Carolina,
Chapel Hill, NC, USA.
BACKGROUND: Interventions to improve medication adherence are diverse and

complex. Consequently, synthesizing this evidence is challenging. We aimed to
extend the results from an existing systematic review of interventions to improve
medication adherence by using qualitative comparative analysis (QCA) to identify
necessary or sufficient configurations of behavior change techniques among
effective interventions.
METHODS: We used data from 60 studies in a completed systematic review to examine
the combinations of nine behavior change techniques (increasing knowledge,
increasing awareness, changing attitude, increasing self-efficacy, increasing
intention formation, increasing action control, facilitation, increasing
maintenance support, and motivational interviewing) among studies demonstrating
improvements in adherence.
RESULTS: Among the 60 studies, 34 demonstrated improved medication adherence.
Among effective studies, increasing patient knowledge was a necessary but not
sufficient technique. We identified seven configurations of behavior change
techniques sufficient for improving adherence, which together accounted for 26
(76 %) of the effective studies. The intervention configuration that included
increasing knowledge and self-efficacy was the most empirically relevant,
accounting for 17 studies (50 %) and uniquely accounting for 15 (44 %).
CONCLUSIONS: This analysis extends the completed review findings by identifying
multiple combinations of behavior change techniques that improve adherence. Our
findings offer direction for policy makers, practitioners, and future comparative
effectiveness research on improving adherence.
DOI: 10.1186/s13643-016-0255-z
PMCID: PMC4875709
807. J Cyst Fibros. 2017 Sep;16(5):637-644. doi: 10.1016/j.jcf.2017.05.001. Epub

2017
May 23.
Development and validation of CF-Medication Beliefs Questionnaire: A

mixed-methods approach.
Eakin MN(1), Chung SE(2), Hoehn J(3), Borrelli B(4), Rand-Giovannetti D(5),
Riekert KA(2).
Author information:
(1)Division of Pulmonary and Critical Care Medicine, Johns Hopkins University,
Baltimore, MD, United States. Electronic address: Meakin1@jhmi.edu.
(2)Division of Pulmonary and Critical Care Medicine, Johns Hopkins University,
Baltimore, MD, United States.
(3)Department of Psychology, University of Maryland, Baltimore County, Baltimore,
MD, United States.
(4)Boston University, Henry M Goldman School of Dental Medicine, Boston, MA,
United States.
(5)Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United
States.
BACKGROUND: Beliefs about medication have been associated with adherence in other
diseases but there are no existing disease-specific medication beliefs
questionnaires for CF. This mixed-methods validated the Cystic Fibrosis
Medication Belief Questionnaire (CF-MBQ), based on social cognitive theory.
METHODS: Based on previous research, items were developed for five domains:
motivation, self-efficacy, perceived importance, and decisional balance to take
or miss medications. Cognitive interviews were conducted with 15 adult patients
with CF to refine item development. 128 patients with CF completed an online
survey and objective medication adherence was measured using pharmacy refill
data.
RESULTS: The five subscales demonstrated strong psychometric properties, with
adequate-to-good internal consistency scores. More importantly, each domain
demonstrated construct validity with adherence.
CONCLUSIONS: These theoretically-derived measures may be important for clinical
purposes to provide guidance on appropriate interventions to improve adherence
and for research to provide enhanced understanding on patient determinants of
rights reserved.
DOI: 10.1016/j.jcf.2017.05.001
PMCID: PMC5581993

eCollection 2017.
Examining whether the information-motivation-behavioral skills model predicts

medication adherence for patients with a rare disease.
Alexander DS(1), Hogan SL(2), Jordan JM(3), DeVellis RF(3), Carpenter DM(1).
Author information:
(1)UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and
Policy, Asheville.
(2)UNC Kidney Center.
NC, USA.
The information-motivation-behavioral skills (IMB) model has been used to explain

and promote medication adherence among patients with diabetes and HIV. The
objective of this study was to examine whether the IMB model predicted medication
adherence among vasculitis patients. Adult vasculitis patients (n=228) completed
online questionnaires at baseline and 3-month follow-up. Linear regressions were
calculated to determine the direct effects of information and motivation on
medication adherence (P<0.05). A mediation analysis using a bootstrapping
approach was used to test whether behavioral skills significantly mediated the
effect of information and motivation on medication adherence. Participants
reported high levels of information (M=4.0; standard deviation [SD]=0.68),
moderate levels of motivation (M=2.7; SD=1.00), and high levels of behavioral
skills (M=4.1; SD=0.74). In the regression model, only behavioral skills (B=0.38;
P<0.001) were significantly associated with medication adherence; however,
mediation analysis revealed that behavioral skills significantly mediated the
effects of information and motivation on medication adherence. The results
support the IMB-hypothesized relationships between information, motivation,
behavioral skills, and medication adherence in our sample. Findings suggest that
providers should work with vasculitis patients to increase their
medication-related skills to improve medication adherence.
DOI: 10.2147/PPA.S115272
PMCID: PMC5238767
PMID: 28138225

this work.
809. Value Health. 2015 Mar;18(2):206-16. doi: 10.1016/j.jval.2014.12.013.
Predictors of self-reported adherence to antihypertensive medicines: a

multinational, cross-sectional survey.
Morrison VL(1), Holmes EA(2), Parveen S(1), Plumpton CO(2), Clyne W(3), De Geest
S(4), Dobbels F(4), Vrijens B(5), Kardas P(6), Hughes DA(7).
Author information:
(1)School of Psychology, Bangor University, Bangor, UK.
(2)Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor,
UK.
(3)Keele University, Keele, Staffordshire, UK.
(4)University of Leuven, Leuven, Belgium.
(5)MWV Healthcare, Visé, Belgium.
(6)Medical University of Lodz, Lodz, Poland.
(7)Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor,
UK. Electronic address: d.a.hughes@bangor.ac.uk.
BACKGROUND: Nonadherence to antihypertensive medicines limits their

effectiveness, increases the risk of adverse health outcome, and is associated
with significant health care costs. The multiple causes of nonadherence differ
both within and between patients and are influenced by patients' care settings.
OBJECTIVES: The objective of this article was to identify determinants of patient
nonadherence to antihypertensive medicines, drawing from psychosocial and
economic models of behavior.
METHODS: Outpatients with hypertension from Austria, Belgium, England, Germany,
Greece, Hungary, The Netherlands, Poland, and Wales were recruited to a
cross-sectional online survey. Nonadherence to medicines was assessed using the
Morisky Medication Adherence Scale (primary outcome) and the Medication Adherence
Rating Scale. Associations with adherence and nonadherence were tested for
demographic, clinical, and psychosocial factors.
RESULTS: A total of 2595 patients completed the questionnaire. The percentage of
patients classed as nonadherent ranged from 24% in The Netherlands to 70% in
Hungary. Low age, low self-efficacy, and respondents' perceptions of their
illness and cost-related barriers were associated with nonadherence measured on
the Morisky Medication Adherence Scale across several countries. In multilevel,
multivariate analysis, low self-efficacy (odds ratio = 0.73; 95% confidence
interval 0.70-0.77) and a high number of perceived barriers to taking medicines
(odds ratio = 1.70; 95% confidence interval 1.38-2.09) were the main significant
determinants of nonadherence. Country differences explained 11% of the variance
in nonadherence.
CONCLUSIONS: Among the variables measured, patients' adherence to
antihypertensive medicines is influenced primarily by their self-efficacy,
illness beliefs, and perceived barriers. These should be targets for
interventions for improving adherence, as should an appreciation of differences
among the countries in which they are being delivered.
Copyright © 2015 International Society for Pharmacoeconomics and Outcomes

Research (ISPOR). Published by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.jval.2014.12.013
810. Ann Epidemiol. 2018 Jul;28(7):462-467. doi: 10.1016/j.annepidem.2018.03.013.

Epub
2018 Mar 29.
The association between hardship and self-rated health: does the choice of
indicator matter?
Marshall GL(1), Tucker-Seeley R(2).
Author information:
(1)Assistant Professor, University of Washington, Tacoma, Social Work Program,
Tacoma, WA. Electronic address: geegee@uw.edu.
(2)Edward L. Schneider Assistant Professor of Gerontology, Leonard Davis School
of Gerontology, University of Southern California, Los Angeles, CA.
PURPOSE: The purpose of this study was to investigate the association between
four specific forms of hardship (difficulty paying bills, ongoing financial
stress, medication reduction due to cost, and food insecurity) and self-rated
health among older men and women.
METHODS: Cross-sectional logistic regression analysis was conducted using the
2010 wave of the Health and Retirement Study Leave-Behind Questionnaire (N =
7619) to determine the association between four hardship indicators and
self-rated health. Hardship indicators (difficulty paying bills, ongoing
financial stress, medication reduction due to cost, and food insecurity) were
dichotomized (0 = no hardship, 1 = yes hardship) for this analysis.
RESULTS: After adjusting for sociodemographic factors, participants reporting
difficulty paying bills had an 1.8 higher odds of reporting poor self-rated
health (95% confidence intervals [CI]: 1.57, 2.15) and those reporting taking
less medication due to cost had a 2.5 times higher odds of poor self-rated health
(95% CI: 1.97, 3.09) compared to those not reporting these hardships. When
stratified by gender, and adjusting for sociodemographic factors, men who took
less medication due to cost had a 1.93 higher odds of low self-rated health (95%
CI: 1.39, 2.67) and women who took less medications due to cost had a 2.9 higher
odds of reporting poor self-rated health (95% CI: 2.23, 2.70) compared to women
not reporting these hardships.
CONCLUSIONS: Research in this area can provide greater conceptual and measurement
clarity on the hardship experience and further elucidate the pathway between
specific hardships and poor health outcomes to inform intervention development.
DOI: 10.1016/j.annepidem.2018.03.013
PMCID: PMC5986601

eCollection 2019.
Comparison of anonymous versus nonanonymous responses to a medication adherence

questionnaire in patients with Parkinson's disease.
Prell T(1)(2), Schaller D(1), Perner C(1)(3), Franke GH(4), Witte OW(1)(2), Kunze
A(1), Grosskreutz J(1)(2).
Author information:
(1)Department of Neurology, Jena University Hospital, Jena, Germany,
tino.prell@med.uni-jena.de.
(2)Center for Healthy Aging, Jena University Hospital, Jena, Germany,
tino.prell@med.uni-jena.de.
(3)Center for Immunology and Inflammatory Diseases, Massachusetts General
Hospital, Harvard Medical School, Charlestown, MA, USA.
(4)University of Applied Sciences, Psychology of Rehabilitation, Stendal,
Germany.
Purpose: Adherence to medication can be assessed by various self-report

questionnaires. One could hypothesize that survey respondents tend to answer
questions in a manner that will be viewed favorably by others. We aimed to answer
if anonymous and nonanonymous responses to a questionnaire on medication
adherence differ.
Patients and methods: Adherence was assessed with the German Stendal Adherence
with Medication Score (SAMS), which includes 18 questions with responses based on
a 5-point Likert scale. Anonymous data from 40 subjects were collected during a
symposium for patients with Parkinson's disease (PD), and nonanonymous data were
obtained from 40 outpatient-clinic PD patients at the Department of Neurology.
Results: The two groups (anonymous self-reported questionnaire and nonanonymous)
did not differ in terms of demographical characteristics and the SAMS sum score.
However, anonymously collected data showed significant higher scoring for the
item 6 ("Do you forget your medications?") than the data collected nonanonymously
(P=0.017). All other items of the SAMS did not significantly differ between both
groups.
Conclusion: Overall assessment of adherence does not depend on whether the
patient remains anonymous or not. There seems to be no relevant social
desirability bias in nonanonymous responses.
DOI: 10.2147/PPA.S186732
PMCID: PMC6342145
PMID: 30697036

812. JMIR Form Res. 2019 Jun 25;3(2):e13558. doi: 10.2196/13558.
The Feasibility of a Using a Smart Button Mobile Health System to Self-Track

Medication Adherence and Deliver Tailored Short Message Service Text Message
Feedback.
Bartlett Ellis RJ(1), Hill JH(#)(2)(3), Kerley KD(1), Sinha A(#)(4), Ganci
A(#)(5), Russell CL(6).
Author information:
(1)Science of Nursing Care Department, Indiana University School of Nursing,
Indianapolis, IN, United States.
(2)Department of Computer & Information Science, Purdue School of Science,
Indiana University-Purdue University, Indianapolis, IN, United States.
(3)Center for Software and Innovation, Purdue School of Science, Indiana
University-Purdue University, Indianapolis, IN, United States.
(4)Richard L Roudebush VA Medical Center, Division of Nephrology, Indiana
University, Indianapolis, IN, United States.
(5)Visual Communication Design, Herron School of Art and Design, Indiana
University-Purdue University Indianapolis, Indianapolis, IN, United States.
(6)School of Nursing and Health Studies, University of Missouri-Kansas City,
Kansas City, MO, United States.
BACKGROUND: As many as 50% of people experience medication nonadherence, yet

studies for detecting nonadherence and delivering real-time interventions to
improve adherence are lacking. Mobile health (mHealth) technologies show promise
to track and support medication adherence.
OBJECTIVE: The study aimed to evaluate the feasibility and acceptability of using
an mHealth system for medication adherence tracking and intervention delivery.
The mHealth system comprises a smart button device to self-track medication
taking, a companion smartphone app, a computer algorithm used to determine
adherence and then deliver a standard or tailored SMS (short message service)
text message on the basis of timing of medication taking. Standard SMS text
messages indicated that the smartphone app registered the button press, whereas
tailored SMS text messages encouraged habit formation and systems thinking on the
basis of the timing the medications were taken.
METHODS: A convenience sample of 5 adults with chronic kidney disease (CKD), who
were prescribed antihypertensive medication, participated in a 52-day
longitudinal study. The study was conducted in 3 phases, with a standard SMS text
message sent in phases 1 (study days 1-14) and 3 (study days 46-52) and tailored
SMS text messages sent during phase 2 (study days 15-45) in response to
participant medication self-tracking. Medication adherence was measured using:
(1) the smart button and (2) electronic medication monitoring caps. Concordance
between these 2 methods was evaluated using percentage of measurements made on
the same day and occurring within ±5 min of one another. Acceptability was
evaluated using qualitative feedback from participants.
RESULTS: A total of 5 patients with CKD, stages 1-4, were enrolled in the study,
with the majority being men (60%), white (80%), and Hispanic/Latino (40%) of
middle age (52.6 years, SD 22.49; range 20-70). The mHealth system was
successfully initiated in the clinic setting for all enrolled participants. Of
the expected 260 data points, 36.5% (n=95) were recorded with the smart button
and 76.2% (n=198) with electronic monitoring. Concordant events (n=94), in which
events were recorded with both the smart button and electronic monitoring,
occurred 47% of the time and 58% of these events occurred within ±5 min of one
another. Participant comments suggested SMS text messages were encouraging.
CONCLUSIONS: It was feasible to recruit participants in the clinic setting for an
mHealth study, and our system was successfully initiated for all enrolled
participants. The smart button is an innovative way to self-report adherence
data, including date and timing of medication taking, which were not previously
available from measures that rely on recall of adherence. Although the selected
smart button had poor concordance with electronic monitoring caps, participants
were willing to use it to self-track medication adherence, and they found the
mHealth system acceptable to use in most cases.
©Rebecca J Bartlett Ellis, James H Hill, K Denise Kerley, Arjun Sinha, Aaron
Ganci, Cynthia L Russell. Originally published in JMIR Formative Research
(http://formative.jmir.org), 25.06.2019.
DOI: 10.2196/13558
PMCID: PMC6614996
PMID: 31237568
813. Health Psychol. 2016 Oct;35(10):1126-1134. doi: 10.1037/hea0000356. Epub 2016

Apr
18.
Social support and moment-to-moment changes in treatment self-efficacy in men

living with HIV: Psychosocial moderators and clinical outcomes.
Turan B(1), Fazeli PL(2), Raper JL(3), Mugavero MJ(3), Johnson MO(4).
Author information:
(1)Department of Psychology.
(2)Family, Community and Health Systems Department.
(3)Department of Medicine.
(4)Department of Medicine, University of California.
OBJECTIVE: For people living with HIV, treatment adherence self-efficacy is an

important predictor of treatment adherence and, therefore, of clinical outcomes.
Using experience sampling method (ESM), this study aimed to examine: (1) the
within-person association between moment-to-moment changes in social support and
HIV treatment self-efficacy; (2) the moderators of this within-person
association; (3) the concordance between questionnaire and ESM measurement of
treatment self-efficacy; and (4) the utility of each approach (ESM and
questionnaire) in predicting adherence to medication, adherence to clinic visits,
CD4 counts, and viral load.
METHOD: Men living with HIV (N = 109) responded to the same set of ESM questions
3 times a day for 7 days via a smart phone given to them for the study. They also
completed cross-sectional questionnaires and their clinic data was extracted from
medical records to examine predictors and consequences of state and trait
treatment self-efficacy.
RESULTS: In within-person hierarchical linear modeling (HLM) analyses, receipt of
recent social support predicted higher current ESM treatment self-efficacy. This
association was stronger for individuals reporting higher avoidance coping with
HIV. The correlation between ESM and questionnaire measures of treatment
self-efficacy was r = .37. ESM measure of average treatment self-efficacy
predicted medication adherence, visit adherence, CD4 counts, and viral load,
while questionnaire-based self-efficacy did not predict these outcomes.
CONCLUSION: Interventions aimed at improving treatment adherence may target
social support processes, which may improve treatment self-efficacy and
adherence. (PsycINFO Database Record
DOI: 10.1037/hea0000356
PMCID: PMC5033657

eCollection 2014.
Evaluating the effectiveness of self-administration of medication (SAM) schemes

in the hospital setting: a systematic review of the literature.
Richardson SJ(1), Brooks HL(1), Bramley G(2), Coleman JJ(3).
Author information:
(1)University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham,
B15 2WB, United Kingdom.
(2)Primary Care Clinical Sciences, School of Health & Population Sciences,
University of Birmingham, Birmingham, B15 2TT, United Kingdom.
(3)University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham,
B15 2WB, United Kingdom; School of Clinical and Experimental Medicine, College of
Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, United
Kingdom.
BACKGROUND: Self-administration of medicines is believed to increase patients'

understanding about their medication and to promote their independence and
autonomy in the hospital setting. The effect of inpatient self-administration of
medication (SAM) schemes on patients, staff and institutions is currently
unclear.
OBJECTIVE: To systematically review the literature relating to the effect of SAM
schemes on the following outcomes: patient knowledge, patient
compliance/medication errors, success in self-administration, patient
satisfaction, staff satisfaction, staff workload, and costs.
DESIGN: Keyword and text word searches of online databases were performed between
January and March 2013. Included articles described and evaluated inpatient SAM
schemes. Case studies and anecdotal studies were excluded.
RESULTS: 43 papers were included for final analysis. Due to the heterogeneity of
results and unclear findings it was not possible to perform a quantitative
synthesis of results. Participation in SAM schemes often led to increased
knowledge about drugs and drug regimens, but not side effects. However, the
effect of SAM schemes on patient compliance/medication errors was inconclusive.
Patients and staff were highly satisfied with their involvement in SAM schemes.
CONCLUSIONS: SAM schemes appear to provide some benefits (e.g. increased patient
knowledge), but their effect on other outcomes (e.g. compliance) is unclear. Few
studies of high methodological quality using validated outcome measures exist.
Inconsistencies in both measuring and reporting outcomes across studies make it
challenging to compare results and draw substantive conclusions about the
effectiveness of SAM schemes.
PMCID: PMC4252074
815. Drugs. 2019 Apr;79(6):647-654. doi: 10.1007/s40265-019-01107-y.
Distinct Profiles on Subjective and Objective Adherence Measures in Patients

Prescribed Antidepressants.
Wouters H(1)(2), Rhebergen D(3), Vervloet M(4), Egberts A(5)(6), Taxis K(7), van
Dijk L(7)(4), Gardarsdottir H(5)(6)(8).
Author information:
(1)Department of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics
(PTEE), Faculty of Science and Engineering, Groningen Research Institute of
Pharmacy, University of Groningen, Groningen, The Netherlands. j.wouters@umcg.nl.
(2)Department of General Practice and Elderly Care Medicine, University Medical
Center Groningen, University of Groningen, Oostersingel, Building 50, P.O. Box
196, 9700 AD, Groningen, The Netherlands. j.wouters@umcg.nl.
(3)Department of Old Age Psychiatry, InGeest Specialized Mental Health Care,
Amsterdam UMC location VU Medical Center, Amsterdam, The Netherlands.
(4)Nivel Netherlands Institute for Health Services Research, Utrecht, The
Netherlands.
(5)Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of
Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University,
Utrecht, The Netherlands.
(6)Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University
Medical Center Utrecht, Utrecht, The Netherlands.
(7)Department of Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics
(PTEE), Faculty of Science and Engineering, Groningen Research Institute of
Pharmacy, University of Groningen, Groningen, The Netherlands.
(8)Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavík, Iceland.
OBJECTIVE: A recurrent observation is that associations between self-reported and

objective medication adherence measures are often weak to moderate. Our aim was
therefore to identify patients with different profiles on self-reported and
objective adherence measures.
STUDY DESIGN AND SETTING: This was an observational study of 221 community
pharmacy patients who were dispensed antidepressants. Adherence profiles were
estimated with Latent Profile Analysis (LPA) using data on self-reported
adherence (Medication Adherence Rating Scale) complemented with data on
medication beliefs (perceived necessity and concerns measured with the Beliefs
about Medicines Questionnaire) and data from objective adherence measures
(electronic monitoring of medication taking and the Medication Possession Ratio
calculated from pharmacy dispensing data).
RESULTS: 'Goodness-of-fit' statistics indicated the presence of three classes:
"concordantly high adherent" (83%, high adherence on all measures), "concordantly
suboptimal adherent" (11%, low adherence on all measures), and "discordant" (6%,
high self-reported adherence but lower adherence on objective measures).
CONCLUSION: Most patients had concordant outcomes on self-reported and objective
measures of adherence. A small discordant class had high self-reported but low
objective adherence. LPA will enable sensitivity analyses in future studies, for
example excluding patients from the discordant class.
DOI: 10.1007/s40265-019-01107-y
PMCID: PMC6483946
PMID: 30941607

eCollection 2019.
Assessing methods of measuring medication adherence in chronically ill children-a

narrative review.
Al-Hassany L(1), Kloosterboer SM(1), Dierckx B(2), Koch BC(1).
Author information:
(1)Erasmus MC, University Medical Center Rotterdam, Department of Hospital
Pharmacy, Rotterdam, The Netherlands.
(2)Erasmus MC, University Medical Center Rotterdam, Department Child and
Adolescent Psychiatry, Rotterdam, The Netherlands.
Nonadherence in children who use long-term medication is a serious problem and

assessing adherence is an important step to provide solutions to this problem.
Medication adherence can be measured by several methods, including (a)
self-report questionnaires or structured interviews, (b) therapeutic drug
monitoring (TDM), (c) electronic devices, and (d) pick-up/refill rates. The
objective of this narrative review is to provide an overview of the literature
about methods for the measurement of medication adherence in chronically ill
children and adolescents. Therefore, we conducted a literature search by using
multiple databases. Four methods of monitoring medication adherence are presented
for the most described chronic diseases: asthma, HIV/AIDS, epilepsy, diabetes
mellitus and ADHD. First, 10 commonly used self-report questionnaires and
structured interviews are described, including the main characteristics,
(dis)advantages and their validation studies. Second, the use of TDM in pediatric
trials for medication adherence measurement is discussed. New sampling methods
(e.g. dried blood spot) and sampling matrices (e.g. hair, saliva and urine) have
shown their benefits for TDM in children. Third, electronic devices to measure
medication adherence in children are presented, being developed for several drug
administration routes. Fourth, the analyses, advantages and disadvantages of
pharmacy data are discussed. The usage of this data requires specific
calculations and interpretations to assess adherence. As presented in this
review, every adherence method has specific (dis)advantages. When deciding which
adherence method is applicable, validity and generalizability should be taken
into account. Combining multiple methods seems to offer the best solution in the
daily clinical practice.
DOI: 10.2147/PPA.S200058
PMCID: PMC6660631
PMID: 31413546

this work.
817. Clin Ther. 2016 Jul;38(7):1653-1664.e1. doi: 10.1016/j.clinthera.2016.05.009.

Epub 2016 Jun 28.
Self-reported Barriers to Adherence and Persistence to Treatment With Injectable

Medications for Type 2 Diabetes.
Spain CV(1), Wright JJ(2), Hahn RM(2), Wivel A(3), Martin AA(4).
Author information:
(1)GlaxoSmithKline, Philadelphia, Pennsylvania. Electronic address:
cvs2@cornell.edu.
(2)Harris Poll, Rochester, New York.
(3)GlaxoSmithKline, King of Prussia, Pennsylvania.
(4)GlaxoSmithKline, Uxbridge, United Kingdom.
PURPOSE: This study explored the barriers that adult Americans experience when
taking injectable medications for type 2 diabetes, from the time of filling the
initial prescription through the decision to discontinue the medication.
METHODS: An Internet-based survey was conducted in 2 waves among adult patients
(N = 2000) who had received a physician prescription for insulin, liraglutide, or
exenatide once weekly (QW), regardless of whether the prescription was filled by
a pharmacy. In wave 1, patients were surveyed on their medication history and
experience and, if relevant, the medication discontinuation process. Those still
taking their injectable medication at the time of wave 1 were contacted 6 months
later (wave 2, n = 585) to assess any changes in their medication experience.
FINDINGS: Among patients who delayed filling their prescription by ≥1 week, cost
was a common reason for delay for refilling of liraglutide (63%) and exenatide QW
(49%). The most commonly reported barrier to maintaining injectable medication
was injection concerns (42%) such as aversion to needles, pain, or needle size.
Lack of perceived need was the most common reason for discontinuation for basal
(47%) and prandial/premixed (44%) insulin. For liraglutide, the most common
reason for discontinuation was experiencing an adverse event (33%); for exenatide
QW, it was injection concerns (38%).
IMPLICATIONS: The diverse barriers we identified underscore the need for better
patient-prescriber communication to ensure that newly prescribed injectable
medications are consistent with a patient's ability or willingness to manage
them, to appropriately set expectations about medications, and to address new
barriers that arise during the course of treatment.
DOI: 10.1016/j.clinthera.2016.05.009
818. AIDS Care. 2016 Aug;28(8):976-81. doi: 10.1080/09540121.2016.1146401. Epub

2016
Feb 24.
Medication adherence among transgender women living with HIV.
Baguso GN(1), Gay CL(2), Lee KA(2).
Author information:
(1)a Department of Community Health Systems , University of California , San
Francisco , CA , USA.
(2)b Department of Family Health Care Nursing , University of California , San
Francisco , CA , USA.
Medication adherence is linked to health outcomes among adults with HIV

infection. Transgender women living with HIV (TWLWH) in the US report suboptimal
adherence to medications and are found to have difficulty integrating HIV
medication into their daily routine, but few studies explore the factors
associated with medication adherence among transgender women. Thus, the purpose
of this paper is to examine demographic and clinical factors related to
self-reported medication adherence among transgender women. This secondary
analysis is based on data collected from the Symptom and Genetic Study that
included a convenience sample of 22 self-identified transgender women, 201
non-transgender men, and 72 non-transgender women recruited in northern
California. Self-reported medication adherence was assessed using the AIDS
Clinical Trials Group Adherence Questionnaire. Gender differences in demographic
and clinical variables were assessed, as were differences between transgender
women reporting high and low adherence. Transgender women had lower adherence to
medications compared to non-transgender males and non-transgender females
(p = .028) and were less likely to achieve viral suppression (p = .039). Within
the transgender group, Black/African-Americans reported better adherence than
participants who were Whites/Caucasian or other races (p = .009). Adherence among
transgender women was unrelated to medication count and estrogen therapy, but
consistent with other reports on the HIV population as a whole; transgender women
with high adherence were more likely to achieve viral suppression compared to the
transgender women with low adherence. Despite the high incidence of HIV infection
in the transgender population, few studies focus on TWLWH, either in regard to
their adherence to antiretroviral therapies or to their healthcare in general. To
address ongoing health disparities, more studies are needed focusing on the
transgender population's continuum of care in HIV therapies.
DOI: 10.1080/09540121.2016.1146401
PMCID: PMC4917432
819. JMIR Mhealth Uhealth. 2019 Jun 18;7(6):e8130. doi: 10.2196/mhealth.8130.
A Medication Adherence App for Children With Sickle Cell Disease: Qualitative
Study.
Curtis K(1)(2), Lebedev A(3), Aguirre E(4)(5), Lobitz S(6).
Author information:
(1)Health Behaviour and Interventions Research, Faculty of Health and Life
Sciences, Coventry University, Coventry, United Kingdom.
(2)Public Health Warwickshire, Warwickshire County Council, Warwick, United
Kingdom.
(3)Klinik für Pädiatrie mS, Onkologie/Hämatologie, Charité-Universitätsmedizin
Berlin, Berlin, Germany.
(4)Division of Psychiatry, University College London, London, United Kingdom.
(5)Research and Development Department, North East London Foundation Trust,
Goodmayes Hospital, Essex, United Kingdom.
(6)Amsterdam Street Children's Hospital, Cologne, Germany.
BACKGROUND: Young people with sickle cell disease (SCD) often demonstrate low
medication adherence and low motivation for effectively self-managing their
condition. The growing sophistication of mobile phones and their popularity among
young people render them a promising platform for increasing medication
adherence. However, so far, few apps targeting SCD have been developed from
research with the target population and underpinned with theory and evidence.
OBJECTIVE: The aim of this study was to develop a theory-and-evidence-based
medication adherence app to support children and adolescents with SCD.
METHODS: The Behavior Change Wheel (BCW), a theoretically based intervention
development framework, along with a review of the literature, 10 interviews with
children and adolescents with SCD aged between 12 and 18 years, and consultation
with experts informed app development. Thematic analysis of interviews provided
relevant theoretical and evidence-based components to underpin the design and
development of the app.
RESULTS: Findings suggested that some patients had lapses in memory for taking
their medication (capability); variation in beliefs toward the effectiveness of
medication and confidence in self-managing their condition (motivation); a
limited time to take medication; and barriers and enablers within the changing
context of social support during the transition into adulthood (opportunity).
Steps were taken to select the appropriate behavioral change components
(involving behavior change techniques [BCTs] such as information on antecedents,
prompts/cues; self-monitoring of the behavior; and social support) and translate
them into app features designed to overcome these barriers to medication
adherence.
CONCLUSIONS: Patients with SCD have complex barriers to medication adherence
necessitating the need for comprehensive models of behavior change to analyze the
problem. Children and adolescents require an app that goes beyond simple
medication reminders and takes into account the patient's beliefs, emotions, and
environmental barriers to medication adherence.
©Kristina Curtis, Anastasiya Lebedev, Elisa Aguirre, Stephan Lobitz. Originally

published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 18.06.2019.
PMCID: PMC6604509
PMID: 31215518
820. Medicine (Baltimore). 2019 May;98(22):e15849. doi:

10.1097/MD.0000000000015849.
Socioeconomic status moderates the association between patient satisfaction with

community health service and self-management behaviors in patients with type 2
diabetes: A cross-sectional survey in China.
Yin T(1), Yin DL(1), Xiao F(1), Xin QQ(1), Li RL(1), Zheng XG(1), Yang HM(1),
Wang LH(1)(2), Ding XY(2), Chen BW(1)(2).
Author information:
(1)Department of Health Development, Capital Institute of Pediatrics.
(2)Community Health Association of China, Beijing, China.
The objective of this study was to examine the association between patient
satisfaction with community health service (CHS) and self-management behaviors in
patients with type 2 diabetes mellitus (T2DM).In all, 1691 patients with T2DM
from 8 community health centers in 5 provinces in China participated in the
present study. The dependent variables included 4 measures of self-management
behaviors: regular self-monitoring of blood glucose (SMBG), prescribed medication
adherence, recommended dietary changes, and regular exercise. The independent
variable was patient satisfaction with CHS. Multivariable logistic regression
models were performed to examine the association between patient satisfaction
with CHS and self-management behaviors.The mean satisfaction score in the
participants was 3.14 (out of a maximum of 5). After adjusting for covariates
including demographic factors, health status, health knowledge, and socioeconomic
status (SES), diabetic patients with high CHS satisfaction had better medication
adherence (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.02-1.55),
increased exercise management (OR 1.19, 95% CI 1.06-1.35), and more SMBG (OR
1.16, 95% CI 1.03-1.32); all these associations varied across SES groups. The
association between satisfaction and medication adherence was significant among
participants younger than 65 years with lower education (OR 2.15, 95% CI
1.37-3.37), income (OR 1.62, 95% CI 1.13-2.32), and lower-status occupations (OR
1.69, 95% CI 1.16-2.47). Among participants younger than 65 years and had lower
education attainment, the association between satisfaction and diet management
was observed. There were positive associations between satisfaction and regular
exercise among subgroups of participants younger than 65 years, except for lower
education group. A significant association between satisfaction and SMBG among
participants ≥65 years old, who also had lower SES and higher-status occupations,
was also observed.The study findings suggested that T2DM patient satisfaction
with CHS was moderate. High satisfaction with CHS indicated better medication
adherence, exercise management, and SMBG, and these associations varied by SES.
DOI: 10.1097/MD.0000000000015849

eCollection 2017.
mHealth intervention to support asthma self-management in adolescents: the ADAPT

study.
Kosse RC(1), Bouvy ML(1), de Vries TW(2), Kaptein AA(3), Geers HC(1), van Dijk
L(4), Koster ES(1).
Author information:
(1)Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute
for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht.
(2)Department of Paediatrics, Medical Center Leeuwarden, Leeuwarden.
(3)Medical Psychology, Leiden University Medical Center, Leiden.
(4)NIVEL, the Netherlands Institute for Health Services Research, Utrecht, the
Netherlands.
PURPOSE: Poor medication adherence in adolescents with asthma results in poorly

controlled disease and increased morbidity. The aim of the ADolescent Adherence
Patient Tool (ADAPT) study is to develop an mHealth intervention to support
self-management and to evaluate the effectiveness in improving medication
adherence and asthma control.
INTERVENTION: The ADAPT intervention consists of an interactive smartphone
application (app) connected to a desktop application for health care providers,
in this study, the community pharmacist. The app contains several functions to
improve adherence as follows: 1) a questionnaire function to rate asthma symptoms
and monitor these over time; 2) short movie clips with medication and disease
information; 3) a medication reminder; 4) a chat function with peers; and 5) a
chat function with the pharmacist. The pharmacist receives data from the
patient's app through the desktop application, which enables the pharmacist to
send information and feedback to the patient.
STUDY DESIGN: The ADAPT intervention is tested in a community pharmacy-based
cluster randomized controlled trial in the Netherlands, aiming to include 352
adolescents with asthma. The main outcome is adherence, measured by patient's
self-report and refill adherence calculated from pharmacy dispensing records. In
addition, asthma control, illness perceptions, medication beliefs, and
asthma-related quality of life are measured.
CONCLUSION: This study will provide in-depth knowledge on the effectiveness of an
mHealth intervention to support asthma self-management in adolescents. These
insights will also be useful for adolescents with other chronic diseases.
DOI: 10.2147/PPA.S124615
PMCID: PMC5360404
PMID: 28356720

822. SAGE Open Med. 2016 Oct 19;4:2050312116674850. eCollection 2016.
Revisiting the internal consistency and factorial validity of the 8-item Morisky
Medication Adherence Scale.
Zongo A(1), Guénette L(1), Moisan J(1), Guillaumie L(2), Lauzier S(1), Grégoire
JP(1).
Author information:
(1)Faculty of Pharmacy, Laval University, Quebec City, QC, Canada; Population
Health and Optimal Health Practices Research Unit, CHU de Québec - Université
Laval Research Centre, Quebec City, QC, Canada; Chair on adherence to treatments,
Laval University, Quebec City, QC, Canada.
(2)Population Health and Optimal Health Practices Research Unit, CHU de Québec -
Université Laval Research Centre, Quebec City, QC, Canada; Chair on adherence to
treatments, Laval University, Quebec City, QC, Canada; Faculty of Nursing, Laval
University, Quebec City, QC, Canada.
OBJECTIVE: To assess the internal consistency and factorial validity of the

adapted French 8-item Morisky Medication Adherence Scale in assessing adherence
to noninsulin antidiabetic drug treatment.
STUDY DESIGN AND SETTING: In a cross-sectional web survey of individuals with
type 2 diabetes of the Canadian province of Quebec, self-reported adherence to
the antidiabetes drug treatment was measured using the Morisky Medication
Adherence Scale-8. We assessed the internal consistency of the Morisky Medication
Adherence Scale-8 with Cronbach's alpha, and factorial validity was assessed by
identifying the underlying factors using exploratory factor analyses.
RESULTS: A total of 901 individuals completed the survey. Cronbach's alpha was
0.60. Two factors were identified. One factor comprised five items: stopping
medication when diabetes is under control, stopping when feeling worse, feeling
hassled about sticking to the prescription, reasons other than forgetting and a
cross-loading item (i.e. taking drugs the day before). The second factor
comprised three other items that were all related to forgetfulness in addition to
the cross-loading item.
CONCLUSION: Cronbach's alpha of the adapted French Morisky Medication Adherence
Scale-8 was below the acceptable value of 0.70. This observed low internal
consistency of the scale is probably related to the causal nature of the items of
the scale but not necessarily a lack of reliability. The results suggest that the
adapted French Morisky Medication Adherence Scale-8 is a two-factor scale
assessing intentional (first factor) and unintentional (second factor)
non-adherence to the noninsulin antidiabetes drug treatment. The scale could be
used to separately identify these outcomes using scores obtained on each of the
sub-scales.
DOI: 10.1177/2050312116674850
PMCID: PMC5117245
PMID: 27895914
Conflict of interest statement: The author(s) declared no potential conflicts of

interest with respect to the research, authorship and/or publication of this
article.

eCollection 2016.
Validity and Reliability of a Self-Reported Measure of Antihypertensive

Medication Adherence in Uganda.
Okello S(1)(2), Nasasira B(1), Muiru AN(2)(3), Muyingo A(1).
Author information:
(1)Department of Internal Medicine, Mbarara University of Science and Technology,
Mbarara, Uganda.
(2)Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston,
Massachusetts, United States of America.
(3)Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts,
United States of America.
Erratum in
PLoS One. 2017 Oct 31;12 (10 ):e0187620.
BACKGROUND: The Morisky Medication Adherence scale (MMAS-8) is a widely used

self-reported measure of adherence to antihypertensive medications that has not
been validated in hypertensive patients in sub-Saharan Africa.
METHODS: We carried out a cross-sectional study to examine psychometric
properties of a translated MMAS-8 (MMAS-U) in a tertiary care hypertension clinic
in Uganda. We administered the MMAS-U to consecutively selected hypertensive
adults and used principal factor analysis and Cronbach's alpha to determine its
validity and internal consistency respectively. Then we randomly selected
one-sixth of participants for a 2-week test-retest telephone interview. Lastly,
we used ordinal logistic regression modeling to explore factors associated with
levels of medication adherence.
RESULTS: Of the 329 participants, 228 (69%) were females, median age of 55 years
[Interquartile range (IQR) (46-66)], and median duration of hypertension of 4
years [IQR (2-8)]. The adherence levels were low (MMAS-U score ≤ 5) in 85%,
moderate (MMAS-U score 6-7) in 12% and high (MMAS-U score ≥8) in 3%. The factor
analysis of construct validity was good (overall Kaiser's measure of sampling
adequacy for residuals of 0.72) and identified unidimensionality of MMAS-U. The
internal consistency of MMAS-U was moderate (Cronbach α = 0.65), and test-retest
reliability was low (weighted kappa = 0.36; 95% CI -0.01, 0.73). Age of 40 years
or greater was associated with low medication adherence (p = 0.02) whereas a
family member buying medication for participants (p = 0.02) and purchasing
medication from a private clinic (p = 0.02) were associated with high adherence.
CONCLUSION: The Ugandan version of the MMAS-8 (MMAS-U) is a valid and reliable
measure of adherence to antihypertensive medication among Ugandan outpatients
receiving care at a public tertiary facility. Though the limited supply of
medication affected adherence, this easy to use tool can be adapted to assess
medication adherence among adults with hypertension in Uganda.
PMCID: PMC4930194
824. Am J Pharm Educ. 2018 Nov;82(9):6444. doi: 10.5688/ajpe6444.
Comparison of Student and Patient Perceptions for Medication Non-adherence.
Darbishire PL(1)(2), Mashrah D(3).
Author information:
(1)Purdue University College of Pharmacy, West Lafayette, Indiana.
(2)Editorial Board Member, American Journal of Pharmaceutical Education,
Arlington, Virginia.
(3)University of Michigan Hospital, Ann Arbor, Michigan.
Objective. To compare pharmacy students' perceptions with patients' reasons for
medication non-adherence. Methods. Pharmacy students completing an experiential
rotation recruited patients exhibiting medication non-adherence from community
pharmacies and asked them to respond to statements about reasons for their
medication non-adherence. Patient responses were ranked in order of prevalence
and compared to self-reported student perceptions on reasons for non-adherence.
Results. There was a significant difference between patients' and students'
rankings of reasons for medication non-adherence. Significant factors for
patients included medications that interfere with lifestyle, sexual health and
drinking alcohol; whereas, students believed that cognitive-related issues were
patients' primary reasons for non-adherence to their medications. Conclusion.
Educational opportunities to reflect on and discuss differing perspectives should
be provided in the pharmacy curriculum to better equip students to address
medication adherence issues and improve patient care.
DOI: 10.5688/ajpe6444
PMCID: PMC6291675
PMID: 30559498
Quit outcomes among clients ineligible for cessation medication through the state
quitline: a retrospective, observational study.
Lent AB(1), O'Connor PA(2), Reikowsky RC(3), Nair US(3), Bell ML(4).
Author information:
(1)Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman
College of Public Health, 1295 N Martin Ave, Tucson, AZ, 85724, USA.
adriennelent@email.arizona.edu.
(2)Biostatistics, University of Arizona, Mel and Enid Zuckerman College of Public
Health, 1295 N Martin Ave, Tucson, AZ, 85724, USA.
(3)Health Promotion Sciences, University of Arizona, Mel and Enid Zuckerman
(4)Epidemiology and Biostatistics, University of Arizona, Mel and Enid Zuckerman
BACKGROUND: Distribution of tobacco cessation medications through state quitlines

increases service utilization and quit outcomes. However, some state quitlines
have moved to models in which callers are instructed to obtain quit medications
through their health insurance pharmaceutical benefit. We aimed to investigate
the impact of this policy on medication access and quit outcomes in the state
quitline setting for clients who must obtain covered medications through the
state Medicaid program. We hypothesized that clients with Medicaid who were
referred by their healthcare provider would be more likely to report using quit
medication and have higher quit rates compared to clients with Medicaid who
engaged the quitline on their own.
METHODS: An observational, retrospective study was conducted using state quitline
clients with Medicaid health insurance who were ineligible for quitline provided
cessation medications. Clients were stratified by referral type: self-referred,
passively referred, and proactively referred. Unadjusted and adjusted logistic
regression was used to estimate the effect of referral type on both quit status
and cessation medication use.
RESULTS: Proactively referred clients were less likely to use quit medication
(53.6%) compared to self (56.9%) and passively referred clients (61.1%).
Proactively referred clients had lower quit rates (31.4%), as compared to
passively referred (36.0%) and self-referred (35.1%). In adjusted models,
proactively referred clients were significantly less likely to be quit than
passively referred clients (OR = 0.75, 95% CI: 0.56, 0.99). There were no
statistically significant differences in medication use or number of coaching
sessions among proactive, passive, and self-referred clients in adjusted models.
CONCLUSIONS: In adjusted models, medication use did not significantly differ by
mode of entry in this population of Medicaid beneficiaries. Psychosocial factors
such as intention to quit in the next 30 days, social support for quitting,
education level, race, and ethnicity impacted quit status and differed by mode of
entry. Quitlines should use tailored strategies to increase engagement and reduce
barriers among proactively referred clients.
DOI: 10.1186/s12889-018-5923-6
PMCID: PMC6086054
PMID: 30097065
826. Int J Circumpolar Health. 2016 Mar 18;75:30726. doi: 10.3402/ijch.v75.30726.

eCollection 2016.
Adherence to health regimens among frequent attenders of Finnish healthcare.
Hirsikangas S(1), Kanste O(2), Korpelainen J(3), Kyngäs H(4)(5).
Author information:
(1)Oulu University Hospital, Oulu, Finland; sari.hirsikangas@ppshp.fi.
(2)National Institute for Health and Welfare, Oulu, Finland.
(3)Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.
(4)Research Group of Nursing Science and Health Management, University of Oulu,
Oulu, Finland.
(5)Northern Ostrobothnia Hospital District, Finland.
OBJECTIVES: The aim of the study was to describe adherence to health regimens and
the factors associated with it among adult frequent attenders (FAs).
DESIGN: This was a cross-sectional study. The study sample consisted of 462
healthcare FAs in 7 municipal health centres in northern Finland. An FA is a
person who has had 8 or more outpatient visits to a GP (in a health centre) or 4
or more outpatient visits to a university hospital during 1 year. The main
outcome was self-reported adherence to health regimens.
RESULTS: Of the FAs, 82% adhered well to their health regimens. Carrying out
self-care, medical care and feeling responsible for self-care were the most
significant predictors to good adherence in all models. No significant
differences in adherence were found in male and female subjects, age groups or
educational levels. Support from healthcare providers and support from relatives
were not significant predictors of good adherence.
CONCLUSION: FAs in Finland adhere well to health regimens and exceptionally well
to medication. Variables that predict the best adherence of FAs to health
regimens are carrying out self-care, receiving medical care and feeling
responsible for self-care.
DOI: 10.3402/ijch.v75.30726
PMCID: PMC4800284
827. Clin Psychopharmacol Neurosci. 2019 May 31;17(2):288-296. doi:

10.9758/cpn.2019.17.2.288.
Medication Adherence Using Electronic Monitoring in Severe Psychiatric Illness: 4

and 24 Weeks after Discharge.
Lee Y(1), Lee MS(1), Jeong HG(1), Youn HC(1), Kim SH(1).
Author information:
(1)Department of Psychiatry, Korea University Guro Hospital, Korea University
College of Medicine.
Objective: : The purpose of this study was to examine post-hospitalization

outpatient drug adherence in patients with severe psychiatric illness, including
bipolar disorder and schizophrenia, and to investigate factors associated with
drug adherence.
Methods: : Eighty-one patients diagnosed with schizophrenia or bipolar disorder
who were hospitalized due to aggravation of psychiatric symptoms were monitored.
At hospitalization, we conducted clinical assessments such as the Clinical Global
Impression-Severity, Drug Attitude Inventory, Contour Drawing Rating Scale,
Multidimensional Scale of Perceived Social Support scale, and patients
demographic factors. We measured drug adherence using the Medication Event
Monitoring System (MEMS), pill count, and patients self-report upon out-patients
visits, 4 and 24 weeks after discharge.
Results: : The mean values of the various measures of adherence were as follows:
MEMS (4 weeks) 84.8%, pill count (4 weeks) 94.6%, self-report (4 weeks) 92.6%,
MEMS (24 weeks) 81.6%, pill count (24 weeks) 90.6%, and self-report (24 weeks)
93.6%. The adherence agreement between MEMS, pill count, and self-report was
moderate (4 weeks intraclass correlation [ICC]=0.54, 24 weeks ICC=0.52).
Non-adherence (MEMS ≤0.08) was observed in 26.4% of the patients at 4 weeks and
37.7% at 24 weeks. There was a negative correlation between drug adherence
assessed 4 weeks after discharge and Contour Drawing Rating Scale difference
score (r=-0.282, p＜0.05). A positive correlation was found between drug adherence
assessed 24 weeks after discharge and Drug Attitude Inventory (r=0.383, p＜0.01).
Conclusion: : Patients attitude towards their medication and their degree of
physical dissatisfaction influenced post-hospitalization drug adherence in severe
psychiatric patients.
DOI: 10.9758/cpn.2019.17.2.288
PMCID: PMC6478086
PMID: 30905129
828. J Adolesc Health. 2017 Apr;60(4):411-416. doi:

10.1016/j.jadohealth.2016.10.428.
Epub 2016 Dec 30.
A Longitudinal Analysis of Antiretroviral Adherence Among Young Black Men Who

Have Sex With Men.
Voisin DR(1), Quinn K(2), Kim DH(3), Schneider J(4).
Author information:
(1)School of Social Service Administration, University of Chicago, Chicago,
Illinois; STI/HIV Intervention Network, University of Chicago, Chicago, Illinois;
Third Coast Center for AIDS Research, University of Chicago and Northwestern
University, Chicago, Illinois; Chicago Center for HIV Elimination, University of
Chicago, Chicago, Illinois. Electronic address: d-voisin@uchicago.edu.
(2)Center for AIDS Intervention Research, Department of Psychiatry and Behavioral
Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
(3)Department of Social Welfare, Chungwoon University, Hongseong, South Korea.
(4)Third Coast Center for AIDS Research, University of Chicago and Northwestern
University, Chicago, Illinois; Department of Medicine, University of Chicago,
Chicago, Illinois; Department of Public Health Sciences, University of Chicago,
Chicago, Illinois.
PURPOSE: Young black men who have sex with men (YBMSM) experience poorer
antiretroviral therapy (ART) medication adherence relative to their white
counterparts. However, few studies have longitudinally examined factors that may
correlate with various classifications of ART adherence among this population,
which was the primary aim of this study.
METHODS: Project nGage was a randomized controlled trial conducted across five
Chicago clinics from 2012 to 2015. Survey and medical records data were collected
at baseline and 3- and 12-month periods to assess whether psychological distress,
HIV stigma, substance use, family acceptance, social support, and self-efficacy
predicted ART medication adherence among 92 YBMSM ages 16-29 years.
RESULTS: Major results controlling for the potential effects of age, education
level, employment, and intervention condition indicated that participants with
high versus low medication adherence were less likely to report daily/weekly
alcohol or marijuana use, had higher family acceptance, and exhibited greater
self-efficacy.
CONCLUSIONS: These findings identity important factors that can be targeted in
clinical and program interventions to help improve ART medication adherence for
YBMSM.

DOI: 10.1016/j.jadohealth.2016.10.428
PMCID: PMC5366075
829. Int J Clin Pharm. 2018 Oct;40(5):1019-1029. doi: 10.1007/s11096-018-0688-7.

Epub
2018 Jul 28.
Exploring medicines management by COPD patients and their social networks after
hospital discharge.
Schafheutle EI(1), Fegan T(2), Ashcroft DM(2).
Author information:
(1)Division of Pharmacy and Optometry, School of Health Sciences, Faculty of
Biology, Medicine and Health, The University of Manchester, Manchester, UK.
ellen.schafheutle@manchester.ac.uk.
Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Background Unplanned hospital admissions (UHAs) for chronic obstructive pulmonary

disease (COPD) are a major burden on health services. Effective medicines
management is crucial to avoid such admissions but little is known about the role
of social networks in supporting medicines-taking. Objective To examine the
activities and strategies recently discharged COPD patients and their social
network members (SNMs) utilise to manage their medicines. Setting COPD patients
recently discharged from an acute NHS Trust in Northwest England. Methods
Semi-structured, face-to-face interviews; audio-recorded and transcribed with
consent, NVivo v11 facilitated qualitative thematic analysis. NHS ethical
approved. Main outcome measure Interview topic guide and analysis informed by
Cheraghi-Sohi et al.'s conceptual framework for 'medication work' exploring
medication-articulation, informational, emotional and surveillance work. Results
Twelve interviews were conducted during March-August 2016. Participants' social
networks were small (n < 5) and restricted to family members and healthcare
professionals. Participants social network members performed similar
medication-articulation and surveillance work to coronary heart disease,
arthritis and diabetes patients. When participants social network
members resolved issues identified by surveillance work, this medication work was
conceptualised as surveillance-articulation work. The social network members
performed little emotional work and were infrequently involved in informational
work despite some participants describing informational needs. After discharge,
participants reverted to pre-admission routines/habits/strategies for obtaining
medication supplies, organising medicines, keeping track of supplies, ensuring
adherence within daily regimens, and monitoring symptoms, which could cause
issues. Conclusion This study applied Cheraghi-Sohi's framework for medication
work to COPD patients and described the role of the social network members.
Pharmacists could proactively explore medication infrastructures and work with
patients and their close social network members to support medication work.
DOI: 10.1007/s11096-018-0688-7
PMCID: PMC6208597
830. Headache. 2016 Jul;56(7):1137-46. doi: 10.1111/head.12836. Epub 2016 May 11.
Adherence to Biobehavioral Recommendations in Pediatric Migraine as Measured by

Electronic Monitoring: The Adherence in Migraine (AIM) Study.
Kroon Van Diest AM(1), Ramsey R(1), Aylward B(2)(3), Kroner JW(1), Sullivan
SM(1), Nause K(1), Allen JR(1), Chamberlin LA(1), Slater S(1)(4)(5), Hommel
K(1)(5), LeCates SL(6)(4), Kabbouche MA(6)(4)(5), O'Brien HL(6)(4)(5), Kacperski
J(6)(4)(5), Hershey AD(6)(4)(5), Powers SW(1)(4)(5).
Author information:
(1)Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's
Hospital Medical Center, Cincinnati, OH, USA.
(2)Department of Pediatrics, Emory University School of Medicine, Atlanta, GA,
USA.
(3)Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Atlanta, GA,
USA.
(4)Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati,
OH, USA.
(5)Department of Pediatrics, University of Cincinnati College of Medicine,
Cincinnati, OH, USA.
(6)Division of Neurology, Cincinnati Children's Hospital Medical Center,
OBJECTIVE: The purpose of this investigation was to examine treatment adherence

to medication and lifestyle recommendations among pediatric migraine patients
using electronic monitoring systems.
BACKGROUND: Nonadherence to medical treatment is a significant public health
concern, and can result in poorer treatment outcomes, decreased
cost-effectiveness of medical care, and increased morbidity. No studies have
systematically examined adherence to medication and lifestyle recommendations in
adolescents with migraine outside of a clinical trial.
METHODS: Participants included 56 adolescents ages 11-17 who were presenting for
clinical care. All were diagnosed with migraine with or without aura or chronic
migraine and had at least 4 headache days per month. Medication adherence was
objectively measured using electronic monitoring systems (Medication Event
Monitoring Systems technology) and daily, prospective self-report via personal
electronic devices. Adherence to lifestyle recommendations of regular exercise,
eating, and fluid intake were also assessed using daily self-report on personal
electronic devices.
RESULTS: Electronic monitoring indicates that adolescents adhere to their
medication 75% of the time, which was significantly higher than self-reported
rates of medication adherence (64%). Use of electronic monitoring of medication
detected rates of adherence that were significantly higher for participants
taking once daily medication (85%) versus participants taking twice daily
medication (59%). Average reported adherence to lifestyle recommendations of
consistent noncaffeinated fluid intake (M = 5 cups per day) was below recommended
levels of a minimum of 8 cups per day. Participants on average also reported
skipping 1 meal per week despite recommendations of consistently eating three
meals per day.
CONCLUSIONS: Results suggest that intervention focused on adherence to preventive
treatments (such as medication) and lifestyle recommendations may provide more
optimal outcomes for children and adolescents with migraine and their families.
Once daily dosing of medication may be preferred to twice daily medication for
increased medication adherence among children and adolescents.
© 2016 American Headache Society.
DOI: 10.1111/head.12836
PMCID: PMC4955694
831. Am J Pharm Educ. 2017 Mar 25;81(2):36. doi: 10.5688/ajpe81236.
Establishment and Implementation of a Required Medication Therapy Management

Advanced Pharmacy Practice Experience.
Nuffer W(1), Gilliam E(1), Thompson M(1), Vande Griend J(1).
Author information:
(1)University of Colorado, Aurora, Colorado.
Objective. To develop a community pharmacy-based medication therapy management

(MTM) advanced pharmacy practice experience (APPE) that provides students with
skills and knowledge to deliver entry-level pharmacy MTM services. Design. The
University of Colorado Skaggs School of Pharmacy & Pharmaceutical Sciences
(SSPPS) partnered with three community pharmacy chains to establish this
three-week, required MTM APPE. Students completed the American Pharmacists
Association MTM Certificate Course prior to entering the APPE. Students were
expected to spend 90% or more of their time at this experience working on MTM
interventions, using store MTM platforms. Assessment. All 151 students
successfully completed this MTM APPE, and each received a passing evaluation from
their preceptor. Preceptor evaluations of students averaged above four
(entry-level practice) on a five-point Likert scale. The majority of students
reported engagement in MTM services for more than 80% of the time on site.
Students' self-reporting of their ability to perform MTM interventions improved
after participation in the APPE. Conclusion. The SSPPS successfully implemented a
required MTM APPE, preparing students for entry-level delivery of MTM services.
DOI: 10.5688/ajpe81236
PMCID: PMC5374925
832. Pharm Pract (Granada). 2018 Oct-Dec;16(4):1274. doi:

10.18549/PharmPract.2018.04.1274. Epub 2018 Dec 25.
Influence of self-efficacy management on adherence to self-care activities and
treatment outcome among diabetes mellitus type 2.
Amer FA(1), Mohamed MS(2), Elbur AI(3), Abdelaziz SI(4), Elrayah ZA(5).
Author information:
(1)Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum,
Khartoum, (Sudan). bakarelbu@yahoo.co.uk.
(2)Department of Pharmaceutics, Faculty of Pharmacy, University of Khartoum,
Khartoum, (Sudan). msmohammed@uofk.edu.
Abdulrahman Bin Faisal University. Dammam (Saudi Arabia). aisaeed@iau.edu.sa.
(4)Department of medicine, Faculty of Medicine, University of Khartoum. Khartoum
(Sudan). sulafibrahim1@gmail.com.
(5)Jabir Abu Elizz Diabetes Centre. Khartoum (Sudan). znab12@gmail.com.
Background: High level of self-efficacy and adherence to self-care activities

have a positive impact on the achievement of glycemic goal among diabetic
patients. In Sudan, there is a gap in knowledge related to self-efficacy
management and its influence on adherence to self-care activities and overall
disease control.
Objective: To identify the influence of management self-efficacy on adherence to
self-care activities and treatment outcome among Sudanese patients with type 2
diabetes mellitus.
Methods: A cross-sectional study was conducted at two health care facilities in
Sudan from April to May 2016. Patients with type 2 diabetes mellitus were
included. Convenience sampling method was adopted. Diabetes Management
Self-Efficacy Scale and the Revised Summary of Diabetes Self-care Activities were
used to collect data through a face-to-face interview. Logistic regression
analysis was performed. A p value <0.05 was considered to be significant. Data
were processed using the software SPPS v 21.0.
Results: A total of 392 patients were included. Respondents classified with high
level of self- efficacy across all domains were 191 (48.7%). Moreover, high level
of education [adjusted OR 0.5 (0.3-0.7), (p=0.001)] and formal health education
on diabetes [adjusted OR 2.4 (1.6-3.7), (p<0.001)], were found to be
significantly associated with high level of diabetes management self-efficacy.
Patients who had high level of self-efficacy to manage nutrition, physical
exercise activity and medication were found more adherent to general diet,
exercise activity, and medication taking, respectively. Patients with controlled
disease were 87(22.2%). The only predictor of diabetes control was diabetes
management self-efficacy [OR 2.1(1.3- 3.5), (p=0.002)].
Conclusions: Diabetes management self-efficacy was associated with high level of
education and receiving health education. Self-efficacy was significantly
associated with adherence to self-care activities and glycemic control.
Substantial efforts are still needed to empower the patients with self-efficacy
and improving adherence to self-care activities through appropriate
interventions.
DOI: 10.18549/PharmPract.2018.04.1274
PMCID: PMC6322981
PMID: 30637026
Conflict of interest statement: CONFLICT OF INTEREST None to be declared.
833. Drug Alcohol Depend. 2016 Mar 1;160:212-7. doi:

10.1016/j.drugalcdep.2016.01.016.
Epub 2016 Jan 30.
Comparison of methods to assess psychiatric medication adherence in
methadone-maintained patients with co-occurring psychiatric disorder.
Dunn KE(1), King VL(1), Brooner RK(2).
Author information:
(1)Johns Hopkins University School of Medicine, Department of Psychiatry and
Behavioral Sciences, United States.
Behavioral Sciences, United States. Electronic address: rkbrooner@jhmi.edu.
BACKGROUND: Adherence with psychiatric medication is a critical issue that has

serious individual and public health implications. This is a secondary analysis
of a large-scale clinical treatment trial of co-occurring substance use and
psychiatric disorder.
METHOD: Participants (n=153) who received a clinically-indicated psychiatric
medication ≥30 days during the 12-month study and provided corresponding data
from Medication Event Monitoring System (MEMS) and Morisky Medication Taking
Adherence Scale (MMAS) self-report adherence ratings were included in the
analyses. Accuracy in MEMS caps openings was customized to each participant's
unique required dosing schedule.
RESULTS: Consistent with expectations, MEMS-based adherence declined slowly over
time, though MMAS scores of forgetting medication remained high and did not
change over the 12-month study. MEMS caps openings were not significantly
impacted by any baseline or treatment level variables, whereas MMAS scores were
significantly associated with younger age and presence of an Axis I disorder and
antisocial personality disorder, or any cluster B diagnoses.
CONCLUSIONS: Results suggest that MEMS caps may be a more objective method for
monitoring adherence in patients with co-occurring substance use and psychiatric
disorder relative to the MMAS self-report. Participants in this study were able
to successfully use the MEMS caps for a 12-month period with <1% lost or broken
caps, suggesting this comorbid population is able to use the MEMS successfully.
Ultimately, these data suggest that an objective method for monitoring adherence
in this treatment population yield more accurate outcomes relative to
self-report.
DOI: 10.1016/j.drugalcdep.2016.01.016
Experiential Education Builds Student Self-Confidence in Delivering Medication

Therapy Management.
Parker WM(1), Donato KM(2), Cardone KE(3), Cerulli J(4).
Author information:
(1)Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue,
Albany, NY 12208, USA. wendy.parker@acphs.edu.
Albany, NY 12208, USA. Kirsten.donato@acphs.edu.
Albany, NY 12208, USA. katie.cardone@acphs.edu.
Albany, NY 12208, USA. cerullij@gmail.com.
To determine the impact of advanced pharmacy practice experiences (APPE) on
student self-confidence related to medication therapy management (MTM),
fourth-year pharmacy students were surveyed pre/post APPE to: identify exposure
to MTM learning opportunities, assess knowledge of the MTM core components, and
assess self-confidence performing MTM services. An anonymous electronic
questionnaire administered pre/post APPE captured demographics, factors predicted
to impact student self-confidence (Grade point average (GPA), work experience,
exposure to MTM learning opportunities), MTM knowledge and self-confidence
conducting MTM using a 5-point Likert scale (1 = Not at all Confident; 5 =
Extremely Confident). Sixty-two students (26% response rate) responded to the
pre-APPE questionnaire and n = 44 (18%) to the post-APPE. Over 90% demonstrated
MTM knowledge and 68.2% completed MTM learning activities. APPE experiences
significantly improved students' overall self-confidence (pre-APPE = 3.27 (0.85
SD), post-APPE = 4.02 (0.88), p < 0.001). Students engaging in MTM learning
opportunities had higher self-confidence post-APPE (4.20 (0.71)) vs. those not
reporting MTM learning opportunities (3.64 (1.08), p = 0.05). Post-APPE, fewer
students reported MTM was patient-centric or anticipated engaging in MTM
post-graduation. APPE learning opportunities increased student self-confidence to
provide MTM services. However, the reduction in anticipated engagement in MTM
post-graduation and reduction in sensing the patient-centric nature of MTM
practice, may reveal a gap between practice expectations and reality.
DOI: 10.3390/pharmacy5030039
PMCID: PMC5622351
PMID: 28970451

eCollection 2015.
The Association of Health Literacy with Illness and Medication Beliefs among
Patients with Chronic Obstructive Pulmonary Disease.
Kale MS(1), Federman AD(1), Krauskopf K(1), Wolf M(2), O'Conor R(2), Martynenko
M(1), Leventhal H(3), Wisnivesky JP(4).
Author information:
(1)Division of General Internal Medicine, Icahn School of Medicine at Mount
Sinai, New York, New York, United States of America.
(2)Division of General Internal Medicine, Feinberg School of Medicine,
Northwestern University, Chicago, Illinois, United States of America.
(3)Institute for Health, Health Care Policy and Aging Research, Rutgers, The
State University of New Jersey, New Brunswick, New Jersey, United States of
America.
(4)Division of General Internal Medicine, Icahn School of Medicine at Mount
Sinai, New York, New York, United States of America; Division of Pulmonary,
Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New
York, New York, United States of America.
BACKGROUND: Low health literacy is associated with low adherence to

self-management in many chronic diseases. Additionally, health beliefs are
thought to be determinants of self-management behaviors. In this study we sought
to determine the association, if any, of health literacy and health beliefs among
elderly individuals with COPD.
METHODS: We enrolled a cohort of patients with COPD from two academic urban
settings in New York, NY and Chicago, IL. Health literacy was measured using the
Short Test of Functional Health Literacy in Adults. Using the framework of the
Self-Regulation Model, illness and medication beliefs were measured with the
Brief Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications
Questionnaire (BMQ). Unadjusted analyses, with corresponding Cohen's d effect
sizes, and multiple logistic regression were used to assess the relationships
between HL and illness and medication beliefs.
RESULTS: We enrolled 235 participants, 29% of whom had low health literacy.
Patients with low health literacy were more likely to belong to a racial minority
group (p<0.001), not be married (p = 0.006), and to have lower income (p<0.001)
or education (p<0.001). In unadjusted analyses, patients with low health literacy
were less likely to believe they will always have COPD (p = 0.003, Cohen's d =
0.42), and were more likely to be concerned about their illness ((p = 0.04,
Cohen's d = 0.17). In analyses adjusted for sociodemographic factors and other
health beliefs, patients with low health literacy were less likely to believe
that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval
[CI]: 0.65-0.94). In addition, the association of low health literacy with
expressed concern about medications remained significant (OR: 1.20, 95% CI:
1.05-1.37) though the association of low health literacy with belief in the
necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82-1.04).
CONCLUSIONS: In this cohort of urban individuals with COPD, low health literacy
was prevalent, and associated with illness beliefs that predict decreased
adherence. Our results suggest that targeted strategies to address low health
literacy and related illness and medications beliefs might improve COPD
medication adherence and other self-management behaviors.
PMCID: PMC4411058
836. Addict Behav. 2017 Oct;73:124-128. doi: 10.1016/j.addbeh.2017.05.009. Epub

2017
May 9.
Heroin refusal self-efficacy and preference for medication-assisted treatment

after inpatient detoxification.
Kenney SR(1), Bailey GL(2), Anderson BJ(3), Stein MD(4).
Author information:
(1)Behavioral Medicine Department, Butler Hospital, Providence, RI 02906, United
States; Warren Alpert Medical School of Brown University, Providence, RI 02912,
United States. Electronic address: Shannon_Kenney@brown.edu.
(2)Warren Alpert Medical School of Brown University, Providence, RI 02912, United
States; Stanley Street Treatment and Resources, Inc., Fall River, MA 02720,
United States.
States.
States; Boston University School of Public Health, Boston, MA 02118, United
States.
OBJECTIVE: An individual's self-efficacy to refuse using heroin in high-risk

situations is believed to minimize the likelihood for relapse. However, among
individuals completing inpatient heroin detoxification, perceived refusal
self-efficacy may also reduce one's perceived need for medication-assisted
treatment (MAT), an effective and recommended treatment for opioid use disorder.
In the current study, we examined the relationship between heroin refusal
self-efficacy and preference for MAT following inpatient detoxification.
METHOD: Participants (N=397) were interviewed at the start of brief inpatient
opioid detoxification. Multiple logistic regression was used to estimate the
adjusted association of background characteristics, depressed mood, and perceived
heroin refusal self-efficacy with preference for MAT.
RESULTS: Controlling for other covariates, depressed mood and lower perceived
refusal self-efficacy were associated with a significantly greater likelihood of
expressing preference for MAT (versus no MAT).
CONCLUSIONS: Perceived ability to refuse heroin after leaving detox is inversely
associated with a heroin user's desire for MAT. An effective continuum of care
model may benefit from greater attention to patient's perceived refusal
self-efficacy during detoxification which may impact preference for MAT and
long-term recovery.
Copyright © 2017. Published by Elsevier Ltd.
DOI: 10.1016/j.addbeh.2017.05.009
PMCID: PMC5510548
Using the extended self-regulatory model to characterise diabetes medication

adherence: a cross-sectional study.
Shiyanbola OO(1), Unni E(2), Huang YM(1), Lanier C(1).
Author information:
of Wisconsin-Madison, Madison, Wisconsin, USA.
(2)Department of Pharmaceutical Sciences, College of Pharmacy, Roseman University
of Health Sciences, Utah, USA.
OBJECTIVES: To cluster the adherence behaviours of patients with type 2 diabetes

based on their beliefs in medicines and illness perceptions and examine the
psychosocial, clinical and sociodemographic characteristics of patient clusters.
DESIGN: Cross-sectional study.
SETTING: A face-to-face survey was administered to patients at two family
medicine clinics in the Midwest, USA.
PARTICIPANTS: One hundred and seventy-four ≥20-year-old, English-speaking adult
patients with type 2 diabetes who were prescribed at least one oral diabetes
medicine daily were recruited using convenience sampling.
PRIMARY AND SECONDARY OUTCOME MEASURES: Beliefs in medicines and illness
perceptions were assessed using the Beliefs about Medicines Questionnaire and the
Brief Illness Perception Questionnaire, respectively. Self-reported medication
adherence was assessed using the Morisky Medication Adherence Scale. Psychosocial
correlates of adherence, health literacy and self-efficacy were measured using
the Newest Vital Sign and the Self-efficacy for Appropriate Medication Use,
respectively. Two-step cluster analysis was used to classify patients.
RESULTS: Participants' mean age was 58.74 (SD=12.84). The majority were women
(57.5%). Four clusters were formed (non-adherent clusters: ambivalent and
sceptical; adherent clusters: indifferent and accepting). The ambivalent cluster
(n=30, 17.2%) included low-adherent patients with high necessity beliefs, high
concern beliefs and high illness perceptions. The sceptical cluster (n=53, 30.5%)
included low adherent patients with low necessity beliefs but high concern
beliefs and high illness perceptions. Both the accepting (n=40, 23.0%) and
indifferent (n=51, 29.3%) clusters were composed of patients with high adherence.
Significant differences between the ambivalent, sceptical, accepting and
indifferent adherent clusters were based on self-efficacy, illness perception
domains (treatment control and coherence) and haemoglobin A1c (p<0.01).
CONCLUSIONS: Patients with diabetes in specific non-adherent and adherent
clusters still have distinct beliefs as well as psychosocial characteristics that
may help providers target tailored medication adherence interventions.

DOI: 10.1136/bmjopen-2018-022803
PMCID: PMC6254403
PMID: 30478112
838. Health Psychol. 2015 May;34(5):496-504. doi: 10.1037/hea0000136. Epub 2014 Aug
11.
Medication beliefs mediate between depressive symptoms and medication adherence

in cystic fibrosis.
Hilliard ME(1), Eakin MN(1), Borrelli B(2), Green A(1), Riekert KA(1).
Author information:
(1)Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research
Center, Division of Pulmonary and Critical Care Medicine.
(2)Warren Alpert School of Medicine at Brown University.
OBJECTIVE: Depression is a known barrier to regimen adherence for chronic

conditions. Despite elevated depression rates and complex regimens for people
with cystic fibrosis (CF), little is known about associations between depressive
symptoms and CF adherence. One possibility is that depressive symptoms distort
beliefs about medications, which may influence adherence.
METHOD: Adolescents and adults (N = 128; mean age = 29 ± 11 years, range = 16-63,
93% Caucasian) with CF reported on depressive symptoms and medication beliefs
(self-efficacy, motivation, perceived importance, and outcome expectancies
related to taking medications). Medication adherence was assessed objectively
through pharmacy refill data. Cross-sectional structural equation models
evaluated medication beliefs as a mediator between depressive symptoms and
RESULTS: Twenty-three percent of participants exceeded clinical cutoffs for
depressive symptoms. Participants took less than half of prescribed pulmonary
medications (mean adherence rate = 44.4 ± 26.7%). Depressive symptoms were
correlated with adherence (r = -.22, p < .05), and medication beliefs (b = -0.13,
95% CI [-0.24, -0.03]) significantly mediated this relation. Higher depressive
symptoms were associated with less positive medication beliefs (b = -0.27, p <
.01), which were associated with lower medication adherence (b = 0.49, p < .01).
CONCLUSIONS: Depressive symptoms are related to beliefs about and adherence to CF
medications. Monitoring depressive symptoms and medication beliefs in routine CF
care may help identify risks for nonadherence and facilitate interventions to
reduce depression, adaptive medication beliefs, and ultimately improve adherence
and CF management. (PsycINFO Database Record
DOI: 10.1037/hea0000136
PMCID: PMC4537164
839. BMC Res Notes. 2017 Mar 21;10(1):131. doi: 10.1186/s13104-017-2454-7.
Patients' perspective of disease and medication adherence for type 2 diabetes in

an urban area in Bangladesh: a qualitative study.
Islam SM(1)(2)(3), Biswas T(4), Bhuiyan FA(4), Mustafa K(5)(6), Islam A(7)(8).
Author information:
(1)NCD Program, International Center for Diarrhoeal Disease Research, Bangladesh
(ICDDR,B), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
shariful.islam@icddrb.org.
(2)Center for International Health, Ludwig-Maximilians Univetsitat, Munich,
Germany. shariful.islam@icddrb.org.
(3)The George Institute for Global Health, University of Sydney, Sydney,
Australia. shariful.islam@icddrb.org.
(4)NCD Program, International Center for Diarrhoeal Disease Research, Bangladesh
(ICDDR,B), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
(5)Department of Public Health, The University of Southern Mississippi,
Hattiesburg, MS, USA.
(6)Bangladesh University of Health Science (BUHS), Dhaka, Bangladesh.
(7)Faculty of Health, School of Health Policy and Management, York University,
Toronto, Canada.
(8)Department of Public Health, North South University, Dhaka, Bangladesh.
BACKGROUND: Patients' perspective of diabetes and adherence to its prescribed

medications is a significant predictor of glycemic control and overall management
of the disease. However, there is a paucity of such information in Bangladesh.
This study aimed to explore patients' perspective of diabetes, their experience
of taking oral hypoglycemic medications and explore factors that contribute to
medication adherence in patients with type 2 diabetes in Bangladesh.
METHODS: We conducted in-depth face-to-face interviews with 12 type 2 diabetes
patients attending a tertiary hospital in Dhaka city between February and March,
2014. Participants were purposively sampled representing different age groups,
education levels, years since diagnosis with diabetes, and glycemic status, to
achieve maximum variation sampling. All interviews were conducted using a topic
guide and were audio-recorded, transcribed verbatim, checked for errors, coded
and analyzed by means of a qualitative content analysis framework.
RESULTS: The data analysis generated rich information on the participants'
knowledge and perception on diabetes, its causes, self-management, medication
use, adverse effects of medication use, medication adherence, and impact of
diabetes, Although most of the participants demonstrated substantive knowledge on
diabetes and its consequences, they also reported numerous misconceptions about
the disease. Knowledge on diabetes medication, their appropriate use and side
effects was rather poor. Respondents also reported non-compliance to dietary and
physical activity advice by their physicians and concerns on diabetes
diabetes-induced psychological stress. High cost of medications, concerns over
medication side effects and forgetfulness was noted as factors for non-adherence
to medication.
CONCLUSION: Participants' knowledge and perception on diabetes are key factors
determining their adherence to medications and, thereby, diabetes management.
Healthcare providers should explore to better understand patients' perspective on
diabetes, medication beliefs, identify psychological stress and provide more
effective health education interventions to enhance medication adherence.
DOI: 10.1186/s13104-017-2454-7
PMCID: PMC5361713
840. Libyan J Med. 2015 Dec 28;10:29797. doi: 10.3402/ljm.v10.29797. eCollection
2015.
Illness perceptions of Libyans with T2DM and their influence on medication

adherence: a study in a diabetes center in Tripoli.
Ashur ST(1), Shah SA(2), Bosseri S(3), Morisky DE(4), Shamsuddin K(2).
Author information:
(1)Department of Community Health, Universiti Kebangsaan Malaysia Medical Centre,
Kuala Lumpur, Malaysia; drsana04@yahoo.com.
Kuala Lumpur, Malaysia.
(3)National Centre for Diabetes and Endocrinology, Tripoli, Libya.
Health, Los Angeles, CA, USA.
BACKGROUND: The surrounding environment influences the constitution of illness

perceptions. Therefore, local research is needed to examine how Libyan diabetes
patients perceive diabetes and how their perceptions influence their medication
adherence.
METHODS: A cross-sectional study was conducted at the National Centre for
Diabetes and Endocrinology in Tripoli, Libya, between October and December 2013.
A total of 523 patients with type 2 diabetes participated in this study. A
self-administered questionnaire was used for data collection; this included the
Revised Illness Perception Questionnaire and the eight-item Morisky Medication
Adherence Scale.
RESULTS: The respondents showed moderately high personal control and treatment
control perceptions and a moderate consequences perception. They reported a high
perception of diabetes timeline as chronic and a moderate perception of the
diabetes course as unstable. The most commonly perceived cause of diabetes was
Allah's will. The prevalence of low medication adherence was 36.1%. The
identified significant predictors of low medication adherence were the low
treatment control perception (p=0.044), high diabetes identity perception
(p=0.008), being male (p=0.026), and employed (p=0.008).
CONCLUSION: Diabetes illness perceptions of type 2 diabetic Libyans play a role
in guiding the medication adherence and could be considered in the development of
medication adherence promotion plans.
DOI: 10.3402/ljm.v10.29797
PMCID: PMC4695620
841. J Multidiscip Healthc. 2016 Oct 19;9:547-555. eCollection 2016.
Psychosocial factors are strongly associated with insomnia in users and nonusers
of prescribed sleep medication: evidence from the HUNT3 study.
Andenæs R(1), Helseth S(1), Misvær N(1), Småstuen MC(1), Ribu L(1).
Author information:
(1)Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo
and Akershus University College of Applied Sciences, Oslo, Norway.
OBJECTIVE: The aim of this study was to examine how neuroticism, stressful life
events, self-rated health, life satisfaction, and selected lifestyle factors were
related to insomnia both by sex and among users and nonusers of prescribed sleep
medication (PSM).
DESIGN: Cross-sectional data from the Norwegian Nord-Trøndelag Health Study
(HUNT3, 2006-2008), a population-based health survey, were linked to individual
data from the Norwegian Prescription Database.
METHODS: Logistic regression analyses were used to investigate the associations
between the selected variables and insomnia in both males and females and among
subjects using and not using PSM. Individuals were considered to have a
presumptive diagnosis of insomnia disorder if they reported difficulty with sleep
initiation, sleep maintenance, or early morning awakening several days per week
for the last 3 months. PSMs were categorized as anxiolytics or hypnotics; the
dose was estimated according to defined daily dose (DDD).
RESULTS: Of the total 50,805 participants, 6,701 (13.2%) used PSM. The
proportions of PSM users were larger among elderly participants. Increased risk
of insomnia was strongly associated with poor self-rated health and higher level
of neuroticism. These associations were evident for both sexes and were similar
among both users and nonusers of PSM. Low satisfaction with life was strongly
related to insomnia, but only among nonusers of PSM. Increased doses of PSM were
not associated with reduced likelihood of insomnia.
CONCLUSION: Insomnia is a problem among both users and nonusers of PSM and is
associated with psychosocial factors. Our findings suggest that successful
treatment for sleep problems should take individual variation into account, such
as age, sex, personality traits, satisfaction with life, and health perception.
DOI: 10.2147/JMDH.S116462
PMCID: PMC5077243
PMID: 27799781

this work.
842. Patient Educ Couns. 2015 Feb;98(2):144-9. doi: 10.1016/j.pec.2014.10.019. Epub

2014 Oct 28.
Health communication, self-care, and treatment satisfaction among low-income

diabetes patients in a public health setting.
White RO(1), Eden S(2), Wallston KA(3), Kripalani S(4), Barto S(5), Shintani
A(2), Rothman RL(4).
Author information:
(1)Division of Community Internal Medicine, Mayo Clinic, Jacksonville, USA;
Department of Family Medicine, Mayo Clinic, Jacksonville, USA. Electronic
address: white.richard@mayo.edu.
(2)Department of Biostatistics, Vanderbilt University, Nashville, USA.
(3)School of Nursing, Vanderbilt University Medical Center, Nashville, USA.
(4)Department of Medicine, Vanderbilt University Medical Center, Nashville, USA;
Institute for Medicine and Public Health, Vanderbilt University, Nashville, USA.
(5)Institute for Medicine and Public Health, Vanderbilt University, Nashville,
USA.
OBJECTIVE: Diabetes patients with limited resources often experience suboptimal

care. Less is known about the role of effective health communication (HC) in
caring for low income diabetes patients.
METHODS: Ten health department clinics in TN participated in a trial evaluating a
literacy-sensitive communication intervention. We assessed the quality of
baseline HC and measured associations with diabetes outcomes. Assessments
included: demographics, measures of HC, health literacy, self-care behaviors,
self-efficacy, medication non-adherence, treatment satisfaction, and A1C.
Unadjusted and adjusted multivariable regression models were used to test
associations.
RESULTS: Participants (N=411) were 49.7±9.5 years, 61% female, uninsured (96%),
with A1C 9.6±2.1. In unadjusted analyses, better communication, was associated
with lower medication non-adherence (OR 0.40-0.68, all p<0.05), higher treatment
satisfaction (OR 1.76-1.96, all p<0.01), portion size reduction (OR 1.43,
p<0.05), diabetes self-efficacy (OR 1.41, p<0.05), and lower A1C (β=-0.06,
p<0.01). In adjusted analyses, communication quality remained associated with
lower medication non-adherence (AOR 0.39-0.68, all p<0.05), and higher treatment
satisfaction (AOR 1.90-2.21, all p<0.001).
CONCLUSIONS: Better communication between low-income patients and providers was
independently associated with lower medication non-adherence and higher treatment
satisfaction.
PRACTICE IMPLICATIONS: Communication quality may be an important modifiable
approach to improving diabetes care for vulnerable populations.
DOI: 10.1016/j.pec.2014.10.019
PMCID: PMC4282939
843. Libyan J Med. 2016 Mar 21;11:31086. doi: 10.3402/ljm.v11.31086. eCollection

2016.
Glycaemic control status among type 2 diabetic patients and the role of their
diabetes coping behaviours: a clinic-based study in Tripoli, Libya.
Ashur ST(1), Shah SA(1), Bosseri S(2), Fah TS(3), Shamsuddin K(4).
Author information:
(3)Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre,
Kuala Lumpur, Malaysia; Khadijah@ppukm.ukm.edu.my.
BACKGROUND: Achieving good glycaemic control is important in diabetes management.

However, poor glycaemic control is widely reported. This article assessed the
prevalence of uncontrolled and poor glycaemic control among Libyans with type 2
diabetes and examined the relative contribution of diabetes coping behaviours to
their glycaemic control status.
METHODS: A cross-sectional study was undertaken in 2013 in a large diabetes
centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours
were measured using the revised version of the Summary of Diabetes Self-Care
Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale
(MMAS-8(©)), while glycaemic control status was based on the HbA1c level.
RESULTS: Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%)
attained the glycaemic control target of HbAc1 of less than 7.0%. Females
(OR=1.74, 95% CI=1.03-2.91), patients on insulin and oral hypoglycaemic agents
(OR=1.92, 95% CI=1.05-3.54), patients on insulin (OR=3.14, 95% CI=1.66-6.03), and
low-medication adherents (OR=2.25, 95% CI=1.36-3.73) were more likely to have
uncontrolled and poor glycaemic control, while exercise contributed to glycaemic
control status as a protective factor (OR=0.85, 95% CI=0.77-0.94).
CONCLUSION: The findings from this study showed the considerable burden of
uncontrolled and poor glycaemic control in one of the largest diabetes care
settings in Libya. Medication adherence as well as exercise promotion programs
would help in reducing the magnitude of poor glycaemic control.
DOI: 10.3402/ljm.v11.31086
PMCID: PMC4803895
844. Rev Esp Enferm Dig. 2017 Aug;109(8):542-551. doi:

10.17235/reed.2017.5137/2017.
Assessing medication adherence in inflammatory bowel diseases. A comparison

between a self-administered scale and a pharmacy refill index.
de Castro ML(1), Sanromán L(2), Martín A(3), Figueira M(4), Martínez N(3),
Hernández V(2), Del Campo V(5), Pineda JR(2), Martínez-Cadilla J(2), Pereira
S(2), Rodríguez Prada JI(2).
Author information:
(1)Aparato Digestivo, Hospital Álvaro Cunqueiro, España.
(2)Aparato Digestivo, Hospital Álvaro Cunqueiro.Fundación Biomédica Galicia
Sur.Complexo Hospitalario Universitario de Vig, España.
(3)Farmacia Hospitalaria, Hospital Álvaro Cunqueiro.Fundación Biomédica Galicia
Sur.Complexo Hospitalario Universitario de Vig, España.
(4)Aparato Digestivo, Hospital Álvaro Cunqueiro.Fundación Biomédica Galicia
Sur.Complexo Hospitalario Universitario de Vig.
(5)Epidemiología y Medicina Preventiva, Hospital Álvaro Cunqueiro.Fundación
Biomédica Galicia Sur.Complexo Hospitalario Universitario de Vig, España.
Comment in
Rev Esp Enferm Dig. 2017 Aug;109 (8):539-541.
BACKGROUND: Medication non-adherence in inflammatory bowel disease (IBD) has a

negative impact on disease outcome. Different tools have been proposed to assess
non-adherence. We aimed to compare a self-administered scale and a pharmacy
refill index as a reliable measure of medication adherence and to determine what
factors are related to adherence.
METHODS: Consecutive non-active IBD outpatients were asked to fill in the
self-reported Morisky Medication Adherence Scale (MMAS-8) and the Beliefs about
Medication Questionnaire (BMQ). Pharmacy refill data were reviewed from the
previous three or six months and the medication possession ratio (MPR) was
calculated. Non-adherence was defined as MMAS-8 scores < 6 or MPR < 0.8.
RESULTS: Two-hundred and three patients were enrolled (60% ulcerative colitis,
40% Crohn's disease); 51% were men, and the mean age was 46.3 (14) years.
Seventy-four per cent of patients were on monotherapy and 26% on combination
therapy; altogether, 65% received mesalazine, 46% thiopurines and 16% anti-tumor
necrosis factor alfa. Non-adherence rate assessed by MPR was 37% and 22.4% by
MMAS-8. Receiver operator curve analysis using a MMAS-8 cut-off of six gave an
area under the curve of 0.6 (95% CI 0.5-0.7), p = 0.001. This score had an 85%
sensitivity and 34% specificity to predict medication non-adherence, with
negative and positive predictive values of 57% and 70% respectively. High scores
in the BMQ potential for harm of medication were significantly associated with
MPR non-adherence (p = 0.01).
CONCLUSION: The accuracy of MMAS-8 to identify medication non-adherence in
inactive IBD outpatients in our setting is poor due to a low specificity and a
negative predictive value. Psychosocial factors such as beliefs about medication
seem to be related to IBD non-adherence.
DOI: 10.17235/reed.2017.5137/2017
845. Sociol Health Illn. 2015 Jul;37(6):904-19. doi: 10.1111/1467-9566.12240. Epub

2015 Feb 27.
'The problem here is that they want to solve everything with pills': medication
use and identity among Mainland Puerto Ricans.
Adams WE(1), Todorova IL(1), Guzzardo MT(1), Falcón LM(2).
Author information:
(1)Northeastern University, Boston, USA.
(2)University of Massachusetts Lowell, Lowell, USA.
Taking medications are complex symbolic acts, infused with diverse meanings
regarding body and identity. This article focuses on the meanings of medications
for older Puerto Ricans living on the United States mainland, a population
experiencing stark health disparities. We aim to gain an understanding of the way
multiple cultural and personal meanings of medications are related to and
integrated in identity, and to understand how they are situated within Puerto
Rican culture, history and circumstance on the US mainland. Data is drawn from
thirty qualitative interviews, transcribed and translated, with older Puerto
Ricans living on mainland United States. Thematic Analysis indicated four
prevalent themes: embodiment of medication use; medications redefining self
through the fabric of daily life; healthcare experience defined through
medication; and medicine dividing the island and the mainland. While identity is
impacted by experience of chronic illness, the experience of medication
prescription and consumption is further related to the construction of the sense
of self in distinct ways. For these individuals, medication use captures the
dilemma of immigration. While cultural belonging and well-being remains on the
island of Puerto Rico, the mainland hosts both easier access to and excess
reliance on medication.
© 2015 Foundation for the Sociology of Health & Illness.
DOI: 10.1111/1467-9566.12240
PMCID: PMC4521983
846. Br J Gen Pract. 2016 Dec;66(653):e913-e919. Epub 2016 Oct 10.
Patients' beliefs on the impediments to good diabetes control: a mixed methods

study of patients in general practice.
Elliott AJ(1), Harris F(2), Laird SG(3).
Author information:
(1)Hollytree Surgery, Farnham, Surrey.
(2)Independent consultant in public health, Farnham, Surrey.
(3)Insight 2 implement Ltd, Elstead, Surrey.
BACKGROUND: Most people with diabetes are not attaining desirable levels of HbA1c
(glycated haemoglobin), or of blood pressure and cholesterol, leaving them at
risk of developing complications.
AIM: To identify ways of improving diabetes control by gaining insight into
patients' attitudes/beliefs.
DESIGN AND SETTING: Questionnaires were offered to patients attending for a
diabetes review in the 24 GP practices of North East Hampshire and Farnham
Clinical Commissioning Group.
METHOD: Infrequent attenders were contacted by post. Volunteers then participated
in focus groups.
RESULTS: Self-reported medication adherence was good with 83% (98/118) of
responders recording ≥9 on a 10-point scale. Patients generally accepted they
'needed' and 'could take' medication. A substantial minority reported 'not
liking' taking tablets. Focus groups confirmed this and revealed a reluctance to
change lifestyle, with medication reported as a way to evade it. A total of 68
out of 112 responders (60.7%) knew their HbA1c value. However, focus groups
identified little understanding of HbA1c, with responders perceiving it as
medical jargon. Phrases such as 'stuck-on-sugar' or 'sugarload' were suggested as
being semantically easier to understand. The questionnaire revealed trust in
clinicians. This was confirmed in focus groups but confounded by frequent reports
of healthcare providers giving inadequate/incorrect advice.
CONCLUSION: Investment in lifestyle change is needed. Participants were reluctant
to change and saw medication as a way of avoiding it. HbA1c needs to be better
explained. Intuitive phrases such as 'stuck-on-sugar' or 'sugarload' could be
adopted into common parlance. Inadequate/incorrect advice seems to be hampering
diabetes management and there appears to be a need for more diabetes-trained
clinicians.
DOI: 10.3399/bjgp16X687589
PMCID: PMC5198664
847. BMC Health Serv Res. 2017 Mar 14;17(1):197. doi: 10.1186/s12913-017-2135-1.
Medication-related calls received by a national telenursing triage and advice

service in Australia: a retrospective cohort study.
Li L(1), Lake R(2), Raban MZ(2), Byrne M(3), Robinson M(3), Westbrook J(2),
Baysari MT(2)(4).
Author information:
(1)Centre for Health Systems and Safety Research, Australian Institute of Health
Innovation, Faculty of Medicine and Health Sciences, Level 6, 75 Talavera Road,
Macquarie University, Sydney, NSW, 2109, Australia. ling.li@mq.edu.au.
(2)Centre for Health Systems and Safety Research, Australian Institute of Health
Innovation, Faculty of Medicine and Health Sciences, Level 6, 75 Talavera Road,
Macquarie University, Sydney, NSW, 2109, Australia.
(3)Healthdirect Australia, Sydney, NSW, Australia.
(4)Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital,
Sydney, Australia.
BACKGROUND: Telenursing triage and advice services are increasingly being used to
deliver health advice. Medication-related queries are common, however little
research has explored the medication-related calls made to these services. The
aim of this study was to examine the profile of medication-related calls to a
national telenursing triage and advice service and the medications involved.
METHODS: This was a retrospective cohort study of medication-related calls
received by Australia's national helpline (healthdirect helpline) in 2014, which
provides free advice from registered nurses. We examined the volume of
medication-related calls over time, user profiles for patients and callers, and
call characteristics and we also investigated medications involved in the calls
by their generic names and therapeutic classes.
RESULTS: Of 675,774 calls, 3.8% (n = 25,744) were medication-related, which was
the largest category of calls. The average call length was 10 min. Over half of
callers (55.4%) were advised to deliver self-care. Of 7,459 calls where the
callers reported they did not know what to do prior to calling, 56.8% were
advised to self-care and 3.5% were transferred to the Poisons Information Centre
immediately. Of 1,277 calls where callers reported that they had originally
intended to call an ambulance or attend an emergency department (ED), none were
advised to do so. Advice most frequently requested was about analgesics and
antipyretics, followed by non-steroidal anti-inflammatory agents.
CONCLUSION: The telenursing triage and advice helpline offered quick and easily
accessible advice, and provided reassurance to patients and callers with
medication-related queries. The service also potentially diverted some patients
from attending an ED unnecessarily.
DOI: 10.1186/s12913-017-2135-1
PMCID: PMC5348865
848. BMC Health Serv Res. 2015 Apr 10;15:153. doi: 10.1186/s12913-015-0809-0.
Validation of the Adherence Barriers Questionnaire - an instrument for

identifying potential risk factors associated with medication-related
non-adherence.
Müller S(1), Kohlmann T(2), Wilke T(3).
Author information:
(1)Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Hochschule
Wismar, Philipp-Müller-Straße 12, Wismar, 23966, Germany.
sabrina.mueller@ipam-wismar.de.
(2)Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald,
Germany. thomas.kohlmann@uni-greifswald.de.
(3)Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Hochschule
Wismar, Philipp-Müller-Straße 12, Wismar, 23966, Germany.
thomas.wilke@ipam-wismar.de.
BACKGROUND: Medication non-adherence is a major challenge in the real-life

treatment of chronically ill patients. To meet this challenge, adherence
interventions with a tailored approach towards patient-specific adherence
barriers that are identified with a reliable and practicable questionnaire are
needed. The aim of this investigation was to develop and validate such a
questionnaire, the "Adherence Barriers Questionnaire (ABQ)".
METHODS: The German ABQ was developed and tested in 432 patients with atrial
fibrillation in a multicentre observational cohort study. Evaluation of the
questionnaire included an assessment of internal consistency as well as factor
analysis. Criterion-related external validity was assessed by comparing the ABQ
score with (1) the degree of self-reported adherence and (2) the time in
therapeutic range which describes the anticoagulation quality achieved by
patients treated with oral anticoagulation.
RESULTS: The final 14-item ABQ scale demonstrated high internal consistency
(Cronbach's alpha = 0.820). Factor analysis identified a three-factor solution,
representing intentional adherence barriers with 5 items (31.9% of the variance),
medication-/health care system-related adherence barriers with 5 items (13.3% of
the variance) and unintentional adherence barriers with 4 items (7.7% of the
variance). The ABQ correlated significantly with self-reported non-adherence
(Spearman's rho = 0.438, p < 0.001) as well as time in therapeutic range
(Spearman's rho = - 0.161, p < 0.010). Patients with above-average ABQ scores
(increased number and/or strength of existing adherence barriers) were
significantly (p < 0.005, Pearson Chi-Square) more likely to have a poor
anticoagulation quality (TTR < 60%) than patients with a lower ABQ score (44.6%
versus 27.3%).
CONCLUSIONS: The ABQ is a practicable, reliable and valid instrument for
identifying patient-specific barriers to medication-related adherence. Future
research is required to examine the ability of the ABQ to identify patient
perception/behaviour changes over time which may be important for the measurement
of success of adherence interventions.
DOI: 10.1186/s12913-015-0809-0
PMCID: PMC4422301
849. BMC Health Serv Res. 2019 Jul 16;19(1):495. doi: 10.1186/s12913-019-4194-y.
Canonical correlations between individual self-efficacy/organizational bottom-up

approach and perceived barriers to reporting medication errors: a multicenter
study.
Kim MS(1), Kim CH(2).
Author information:
(1)Department of Nursing, Pukyong National University, 599-1, Daeyeon 3 dong,
Namgu, Busan, 48513, South Korea.
(2)College of Medicine, Dong-A University Hospital, 26 Daesingongwon-ro, Seo-gu,
Busan, 49201, South Korea. bbp2000@dau.ac.kr.
BACKGROUND: Individual and organizational factors correlate with perceived

barriers to error reporting. Understanding medication administration errors
(MAEs) reduces confusion about error definitions, raises perceptions of MAEs, and
allows healthcare providers to report perceived and identified errors more
frequently. Therefore, an emphasis must be placed on medication competence,
including medication administration knowledge and decision-making. It can be
helpful to utilize an organizational approach, such as collaboration between
nurses and physicians, but this type of approach is difficult to establish and
maintain because patient-safety culture starts at the highest levels of the
healthcare organization. This study aimed to examine the canonical correlations
of an individual self-efficacy/bottom-up organizational approach variable set
with perceived barriers to reporting MAEs among nurses.
METHODS: We surveyed 218 staff nurses in Korea. The measurement tools included a
questionnaire on knowledge of high-alert medication, nursing decision-making,
nurse-physician collaboration satisfaction, and barriers to reporting MAEs.
Descriptive statistics, t-tests, analysis of variance (ANOVA), Pearson's
correlation coefficient, and canonical correlations were used to analyze results.
RESULTS: Two canonical variables were significant. The first variate indicated
that less knowledge about medication administration (- 0.83) and a higher
perception of nurse-physician collaboration (0.42) were related to higher
disagreement over medication error (0.64). The second variate showed that
intuitive clinical decision-making (- 0.57) and a higher perception of
nurse-physician collaboration (0.84) were related to lower perceived barriers to
reporting MAEs.
CONCLUSIONS: Enhancing positive collaboration among healthcare professionals and
promoting analytic decision-making supported by sufficient knowledge could
facilitate MAE reporting by nurses. In the clinical phase, providing medication
administration education and improving collaboration may reduce disagreement
about the occurrence of errors and facilitate MAE reporting. In the policy phase,
developing an evidence-based reporting system that informs analytic
decision-making may reduce the perceived barriers to MAE reporting.
DOI: 10.1186/s12913-019-4194-y
PMCID: PMC6636092
PMID: 31311542
850. World J Cardiol. 2015 Dec 26;7(12):938-47. doi: 10.4330/wjc.v7.i12.938.
Adherence to cardiovascular medications in the South Asian population: A

systematic review of current evidence and future directions.
Akeroyd JM(1), Chan WJ(1), Kamal AK(1), Palaniappan L(1), Virani SS(1).
Author information:
(1)Julia M Akeroyd, Winston J Chan, Salim S Virani, the Health Policy, Quality
and Informatics Program, Michael E DeBakey Veterans Affairs Medical Center,
Health Services Research and Development Center for Innovations, Houston, TX
77030, United States.
AIM: To review methods of assessing adherence and strategies to improve adherence

to cardiovascular disease (CVD) medications, among South Asian CVD patients.
METHODS: We conducted a systematic review of English language studies that
examined CVD medication adherence in South Asian populations from 1966 to April
1, 2015 in SCOPUS and PubMed. Working in duplicate, we identified 61 studies.
After exclusions, 26 studies were selected for full text review. Of these, 17
studies were included in the final review. We abstracted data on several factors
including study design, study population, method of assessing adherence and
adherence rate.
RESULTS: These studies were conducted in India (n = 11), Pakistan (n = 3),
Bangladesh (n = 1), Nepal (n = 1) and Sri Lanka (n = 1). Adherence rates ranged
from 32%-95% across studies. Of the 17 total publications included, 10 focused on
assessing adherence to CVD medications and 7 focused on assessing the impact of
interventions on medication adherence. The validated Morisky Medication Adherence
Scale (MMAS) was used as the primary method of assessing adherence in five
studies. Three studies used validated questionnaires similar to the MMAS, and one
study utilized Medication Event Monitoring System caps, with the remainder of the
studies utilizing pill count and self-report measures. As expected, studies using
non-validated self-report measures described higher rates of adherence than
studies using validated scale measurements and pill count. The included
intervention studies examined the use of polypill therapy, provider education and
patient counseling to improve medication adherence.
CONCLUSION: The overall medication adherence rates were low in the region, which
suggest a growing need for future interventions to improve adherence.
DOI: 10.4330/wjc.v7.i12.938
PMCID: PMC4691821
PMID: 26730300
851. J Am Pharm Assoc (2003). 2017 Jan - Feb;57(1):38-46.e2. doi:

10.1016/j.japh.2016.08.019. Epub 2016 Nov 11.
Pediatric medication use experiences and patient counseling in community

pharmacies: Perspectives of children and parents.
Abraham O, Brothers A, Alexander DS, Carpenter DM.
OBJECTIVES: This study aimed to explore the perspectives of children and parents
regarding: 1) pediatric patients' knowledge and medication use experiences for
chronic conditions; 2) how they want to learn about medicines; and 3) perceptions
of community pharmacist-provided counseling.
DESIGN: Qualitative study using semistructured interviews and thematic analyses.
SETTING: Three community pharmacies in 2 eastern states: one in rural western
North Carolina, and 2 in an urban region of western Pennsylvania.
PARTICIPANTS: A total of 39 study participants: 20 children using medications for
chronic conditions and 19 parents interviewed July-December 2015.
MAIN OUTCOME MEASURES: Child and parent perspectives regarding pediatric
medication use, knowledge, experiences, and pharmacist-provided patient
counseling.
RESULTS: Children and parents had similar perspectives on pediatric medication
use and pharmacist counseling experiences. Six themes emerged: 1) child's
knowledge, self-management, and medication use experiences; 2) essential
medication information and sources; 3) child's frequent absence from the
pharmacy; 4) patient counseling needs and recommendations; 5) use of interactive
technologies to facilitate learning about medicines; and 6) perceptions of
pharmacists. Participants reported that children were independently managing
their medications, although they had minimal knowledge about medicines. Children
and parents stated that the child's absence during medication pick-up at
pharmacies was a barrier to receiving counseling by pharmacists. Children were
comfortable and receptive to pharmacists educating them about their medicines,
particularly how medications affect the human body, how they were manufactured,
and research studies on their medications. Parents and children recommended the
use of interactive and educational technologies for pediatric counseling.
CONCLUSION: Children are frequently not present at pharmacies during prescription
pick-up; however, children and parents are comfortable with and receptive to
pediatric medication counseling by pharmacists. Interactive and educational
technologies need to be developed and used by pharmacists to facilitate
counseling and educate children about the effective and safe use of medicines.
Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc.

DOI: 10.1016/j.japh.2016.08.019
852. Am J Manag Care. 2016 Nov;22(11):747-754.
Prescribers' perceptions of medication discontinuation: survey instrument

development and validation.
Linsky A(1), Simon SR, Stolzmann K, Bokhour BG, Meterko M.
Author information:
(1)VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA 02130. E-mail:
amy.linsky@va.gov.
OBJECTIVES: Primary care providers (PCPs) and clinical pharmacists have concerns
about the adverse consequences of using medications inappropriately and generally
support the notion of reducing unnecessary drugs. Despite this attitude, many
factors impede clinicians' ability to discontinue medication in clinical
settings. We sought to develop a survey instrument that assesses PCPs' and
pharmacists' experiences, attitudes, and beliefs toward medication
discontinuation.
STUDY DESIGN: Survey development and psychometric assessment.
METHODS: Based on a conceptual framework, we developed a questionnaire and
surveyed a national sample of Department of Veterans Affairs PCPs with
prescribing privileges, including physicians, nurse practitioners, physician
assistants, and clinical pharmacy specialists. We randomly divided respondents
into derivation and validation samples and used iterations of multi-trait
analysis to assess the psychometric properties of the proposed measures.
Multivariable regression models identified factors associated with the outcome of
self-rated comfort with medication discontinuation.
RESULTS: Using established criteria for scale development, we identified 5
scales: Medication Characteristics, Current Patient Clinical Factors, Predictions
of Future Health States, Patients' Resources to Manage Their Own Health, and
Education and Experience. Three of these dimensions predicted providers'
self-rated comfort with making decisions to discontinue medication (Current
Patient Clinical Factors, Predictions of Future Health States, and Education and
Experience).
CONCLUSIONS: We developed a psychometrically sound instrument to measure
prescribers' attitudes toward, and experiences with, medication discontinuation.
This survey will enable identification of perceived barriers to, and facilitators
of, proactive discontinuation-an important step toward developing interventions
that improve the quality and safety of care in medication use.
853. Respir Med. 2017 Aug;129:117-123. doi: 10.1016/j.rmed.2017.06.007. Epub 2017

Jun
13.
Adherence to COPD treatment: Myth and reality.
Rogliani P(1), Ora J(2), Puxeddu E(1), Matera MG(3), Cazzola M(4).
Author information:
(1)Chair of Respiratory Medicine, Department of Systems Medicine, University of
Rome Tor Vergata, Rome, Italy; Division of Respiratory Medicine, Department of
Internal Medicine, University Hospital Tor Vergata, Rome, Italy.
(2)Division of Respiratory Medicine, Department of Internal Medicine, University
Hospital Tor Vergata, Rome, Italy.
(3)Chair of Pharmacology, Department of Experimental Medicine, University of
Campania "Luigi Vanvitelli", Naples, Italy.
(4)Chair of Respiratory Medicine, Department of Systems Medicine, University of
Rome Tor Vergata, Rome, Italy. Electronic address: mario.cazzola@uniroma2.it.
COPD is a chronic disease in which effective management requires long-term

adherence to pharmacotherapies but the level of adhesion to the prescribed
medications is very low and this has a negative influence on outcomes. There are
several approaches to detect non-adherence, such as pharmacy refill methods,
electronic monitoring, and self-report measures, but they are all burdened with
important limitations. Medication adherence in COPD is multifactorial and is
affected by patients (health beliefs, cognitive abilities, self-efficacy,
comorbidities, psychological profile, conscientiousness), physicians (method of
administration, dosing regimen, polypharmacy, side effects), and society
(patient-prescriber relationship, social support, access to medication, device
training, follow-up). Patient-health care professional communication, especially
that between patient and physician or pharmacist, is central to optimizing
patient adherence. However, the most realistic approach is to keep in mind that
non-adherence is always possible, indeed, probable.
DOI: 10.1016/j.rmed.2017.06.007
854. Respir Care. 2016 May;61(5):571-6. doi: 10.4187/respcare.04493. Epub 2016 Feb
9.
Prevalence of Exercise-Induced Bronchoconstriction Measured by Standardized

Testing in Healthy College Athletes.
Burnett DM(1), Burns S(2), Merritt S(2), Wick J(3), Sharpe M(3).
Author information:
(1)University of Kansas Medical Center, Kansas City, Kansas. dburnett@kumc.edu.
(2)University of Central Missouri, Warrensburg, Missouri.
(3)University of Kansas Medical Center, Kansas City, Kansas.
Comment in
Respir Care. 2016 May;61(5):713.
BACKGROUND: Exercise-induced bronchoconstriction (EIB) can lead to long-term

respiratory illness and even death. EIB prevalence rates are both high and
variable in college athletes. Prevalence rates may be underestimated due to
ineffective testing and screening. The purpose of this study was to investigate
the prevalence of EIB in college athletes by a standardized EIB test that can be
used on many college campuses. In addition, we assessed the usefulness of
self-reporting EIB/asthma (1) history, (2) symptoms, and (3) respiratory
medication obtained from a simple screening questionnaire for predicting an
EIB-positive athlete.
METHODS: A standardized EIB test and self-report questionnaire were administered
to college athletes on 10 different sports teams. Information collected included
pulmonary function (spirometry), expired gas analysis (maximal oxygen uptake),
CO2 production, minute ventilation, EIB/asthma history, current symptoms, and
medication use.
RESULTS: Results showed that 34 of 80 athletes (42.5%) were EIB-positive by
standardized exercise testing. The majority (76.5 and 58.8%) of the 34 athletes
who tested positive self-reported a negative history or no symptoms,
respectively. Also, 79.4% of the athletes who tested positive for EIB reported
not using a respiratory medication. There were no significant differences in a
positive EIB test when assessing interactions for history (P = .93), current
symptoms (P = .12), or respiratory medication use (P = .66).
CONCLUSIONS: A high proportion of college athletes tested positive for EIB when
using a standardized test. Positive history, current symptoms of EIB/asthma, and
respiratory medication use were not predictive of a positive test. Many
EIB-positive athletes are not using a respiratory medication. More work is needed
to develop an effective screening tool and improve education for EIB in college
athletes.
Copyright © 2016 by Daedalus Enterprises.
DOI: 10.4187/respcare.04493
855. AIDS Behav. 2015 Sep;19(9):1619-29. doi: 10.1007/s10461-015-1037-7.
Examining Adherence Among Challenging Patients in Public and Private HIV Care in
Argentina.
Jones D(1), Cook R, Cecchini D, Sued O, Bofill L, Weiss S, Waldrop-Valverde D,

Lopez MR, Spence A.
Author information:
(1)Department of Psychiatry & Behavioral Sciences, University of Miami Miller
School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA,
djones@med.miami.edu.
Treatment engagement, retention and adherence to care are required for optimal
HIV outcomes. Yet, patients may fall below the treatment recommendations for
achieving undetectable viral load or not be retained in care. This study examined
the most challenging patients in Buenos Aires, Argentina, those non-adherent to
HIV care. Men (n = 61) and women (n = 59) prescribed antiretrovirals (ARVs) and
non-adherent to treatment in the prior 3-6 months were enrolled and assessed
regarding adherence, knowledge, motivation and attitudes regarding treatment.
Private clinic patients had lower viral load and higher self-reported adherence
than public clinic patients. Motivations to be adherent and positive beliefs
regarding ARVs were associated with increased adherence in public clinic
participants. Increased self-efficacy was associated with increased adherence
among participants from both clinics. Results support patient and provider
interventions that strengthen the characteristics supporting adherence,
engagement and retention in public and private clinic settings.
DOI: 10.1007/s10461-015-1037-7
PMCID: PMC4553072
856. J Pharm Policy Pract. 2016 Apr 21;9:17. doi: 10.1186/s40545-016-0066-6.

eCollection 2016.
A cross-sectional survey of pharmacists to understand their personal preference

of brand and generic over-the-counter medications used to treat common health
conditions.
Patel M(1), Slack M(1), Cooley J(1), Bhattacharjee S(1).
Author information:
(1)College of Pharmacy, The University of Arizona, Tucson, Arizona USA.
BACKGROUND: Consumers are hesitant in choosing generic medications as they are

under the assumption that they are not as safe nor effective as brand
medications. However, pharmacists do have the education and training to know that
this is not the case. The aim of this study was to determine pharmacists'
preference of generic versus brand over-the-counter (OTC) medication for their
personal use as self-treatment for various health symptoms.
METHODS: A prospective, cross sectional study was conducted on 553 licensed
pharmacists who were presumed to have expertise in the use of generic and brand
name OTC medications. In a single Southwestern state in the United States, from
December 2014 to January 2015, a web-based questionnaire was sent to pharmacists
to explore their preference of brand and generic medications based on various
health symptoms. Thirty-one brand-generic medication pairs were used to identify
which medication type pharmacists preferred when asked about nine health
symptoms. Frequency counts of pharmacists' preference of a brand medication or a
generic OTC medication overall and for each of the nine health symptoms were
determined. Chi-squared analyses and one-way ANOVA were conducted to determine if
there were any differences between the preferences of brand and generic OTC
medications across each symptom.
RESULTS: The study overall showed that pharmacists preferred generic OTC
medications to brand OTC medications (62 to 5 %, respectively). Based on an
11-point rating scale, pharmacists were likely to take OTC generic medications
(as their choice of self-treatment) when presented with health symptoms
(mean = 7.32 ± 2.88). In addition, pharmacists chose generic OTC medications over
brand medications regardless of health symptoms (p < 0.001).
CONCLUSION: Pharmacists who have expertise in medications were shown to prefer
using generic OTC medications rather than brand name OTC medications for
self-treating a variety of health symptoms. These study findings support the
theory that expertise affects preference for generic versus brand name OTC
medications. This information can be used to provide consumers the evidence
needed to make well-informed choices when choosing between brand and generic
medications.
DOI: 10.1186/s40545-016-0066-6
PMCID: PMC4839112
PMID: 27103997
857. Am J Med. 2017 Sep;130(9):1092-1098.e2. doi: 10.1016/j.amjmed.2017.03.038.

Epub
2017 Apr 26.
Association Between Patient-Reported Medication Adherence and Anticoagulation

Control.
Sevilla-Cazes J(1), Finkleman BS(2), Chen J(3), Brensinger CM(3), Epstein AE(4),
Streiff MB(5), Kimmel SE(6).
Author information:
(1)Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
(2)Perelman School of Medicine at the University of Pennsylvania, Philadelphia;
Center for Clinical Epidemiology and Biostatistics, Philadelphia, Penn; Center
for Therapeutic Effectiveness Research, Philadelphia, Penn.
Center for Clinical Epidemiology and Biostatistics, Philadelphia, Penn.
Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Penn.
(5)Johns Hopkins University School of Medicine, Baltimore, Md.
Center for Clinical Epidemiology and Biostatistics, Philadelphia, Penn; Center
for Therapeutic Effectiveness Research, Philadelphia, Penn. Electronic address:
stevek@mail.med.upenn.edu.
BACKGROUND: The prevention of thromboembolism events remains challenging in cases

of poor medication adherence. Unfortunately, clinical prediction of future
adherence has been suboptimal. The objective of this study was to examine the
correlation between 2 measures of real-time, self-reported adherence and
anticoagulation control.
METHODS: The IN-RANGE2 cohort recruited patients initiating warfarin therapy in 3
urban anticoagulation clinics. At each study visit, participants reported
adherence using a 100-point visual analogue scale (VAS, marking percentage of
pills taken since prior visit on a linear scale) and 7-day recall of pill-taking
behavior. Anticoagulation control was measured by between-visit percent time in
international normalized ratio range (BVTR), dichotomized at the cohort median.
The longitudinal association between adherence and anticoagulation control was
estimated using generalized estimating equations, controlling for clinical and
demographic characteristics, prior BVTR, and warfarin dose changes.
RESULTS: Among 598 participants with 3204 (median 4) visits, the median BVTR was
36.8% (interquartile range 0%-73.9%). Participants reported ≤80% adherence in 182
visits (5.7%) and missed pills in the past 7 days in 377 visits (11.8%).
Multivariable regression analysis found poorer anticoagulation control (BVTR
<36.8%) in those with a VAS ≤80% (odds ratio 1.89; 95% confidence interval,
1.12-3.18; P = .02) and self-reported change in adherence since last visit (odds
ratio 1.55; 95% confidence interval, 1.20-2.01; P = .001).
CONCLUSION: Self-reported VAS medication adherence at a clinic visit and changes
in reported adherence since the last visit are independently associated with
BVTR. Clinicians may gain additional insight into patients' medication adherence
by incorporating this information into patient management.
DOI: 10.1016/j.amjmed.2017.03.038
PMCID: PMC5572106
858. Int J Dev Disabil. 2016;62(3):183-191. Epub 2016 Apr 27.
Measuring the Complexity of Treatment for Challenging Behavior using the

Treatment Intensity Rating Form.
Zarcone J(1), Hagopian L(1), Ninci J(1), McKay C(1), Bonner A(1), Dillon C(1),
Hausman N(1).
Author information:
(1)Kennedy Krieger Institute and Johns Hopkins School of Medicine.
OBJECTIVES: The goal of this study was to develop and evaluate a tool to measure
the complexity and intensity of psychotropic medication interventions, behavioral
interventions, and issues related to crisis management for challenging behavior
using a standardized rating form.
METHOD: The Treatment Intensity Rating Form (TIRF) is a 10-item scale with three
categories: pharmacological interventions, behavior supports, and protective
equipment. In a retrospective review we examined the final treatment
recommendations for 74 individuals with self-injurious behavior (SIB) based on
psychiatric and behavioral notes and reports. We also compared whether TIRF
scores differed across individuals for whom SIB was maintained by social
reinforcement (e.g., to access attention or toys/activities, or escape from
tasks) versus those for whom SIB was maintained by automatic reinforcement (e.g.,
occurs independent of social variables, and is presumed to be maintained by
sensory reinforcement).
RESULTS: The TIRF was demonstrated to have strong inter-rater reliability (98%)
and appears to have good face validity. As hypothesized, individuals with SIB
maintained by automatic reinforcement had significantly more medication trials
(p=0.0005) and required more protective equipment than individuals with SIB
maintained by social reinforcement (p=0.0002). Antidepressant medication was used
more often with individuals with automatically reinforced SIB, although
antipsychotics and anticonvulsants were also commonly used across both groups.
CONCLUSION: Findings provide initial support for the TIRF's reliability, and face
validity as a measure the level of complexity of medical and behavioral treatment
plans - although additional research is needed to fully evaluate its psychometric
properties.
DOI: 10.1080/20473869.2016.1173316
PMCID: PMC5127402
PMID: 27917287
859. Front Psychol. 2017 Sep 20;8:1621. doi: 10.3389/fpsyg.2017.01621. eCollection

2017.
Adults with Attention Deficit Hyperactivity Disorder Report High Symptom Levels
of Troubled Sleep, Restless Legs, and Cataplexy.
Bjorvatn B(1)(2), Brevik EJ(3)(4)(5), Lundervold AJ(4)(5), Halmøy A(3)(4),

Posserud MB(3)(4), Instanes JT(1)(4), Haavik J(3)(4).
Author information:
(1)Department of Global Public Health and Primary Care, University of
BergenBergen, Norway.
(2)Norwegian Competence Center for Sleep Disorders, Haukeland University
HospitalBergen, Norway.
(3)Division of Psychiatry, Haukeland University HospitalBergen, Norway.
(4)Department of Biomedicine, K.G. Jebsen Centre for Neuropsychiatric Disorders,
University of BergenBergen, Norway.
(5)Department of Biological and Medical Psychology, University of BergenBergen,
Norway.
Objective: To compare the occurrence of a spectrum of different self-reported

sleep problems in adults with ADHD and a control group, and to study the impact
of current ADHD medication use and clinical ADHD subtype. Method: Cross-sectional
study of 268 clinically ascertained adult ADHD patients (DSM-IV criteria) and 202
randomly selected controls. Sleep problems were self-reported using validated
questions, partly from Global Sleep Assessment Questionnaire. Results: ADHD
patients reported more sleep problems than controls: Lifetime occurrence of sleep
problems (82.6 vs. 36.5%), hypnotics use (61.4 vs. 20.2%), current sleep duration
below 6 h (26.6 vs. 7.6%), and symptoms/signs during the past 4 weeks of
excessive daytime sleepiness, cataplexy, loud snoring, breathing pauses during
sleep, restless legs, and periodic limb movements in sleep (significant odds
ratios ranged from 1.82 to 14.55). Current ADHD medication use was associated
with less cataplexy compared with not using medication. Patients with inattentive
subtype reported better sleep quality and less restless legs than patients with
hyperactive/impulsive subtypes. Conclusions: Adults with ADHD reported a very
high occurrence of many different self-reported sleep problems, underlining the
importance of screening for sleep disorders. Among the ADHD patients, medication
use was not associated with more sleep-related symptoms, but in fact less
cataplexy. When comparing ADHD subtypes, the inattentive subtype was associated
with less sleep problems.
DOI: 10.3389/fpsyg.2017.01621
PMCID: PMC5611698
PMID: 28979226
860. MMWR Morb Mortal Wkly Rep. 2018 Feb 23;67(7):219-224. doi:
10.15585/mmwr.mm6707a4.
Prevalence of Self-Reported Hypertension and Antihypertensive Medication Use

Among Adults Aged ≥18 Years - United States, 2011-2015.
Fang J(1), Gillespie C(1), Ayala C(1), Loustalot F(1).
Author information:
(1)Division for Heart Disease and Stroke Prevention, National Center for Chronic
Disease Prevention and Health Promotion, CDC.
Hypertension, which affects nearly one third of adults in the United States, is a
major risk factor for heart disease and stroke (1), and only approximately half
of those with hypertension have their hypertension under control (2). The
prevalence of hypertension is highest among non-Hispanic blacks, whereas the
prevalence of antihypertensive medication use is lowest among Hispanics (1).
Geographic variations have also been identified: a recent report indicated that
the Southern region of the United States had the highest prevalence of
hypertension as well as the highest prevalence of medication use (3). Using data
from the Behavioral Risk Factor Surveillance System (BRFSS), this study found
minimal change in state-level prevalence of hypertension awareness and treatment
among U.S. adults during the first half of the current decade. From 2011 to 2015,
the age-standardized prevalence of self-reported hypertension decreased slightly,
from 30.1% to 29.8% (p = 0.031); among those with hypertension, the
age-standardized prevalence of medication use also decreased slightly, from 63.0%
to 61.8% (p<0.001). Persistent differences were observed by age, sex,
race/ethnicity, level of education, and state of residence. Increasing
hypertension awareness, as well as increasing hypertension control through
lifestyle changes and consistent antihypertensive medication use, requires
diverse clinical and public health intervention.
DOI: 10.15585/mmwr.mm6707a4
PMCID: PMC5858041
Conflict of interest statement: No conflicts of interest were reported.
861. Gen Hosp Psychiatry. 2014 Nov-Dec;36(6):662-8. doi:

10.1016/j.genhosppsych.2014.06.011. Epub 2014 Jul 9.
Independent effects of socioeconomic and psychological social determinants of

health on self-care and outcomes in Type 2 diabetes.
Walker RJ(1), Gebregziabher M(2), Martin-Harris B(3), Egede LE(4).
Author information:
(1)Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA
HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC; Center for Health Disparities
Research, Medical University of South Carolina, Charleston, SC; Department of
Health Science and Research, Medical University of South Carolina, Charleston,
SC.
HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC; Division of Public Health
Sciences, Department of Medicine, Medical University of South Carolina,
Charleston, SC.
(3)Department of Health Science and Research, Medical University of South
Carolina, Charleston, SC; Department of Otolaryngology-Head and Neck Surgery,
Medical University of South Carolina, Charleston, SC.
HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC; Center for Health Disparities
Research, Medical University of South Carolina, Charleston, SC; Division of
General Internal Medicine and Geriatrics, Department of Medicine, Medical
University of South Carolina, Charleston, SC. Electronic address:
egedel@musc.edu.
OBJECTIVE: The purpose of this study was to investigate the independent effects
of socioeconomic and psychological social determinants of health on diabetes
knowledge, self-care, diabetes outcomes and quality of life.
RESEARCH DESIGN AND METHODS: Cross-sectional sample of 615 adults from two adult
primary care clinics in the southeastern United States. Primary outcome variables
were diabetes knowledge, self-care behaviors (diet, exercise, medication
adherence, blood sugar testing, foot care) and diabetes outcomes (HbA1c,
low-density lipoprotein, blood pressure, physical component summary score of SF12
quality of life, mental component summary score of SF12 quality of life).
Covariates included age, sex, race/ethnicity, marital status, health literacy and
comorbidity. Linear regression models were used to assess independent
associations controlling for covariates.
RESULTS: In final adjusted models, significant associations for HbA1c included
education [β = -0.72, 95% confidence interval (CI): -1.36 to -0.08], income (β =
-0.66, CI: -1.30 to -0.16), self-efficacy (β = -0.12, CI: -0.15 to -0.08) and
diabetes distress (β = 0.43, CI: 0.14 to 0.72). Significant associations for
self-care included medication adherence with diabetes distress (β = -0.58, CI:
-0.91 to -0.25) and perceived stress (β = -0.12, CI: -0.18 to -0.05) and exercise
with depression (β = -0.06, CI: -0.10 to -0.01) and self-efficacy (β = 0.06, CI:
0.01 to 0.10). Significant associations for quality of life included depression
(β = -0.08, CI: -0.12 to -0.03), serious psychological distress (β = -0.09, CI:
-0.12 to -0.05), social support (β = 0.01, CI: 0.001 to 0.02) and perceived
stress (β = -0.12, CI: -0.19 to -0.06).
CONCLUSIONS: Social determinants of health were significantly associated with
diabetes self-care and outcomes with socioeconomic factors being most often
associated with diabetes outcomes and psychological factors, specifically
self-efficacy and perceived stress being most often associated with self-care and
quality of life.
DOI: 10.1016/j.genhosppsych.2014.06.011
PMCID: PMC4254055
862. Rev Esc Enferm USP. 2017;51:e03282. doi: 10.1590/s1980-220x2017008003282. Epub

2018 Mar 15.
Association of self-efficacy of parents/caregivers with childhood asthma control

parameters.
Gomes ALA(1), Lima KF(1), Mendes ERDR(1), Joventino ES(2), Martins MC(1), Almeida
PC(3), Ximenes LB(1).
Author information:
(1)Universidade Federal do Ceará, Fortaleza, CE, Brazil.
(2)Universidade da Integração Internacional da Lusofonia Afro-Brasileira,
Redenção, CE, Brazil.
(3)Universidade Estadual do Ceará, Fortaleza, CE, Brazil.
Objective To verify the association between the self-efficacy of

parents/caregivers and control parameters of childhood asthma. Method
Cross-sectional study with parents/caregivers of asthmatic children. Data were
collected through a sociodemographic questionnaire and the Self-efficacy and
their child's level of asthma control scale: Brazilian version. Results
Participation of 216 parents/caregivers in the study. There was a statistically
significant association between self-efficacy scores and the following variables:
unscheduled physician visit (p=0.001), visit to emergency department (p<0.001),
hospital stays in the previous 12 months (p=0.005), physical activity limitation
(p=0.003), school days missed (p<0.001), impaired sleep (p<0.001), ability to
differentiate crisis medication from control medication (p=0.024), use of spacer
(p=0.001), performing oral hygiene after use of inhaled corticosteroids
(p=0.003), and knowledge of medication gratuity (p=0.004). Conclusion A
significant relationship of the self-efficacy of parents/caregivers of asthmatic
children with control parameters and training on the necessary skills to reach
this control was demonstrated in the study.
DOI: 10.1590/s1980-220x2017008003282
863. Korean J Intern Med. 2018 Jan;33(1):203-210. doi: 10.3904/kjim.2015.383. Epub

2017 Apr 20.
Medication nonadherence in Korean patients with rheumatoid arthritis: the

importance of belief about medication and illness perception.
Suh YS(1), Cheon YH(1), Kim HO(1), Kim RB(2), Park KS(2), Kim SH(3), Lee SG(4),
Park EK(4), Hur J(5), Lee SI(1).
Author information:
(1)Department of Internal Medicine and Health Science Institute, Gyeongsang
National University Hospital, Jinju, Korea.
(2)Department of Preventive Medicine, Gyeongsang National University Hospital,
Jinju, Korea.
(3)Department of Internal Medicine, Keimyung University Dongsan Medical Center,
Daegu, Korea.
(4)Department of Internal Medicine, Pusan National University School of Medicine,
Busan, Korea.
(5)Department of Internal Medicine, Yeungnam University Medical Center, Daegu,
Korea.
Comment in
Korean J Intern Med. 2018 Nov;33(6):1252-1253.
Korean J Intern Med. 2018 Nov;33(6):1254.
BACKGROUND/AIMS: To investigate medication nonadherence in Korean patients with

rheumatoid arthritis (RA) and analyze related factors.
METHODS: A total of 292 patients with RA participated in this study. Medication
nonadherence, intentional or unintentional, was gauged via self-reported
questionnaire. Patient perceptions of illness, treatment beliefs, and moods were
measured via Brief Illness Perception Questionnaire, Beliefs about Medicines
Questionnaire, and Patient Health Questionnaire-2, respectively. Demographic and
clinical data were also collected. Multinomial regression analysis was used to
assess the impact of demographic, clinical, and psychological factors on
medication nonadherence.
RESULTS: The medication nonadherence rate was 54.1% (intentional, 21.6%;
unintentional, 32.5%). Intentional nonadherence was reported most often in
patients treated daily drugs (nonsteroidal anti-inflammatory drugs and/or
disease-modifying antirheumatic drugs) (24.2%), and unintentional nonadherence
was highest in patients receiving methotrexate (33.3%) (p = 0.872). In univariate
analysis, beliefs in necessity and concerns of medication differed significantly
in adherent and nonadherent patients (intentional or unintentional). When
controlling for other factors that may impact medication nonadherence, less
belief in necessity of medication (odds ratio [OR], 0.81; 95% confidence interval
[CI], 0.68 to 0.95) and greater emotional response to disease (OR, 1.19; 95% CI,
1.01 to 1.40) were important predictors of intentional nonadherence.
CONCLUSIONS: Medication nonadherence is common in Korean patients with RA. Less
belief in necessity of medication and greater emotional response to disease were
identified as key factors prompting intentional nonadherence. These factors may
be strategically targeted to improve medication adherence rates and subsequent
clinical outcomes.
DOI: 10.3904/kjim.2015.383
PMCID: PMC5768535
864. Biol Blood Marrow Transplant. 2017 Apr;23(4):562-568. doi:

10.1016/j.bbmt.2017.01.008. Epub 2017 Jan 10.
Medication Adherence in Hematopoietic Stem Cell Transplantation: A Review of the

Literature.
Morrison CF(1), Martsolf DM(2), Wehrkamp N(2), Tehan R(2), Pai ALH(3).
Author information:
(1)Center for the Promotion of Adherence and Self-Management, Division of
Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital
Medical Center, Cincinnati, Ohio. Electronic address:
caroline.morrison@cchmc.org.
(2)College of Nursing, University of Cincinnati, Cincinnati, Ohio.
Medical Center, Cincinnati, Ohio; Patient and Family Wellness Center, Cancer and
Blood Diseases Institute, Cincinnati Children's Hospital Medical Center,
Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati School of
Medicine, Cincinnati, Ohio.
Adherence to oral medications has been repeatedly shown to fall below the
recommended 80% to 95% in pediatric and adult cancer populations. The purpose of
this review is to report the state of the science about oral medication adherence
during the acute phase of hematopoietic stem cell transplantation across the
lifespan. An exhaustive search of the literature yielded 5 records for inclusion
in the review. Two studies examined adherence in pediatrics, 2 in adults, and 1
included both pediatric and adult patients. Three studies were descriptive and 2
were interventional in design. The rate of adherence to oral medications ranged
from 33% to 94.7%. Adherence decreased over time in all studies except in 1
pharmacist-led intervention study. Different methods were used to measure
adherence, but most relied on self-report. Further research is needed in
medication adherence in hematopoietic stem cell transplantation to better
understand facilitators, barriers, and relationships to health outcomes.
Copyright © 2017 The American Society for Blood and Marrow Transplantation.
Published by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.bbmt.2017.01.008

eCollection 2015.
A systematic review of interventions addressing adherence to anti-diabetic

medications in patients with type 2 diabetes--impact on adherence.
Sapkota S(1), Brien JA(1), Greenfield J(2), Aslani P(1).
Author information:
(1)Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
(2)Department of Endocrinology, St. Vincent Hospital, Sydney, NSW, Australia.
BACKGROUND: The global prevalence of diabetes is increasing. Medications are a

recommended strategy to control hyperglycaemia. However, patient adherence can be
variable, impacting health outcomes. A range of interventions for patients with
type 2 diabetes have focused on improving treatment adherence. This review
evaluates the impact of these interventions on adherence to anti-diabetic
medications and focuses on the methods and tools used to measure adherence.
METHOD: Medline, Embase, CINAHL, IPA, PUBmed, and PsychINFO were searched for
relevant articles published in 2000-2013, using appropriate search terms.
RESULTS: Fifty two studies addressing adherence to anti-diabetic medications in
patients with type 2 diabetes met the inclusion criteria and were reviewed. Each
study was assessed for research design, method(s) used for measuring medication
adherence, and impact of intervention on medication adherence and glycaemic
control. Fourteen studies were published in 2000-2009 and 38 in 2010-2013. Twenty
two interventions led to improvements in adherence to anti-diabetic medications,
while only nine improved both medication adherence and glycaemic control. A
single strategy could not be identified which would be guaranteed to improve
anti-diabetic medication adherence consistently. Nonetheless, most interventions
were successful in influencing one or more of the outcomes assessed, indicating
the usefulness of these interventions under certain circumstances. Self-report,
particularly the Summary of Diabetes Self-Care Activities questionnaire was the
most commonly used tool to assess medication adherence, although other
self-report tools were used in more recent studies. Overall, there was a slight
increase in the number of studies that employed multiple methods to assess
medication adherence in studies conducted after 2008.
CONCLUSION: The diversity of interventions and adherence measurements prevented a
meta-analysis of the impact of interventions on adherence to therapy,
highlighting the need for more consistency in methods in the area of adherence
research. Whilst effective interventions were identified, it is not possible to
conclude on an effective intervention that can be generalised to all patients
PMCID: PMC4339210
866. Diabetes Res Clin Pract. 2014 Dec;106(3):435-42. doi:

10.1016/j.diabres.2014.09.029. Epub 2014 Oct 5.
Effect of neighborhood factors on diabetes self-care behaviors in adults with

type 2 diabetes.
Smalls BL(1), Gregory CM(2), Zoller JS(3), Egede LE(4).
Author information:
(1)Center for Health Organization and Implementation Research (CHOIR), eHealth
Quality Enhancement Research Initiative (QUERI), Edith Nourse Rogers Memorial
Veterans Hospital, Bedford, MA, United States.
(2)Department of Health Sciences and Research, College of Health Professions,
Medical University of South Carolina, Charleston, SC, United States.
(3)Department of Healthcare Leadership and Management, College of Health
Professions, Medical University of South Carolina, Charleston, SC, United States.
(4)Center for Health Disparities Research, Medical University of South Carolina,
Charleston, SC, United States; Division of General Internal Medicine and
Geriatrics, Department of Medicien, Medical University of South Carolina,
Charleston, SC, United States; Health Equity and Rural Research Innovation Center
(HEROIC), Charleston VA HSR&D COIN, Charleston, SC, United States. Electronic
address: egedel@musc.edu.
OBJECTIVE: The objective of this study was to identify latent variables for
neighborhood factors and diabetes self-care and examine the effect of
neighborhood factors on diabetes self-care in adults with type 2 diabetes.
RESEARCH DESIGN AND METHODS: 615 subjects were recruited from an academic medical
center and a Veterans affairs medical center in the southeastern United States.
Validated scales were used to assess neighborhood factors and diabetes-related
self-care. Confirmatory factor analysis (CFA) was used to determine the latent
constructs. Structural equation modeling (SEM) was then used to assess the
relationship between neighborhood factors and diabetes self-care.
RESULTS: Based on a theoretical framework, CFA yielded four latent variables for
neighborhood factors (neighborhood violence, access to healthy food, social
support, and neighborhood esthetics) and one latent variable diabetes self-care
(including diet, exercise, foot care, blood sugar testing and medication
adherence). SEM showed that social support (r=0.28, p<0.001) and access to
healthy foods (r=-0.16, p=0.003) were significantly associated with self-care
behaviors, while neighborhood violence (r=-0.06, p<0.001) and esthetics (r=-0.07,
p=0.278) were not χ(2) (180, N=611)=192, p=0.26, RMSEA=0.01, CFI=0.999). In the
final trimmed model, social support (r=0.31, p<0.001) and access to healthy foods
(r=-0.20, p<0.001) remained significantly associated with self-care behaviors
χ(2) (76, N=611)=60, p=0.91, RMSEA=0.00, CFI=1.0).
CONCLUSION: This study developed latent factors for neighborhood characteristics
and diabetes self-care and found that social support and access to healthy foods
were significantly associated with diabetes self-care and should be considered as
targets for future interventions.
DOI: 10.1016/j.diabres.2014.09.029
PMCID: PMC4275065

eCollection 2015.
Drug holidays: the most frequent type of noncompliance with calcium plus vitamin
D supplementation in persistent patients with osteoporosis.
Touskova T(1), Vytrisalova M(1), Palicka V(2), Hendrychova T(1), Fuksa L(1),
Holcova R(1), Konopacova J(1), Kubena AA(1).
Author information:
Kralove, Charles University in Prague, Hradec Kralove, Czech Republic.
(2)Osteocentre, Institute of Clinical Biochemistry and Diagnostics, Charles
University in Prague, Faculty of Medicine and University Hospital in Hradec
Kralove, Hradec Kralove, Czech Republic.
PURPOSE: All current recommendations include calcium and vitamin D (Ca-D) as an

integrated part of osteoporosis treatment. The purpose of this pilot study was to
analyze compliance with a fixed combination of Ca-D in women persistent with the
treatment.
PATIENTS AND METHODS: An observational study was carried out in three
osteocenters in the Czech Republic. Women with osteoporosis ≥55 years of age
concurrently treated with oral ibandronate were eligible. Compliance was
evaluated in a period of 3 months by Medication Event Monitoring System (MEMS),
tablet count, and self-report. Nonpersistence was defined as a MEMS-based gap in
the use of Ca-D to be 30 days or more.
RESULTS: A total of 73 patients were monitored, of which 49 patients were
analyzed (target population). Based on MEMS, mean overall compliance was 71%;
good compliance (≥80%) was observed in 59% of the patients. As many as 71% of the
patients took drug holidays (≥3 consecutive days without intake); overall
compliance of these patients was 59% and was slightly lower on Fridays and
weekends. Patients without drug holidays were fully compliant (did not omit
individual doses). Compliance differed according to daily time at which the
patients mostly used the Ca-D. Afternoon/evening takers showed a mean overall
compliance of 82% while morning/night takers only 51% (P=0.049). Based on MEMS,
tablet count, and self-report, compliance ≥75% was observed in 59%, 100%, and 87%
of the patients, respectively. Outcomes obtained by the three methods were not
associated with each other. Undesirable concurrent ingestion of Ca-D and
ibandronate was present only twice.
CONCLUSION: Despite almost perfect self-reported and tablet count-based
compliance, MEMS-based compliance was relatively poor. Consecutive
supplementation-free days were common; more than two-thirds of the patients took
at least one drug holiday. This pilot study showed drug holiday to be the most
important type of noncompliance with Ca-D in those who are persistent with the
treatment.
DOI: 10.2147/PPA.S88630
PMCID: PMC4689262
PMID: 26719680
868. BMC Endocr Disord. 2016 May 31;16(1):28. doi: 10.1186/s12902-016-0114-x.
Diabetes related knowledge, self-care behaviours and adherence to medications

among diabetic patients in Southwest Ethiopia: a cross-sectional survey.
Kassahun T(1), Gesesew H(2)(3), Mwanri L(4), Eshetie T(5).
Author information:
(1)Dilchora Hospital, Diredawa, East Ethiopia.
(2)Department of Epidemiology, College of Health Sciences, Jimma University,
Jimma, Ethiopia. hailushepi@gmail.com.
Flinders University, Adelaide, Australia. hailushepi@gmail.com.
Flinders University, Adelaide, Australia.
(5)Department of Clinical Pharmacy, College of Health Sciences, Jimma University,
Jimma, Ethiopia.
BACKGROUND: The provision of health education involving self-care and good

adherence to medications has been acknowledged to be a cost effective strategy
for improving quality of life of diabetes patients. We assessed levels of
knowledge about type 2 diabetes mellitus (T2DM), self-care behaviours and
adherence to medication among DM patients.
METHODS: A facility based cross-sectional survey of 325 adults with T2DM patients
attending Jimma University Teaching Hospital, Southwest Ethiopia was conducted.
We used diabetes Knowledge Test, Expanded Version of the Summary of Diabetes
Self-Care Activities and Morisky 8-Item medication adherence as tools to measure
diabetic knowledge, self-care behaviours and adherence to medications
respectively. Multinomial logistic regression analyses were used to assess the
independent predictors of diabetes knowledge and adherence to medications. The
binary logistic regression was applied for self-care behaviours.
RESULTS: 309 respondents were included in the survey. Of all the respondents,
44.9 %, 20.1 % and 34.9 % had low, medium and high level diabetic knowledge
respectively. High level of diabetic knowledge was the reference group. Being
illiterate (AOR = 3.1, 95%CI: 1.03-9.3), having BMI <18 kg/m(2) (AOR = 6.4,
95%CI: 1.2-34.9) and duration of DM < 5 years (AOR = 4.2, 95%CI: 1.9-9.5) were
significantly associated with low level of diabetic knowledge. T2DM patients who
practiced good self-care (AOR = 0.5, 95%CI: 0.3-0.9) were less likely to have low
knowledge. Duration of DM < 5 years (AOR = 9.8, 95%CI: 3.2-30.2) was
significantly associated with medium level of diabetic knowledge. 157(50.8 %)
patients had poor self-care behaviour and this was associated with level of
education and adherence to medication. The proportions of patients with low,
medium and high adherence to medication were 24.9 %, 37.9 % and 37.2 %
respectively. Being a merchant, having medium level of diabetic knowledge and
having good glycemic control level were associated with low adherence to
medications.
CONCLUSIONS: Significant number of DM patients had low level of knowledge, poor
self-care behaviours and low level of adherence to medications. These findings
call for the need of integrated interventional management on diabetic knowledge,
self-care behaviours and adherence to medications. To ensure effective T2DM
management, a strategic approach that improves health literacy could be a cross
cutting intervention.
DOI: 10.1186/s12902-016-0114-x
PMCID: PMC4933997
869. BMC Infect Dis. 2018 Nov 15;18(1):575. doi: 10.1186/s12879-018-3497-7.
Associations between perceived barriers and benefits of using HIV pre-exposure

prophylaxis and medication adherence among men who have sex with men in Western
China.
Hu Y(1), Zhong XN(2), Peng B(1), Zhang Y(1), Liang H(3), Dai JH(4), Zhang JY(5),
Huang AL(6).
Author information:
(1)Department of Health Statistics and Information Management, School of Public
Health and Management, Chongqing Medical University, Chongqing, China.
(2)Department of Health Statistics and Information Management, School of Public
Health and Management, Chongqing Medical University, Chongqing, China.
zxn133cq@sina.com.
(3)Department of Epidemiology and Medical Statistics, School of Public Health,
Guangxi Medical University, Nanning, China.
(4)Department of Epidemiology and Health Statistics, School of Public Health,
Xinjiang Medical University, Xinjiang, China.
(5)Department of Epidemiology and Medical Statistics, School of Public Health,
Sichuan University, Sichuan, China.
(6)Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of
Education, Chongqing Medical University, Chongqing, China.
BACKGROUND: To investigate the associations between the perceived barriers and

benefits of using HIV pre-exposure prophylaxis medication, including worries
about the side effects, disliking taking drugs, perceived burden of taking
medication, positive expectations as to the efficacy of the drugs, favourable
doctor-patient relationships, and medication adherence among men who have sex
with men (MSM) to provide a target for improving medication adherence and
reducing HIV infection among MSM.
METHODS: MSM were recruited in western China from April 2013 to October 2014,
administered oral tenofovir (TDF) daily and followed up every 12 weeks for
2 years. At each follow-up, the medication rate was calculated based on the
self-reported number of missed doses over 2 weeks, and then, the medication
adherence was evaluated. The barriers and benefits perceived during medication
were obtained by a self-administered questionnaire, and their effects on
medication adherence were analysed by linear mixed models.
RESULTS: A total of 411 participants were enrolled in this study, and 1561
follow-up observation points were obtained. The average medication rate was
0.62 ± 0.37, and the medication rate increased with longer follow-up (P < 0.05).
The medication rate was higher among MSM who were divorced (compared to those who
were unmarried, P < 0.0001). MSM with more positive expectations as to the
efficacy of the drugs showed higher rates of medication (P < 0.0001), while those
who were more worried about side effects had a lower medication rate
(P = 0.0208). In contrast, the dislike of taking the drugs and the burden
perceived during medication had no effects on the actual medication rate of
taking TDF (P > 0.05).
CONCLUSION: How to obtain and maintain high medication adherence among MSM is the
key to the PrEP intervention strategy for effective reduction of HIV infection.
For MSM in China, we should deepen their understanding of the effectiveness and
safety of PrEP and increase their confidence in PrEP, thereby improving their
TRIAL REGISTRATION: ChiCTR-TRC-13003849 . Registered on 24/06/2013.
DOI: 10.1186/s12879-018-3497-7
PMCID: PMC6238290
870. Trop Med Int Health. 2018 Jul;23(7):785-794. doi: 10.1111/tmi.13078.
Compliance with follow-up and adherence to medication in hypertensive patients in

an urban informal settlement in Kenya: comparison of three models of care.
Kuria N(1), Reid A(2), Owiti P(3)(4), Tweya H(5), Kibet CK(6), Mbau L(1), Manzi
M(2), Murunga V(1), Namusonge T(1), Kibachio J(7)(8).
Author information:
(1)Amref Health Africa in Kenya, Nairobi, Kenya.
(2)Operational Research Unit, Operational Centre Brussels, Medécins Sans
Frontières, Luxembourg, Luxembourg.
(3)Academic Model Providing Access to Healthcare, Eldoret, Kenya.
(4)International Union against Tuberculosis and Lung Disease, Paris, France.
(5)Lighthouse Trust, Lilongwe, Malawi.
(6)Computer Science Department, Rhodes University, Rhodes, South Africa.
(7)Division of Noncommunicable Diseases, Ministry of Health, Nairobi, Kenya.
(8)The National Public Health Institute, Nairobi, Kenya.
OBJECTIVE: To determine and compare, among three models of care, compliance with
scheduled clinic appointments and adherence to antihypertensive medication of
patients in an informal settlement of Kibera, Kenya.
METHODS: Routinely collected patient data were used from three health facilities,
six walkway clinics and one weekend/church clinic. Patients were eligible if they
had received hypertension care for more than 6 months. Compliance with clinic
appointments and self-reported adherence to medication were determined from
clinic records and compared using the chi-square test. Univariate and
multivariate logistic regression models estimated the odds of overall adherence
to medication.
RESULTS: A total of 785 patients received hypertension treatment eligible for
analysis, of whom two-thirds were women. Between them, there were 5879 clinic
visits with an overall compliance with appointments of 63%. Compliance was high
in the health facilities and walkway clinics, but men were more likely to attend
the weekend/church clinics. Self-reported adherence to medication by those
complying with scheduled clinic visits was 94%. Patients in the walkway clinics
were two times more likely to adhere to antihypertensive medication than patients
at the health facility (OR 1.97, 95% CI 1.25-3.10).
CONCLUSION: Walkway clinics outperformed health facilities and weekend clinics.
The use of multiple sites for the management of hypertensive patients led to good
compliance with scheduled clinic visits and very good self-reported adherence to
medication in a low-resource setting.
© 2018 The Authors. Tropical Medicine & International Health Published by John
Wiley & Sons Ltd.
DOI: 10.1111/tmi.13078
871. Res Social Adm Pharm. 2019 Aug 13. pii: S1551-7411(19)30192-5. doi:
10.1016/j.sapharm.2019.08.004. [Epub ahead of print]
How are medication related problems managed in primary care? An exploratory study
in patients with diabetes and primary care providers.
van Eikenhorst L(1), Taxis K(2), Rademakers J(3), Zullig LL(4), de Gier H(5), van
Dijk L(6).
Author information:
(1)University of Groningen, Groningen Research Institute of Pharmacy,
PharmacoTherapy, -Epidemiology & -Economics, P.O. Box 196, 9700 AD, Groningen,
the Netherlands. Electronic address: l.van.eikenhorst@rug.nl.
the Netherlands. Electronic address: k.taxis@rug.nl.
(3)Nivel, Netherlands Institute for Health Services Research, Otterstraat 118,
3513 CR, Utrecht, the Netherlands; Department of Family Medicine, Care and Public
Health Research Institute (CAPHRI), Maastricht University, 6200 MD, Maastricht,
the Netherlands. Electronic address: j.rademakers@nivel.nl.
(4)Department of Population Health Sciences, Duke University, 215 Morris Street,
Durham, NC, 27701, USA; Center to Accelerate Discovery and Practice
Transformation (ADAPT), Durham Veterans Affairs Health Care System, 411 West
Chapel Hill Street, Suite 600, Durham, NC, 27701, USA. Electronic address:
leah.zullig@duke.edu.
the Netherlands. Electronic address: degiercs@wxs.nl.
the Netherlands; Nivel, Netherlands Institute for Health Services Research,
Otterstraat 118, 3513 CR, Utrecht, the Netherlands. Electronic address:
l.vandijk@nivel.nl.
BACKGROUND: Medication self-management is important for patients who are

controlling diabetes. Achieving medication self-management goals, may depend on
treatment complexity and patients' capacities such as health literacy, knowledge
and attitude.
OBJECTIVES: The aims of this study were to explore how patients with diabetes
self-manage their medications, how patients seek support when experiencing
problems and how primary healthcare providers identify patients' medication
related problems and provide support.
METHODS: Semi-structured interviews were conducted among patients with diabetes
receiving primary care and with their primary healthcare providers - GPs, nurses,
pharmacists and technicians - between January and June 2017. A purposive sampling
strategy was used to identify and select participants. An interview guide based
on the Cycle of Complexity model was developed. Interviews were audiotaped and
transcribed verbatim. Transcripts were coded with a combination of deductive and
inductive codes. A thematic analysis was performed to identify categories and
themes in the data. Findings were compared with the Cycle of Complexity model.
RESULTS: Twelve patients and 27 healthcare providers were included in the study.
From the transcripts 95 codes, 6 categories and 2 major themes were extracted.
Patients used practical solutions and gaining knowledge to manage their
medication. Their problems were often related to stress and concerns about using
medications. A trusted relationship with the healthcare provider was essential
for patients to share problems and ask for support. Informal support was sought
from family and peer-patients. Healthcare providers perceive problem
identification as challenging. They relied on patients coming forward, computer
notifications, clinical parameters and gut-feeling. Healthcare providers were
able to offer appropriate support if a medication management problem was known.
CONCLUSION: Patients are confident of finding their way to manage their
medications. However, sharing problems with healthcare providers requires a
trusted relationship. This is acknowledged by both patients and healthcare
providers.
DOI: 10.1016/j.sapharm.2019.08.004
PMID: 31427177
872. Res Social Adm Pharm. 2015 Mar-Apr;11(2):253-64. doi:

10.1016/j.sapharm.2014.08.005. Epub 2014 Oct 8.
Utility of a brief screening tool for medication-related problems.
Snyder ME(1), Pater KS(2), Frail CK(3), Hudmon KS(4), Doebbeling BN(5), Smith
RB(2).
Author information:
(1)Purdue University College of Pharmacy, 640 Eskenazi Ave., Indianapolis, IN
46202, USA. Electronic address: snyderme@purdue.edu.
(2)University of Pittsburgh School of Pharmacy, 3501 Terrace St., Pittsburgh, PA
15261, USA.
(3)University of Minnesota College of Pharmacy, 7-174 Weaver-Densford Hall, 308
Harvard St., SE, Minneapolis, MN 55455, USA.
(4)Purdue University College of Pharmacy, 640 Eskenazi Ave., Indianapolis, IN
46202, USA.
(5)Department of Biohealth Informatics, Indiana University and Purdue University
Indianapolis, School of Informatics & Computing, 719 Indiana Ave, WK 303,
Indianapolis, IN 46202, USA.
BACKGROUND: Medication therapy management (MTM) services position pharmacists to

prevent, detect, and resolve medication-related problems (MRPs.) However,
selecting patients for MTM who are most at risk for MRPs is a challenge. Using
self-administered scales that are practical for use in clinical practice are one
approach.
OBJECTIVE: The objective of this study was to estimate the psychometric
properties of a brief self-administered scale as a screening tool for MRPs.
METHODS: This was a non-randomized study utilizing questionnaires administered
cross-sectionally. In Phase 1, patients (n = 394) at community pharmacies and
outpatient clinics completed 78 items, provided to the study team by item
authors, assessing perceived MRPs. These data were used to select items for
further investigation as a brief, self-administered scale, and estimate the
reliability and construct validity of the resulting instrument. In Phase 2, a
convenience sample of patients (n = 200) at community pharmacies completed a
nine-item, self-administered scale. After completion, they were engaged in a
comprehensive medication review by their pharmacist who was blinded to
questionnaire responses. The main outcome measure for estimating the
criterion-related validity of the scale was the number of pharmacist-identified
medication-related problems (MRPs.) Item statistics were computed as well as
bivariate associations between scale scores and other variables with MRPs. A
multivariate model was constructed to examine the influence of scale scores on
MRPs after controlling for other significant variables.
RESULTS: Higher scores on the questionnaire were positively correlated with more
pharmacist-identified MRPs (r = 0.24; P = 0.001) and scores remained as a
significant predictor (P = 0.031) when controlling for other relevant variables
in a multivariate regression model (R(2) = 0.21; P < 0.001).
CONCLUSIONS: Patient responses on the scale may have a modest role in predicting
MRPs. The use of self-administered questionnaires such as this may supplement
other available patient data in developing patient eligibility criteria for MTM,
however, additional research is warranted.
DOI: 10.1016/j.sapharm.2014.08.005
PMCID: PMC4329268
873. Psychol Med. 2017 Oct;47(13):2369-2378. doi: 10.1017/S0033291717000903. Epub

2017
Apr 19.
What side effects are problematic for patients prescribed antipsychotic

medication? The Maudsley Side Effects (MSE) measure for antipsychotic medication.
Wykes T(1), Evans J(2), Paton C(3), Barnes TRE(4), Taylor D(5), Bentall R(6),
Dalton B(7), Ruffell T(8), Rose D(8), Vitoratou S(8).
Author information:
(1)Psychology Department,Institute of Psychiatry, Psychology, and Neuroscience,
King's College London,London,UK.
(2)NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation
Trust and Institute of Psychiatry, Psychology, and Neuroscience, King's College
London,London,UK.
(3)Chief Pharmacist,Oxleas NHS Foundation Trust,Dartford,UK.
(4)Centre for Psychiatry, Imperial College London,London,UK.
(5)Pharmacy and Pathology,South London and Maudsley NHS Foundation
Trust,London,UK.
(6)Department of Psychological Sciences,University of Liverpool,UK.
(7)Department for Psychological Medicine,Institute of Psychiatry, Psychology, and
Neuroscience, King's College London,London,UK.
(8)Health Service & Population Research,Centre for Implementation
Science,Institute of Psychiatry, Psychology, and Neuroscience, King's College
London,London,UK.
BACKGROUND: Capturing service users' perspectives can highlight additional and

different concerns to those of clinicians, but there are no up to date,
self-report psychometrically sound measures of side effects of antipsychotic
medications. Aim To develop a psychometrically sound measure to identify
antipsychotic side effects important to service users, the Maudsley Side Effects
(MSE) measure.
METHOD: An initial item bank was subjected to a Delphi exercise (n = 9) with
psychiatrists and pharmacists, followed by service user focus groups and expert
panels (n = 15) to determine item relevance and language. Feasibility and
comprehensive psychometric properties were established in two samples (N43 and
N50). We investigated whether we could predict the three most important side
effects for individuals from their frequency, severity and life impact.
RESULTS: MSE is a 53-item measure with good reliability and validity. Poorer
mental and physical health, but not psychotic symptoms, was related to
side-effect burden. Seventy-nine percent of items were chosen as one of the three
most important effects. Severity, impact and distress only predicted 'putting on
weight' which was more distressing, more severe and had more life impact in those
for whom it was most important.
CONCLUSIONS: MSE is a self-report questionnaire that identifies reliably the
side-effect burden as experienced by patients. Identifying key side effects
important to patients can act as a starting point for joint decision making on
the type and the dose of medication.
DOI: 10.1017/S0033291717000903
PMCID: PMC5820531
874. Nicotine Tob Res. 2016 May;18(5):1202-5. doi: 10.1093/ntr/ntv179. Epub 2015
Nov
13.
Adolescent Smoking Cessation With Bupropion: The Role of Adherence.
Leischow SJ(1), Muramoto ML(2), Matthews E(2), Floden LL(2), Grana RA(3).
Author information:
(1)Department of Research, Mayo Clinic Arizona, Scottsdale, AZ;
leischow.scott@mayo.edu.
(2)Department of Family and Community Medicine, University of Arizona, Tucson,
AZ;
(3)Tobacco Control Research Branch, National Cancer Institute, Bethesda, MD.
INTRODUCTION: While many medications can be effective aids to quitting tobacco,

real world adherence to smoking cessation medications may render a potentially
effective medication ineffective. The present study investigated the role of
adherence on treatment outcomes in a bupropion dose-response study among
adolescent smokers trying to quit smoking.
METHODS: Three hundred twelve adolescent boys (n = 143) and girls (n = 169)
between the ages of 14-17 were enrolled in the study, and were randomly assigned
to use either 300 mg, 150 mg or placebo bupropion to quit smoking. Among the
eligibility criterion, participants had to smoke at least six cigarettes per day,
be motivated to quit smoking (self report), have an exhaled carbon monoxide level
greater than or equal to 10 ppm, and report at least two previous quit attempts.
Adherence to medication was determined by both self-report and actual counts of
unused medication and empty medication packaging. Smoking status was determined
by a combination of self-report and biochemical verification (breath carbon
monoxide and urine cotinine).
RESULTS: Cotinine-confirmed quit rates were significantly higher as a function of
high adherence (20.69%) relative to low adherence (0.00%) in the 300-mg Bupropion
Sustained Release group. Overall adherence in all study conditions in this highly
controlled study was high (74%), but was significantly lower in non-white
participants.
CONCLUSIONS: Effectiveness of bupropion for adolescent smoking cessation is
contingent on achieving high rates of medication adherence, but considerable
variations in adherence impacted outcomes.
IMPLICATIONS: Few studies have assessed the safety and efficacy of medications to
help adolescent smokers quit, and we conducted one such study assessing
bupropion. In this analysis of that original study, we assess the role of
adherence in use of medication and quit rates. We found that adherence was
related to outcomes, particularly in the 300-mg dose of bupropion.
for Research on Nicotine and Tobacco. All rights reserved. For permissions,
DOI: 10.1093/ntr/ntv179
PMCID: PMC5896821
875. Am Heart J. 2015 Apr;169(4):539-48. doi: 10.1016/j.ahj.2015.01.006. Epub 2015

Jan
14.
Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence

study: A randomized intervention in high-risk patients.
Granger BB(1), Ekman I(2), Hernandez AF(3), Sawyer T(4), Bowers MT(5), DeWald
TA(4), Zhao Y(6), Levy J(7), Bosworth HB(8).
Author information:
(1)Duke University School of Nursing, Durham, NC; Duke University Health Systems,
Durham, NC. Electronic address: bradi.granger@dm.duke.edu.
(2)Institute of Health and Care Sciences, Centre for Person-Centred Care,
University of Gothenburg, Göteborg, Sweden.
(3)Duke Clinical Research Institute, Duke Medicine, Durham, NC.
(4)Duke University Health Systems, Durham, NC.
(5)Duke University School of Nursing, Durham, NC; Duke University Health Systems,
Durham, NC.
(6)SAS Institute, Cary, NC.
(7)Duke University School of Nursing, Durham, NC.
(8)Center for Health Services Research in Primary Care, VA Medical Center,
Durham, NC.
BACKGROUND: Poor adherence to evidence-based medications in heart failure (HF) is

a major cause of avoidable hospitalizations, disability, and death. To test the
feasibility of improving medication adherence, we performed a randomized
proof-of-concept study of a self-management intervention in high-risk patients
with HF.
METHODS: Patients with HF who screened positively for poor adherence (<6 Morisky
Medication Adherence Scale 8-item) were randomized to either the intervention or
attention control group. In the intervention group (n = 44), a nurse conducted
self-management training before discharge that focused on identification of
medication goals, facilitation of medication-symptom associations, and use of a
symptom response plan. The attention control group (n = 42) received usual care;
both groups received follow-up calls at 1 week. However, the content of follow-up
calls for the attention control group was unrelated to HF medications or
symptoms. General linear mixed models were used to evaluate the magnitude of
change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up
clinic visits. Efficacy was measured as improved medication adherence using
nurse-assessed pill counts at each time point.
RESULTS: Pooled over all time points, patients in the intervention group were
more likely to be adherent to medications compared with patients in the attention
control group (odds ratio 3.92, t = 3.51, P = .0007).
CONCLUSIONS: A nurse-delivered, self-care intervention improved medication
adherence in patients with advanced HF. Further work is needed to examine whether
this intervention can be sustained to improve clinical outcomes.
DOI: 10.1016/j.ahj.2015.01.006
PMCID: PMC5058442
876. Afr Health Sci. 2017 Sep;17(3):738-745. doi: 10.4314/ahs.v17i3.16.
The relationship between patient-related factors and medication adherence among

Nigerian patients taking highly active anti-retroviral therapy.
Nduaguba SO(1), Soremekun RO(2), Olugbake OA(2), Barner JC(1).
Author information:
(1)Health Outcomes and Pharmacy Practice Division, The University of Texas at
Austin College of Pharmacy, Austin, Texas, United States.
(2)Department of Clinical Pharmacy and Biopharmacy, Faculty of Pharmacy,
University of Lagos, Lagos, Nigeria.
BACKGROUND: Through several initiatives, there are increasingly more people who
have access to anti-retroviral therapy. Adherence to therapy is, however,
necessary for successful management of disease.
OBJECTIVES: The objectives of this study were to describe adherence rates and
determine what patient-related factors are related to adherence to
anti-retroviral therapy among adult patients in an HIV clinic located in Lagos,
Nigeria.
METHODS: Adherence was measured using the two-week self-recall method. Barriers,
satisfaction with therapy, and socio-demographic and clinical variables served as
independent variables. Data were collected via self-administered surveys.
RESULTS: Most of the patients (79.5%) reported 100% adherence. The significant
(p<0.05) barriers to adherence were forgetfulness, running out of medication,
alcohol use, and medication side effects. For every unit increase in the number
of barriers, patients were 60.8% less likely to be 100% adherent (p <0.05, odds
ratio, OR = 0.392, 95% CI = 0.295-0.523).
CONCLUSION: Interventions should target helping patients cope with forgetfulness,
specifically employing strategies to overcome busyness in schedules, being away
from home, and tiredness.
DOI: 10.4314/ahs.v17i3.16
PMCID: PMC5656197

eCollection 2017.
Self-Care Practices among Diabetes Patients in Addis Ababa: A Qualitative Study.
Tewahido D(1), Berhane Y(1).
Author information:
(1)Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
BACKGROUND: Self-care practices that include self-monitoring of blood sugar

level, diet management, physical exercise, adherence to medications, and foot
care are the cornerstones of diabetes management. However, very little is known
about self-care in developing countries where the prevalence of diabetes is
increasing.
OBJECTIVE: The objective of this study was to describe self-care practices among
individuals with type II diabetes in Addis Ababa, Ethiopia.
METHODS: A qualitative method was used to gather data from type II diabetes
patients. Patients were recruited from the outpatient diabetes clinics of two
public hospitals in Addis Ababa. Data were collected using a semi structured
interview guide. A thematic analysis approach was used to process the data.
RESULTS: Overall self-care practices were not adequate. Most patients reported
irregular self-monitoring of blood sugar. Dietary and physical exercise
recommendations were inadequately practiced by most of the participants. Most
patients better adhered to medication prescriptions. Patients generally lack
proper information/knowledge regarding the importance of self-care and how it
should be implemented. Based on reported behavior we identified three main
categories of patients; which are those 'endeavor to be compliant', 'confused'
and 'negligent'.
CONCLUSION: Diabetes patients largely depend on prescribed medications to control
their blood sugar level. The importance of proper self-care practices for
effective management of diabetes is not adequately emphasized in diabetes care
centers and patients lack sufficient knowledge for proper self-care.
PMCID: PMC5207399

interests exist.
878. Acad Pediatr. 2018 Apr;18(3):317-323. doi: 10.1016/j.acap.2018.01.006. Epub

2018
Jan 31.
Knowledge of Inhaled Therapy and Responsibility for Asthma Management Among Young
Teens With Uncontrolled Persistent Asthma.
Frey SM(1), Jones MR(2), Goldstein N(2), Riekert K(3), Fagnano M(2), Halterman
JS(2).
Author information:
(1)University of Rochester School of Medicine and Dentistry, Rochester, NY.
Electronic address: Sean_Frey@urmc.rochester.edu.
(2)University of Rochester School of Medicine and Dentistry, Rochester, NY.
(3)Johns Hopkins School of Medicine, Baltimore, Md.
OBJECTIVES: To compare the abilities of teens with uncontrolled persistent asthma

and their caregivers to identify inhaled medications and state correct
indications for use; examine medication responsibility within dyads; and
determine whether responsibility is associated with knowledge about inhaled
therapies.
METHODS: In the baseline survey for the School-Based Asthma Care for Teens
(SB-ACT) trial, we separately asked caregivers and teens to: 1) identify the
teen's inhaled asthma therapies by name and from a picture chart (complete
matches considered "concordant"); 2) describe indications of use for each
medication; and 3) describe the allocation of responsibility for medication use
within dyads. We limited analyses to dyads in which either member reported at
least one rescue and one inhaled controller medication; we used McNemar and
Pearson chi-square tests.
RESULTS: A total of 136 dyads were analyzed. More caregivers than teens
concordantly identified medications (63% vs 31%, P < .001). There was no
difference between caregivers and teens in the ability to state correct
indications for use (56% vs 54%, P = .79). More teens than caregivers endorsed
"full teen responsibility" for rescue medication (65% vs 27%, P < .001) and
controller medication use (50% vs 15%, P < .001). Neither concordant
identification nor knowing indications for use was associated with reported
medication responsibility.
CONCLUSIONS: Medication responsibility within dyads of caregivers and teens with
persistent asthma is not associated with knowledge about inhaled therapies.
Targeting both members of the dyad with education and self-management strategies
before responsibility transitions start may allow providers to avoid a missed
opportunity to support these emerging stakeholders to adherence.
Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All

rights reserved.
DOI: 10.1016/j.acap.2018.01.006
PMCID: PMC5903444
879. AMIA Annu Symp Proc. 2014 Nov 14;2014:1728-37. eCollection 2014.
MedMinify: An Advice-giving System for Simplifying the Schedules of Daily Home

Medication Regimens Used to Treat Chronic Conditions.
Flynn AJ(1), Klasnja P(1), Friedman CP(2).
Author information:
(1)School of Information, University of Michigan, Ann Arbor, MI.
(2)School of Information, University of Michigan, Ann Arbor, MI ; School of
Public Health, University of Michigan, Ann Arbor, MI.
For those with high blood pressure, diabetes, or high cholesterol, adherence to a
home medication regimen is important for health. Reductions in the number of
daily medication-taking events or daily pill burden improve adherence. A novel
advice-giving computer application was developed using the SMART platform to
generate advice on how to potentially simplify home medication regimens.
MedMinify generated advice for 41.3% of 1,500 home medication regimens for adults
age 60 years and older with chronic medical conditions. If the advice given by
MedMinify were implemented, 320 regimen changes would have reduced daily
medication-taking events while an additional 295 changes would have decreased the
daily pill burden. The application identified four serious drug-drug interactions
and so advised against taking two pairs of medications simultaneously. MedMinify
can give advice to change home medication regimens that could result in simpler
home medication-taking schedules.
PMCID: PMC4420013
880. Clin J Am Soc Nephrol. 2016 Jun 6;11(6):1054-62. doi: 10.2215/CJN.10681015.

Epub
2016 May 12.
Integrating a Smartphone-Based Self-Management System into Usual Care of Advanced

CKD.
Ong SW(1), Jassal SV(2), Miller JA(3), Porter EC(4), Cafazzo JA(5), Seto E(6),
Thorpe KE(7), Logan AG(8).
Author information:
(1)Departments of Pharmacy, Nephrology.
(2)Medicine, Nephrology, Institute of Health Policy, Management and Evaluation,
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;
(3)Medicine, Nephrology, Faculty of Medicine, University of Toronto, Toronto,
Ontario, Canada;
(4)Nursing, and Nephrology.
(5)Lunenfeld-Tanenbaum Research Institute and Department of Medicine, Mount Sinai
Hospital, Toronto, Ontario, Canada; Techna Institute, University Health Network,
Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation,
Institute of Biomaterials and Biomedical Engineering.
(6)Institute of Health Policy, Management and Evaluation, Centre for Global
eHealth Innovation, and Techna Institute, University Health Network, Toronto,
Ontario, Canada;
(7)Dalla Lana School of Public Health, University of Toronto, and Applied Health
Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital,
Toronto, Ontario, Canada.
(8)Medicine, Nephrology, Lunenfeld-Tanenbaum Research Institute and Department of
Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada; Faculty of Medicine,
University of Toronto, Toronto, Ontario, Canada; logan@lunenfeld.ca.
Comment in
Clin J Am Soc Nephrol. 2016 Jun 6;11(6):935-7.
BACKGROUND AND OBJECTIVES: Patient self-management has been shown to improve

health outcomes. We developed a smartphone-based system to boost self-care by
patients with CKD and integrated its use into usual CKD care. We determined its
acceptability and examined changes in several clinical parameters.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We recruited patients with stage 4
or 5 CKD attending outpatient renal clinics who responded to a general
information newsletter about this 6-month proof-of-principle study. The
smartphone application targeted four behavioral elements: monitoring BP,
medication management, symptom assessment, and tracking laboratory results.
Prebuilt customizable algorithms provided real-time personalized patient feedback
and alerts to providers when predefined treatment thresholds were crossed or
critical changes occurred. Those who died or started RRT within the first 2
months were replaced. Only participants followed for 6 months after recruitment
were included in assessing changes in clinical measures.
RESULTS: In total, 47 patients (26 men; mean age =59 years old; 33% were ≥65
years old) were enrolled; 60% had never used a smartphone. User adherence was
high (>80% performed ≥80% of recommended assessments) and sustained. The mean
reductions in home BP readings between baseline and exit were statistically
significant (systolic BP, -3.4 mmHg; 95% confidence interval, -5.0 to -1.8 and
diastolic BP, -2.1 mmHg; 95% confidence interval, -2.9 to -1.2); 27% with normal
clinic BP readings had newly identified masked hypertension. One hundred
twenty-seven medication discrepancies were identified; 59% were medication errors
that required an intervention to prevent harm. In exit interviews, patients
indicated feeling more confident and in control of their condition; clinicians
perceived patients to be better informed and more engaged.
CONCLUSIONS: Integrating a smartphone-based self-management system into usual
care of patients with advanced CKD proved feasible and acceptable, and it
appeared to be clinically useful. The results provide a strong rationale for a
randomized, controlled trial.
DOI: 10.2215/CJN.10681015
PMCID: PMC4891756
881. Am J Health Behav. 2016 Mar;40(2):155-71. doi: 10.5993/AJHB.40.2.1.
Meta-analyses of Theory Use in Medication Adherence Intervention Research.
Conn VS(1), Enriquez M(2), Ruppar TM(2), Chan KC(2).
Author information:
(1)University of Missouri School of Nursing, Columbia, MO, USA conn@missouri.edu.
(2)University of Missouri School of Nursing, Columbia, MO, USA.
OBJECTIVE: This systematic review applied meta-analytic procedures to integrate

primary research that examined theory- or model-linked medication adherence
interventions.
METHODS: Extensive literature searching strategies were used to locate trials
testing interventions with medication adherence behavior outcomes measured by
electronic event monitoring, pharmacy refills, pill counts, and self-reports.
Random-effects model analysis was used to calculate standardized mean difference
effect sizes for medication adherence outcomes.
RESULTS: Codable data were extracted from 146 comparisons with 19,348
participants. The most common theories and models were social cognitive theory
and motivational interviewing. The overall weighted effect size for all
interventions comparing treatment and control participants was 0.294. The effect
size for interventions based on single-theories was 0.323 and for multiple-theory
interventions was 0.214. Effect sizes for individual theories and models ranged
from 0.041 to 0.447. The largest effect sizes were for interventions based on the
health belief model (0.477) and adult learning theory (0.443). The smallest
effect sizes were for interventions based on PRECEDE (0.041) and self-regulation
(0.118).
CONCLUSION: These findings suggest that theory- and model-linked interventions
have a significant but modest effect on medication adherence outcomes.
DOI: 10.5993/AJHB.40.2.1
882. Seizure. 2017 Aug;50:38-42. doi: 10.1016/j.seizure.2017.06.001. Epub 2017 Jun

10.
Seizure management by preschool teachers: A training concept focussing on

practical skills.
Dumeier HK(1), Neininger MP(1), Kaune A(1), Schumacher PM(1), Merkenschlager

A(2), Kiess W(2), Bernhard MK(2), Bertsche T(1), Bertsche A(3).
Author information:
(1)Drug Safety Center and Dept. of Clinical Pharmacy, Leipzig University,
Brüderstraße 22, 04103 Leipzig, Germany.
(2)University Hospital for Children and Adolescents, Centre of Paediatric
Research, Liebigstraße 20a, 04103, Leipzig, Germany.
(3)University Hospital for Children and Adolescents, Centre of Paediatric
Research, Liebigstraße 20a, 04103, Leipzig, Germany. Electronic address:
Astrid.Bertsche@medizin.uni-leipzig.de.
PURPOSE: Prolonged seizures can cause severe harm and even death. For seizures
lasting longer than 5min, an administration of rescue medication is therefore
recommended. Caregivers such as preschool teachers should be able to administer
correctly anticonvulsive rescue medication to children.
METHODS: A training concept for preschool teachers on seizure management
focussing on practical skills was developed. To assess the success of the
training, a structured interview on attitudes relating to rescue medication
administration was conducted. The number of committed errors during
administration of a rectal/buccal rescue medication to dummy dolls was compared
before and after training.
RESULTS: 210 teachers from 115 preschools participated while all teachers from
303 preschools had been invited. The self-reported level of confidence in their
own skills to administer anticonvulsive rescue medication increased from 5 to 8
on a scale from 1 to 10 (p<0.001). The number of participants who agreed to
administer rescue medication rose from 195/210 (92.8%) before training to 209/210
(99.5%, p<0.001) after training for the rectal route, and from 173/210 (82.4%) to
209/210 (99.5%, p<0.001) for the buccal route. For teachers who administered
rescue medication before and after training, the number of administrations
without any administration errors rose from 1/195 (0.5%) to 117/195 (60.0%,
p<0.001) for the rectal route, and from 13/173 (7.5%) to 95/173 (54.9%, p<0.001)
for the buccal route.
CONCLUSION: A training for preschool teachers boosted the level of
self-confidence relating to administration of anticonvulsive rescue medication.
Teachers also committed fewer errors when administering rescue medication to
dummy dolls.
Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All

rights reserved.
DOI: 10.1016/j.seizure.2017.06.001
883. Arab J Urol. 2017 Nov 16;15(4):372-379. doi: 10.1016/j.aju.2017.10.007.

A new tool for self-evaluation of adherence to antimuscarinic drugs treatment in

patients with urinary incontinence.
Kosilov KV(1)(2), Loparev SA(3), Kuzina IG(4), Shakirova OV(5), Gainullina YI(1),
Kosilova LV(6), Prokofyeva AS(7).
Author information:
(1)Department of Social Sciences, School of Humanities, Far Eastern Federal
University, Vladivostok, Primorsky Region, Russian Federation.
(2)Department of Public Helth, Pacific Medical State University, Vladivostok,
Russian Federation.
(3)Department of Urology, City Polyclinic № 3, Vladivostok, Russian Federation.
(4)Department of Social Science, Far Eastern Federal University, Vladivostok,
Primorsky Region, Russian Federation.
(5)Department of Theory and Methods of Adaptive Physical Education, Far Eastern
Federal University, Vladivostok, Primorsky Region, Russian Federation.
(6)Department of Functional Methods of Examination, Med. Association № 2 of
Vladivostok City, Vladivostok, Russian Federation.
(7)Department Social Science, Far Eastern Federal University, Vladivostok,
Primorsky Region, Russian Federation.
Abstract objective: To evaluate the validity of the Medication Adherence

Self-Report Inventory (MASRI) questionnaire in determining antimuscarinic drugs
adherence in patients with urinary incontinence (UI).
Patients and methods: In all, 629 patients [355 (56.4%) women and 274 (43.6%)
men], aged 18-65 years, were included. All patients were prescribed
antimuscarinic drugs and treatment adherence was tested at the start, and after
4, 8 and 12 weeks using the MASRI. The standard of external monitoring was the
Brief Medication Questionnaire (BMQ) and visual count of the remaining pills. The
functional status of the lower urinary tract was tested using voiding diaries and
uroflowmetry.
Results: The correlation between indicators of adherence according to the MASRI
and screen mode of the BMQ was r = 0.84 (P ≤ 0.01), r = 0.72 (P ≤ 0.01), r = 0.7
(P ≤ 0.05) at 4, 8 and 12 weeks of follow-up, respectively, which indicated a
satisfactory competitive validity. In the study of the discriminant validity, we
found that non-adherent patients were correctly identified according to the MASRI
in 96.2%, 96.9% and 96.2% of cases at 4, 8 and 12 weeks of follow-up,
respectively. The values of the positive likelihood ratio (7.92, 10.81, and 12.8
at 4, 8 and 12 weeks of follow-up, respectively) were quite acceptable for the
adherence forecast. The receiver operating characteristic analysis revealed a
failure of the null hypothesis of the excess/insufficient discrimination power of
the MASRI. The correlation between the percentage of non-adherent patients and
the percentage of patients with impaired lower urinary tract function according
to uroflowmetry data was r = 0.55 (P ≤ 0.05) at 4 weeks; r = 0.59 (P ≤ 0.05) at
8 weeks; and r = 0.62 (P ≤ 0.01) at 12 weeks.
Conclusion: The MASRI questionnaire is highly constructive, competitive, has
discriminant validity, and is suitable for self-assessment of treatment adherence
in patients with UI taking antimuscarinics. Using the MASRI is less costly and
faster compared with other assessment tools.
DOI: 10.1016/j.aju.2017.10.007
PMCID: PMC5717450
PMID: 29234543
884. Alcohol Clin Exp Res. 2016 Jul;40(7):1425-9. doi: 10.1111/acer.13095. Epub
2016
May 24.
Effect of Intravenous Ethanol on Capsaicin-Induced Hyperalgesia in Human

Subjects.
Arout CA(1), Perrino AC Jr(2), Ralevski E(1), Acampora G(3), Koretski J(1),
Limoncelli D(1), Newcomb J(1), Petrakis IL(1).
Author information:
(1)Department of Psychiatry, Center for Translational Neuroscience of Alcoholism
and VA Alcohol Research Center, Yale University School of Medicine, West Haven,
Connecticut.
(2)Department of Anesthesiology, VA Connecticut Healthcare System, Yale
University School of Medicine, West Haven, Connecticut.
(3)Department of Psychiatry, Massachusetts General Hospital, Harvard Center for
Addiction Medicine, Boston, Massachusetts.
BACKGROUND: The objective of this study was to assess ethanol's (EtOH's) effects
on capsaicin-induced hyperalgesia in healthy participants. Specifically, we
investigated the change in area of capsaicin-induced hyperalgesia following 3
interventions: intravenous EtOH at 2 targeted breath alcohol concentrations
(BrAC), or placebo.
METHODS: Eighteen participants participated in 3 test days in a randomized order.
Each test day, participants received an intradermal capsaicin injection on the
volar surface of the forearm, followed by either infusion of high concentration
EtOH (targeted BrAC = 0.100 g/dl), low concentration EtOH (targeted
BrAC = 0.040 g/dl), or placebo. The area of hyperalgesia was determined by von
Frey technique at 2 time points, prior to EtOH infusion, and again when target
BrAC was reached. The primary outcome was the percent change in the area of
capsaicin-induced hyperalgesia. Additional outcome measures included the visual
analogue scale of mood states (VAS), which was administered at each time point.
RESULTS: There was a marked 30% reduction in the area of capsaicin-induced
hyperalgesia with infusion of a high concentration of EtOH (p < 0.05). Low
concentration EtOH produced a 10% reduction in hyperalgesia area, although this
finding did not reach significance. Further, participants reported significant
feelings of euphoria and drowsiness at high concentrations of EtOH (p < 0.05), as
measured by the VAS.
CONCLUSIONS: In a human model examining pain phenomena related to central
sensitization, this study is the first to demonstrate that capsaicin-induced
hyperalgesia is markedly attenuated by EtOH. The capsaicin experimental pain
paradigm employed provides a novel approach to evaluate EtOH's effects on pain
processing. The antihyperalgesic effects of EtOH observed have important clinical
implications for the converging fields of substance abuse and pain medicine and
may inform why patients with chronic pain often report alcohol use as a form of
self-medication.
DOI: 10.1111/acer.13095
PMCID: PMC4930397
885. Clin J Pain. 2018 Apr;34(4):357-365. doi: 10.1097/AJP.0000000000000550.
Medicate or Meditate? Greater Pain Acceptance is Related to Lower Pain Medication

Use in Persons With Chronic Pain and Spinal Cord Injury.
Kratz AL(1), F Murphy J 3rd, Kalpakjian CZ, Chen P.
Author information:
(1)Department of Physical Medicine and Rehabilitation, University of Michigan,
Ann Arbor, MI.
OBJECTIVES: There is little information about whether use of pain self-management

skills that are common targets of psychosocial interventions for pain are
associated with reduced reliance on pain medications. The aim of this study was
to test whether higher chronic pain acceptance, which is a readily modified pain
self-management approach, is related to lower use of pain medications (eg, opioid
medications, and gabapentinoids) in a sample with chronic pain and spinal cord
injury (SCI).
MATERIALS AND METHODS: This is a cross-sectional survey study of pain medication
use, pain severity and distribution (Brief Pain Inventory [BPI]), depressive
symptoms (Patient Health Questionnaire-9 [PHQ-9]), and chronic pain acceptance
(Chronic Pain Acceptance Questionnaire [CPAQ]) administered to a sample of 120
adults with chronic pain and SCI.
RESULTS: Regression results indicated that, above and beyond the effects of pain
intensity, pain distribution, and depressive symptoms, higher pain acceptance was
related to lower use of all types of pain medications, and lower odds of using
opioid medications or gabapentinoids. Pain intensity was not related to pain
medication use, but greater pain distribution was related to using more pain
medications in general and to greater odds of using gabapentinoids.
DISCUSSION: Findings from this study indicate that those with chronic pain and
SCI who have a more accepting orientation to pain are less reliant on pain
medications, and thereby experience lower risks associated with medication
consumption. Longitudinal, daily process, and clinical trial studies are needed
to better understand the association between pain acceptance and pain medication
consumption.
DOI: 10.1097/AJP.0000000000000550
PMCID: PMC5835158
886. Respir Care. 2016 Jul;61(7):897-901. doi: 10.4187/respcare.04553. Epub 2016

Mar
22.
Perception of Exercise-Induced Bronchoconstriction in College Athletes.
Burnett DM(1), Vardiman JP(2), Deckert JA(2), Ward JL(2), Sharpe MR(3).
Author information:
(1)University of Kansas Medical Center, Kansas City, Kansas. dburnett@kumc.edu.
(2)University of Kansas, Lawrence, Kansas.
(3)University of Kansas Medical Center, Kansas City, Kansas.
Comment in
Respir Care. 2016 Jul;61(7):994-5.
BACKGROUND: Exercise-induced bronchoconstriction (EIB) can lead to long-term

respiratory illness and even death. EIB prevalence rates are both high and
variable in college athletes. Also, prevalence rates may be underestimated due to
ineffective screening. The purpose of this study is to investigate the prevalence
of EIB and the perceived impact of EIB in college athletes via a self-report
questionnaire.
METHODS: A self-report EIB questionnaire was administered to college athletes on
8 different sports teams. Information collected was used to identify athletes who
self-reported: (1) a history of EIB and/or asthma, (2) respiratory symptoms
during exercise, (3) medication use, and (4) concern about EIB.
RESULTS: Results showed that 56 of 196 athletes (28.6%) self-reported a history
of EIB or asthma. Over half (52%) reported a history of EIB/asthma or current EIB
symptoms. Forty-six of the 140 athletes (32.9%) who did not report a history of
EIB or asthma indicated symptoms of EIB during sports, training, or exercise.
Fourteen of 56 athletes (25%) self-reporting a history of EIB or asthma did not
report the use of a respiratory medication. Nineteen of 196 athletes (9.7%)
reported being concerned that EIB was adversely affecting their sports
performance.
CONCLUSIONS: College athletes self-report a high prevalence of EIB or asthma.
Although college athletes may not report a history of EIB or asthma, they
indicate symptoms of EIB. A majority of athletes reported a history or current
symptoms related to EIB or asthma. Many athletes with a history of EIB or asthma
are not taking any asthma medication. Last, athletes report concern about EIB
adversely affecting their sports performance. More work is needed using a
combination of a screening questionnaire and standardized EIB testing to develop
a validated tool for accurately screening and diagnosing EIB in college athletes.

887. Self-management of Epilepsy: A Systematic Review [Internet].
Luedke MW, Blalock DV, Lewinski AA, Shapiro A, Drake C, Lewis JD, Goldstein KM,
Husain AM, Gierisch JM, Sinha SR, Tran TT, Gordon AM, Kosinski AS, Bosworth HB,
Van Noord M, Williams, Jr. JW.
Washington (DC): Department of Veterans Affairs (US); 2019.
VA Evidence-based Synthesis Program Reports.
Epilepsy affects about 50 million people worldwide. In the Veterans Health

Administration (VHA), an estimated 79,576 Veterans were treated for epilepsy in
2016. Seizure control and medication adherence are common challenges among
patients; decreased health care literacy, poor social support, burdensome side
effects, low socioeconomic status, and co-occurring psychiatric disorders are all
associated with lower medication adherence. Patient self-management behaviors are
important to the management of epilepsy, as decreased patient participation in
treatment regimens is a major cause of breakthrough seizures, leading to
increased hospital utilization and mortality. In 2003, the Institute of Medicine
defined self-management support as “the systematic provision of education and
supportive interventions by health care staff to increase patients’ skills and
confidence in managing their health problems, including regular assessment of
progress and problems, goal setting, and problem-solving support.” In Veterans
Affairs (VA), self-management has an established role in the management of
chronic conditions, such as diabetes mellitus, chronic obstructive pulmonary
disease, and depressive disorders. For patients with epilepsy, improved
self-management skills could improve self-efficacy, medication adherence,
avoidance of seizure triggers, and improve patient and family knowledge about
when to seek urgent medical care. A Cochrane review that included literature
published through December 2013 evaluated self-management strategies for adults
with epilepsy. The review identified only 4 trials and concluded that
self-management education has some evidence of benefit but did not find clear
evidence of substantially improved outcomes for adults with epilepsy. Prior
systematic reviews on this topic were inadequate for the needs of our
stakeholders because they do not include recent important studies and did not
adequately consider components such as peer support, which has particular
relevance to Veterans. This review will address these gaps in evidence,
synthesize the current evidence on self-management programs for patients with
epilepsy, and identify potential barriers in the adoption of these programs
within the VHA system.
PMID: 31361424
888. Acta Inform Med. 2017 Jun;25(2):108-111. doi: 10.5455/aim.2017.25.108-111.
Developing the Medication Reminder Mobile Application "Seeb".
Saghaeiannejad-Isfahani S(1), Ehteshami A(2), Savari E(3), Samimi A(3).
Author information:
(1)Social Determinants of Health research center, Isfahan University of Medical
Sciences, Isfahan, Iran.
(2)Health Information Technology Research Center, Isfahan University of Medical
(3)Department of Health Information Technology and Management, School of
Management and Medical Information Sciences, Isfahan University of Medical
INTRODUCTION: Today, the structure of comprehensive health care emphasizes

self-care more than therapy. Medication therapy is a strong instrument for
therapy received through the health setting, especially in medication area. Error
in medication administration has produced different problems and they cost
billions of dollars every year. Regarding mobile phone extensions, we developed a
local medication reminder mobile application called "Seeb" as a suitable solution
for decreasing medication errors for Iranians.
METHODS: We conducted a mixed methods study in three Phases: 1) Comparative study
of existing mobile applications; 2) developed its object-oriented model; 3)
Developed the initial version of "Seeb" that was approved for production.
RESULTS: This application was designed for the appropriate medication
administration including time and dosages through: recording patient and
medication data; scheduling patients' medication; and reporting medication
administration on progress.
CONCLUSION: "Seeb" has been designed in compliance with Iranian health
information technologists and pharmacists requirements. It is expected to reduce
medication error and improve patient adherence to medical prescriptions.
DOI: 10.5455/aim.2017.25.108-111
PMCID: PMC5544449
PMID: 28883675
Conflict of interest statement: • Conflict of interest: none declared
889. Am Psychol. 2016 Oct;71(7):539-551.
Psychosocial factors in medication adherence and diabetes self-management:

Implications for research and practice.
Gonzalez JS(1), Tanenbaum ML(2), Commissariat PV(3).
Author information:
(1)Ferkauf Graduate School of Psychology.
(2)Department of Pediatrics, Stanford University School of Medicine.
(3)Joslin Diabetes Center.
Diabetes is a chronic illness that places a significant self-management burden on

affected individuals and families. Given the importance of health behaviors-such
as medication adherence, diet, physical activity, blood glucose
self-monitoring-in achieving optimal glycemic control in diabetes, interventions
designed and delivered by psychologists hold promise in assisting children,
adolescents, and adults with diabetes in improving their health status and
lowering their risk of serious complications. This article first provides an
overview of diabetes self-management and associated challenges and burdens.
Socioeconomic status factors that may influence diabetes management and outcomes
are briefly highlighted. We then review the evidence base for select psychosocial
factors that may be implicated in diabetes self-management. Modifiable targets of
psychological intervention are presented across 3 overarching domains: (a)
knowledge, beliefs, and related cognitive constructs; (b) emotional distress and
well-being; and (c) behavioral skills and coping. Important methodological issues
facing future research are discussed, along with opportunities for psychologists
in improving the care and treatment outcomes of individuals and families living
with diabetes. In conclusion, we advocate for continued research emphasis on
improving psychosocial aspects of living with diabetes, with greater attention to
the situational context in which the self-regulatory processes underlying
self-management occur. Psychologists have important roles to play in reducing
emotional distress, improving patient knowledge, and providing training in
behavioral skills to promote successful self-management and to support
patient-centered diabetes care. (PsycINFO Database Record
DOI: 10.1037/a0040388
PMCID: PMC5792162

eCollection 2017.
Why wait? The social determinants underlying tuberculosis diagnostic delay.
Bonadonna LV(1)(2)(3)(4), Saunders MJ(3)(4)(5), Zegarra R(2), Evans C(3)(4)(5),

Alegria-Flores K(6), Guio H(2).
Author information:
(1)The University of Michigan, Ann Arbor, Michigan, United States of America.
(2)Instituto Nacional de Salud, Lima, Perú.
(3)Innovación Por la Salud Y Desarrollo (IPSYD), Asociación Benéfica PRISMA,
Lima, Perú.
(4)Innovation for Health and Development (IFHAD), Laboratory of Research and
Development, Universidad Peruana Cayetano Heredia, Lima, Perú.
(5)Infectious Diseases & Immunity, Imperial College London, and Wellcome Trust
Imperial College Centre for Global Health Research, London, United Kingdom.
(6)Department of Health Policy and Management, University of North Carolina
Gillings School of Global Public Health, Chapel Hill, North Carolina, United
States of America.
BACKGROUND: Early detection and diagnosis of tuberculosis remain major global

priorities for tuberculosis control. Few studies have used a qualitative approach
to investigate the social determinants contributing to diagnostic delay and none
have compared data collected from individual, community, and health-system
levels. We aimed to characterize the social determinants that contribute to
diagnostic delay among persons diagnosed with tuberculosis living in
resource-constrained settings.
METHODS/PRINCIPLE FINDINGS: Data were collected in public health facilities with
high tuberculosis incidence in 19 districts of Lima, Peru. Semi-structured
interviews with persons diagnosed with tuberculosis (n = 105) and their family
members (n = 63) explored health-seeking behaviours, community perceptions of
tuberculosis and socio-demographic circumstances. Focus groups (n = 6) were
conducted with health personnel (n = 35) working in the National Tuberculosis
Program. All interview data were transcribed and analysed using a grounded theory
approach. The median delay between symptom onset and the public health facility
visit that led to the first positive diagnostic sample was 57 days (interquartile
range 28-126). The great majority of persons diagnosed with tuberculosis
distrusted the public health system and sought care at public health facilities
only after exhausting other options. It was universally agreed that persons
diagnosed with tuberculosis faced discrimination by public and health personnel.
Self-medication with medicines bought at local pharmacies was reported as the
most common initial health-seeking behaviour due to the speed and low-cost of
treatment in pharmacies. Most persons diagnosed with tuberculosis initially
perceived their illness as a simple virus.
CONCLUSIONS: Diagnostic delay was common and prolonged. When individuals reached
a threshold of symptom severity, they addressed their health with the least
time-consuming, most economically feasible, and well-known healthcare option
available to them. In high-burden settings, more human and material resources are
required to promote tuberculosis case-finding initiatives, reduce tuberculosis
associated stigma and address the social determinants underlying diagnostic
delay.
PMCID: PMC5612650
Current knowledge, attitude and behaviour of hand and food hygiene in a developed
residential community of Singapore: a cross-sectional survey.
Pang J(1), Chua SW(2), Hsu L(3)(4).
Author information:
(1)Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School
of Public Health, National University of Singapore, Singapore, Singapore.
Junxiong_Pang@nuhs.edu.sg.
jonathan_lumen@nuhs.edu.sg.
hsuliyang@gmail.com.
(4)Department of Medicine, Yong Loo Lin School of Medicine, National University
of Singapore, Singapore, Singapore. hsuliyang@gmail.com.
BACKGROUND: Diarrhoea incidence has been increasing progressively over the past
years in developed countries, including Singapore, despite the accessibility and
availability to clean water, well-established sanitation infrastructures and
regular hygiene promotion. The aim of this study is to determine the current
knowledge, attitude and behaviour of hand and food hygiene, and the potential
risk factors of diarrhoea in a residential community of Singapore.
METHODS: A cross-sectional study was conducted within a residential area in the
west of Singapore from June to August 2013. A total of 1,156 household units were
randomly sampled and invited to participate in an interviewer-assisted survey
using standardised questionnaires. Descriptive, univariate and multivariate
analyses were performed using descriptive statistics, Fisher's Exact test and
multivariate logistic regression modelling, respectively. R program was used for
all statistical analysis. All tests were conducted at 5% level of significance
with 95% confidence intervals (CI) reported where applicable.
RESULTS: A total of 240 units (20.8%) consented and responded to the survey
invitation. About 77% of the expected knowledge and attitude were observed in at
least 80% of the participants, compared to only about 31% of the expected
behaviours and practises. Being single [adjusted odds ratio (AOR) = 2.29; 95%
CI = 1.16-4.48], having flu in the past six month (AOR = 3.24; 95%
CI = 1.74-6.06), preferred self-medication (AOR = 2.07; 95% CI = 1.06-4.12) were
risk factors of diarrhoea. Washing hands with water before attending to children
or sick persons (AOR = 0.30; 95% CI = 0.11-0.82), washing hands with water
(AOR = 0.16; 95% CI = 0.05-0.45) and water with soap (AOR = 0.29; 95%
CI = 0.12-0.72) after attending to children or sick persons, and hand washing
between 30 s to a minute (AOR = 0.44; 95% CI = 0.20-0.90) were protective factors
against diarrhoea.
CONCLUSIONS: Good knowledge and attitude of the participants did not positively
translate into high compliance and motivation to perform good hygiene practices.
This observation may have resulted in a significant extent on the increasing
diarrhoea incidences. Current interventions may be improved with more active
community partnership among the residents, schools and the relevant social
organizations, to raise awareness on the importance of compliance to good hygiene
practices, and the risk factors of diarrhoea. A large case-control study would be
required to validate these findings in future.
DOI: 10.1186/s12889-015-1910-3
PMCID: PMC4475322
Factors associated with treatment delay among newly diagnosed tuberculosis

patients in Dessie city and surroundings, Northern Central Ethiopia: a
Seid A(1), Metaferia Y(2).
Author information:
(1)Department of Medical Laboratory Science, College of Medicine and Health
nebat_abdurae2003@yahoo.com.
(2)Department of Medical Laboratory Science, College of Medicine and Health
BACKGROUND: Delayed treatment of tuberculosis (TB) cases increases the risk of

death and rate of infection in the community. Early diagnosis and initiation of
treatment is essential for effective TB control. The aim of this study was to
assess length of delays and analyze predictors of treatment delay of newly
diagnosed TB patients.
METHODS: A cross-sectional study was conducted in Dessie city and surroundings
from April1, 2016 to January 30, 2017. Fifteen health facilities of study area
were selected randomly and 382 adult TB patients were included consecutively.
Data were collected using a questionnaire and analyzed using SPSS version 20.0.
Delay was analyzed at three levels (patient, health system and total) using
median as cut-off. Logistic regression analysis was performed to investigate
predictors of delays. A p-value of ≤0.05 at multivariate analysis was considered
RESULTS: The median total, patients' and health system's delay was 36
[interquartile range (IQR): 24, 64], 30 (IQR: 15, 60) and 6 (IQR: 4, 8) days,
respectively. About 41 and 47% of patients had prolonged patients' and total
delay, respectively. Practicing self-medication [adjusted odds ratio (AOR): 3.0;
95% CI: 1.3-5.6], having more than three family member in the household (AOR:
1.6; 95% CI: 1.02-2.50), older age (≥55 years) (AOR: 2.7; 95% CI: 1.27-5.83),
being smear negative pulmonary tuberculosis (AOR: 2.3; 95% CI: 1.25-4.21) and
extrapulmonary tuberculosis (AOR: 2.3; 95% CI: 1.28-4.07) were independent
predictors of patients' delay. Initial visit of general practitioners (AOR: 2.57;
95% CI: 1.43-4.63) and more than one health care visit (AOR: 2.12; 95% CI:
1.30-3.46) were independent predictors of health system's delay. However,
patients' delay was shorter among widowed/divorced patients (AOR: 0.3; 95% CI:
0.1-0.8). Lower level of education [illiterate (AOR: 0.42; 95% CI: 0.20-0.92),
grade 1-8 (AOR: 0.38; 95% CI: 0.18-0.81)] and diagnosis of TB using a chest X-ray
(AOR, 0.32; 95% CI, 0.16-0.68) significantly reduce health system's delay.
CONCLUSION: About half of TB patients delayed beyond 36 days before starting
treatment, and the late patient health seeking behavior was the major contributor
of total delay. Development and implementation of strategies aimed at addressing
identified factors should be recognized in order to reduce TB treatment delay.
Further well designed research is needed to explore additional risk factors of
delayed treatment.
DOI: 10.1186/s12889-018-5823-9
PMCID: PMC6064094
PMID: 30055593
893. Int J Technol Assess Health Care. 2017 Jan;33(2):192-198. doi:

10.1017/S0266462317000320. Epub 2017 Jun 7.
SOCIETAL PERSPECTIVE ON COST DRIVERS FOR HEALTH TECHNOLOGY ASSESSMENT IN SINDH,

PAKISTAN.
Khowaja AR(1), Mitton C(2), Qureshi R(3), Bryan S(4), Magee LA(5), von Dadelszen
P(5), Bhutta ZA(6).
Author information:
(1)Department of Obstetrics and Gynaecology,and British Columbia Children's
Hospital,University of British Columbia,Centre for Clinical Epidemiology and
Evaluation,Vancouver Coastal Health Research Institute,Division of Women & Child
Health,Aga Khan University.
(2)Centre for Clinical Epidemiology and Evaluation,Vancouver Coastal Health
Research Institute,School of Population and Public Health,University of British
Columbia,craig.mitton@ubc.ca.
(3)Division of Women & Child Health,Aga Khan University.
(4)Centre for Clinical Epidemiology and Evaluation,Vancouver Coastal Health
Research Institute,School of Population and Public Health,University of British
Columbia.
(5)Molecular and Clinical Sciences Research Institute,St George's,University of
London,Department of Obstetrics and Gynaecology,St George's University Hospitals
NHS Foundation Trust.
(6)Division of Women & Child Health,Aga Khan University,Program for Global
Pediatric Research,Hospital For Sick Children,Toronto.
BACKGROUND: Understanding cost-drivers and estimating societal costs are

important challenges for economic evaluation of health technologies in low- and
middle-income countries (LMICs). This study assessed community experiences of
health resource usage and perceived cost-drivers from a societal perspective to
inform the design of an economic model for the Community Level Interventions for
Pre-eclampsia (CLIP) trials.
METHODS: Qualitative research was undertaken alongside the CLIP trial in two
districts of Sindh province, Pakistan. Nine focus groups were conducted with a
wide range of stakeholders, including pregnant women, mothers-in-law, husbands,
fathers-in-law, healthcare providers at community and health facility-levels, and
health decision/policy makers at district-level. The societal perspective
included out-of-pocket (OOP), health system, and program implementation costs
related to CLIP. Thematic analysis was performed using NVivo software.
RESULTS: Most pregnant women and male decision makers reported a large burden of
OOP costs for in- and out-patient care, informal care from traditional healers,
self-medication, childbirth, newborn care, transport to health facility, and
missed wages by caretakers. Many healthcare providers identified health system
costs associated with human resources for hypertension risk assessment,
transport, and communication about patient referrals. Health decision/policy
makers recognized program implementation costs (such as the mobile health
infrastructure, staff training, and monitoring/supervision) as major investments
for the health system.
CONCLUSIONS: Our investigation of care-seeking practices revealed financial
implications for families of pregnant women, and program implementation costs for
the health system. The societal perspective provided comprehensive knowledge of
cost drivers to guide an economic appraisal of the CLIP trial in Sindh, Pakistan.
DOI: 10.1017/S0266462317000320
PMCID: PMC5934709
894. Sci Rep. 2017 Jan 19;7:40653. doi: 10.1038/srep40653.
Investigating causality in associations between smoking initiation and

schizophrenia using Mendelian randomization.
Gage SH(1)(2), Jones HJ(1)(3), Taylor AE(1)(2), Burgess S(1)(4), Zammit S(3)(5),
Munafò MR(1)(2).
Author information:
(1)MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol,
UK.
(2)UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology,
University of Bristol, Bristol, UK.
(3)School of Social and Community Medicine, University of Bristol, Bristol, UK.
Cambridge, UK.
(5)MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University,
Cardiff, UK.
Smoking is strongly associated with schizophrenia. Although it has been widely

assumed that this reflects self-medication, recent studies suggest that smoking
may be a risk factor for schizophrenia. We performed two-sample bi-directional
Mendelian randomization using summary level genomewide association data from the
Tobacco And Genetics Consortium and Psychiatric Genomics Consortium. Variants
associated with smoking initiation and schizophrenia were combined using an
inverse-variance weighted fixed-effects approach. We found evidence consistent
with a causal effect of smoking initiation on schizophrenia risk (OR 1.73, 95% CI
1.30-2.25, p < 0.001). However, after relaxing the p-value threshold to include
variants from more than one gene and minimize the potential impact of pleiotropy,
the association was attenuated (OR 1.03, 95% CI 0.97-1.09, p = 0.32). There was
little evidence in support of a causal effect of schizophrenia on smoking
initiation (OR 1.01, 95% CI 0.98-1.04, p = 0.32). MR Egger regression sensitivity
analysis indicated no evidence for pleiotropy in the effect of schizophrenia on
smoking initiation (intercept OR 1.01, 95% CI 0.99-1.02, p = 0.49). Our findings
provide little evidence of a causal association between smoking initiation and
schizophrenia, in either direction. However, we cannot rule out a causal effect
of smoking on schizophrenia related to heavier, lifetime exposure, rather than
initiation.
DOI: 10.1038/srep40653
PMCID: PMC5244403
895. Alcohol. 2016 May;52:25-32. doi: 10.1016/j.alcohol.2016.01.004. Epub 2016 Feb

17.
Fear conditioning in mouse lines genetically selected for binge-like ethanol

drinking.
Crabbe JC(1), Schlumbohm JP(2), Hack W(2), Barkley-Levenson AM(2), Metten P(2),
Lattal KM(3).
Author information:
(1)Portland Alcohol Research Center, VA Portland Health Care System, Portland, OR
97239, USA; Department of Behavioral Neuroscience, Oregon Health & Science
University, Portland, OR 97239, USA. Electronic address: crabbe@ohsu.edu.
(2)Portland Alcohol Research Center, VA Portland Health Care System, Portland, OR
97239, USA; Department of Behavioral Neuroscience, Oregon Health & Science
University, Portland, OR 97239, USA.
(3)Department of Behavioral Neuroscience, Oregon Health & Science University,
Portland, OR 97239, USA.
The comorbidity of substance- and alcohol-use disorders (AUD) with other

psychiatric conditions, especially those related to stress such as post-traumatic
stress disorder (PTSD), is well-established. Binge-like intoxication is thought
to be a crucial stage in the development of the chronic relapsing nature of the
addictions, and self-medication through binge-like drinking is commonly seen in
PTSD patients. We have selectively bred two separate High Drinking in the Dark
(HDID-1 and HDID-2) mouse lines to reach high blood ethanol concentrations (BECs)
after a 4-h period of access to 20% ethanol starting shortly after the onset of
circadian dark. As an initial step toward the eventual goal of employing
binge-prone HDID mice to study PTSD-like behavior including alcohol binge
drinking, we sought first to determine their ability to acquire conditioned fear.
We asked whether these mice acquired, generalized, or extinguished conditioned
freezing to a greater or lesser extent than unselected control HS/Npt mice. In
two experiments, we trained groups of 16 adult male mice in a standard
conditioned fear protocol. Mice were tested for context-elicited freezing, and
then, in a novel context, for cue-induced freezing. After extinction tests,
renewal of conditioned fear was tested in the original context. Mice of all three
genotypes showed typical fear responding. Context paired with shock elicited
freezing behavior in a control experiment, but cue unpaired with shock did not.
These studies indicate that fear learning per se does not appear to be influenced
by genes causing predisposition to binge drinking, suggesting distinct neural
mechanisms. However, HDID mice are shown to be a suitable model for studying the
role of conditioned fear specifically in binge-like drinking.
DOI: 10.1016/j.alcohol.2016.01.004
PMCID: PMC4855306
896. J Adv Nurs. 2015 Dec;71(12):2965-76. doi: 10.1111/jan.12714. Epub 2015 Jun 23.
A randomized controlled trial of the feasibility and preliminary efficacy of a

texting intervention on medication adherence in adults prescribed oral
anti-cancer agents: study protocol.
Spoelstra SL(1), Given CW(2), Sikorskii A(3), Coursaris CK(4), Majumder A(3),
DeKoekkoek T(1), Schueller M(1), Given BA(1).
Author information:
(1)College of Nursing, Michigan State University, East Lansing, Michigan, USA.
(2)Institute for Health Care Studies, Michigan State University, East Lansing,
Michigan, USA.
(3)Department of Statistics and Probability, Michigan State University, East
Lansing, Michigan, USA.
(4)Department of Telecommunication, Information Studies (Dr. Coursaris), Michigan
State University, East Lansing, Michigan, USA.
AIM: The aim of this study was to report a study protocol that examines
feasibility, preliminary efficacy and satisfaction of a text message intervention
on the outcome of medication adherence in adult patients prescribed oral
anti-cancer agents.
BACKGROUND: Administration of oral anti-cancer agents occurs in the home setting,
requiring patients to self-manage the regimen as prescribed. However, many
barriers to medication adherence exist: regimens are often complex, with cycling
of two or more medications; side effects of treatment; most cancer patients are
older with comorbid conditions and competing demands; and cognitive decline and
forgetfulness may occur. Research indicates patients miss nearly one-third of the
prescribed oral anti-cancer agent dosages. Text message interventions have been
shown to improve medication adherence in chronic conditions other than cancer.
However, a majority of those patients were less than 50 years of age and most
cancer patients are diagnosed later in life.
DESIGN: A two-group randomized controlled trial with repeated measures.
METHODS: Seventy-five adult patients newly prescribed an oral anti-cancer agent
will be recruited (project funded in April 2013) from community cancer centres
and a specialty pharmacy. Participants will be randomized to either a control
group (n = 25; usual care) or an intervention group (n = 50; usual care plus text
messages timed to medication regimen). Outcome measures include: medication
adherence, feasibility and satisfaction with the intervention. Data will be
collected over 8 weeks: baseline, weekly and exit.
DISCUSSION: Standardized text message intervention protocol and detailed study
procedures have been developed in this study to improve medication adherence.
DOI: 10.1111/jan.12714
PMCID: PMC4689681
897. BMJ Open Diabetes Res Care. 2016 Jun 29;4(1):e000182. doi:
The agreement of patient-reported versus observed medication adherence in type 2

diabetes mellitus (T2DM).
Kelly K(1), Grau-Sepulveda MV(2), Goldstein BA(2), Spratt SE(3), Wolfley A(2),
Hatfield V(4), Murphy M(5), Jones E(6), Granger BB(7).
Author information:
(1)Department of Advanced Clinical Practice , Duke University Health System ,
Durham, North Carolina , USA.
(2)Duke Clinical Research Institute , Durham, North Carolina , USA.
(3)Department of Medicine , Duke University School of Medicine , Durham, North
Carolina , USA.
(4)Williamson Memorial Hospital Diabetes Management Clinic , Williamson, West
Virginia , USA.
(5)Department of Community Health , Cabarrus Health Alliance , Kannapolis, North
Carolina , USA.
(6)University of Mississippi Medical Center, School of Health Related Professions
, Jackson, Mississippi , USA.
(7)Duke University Health System, School of Nursing , Durham, North Carolina ,
USA.
OBJECTIVE: Medication adherence in type 2 diabetes mellitus (T2DM) improves

glycemic control and is associated with reduced adverse clinical events, and
accurately assessing adherence assessment is important. We aimed to determine
agreement between two commonly used adherence measures-the self-reported Morisky
Medication Adherence Scale (MMAS) and direct observation of medication use by
nurse practitioners (NPs) during home visits-and determine the relationship
between each measure and glycated hemoglobin (HbA1c).
RESEARCH DESIGN AND METHODS: We evaluated agreement between adherence measures in
the Southeastern Diabetes Initiative (SEDI) prospective clinical intervention
home visit cohort, which included high-risk patients (n=430) in 4
SEDI-participating counties. The mean age was 58.7 (SD 11.6) years. The majority
were white (n=210, 48.8%), female (n=236, 54.9%), living with a partner (n=316,
74.5%), and insured by Medicare/Medicaid (n=361, 84.0%). Medication adherence was
dichotomized to 'adherent' or 'not adherent' using established cut-points.
Inter-rater agreement was evaluated using Cohen's κ coefficient. Relationships
among adherence measures and HbA1c were evaluated using the Wilcoxon rank-sum
test and c-statistics.
RESULTS: Fewer patients (n=261, 61%) were considered adherent by self-reported
MMAS score versus the NP-observed score (n=338; 79%). Inter-rater agreement
between the two adherence measures was fair (κ=0.24; 95% CI 0.15 to 0.33;
p<0.0001). Higher adherence was significantly associated with lower HbA1c levels
for both measures, yet discrimination was weak (c-statistic=0.6).
CONCLUSIONS: Agreement between self-reported versus directly observed medication
adherence was lower than expected. Though scores for both adherence measures were
significantly associated with HbA1c, neither discriminated well for discrete
levels of HbA1c.
DOI: 10.1136/bmjdrc-2015-000182
PMCID: PMC4932248
PMID: 27403322
898. Am J Pharm Educ. 2019 Jun;83(5):6995. doi: 10.5688/ajpe6995.
Impacting Student Self-Efficacy and Beliefs of Medication Therapy Management

Through a Two-Week Elective.
Naboulsi M(1), Hardin H(1), Behar-Horenstein L(2), Su Y(3), Segal R(1).
Author information:
(1)University of Florida College of Pharmacy, Gainesville, Florida.
(2)University of Florida Colleges of Dentistry & Education, Gainesville, Florida.
(3)Amplify, Brooklyn, New York.
Objective. To develop and introduce an intensive, two-week Foundations of

Medication Therapy Management (MTM) elective course into the Doctor of Pharmacy
curriculum, and to determine whether the course impacted students'
self-confidence in their abilities to perform MTM services and future plans and
beliefs about implementing MTM in practice. Methods. The MTM course was an
interactive learning environment where students performed actual comprehensive
medication reviews within a real-world documentation platform. A 20-item,
Likert-scale survey was administered before and after the course to measure
students' confidence in learned skills, future plans for using MTM, and beliefs
about MTM. Results. Students reported a significant improvement in 10
MTM-specific skill domains. There were significant changes in students'
self-confidence in their ability to provide MTM services and in their beliefs
about MTM-related services. Students reported overall improvement in
self-perceived MTM specific skills. There was no significant change in students'
willingness or plans to engage in MTM-related practice in the future. Conclusion.
The findings showed that following participation in an MTM elective course,
student pharmacists' perceived ability to deliver MTM care increased and their
opinions about MTM services improved. Providing a brief MTM elective course that
used first-person case studies may empower student pharmacists to confidently
perform MTM services in subsequent courses and in their future practice.
DOI: 10.5688/ajpe6995
PMCID: PMC6630849
PMID: 31333264
899. Trials. 2017 Jul 20;18(1):339. doi: 10.1186/s13063-017-2075-4.
Patient-oriented education and medication management intervention for people with

decompensated cirrhosis: study protocol for a randomized controlled trial.
Hayward KL(1)(2), Martin JH(3), Cottrell WN(4), Karmakar A(1), Horsfall LU(5)(6),
Patel PJ(5)(6), Smith DD(7), Irvine KM(5), Powell EE(5)(6), Valery PC(8).
Author information:
(1)School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
(2)Pharmacy Department, Princess Alexandra Hospital, Brisbane, QLD, Australia.
(3)School of Medicine and Public Health, The University of Newcastle, Newcastle,
NSW, Australia.
(4)School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
(5)The Centre for Liver Disease Research, Translational Research Institute, The
University of Queensland, Brisbane, QLD, Australia.
(6)Department of Gastroenterology and Hepatology, Princess Alexandra Hospital,
Brisbane, QLD, Australia.
(7)Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD,
Australia.
(8)Cancer and Chronic Disease Research Group, Level 4, Central, QIMR Berghofer
Medical Research Institute, 300 Herston Rd, Brisbane, QLD, 4006, Australia.
patricia.valery@qimrberghofer.edu.au.
BACKGROUND: People with decompensated cirrhosis require complex medical care and
are often prescribed an intricate and frequently changing medication and
lifestyle regimen. However, many patients mismanage their medications or have
poor comprehension of their disease and self-management tasks. This can lead to
harm, hospitalization, and death.
METHODS/DESIGN: A patient-oriented education and medication management
intervention has been developed for implementation at a tertiary hospital
hepatology outpatient center in Queensland, Australia. Consenting patients with
decompensated cirrhosis will be randomly allocated to education intervention or
usual care treatment arms when they attend routine follow-up appointments. In the
usual care arm, participants will be reviewed by their hepatologist according to
the current model of care in the hepatology clinic. In the intervention arm,
participants will be reviewed by a clinical pharmacist to receive the education
and medication management intervention at baseline in addition to review by their
hepatologist. Intervention participants will also receive three further
educational contacts from the clinical pharmacist within the following 6-month
period, in addition to routine hepatologist review that is scheduled within this
time frame. All participants will be surveyed at baseline and follow-up
(approximately 6 months post-enrollment). Validated questionnaire tools will be
used to determine participant adherence, medication beliefs, illness perceptions,
and quality of life. Patients' knowledge of dietary and lifestyle modifications,
their current medications, and other clinical data will be obtained from the
survey, patient interview, and medical records. Patient outcome data will be
collected at 52 weeks.
DISCUSSION: The intervention described within this protocol is ready to adapt and
implement in hepatology ambulatory care centers globally. Investigation of
potentially modifiable variables that may impact medication management, in
addition to the effect of a clinical pharmacist-driven education and medication
management intervention on modifying these variables, will provide valuable
information for future management of these patients.
TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry
identifier: ACTRN12616000780459 . Registered on 15 June 2016.
DOI: 10.1186/s13063-017-2075-4
PMCID: PMC5520368
900. BMC Med Educ. 2015 Dec 18;15:223. doi: 10.1186/s12909-015-0513-0.
Factors associated with nursing students' medication competence at the beginning

and end of their education.
Sulosaari V(1), Huupponen R(2), Hupli M(3), Puukka P(4), Torniainen K(5),
Leino-Kilpi H(6).
Author information:
(1)Department of Nursing Science, University of Turku, FI-20014, Turku, Finland.
virsul@utu.fi.
(2)Clinical Pharmacology Unit, Department of Pharmacology, Drug Development and
Therapeutics, University of Turku, FI-20014, Turku, Finland.
risto.huupponen@utu.fi.
maija.hupli@utu.fi.
(4)National Institute for Health and Welfare, PL 57, FI-20521, Turku, Finland.
pauli.puukka@thl.fi.
(5)Hospital Pharmacy Hospital Pharmacy, Turku University Hospital, PO Box 52,
FI-20521, Turku, Finland. kirsti.torniainen@tyks.fi.
helena.leino-kilpi@utu.fi.
BACKGROUND: In previous studies, deficiencies in nursing students' medication

competence have been highlighted. However, the focus of research has been limited
especially to medication calculation competence and factors associated with it.
In order to develop undergraduate nursing education and research, an
understanding of the individual and learning environmental factors associated
with medication competence from a broader approach is warranted. Our aim was
therefore to evaluate the theoretical, practical and decision-making competence
of nursing students and to identify factors associated with their medication
competence at the beginning and end of their education.
METHODS: We used a descriptive, correlational study design with a structured
instrument including a set of potential associated factors, knowledge test,
medication calculation test and patient vignettes. The participants were nursing
students at the beginning (n = 328) and at the end of their education (n = 338).
Data were analyzed statistically.
RESULTS: In the evaluation of theoretical medication competence, the students'
mean score over the semesters was 72 % correct answers in a knowledge test. In
the evaluation of practical medication competence, the mean score was 74 %
correct answers in a medication calculation test. In the evaluation of
decision-making competence, the mean score was 57 % correct answers on deciding
the best action in the situation given in patient vignettes. At the end of their
education, students were able to solve patient vignettes significantly better.
Individual factors were most evidently associated with medication competence. At
the beginning of their education, students' previous academic success had a
stronger association with medication competence. However, at the end of the
education students' abilities in self-regulated learning and study motivation
were more significant factors.
CONCLUSION: The core elements of medication competence are significantly
interrelated, highlighting the need to provide integrated and comprehensive
medication education throughout the undergraduate education. Students' learning
style is associated with medication competence. There is a need for methods to
identify and support students having difficulties to self-regulate their
learning. To increase the safety of medication care of patients, research
focusing on the development of effective teaching methods is needed. This study
produced information for future nursing education research in this field,
especially for interventional studies.
DOI: 10.1186/s12909-015-0513-0
PMCID: PMC4683869
901. J Manag Care Spec Pharm. 2015 Aug;21(8):670-7.
Impact of Employer-Sponsored Onsite Pharmacy and Condition Management Programs on

Medication Adherence.
Aguilar KM(1), Hou Q, Miller RM.
Author information:
(1)Cerner Research Consulting, 600 Corporate Pointe, Ste. 320, Culver City, CA
90230. Kat.Aguilar@cerner.com.
BACKGROUND: Poor medication adherence is associated with worsened health outcomes

and higher health care expenditures. An increasing number of employers are
sponsoring wellness initiatives designed to support healthy lifestyles, improve
productivity, and offer a return on investment. Onsite pharmacies may facilitate
higher medication adherence rates by providing employees a convenient, low-cost
option for filling prescriptions that is integrated with other onsite health
services.
OBJECTIVES: To (a) assess the impact of an employer's onsite pharmacy on health
plan members' medication adherence using multiple measures of medication
adherence and persistence, including medication possession ratio (MPR), average
number of days until discontinuation (60-day gap in coverage), and percentage of
members without a 30-day gap in coverage, and (b) evaluate these outcomes between
those members who participated in condition management programs and those who did
not.
METHODS: A retrospective analysis of a self-insured employer's claims data was
undertaken. Medication adherence was assessed among the self-insured employer's
health plan members, which included subscribers and their dependents who filled
an asthma, depression, diabetes, hypertension, or hyperlipidemia medication at an
onsite pharmacy, compared with those who used a community pharmacy. Multiple
standard measures of medication adherence were considered. These measures
included MPR, which was assessed for 1- and 2-year time periods. MPR was chosen
because it is one of the most commonly referenced formulas in the literature and
represents adherence over a fixed period of time. In addition, medication
persistence was estimated by 30-day gaps in coverage and discontinuation of
treatment. To assess the impact of onsite pharmacy use and account for covariate
effects, the linear mixed model approach was applied with the logit transformed
MPR as the response variable. An analysis of MPR among condition management
participants was also performed.
RESULTS: In total, 2,498 subscribers and their dependents were included in the
analysis. The average MPR at 365 days was significantly higher (P < 0.0001)
among onsite pharmacy users for all medication types, ranging from 13% higher for
depression medications to 20% higher for hypertension medications. This trend
persisted at 730 days (P < 0.001), with average MPRs ranging from 6% higher for
hyperlipidemia medications to 11% higher for hypertension medications. A mixed
model analysis indicated that members who used the onsite pharmacy were 3.44
times more likely to demonstrate medication adherence (95% CI = 2.84-4.16; P <
0.0001) at 365 days. Likewise, at 180 and 365 days, onsite pharmacy users were
less likely to have 30-day gaps in treatment. The average number of days until
discontinuation (defined as a 60-day gap) was also significantly longer (P <
0.0001) among onsite pharmacy users, ranging from an average of 56 additional
days for depression medications to 105 additional days for hypertension
medications. While the average MPR tended to be higher among those subscribers
and their dependents who participated in condition management programs, this
trend was not statistically significant for all medication types.
CONCLUSIONS: Based on multiple measures, onsite pharmacy use was associated with
higher medication adherence, while the results were inconclusive for condition
management participation.
DOI: 10.18553/jmcp.2015.21.8.670
902. J Parkinsons Dis. 2018;8(3):441-446. doi: 10.3233/JPD-181314.
Precision Medicine in Parkinson's Disease - Exploring Patient-Initiated

Self-Tracking.
Riggare S(1), Hägglund M(1).
Author information:
(1)Department for Learning, Informatics, Management and Ethics, Karolinska
BACKGROUND: Individually tailored healthcare, in the form of precision medicine,

holds substantial potential for the future of medicine, especially for a complex
disorder like Parkinson's disease (PD). Patient self-tracking is an
under-researched area in PD.
OBJECTIVE: This study aimed to explore patient-initiated self-tracking in PD and
discuss it in the context of precision medicine.
METHODS: The first author used a smartphone app to capture finger-tapping data
and also noted times for medication intakes.
RESULTS: Data were collected during four subsequent days. Only data from the
first two days were complete enough to analyze, leading to the realization that
the collection of data over a period of time can pose a significant burden to
patients. From the first two days of data, a dip in finger function was observed
around the time for the second medication dose of the day.
CONCLUSIONS: Patient-initiated self-tracking enabled the first author to glean
important insights about how her PD symptoms varied over the course of the day.
Symptom tracking holds great potential in precision medicine and can, if shared
in a clinical encounter, contribute to the learning of both patient and
clinician. More work is needed to develop this field and extra focus needs to be
given to balancing the burden of tracking for the patient against any expected
benefit.
DOI: 10.3233/JPD-181314
PMCID: PMC6130409
PMID: 30124453
903. Neuropsychiatr Dis Treat. 2017 Mar 7;13:733-736. doi: 10.2147/NDT.S132355.
eCollection 2017.
Bipolar disorder recurrence prevention using self-monitoring daily mood charts:

case reports from a 5 year period.
Yasui-Furukori N(1), Nakamura K(1).
Author information:
(1)Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki
University, Hirosaki, Japan.
Mood symptoms in bipolar disorders are significantly related to psychosocial

events, and the personalized identification of symptom triggers is important.
Ecological momentary assessments have been used in paper-and-pencil form to
explore emotional reactivity to daily life stress in patients with bipolar
disorder. However, there are few data on long-term recurrence prevention effects
using ecological momentary assessments. Subjects were three outpatients with
bipolar disorder who had a history of at least one admission. They recorded
self-monitoring daily mood charts using a 5-point Likert scale. Paper-and-pencil
mood charts included mood, motivation, thinking speed, and impulsivity.
Additionally, they recorded waking time, bedtime, and medication compliance.
Fewer manic or depressive episodes including admissions occurred after
self-monitoring daily mood charts compared to patients' admissions in the past 3
years. This study suggests that self-monitoring daily mood in addition to mood
stabilizing medication has some effect on recurrence prevention in follow-up
periods of at least 5 years. Further studies with rigorous designs and large
sample sizes are needed.
DOI: 10.2147/NDT.S132355
PMCID: PMC5349503
PMID: 28331323
Conflict of interest statement: Disclosure Norio Yasui-Furukori has received

grant/research support or honoraria from and has been a lecturer for Asteras,
Dainippon, Eli Lilly, GSK, Janssen-Pharma, Meiji, Mochida, MSD, Otsuka, Pfizer,
Takeda, and Yoshitomi; none of the funders had a role in study design, data
collection and analysis, decision to publish, or preparation of the manuscript.
The authors report no other competing interests or conflicts of interest in this
work.
904. Am J Pharm Educ. 2016 Jun 25;80(5):86. doi: 10.5688/ajpe80586.
Using Simulation to Improve First-Year Pharmacy Students' Ability to Identify

Medication Errors Involving the Top 100 Prescription Medications.
Atayee RS(1), Awdishu L(1), Namba J(1).
Author information:
(1)University of California-San Diego, San Diego, California.
Objective. To evaluate first-year pharmacy students' ability to identify

medication errors involving the top 100 prescription medications. Design. In the
first quarter of a 3-quarter pharmacy self-care course, a didactic lecture on the
most common prescribing and dispensing prescription errors was presented to
first-year pharmacy students (P1) in preparation for a prescription review
simulation done individually and as a group. In the following quarter, they were
given a formal prescription review workshop before a second simulation involving
individual and group review of a different set of prescriptions. Students were
evaluated based on the number of correctly checked prescriptions and a
self-assessment of their confidence in reviewing prescriptions. Assessment. All
63 P1 students completed the prescription review simulations. The individual
scores did not significantly change, but group scores improved from 79 (16.2%) in
the fall quarter to 98.6 (4.7%) in the winter quarter. Students perceived
improvement of their prescription checking skills, specifically in their ability
to fill a prescription on their own, identify prescribing and dispensing errors,
and perform pharmaceutical calculations. Conclusion. A prescription review module
consisting of a didactic lecture, workshop and simulation-based methods to teach
prescription analysis was successful at improving first year pharmacy students'
knowledge, confidence, and application of these skills.
DOI: 10.5688/ajpe80586
PMCID: PMC4937981

eCollection 2016.
How payment scheme affects patients' adherence to medications? A systematic

review.
Aziz H(1), Hatah E(2), Makmor Bakry M(2), Islahudin F(2).
Author information:
Aziz, Kuala Lumpur, Malaysia; Pharmacy Division, Ministry of Health, Jalan
Universiti, Petaling Jaya, Malaysia.
Aziz, Kuala Lumpur, Malaysia.
BACKGROUND: A previous systematic review reported that increase in patients'

medication cost-sharing reduced patients' adherence to medication. However, a
study among patients with medication subsidies who received medication at no cost
found that medication nonadherence was also high. To our knowledge, no study has
evaluated the influence of different medication payment schemes on patients'
OBJECTIVE: This study aims to review research reporting the influence of payment
schemes and their association with patients' medication adherence behavior.
METHODS: This study was conducted using systematic review of published articles.
Relevant published articles were located through three electronic databases
Medline, ProQuest Medical Library, and ScienceDirect since inception to February
2015. Included articles were then reviewed and summarized narratively.
RESULTS: Of the total of 2,683 articles located, 21 were included in the final
analysis. There were four types of medication payment schemes reported in the
included studies: 1) out-of-pocket expenditure or copayments; 2) drug coverage or
insurance benefit; 3) prescription cap; and 4) medication subsidies. Our review
found that patients with "lower self-paying constraint" were more likely to
adhere to their medication (adherence rate ranged between 28.5% and 94.3%).
Surprisingly, the adherence rate among patients who received medication as fully
subsidized was similar (rate between 34% and 84.6%) as that of other payment
schemes. The studies that evaluated patients with fully subsidized payment scheme
found that the medication adherence was poor among patients with nonsevere
illness.
CONCLUSION: Although medication adherence was improved with the reduction of
cost-sharing such as lower copayment, higher drug coverage, and prescription cap,
patients with full-medication subsidies payment scheme (received medication at no
cost) were also found to have poor adherence to their medication. Future studies
comparing factors that may influence patients' adherence to medication among
patients who received medication subsidies should be done to develop strategies
to overcome medication nonadherence.
DOI: 10.2147/PPA.S103057
PMCID: PMC4874730
PMID: 27313448
906. Arthritis Care Res (Hoboken). 2017 Nov;69(11):1706-1713. doi:

10.1002/acr.23191.
Epub 2017 Sep 21.
Medication Nonadherence in Systemic Lupus Erythematosus: A Systematic Review.
Mehat P(1), Atiquzzaman M(1), Esdaile JM(1), AviÑa-Zubieta A(1), De Vera MA(1).
Author information:
(1)University of British Columbia, Vancouver, and Arthritis Research Centre of
Canada, Richmond, British Columbia, Canada.
OBJECTIVE: Medication nonadherence has not been well characterized in systemic

lupus erythematosus (SLE). Our objective was to a conduct a systematic review of
the literature, examining the burden and determinants of medication nonadherence
in SLE.
METHODS: We conducted a systematic search of Medline (1946-2015), Embase
(1974-2015), and Web of Science (1900-2015) databases and selected original
studies of SLE patients that evaluated nonadherence to SLE therapies as the
primary study outcome. We extracted information on study design, sample size,
length of followup, data sources, type of nonadherence problem examined,
adherence measures and reported estimates, and determinants of adherence reported
in multivariable analyses.
RESULTS: After screening 4,111 titles, 11 studies met the inclusion criteria.
Study sample sizes ranged from 32 to 246 patients, and studies were categorized
according to data source: self-report (5), electronic monitoring devices (1),
clinical records from rheumatology clinics (3), and refill information from
pharmacy records (2). Overall, the percentage of nonadherent patients ranged from
43% to 75%, with studies consistently reporting that over half of patients are
nonadherent. Studies also showed that up to 33% of patients discontinue therapy
after 5 years. Determinants of nonadherence included having depression, rural
residence, lower education level, and polypharmacy.
CONCLUSION: Overall, synthesis of current evidence suggests that the burden of
medication nonadherence is substantial in SLE. Findings highlight the importance
of developing interventions to support adherence and improve outcomes among
patients.
© 2017, American College of Rheumatology.
DOI: 10.1002/acr.23191

eCollection 2019.
Practice and predictors of self-care behaviors among ambulatory patients with

hypertension in Ethiopia.
Niriayo YL(1), Ibrahim S(1), Kassa TD(1), Asgedom SW(1), Atey TM(1), Gidey K(1),
Demoz GT(2), Kahsay D(1).
Author information:
(1)Department of Clinical Pharmacy, School of Pharmacy, College of Health
Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
(2)Clinical Pharmacy and Pharmacy Practice Unit, Department of Pharmacy, College
of Health Sciences, Aksum University, Aksum, Tigray, Ethiopia.
BACKGROUND: Despite the benefits of evidence-based self-care behaviors in the

management of hypertension, hypertensive patients have low rate of adherence to
the recommended self-care behaviors. Studies related to self-care behaviors among
hypertensive patients are limited in Ethiopia.
OBJECTIVE: To assess the rate of adherence to self-care behaviors and associated
factors among hypertensive patients.
METHOD: A cross-sectional study was conducted at the cardiac clinic of Ayder
comprehensive specialized hospital among ambulatory hypertensive patients.
Self-care behaviors were assessed using an adopted Hypertension Self-Care
Activity Level Effects (H-SCALE). Data were collected through patient interview
and review of medical records. Binary logistic regression analysis was performed
to identify predictors of self-care behaviors.
RESULT: A total of 276 patients were included in the study. The majority of the
participants were nonsmokers (89.9%) and alcohol abstainers (68.8%). Less than
half of the participants were adherent to the prescribed antihypertensive
medications (48.2%) and recommended physical activity level (44.9%). Moreover,
only 21.45% and 29% were adherent to weight management and low salt diet
recommendations, respectively. Our finding indicated that rural resident
(adjusted odds ratio [AOR]: 0.45, 95% confidence interval [CI]: 0.21-0.97),
comorbidity (AOR: 0.16, 95% CI: 0.08-0.31), and negative medication belief (AOR:
0.25, 95% CI: 0.14-0.46) were significantly associated with medication adherence.
Female sex (AOR: 0.46, 95% CI: 0.23-0.92), old age (AOR: 0.19, 95% CI: 0.06-0.60)
and lack of knowledge on self-care behaviors (AOR: 0.13, 95% CI: 0.03-0.57) were
significantly associated with adherence to weight management. Female sex (AOR:
1.97, 95% CI: 1.03-3.75) and lack of knowledge on self-care (AOR: 0.07, 95% CI:
0.03-0.16) were significantly associated with adherence to alcohol abstinence.
Female sex (AOR: 6.33, 95% CI: 1.80-22.31) and khat chewing (AOR: 0.08, 95% CI:
0.03-0.24) were significantly associated with non-smoking behavior. There was
also a significant association between female sex and physical activity (AOR:
0.22, 95% CI: 0.12-0.40).
CONCLUSION: The rate of adherence to self-care behaviors particularly weight
management, low salt intake, physical exercise, and medication intake was low in
our study. Elders, females, khat chewers, rural residents, and patients with
negative medication belief, comorbidity, and inadequate knowledge of SCBs were
less adherent to self-care behaviors compared to their counterparts. Therefore,
health care providers should pay more emphasis to patients at risk of having low
self-care behaviors.
PMCID: PMC6594646
PMID: 31242265

interests exist.
908. Am J Mens Health. 2018 Jul;12(4):779-787. doi: 10.1177/1557988316642274. Epub

2016 Apr 11.
"The More I Do, the Better I'll Be": The Treatment Preferences of Type 2 Diabetes
Among African American Men.
Sherman LD(1), Fawole T(1).
Author information:
(1)1 Texas A&M University, College Station, TX, USA.
To gain better insight to the preferred methods of managing and treating type 2
diabetes among African American men (AA men). Participants ( n = 19) were AA men
aged 35 to 69 years, who were diagnosed with type 2 diabetes. Participants were
recruited via community outreach efforts, including barbershops and churches
located in predominantly African American communities in Southeast United States.
On consent, individual interviews were conducted, audio recorded, and
subsequently transcribed. Transcripts were analyzed using a phenomenological
approach, and focused on identifying common themes among the descriptions of AA
men's experiences specific to type 2 diabetes. Participants' statements indicated
three main commonalities regarding treatment preferences which were medication,
dietary changes, and increase in exercise. Some participants from the study
stated that they preferred taking oral medication primarily out of convenience,
lack of pain, and how well the medicine makes them feel. Others stated educating
themselves and having a consistent relationship with the diabetes physician has
assisted them the most. Other participants shared preferences of being dedicated
to proper diet and exercise without any medication (pill or injection), as well
as maintaining the mental motivation needed to sustain management. Some
participants preferred to not take an oral pill, while some did not mind taking
pills at all. For some of the participants, it appears that it is easier for them
to manage their diabetes by prescription medication than by lifestyle changes
such as diet and exercise. Future studies are needed to investigate how social
support system also assists these men in managing their diabetes.
DOI: 10.1177/1557988316642274
PMCID: PMC6131424
909. Indian Heart J. 2017 Mar - Apr;69(2):133-135. doi: 10.1016/j.ihj.2017.03.004.
Our intellectuals have failed us - System of a Down.
Mishra S.
Medical profession is at cross-roads. On one hand are issues like medical

mal-practice and negligence but on the other are loss of respect, low
re-imbursement, lawsuits against medical professionals, violence against
physicians all contributing to a lot of stress as also a high suicide rate among
medical practitioners. While some of the problems seem related to changing
societal norms, most of them seem to stem from a failure, active or passive on
the part of medical intellectual, moving away from altruism, justice and self
regulation to pursuance of self interest with a consequent loss of trust in
doctor-patient relationship. The solution lies not only in regaining this trust
by following a path of community welfare, change in medical curriculum but also
recognition by society, the problems faced by medical fraternity; long hours, low
re-imbursement for mental and physical effort but most importantly loss of
prestige. Urgent steps to reverse this malady should be undertaken, otherwise a
full-fledged commercial and profit making medical field is the only alternative.
DOI: 10.1016/j.ihj.2017.03.004
PMCID: PMC5415115
910. J Behav Med. 2017 Aug;40(4):602-611. doi: 10.1007/s10865-017-9829-z. Epub 2017

Feb 11.
Depressive symptoms moderate the relationship between medication regimen

complexity and objectively measured medication adherence in adults with heart
failure.
Goldstein CM(1)(2), Gathright EC(3)(4), Gunstad J(4), A Dolansky M(5), Redle

JD(6), Josephson R(7)(8), Moore SM(5), Hughes JW(4)(6).
Author information:
(1)Department of Psychiatry and Human Behavior, Warren Alpert Medical School,
Brown University, 196 Richmond Street, Providence, RI, 02903, USA.
carly_goldstein@brown.edu.
(2)The Weight Control and Diabetes Research Center, The Miriam Hospital,
Providence, RI, 02903, USA. carly_goldstein@brown.edu.
Brown University, 196 Richmond Street, Providence, RI, 02903, USA.
(4)Department of Psychological Sciences, Kent State University, Kent, OH, 44242,
USA.
(5)School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA.
(6)Summa Cardiovascular Institute, Akron City Hospital, Summa Health System,
Akron, OH, 44307, USA.
(7)School of Medicine, Case Western Reserve University, Cleveland, OH, 44106,
USA.
(8)Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH,
44106, USA.
Patients with heart failure (HF) take many medications to manage their HF and
comorbidities, and 20-50% experience depression. Depressed individuals with more
complex medication regimens may be at greater risk for poor adherence. The aim of
this study was to assess depressive symptoms as a moderator of the relationship
between medication regimen complexity and medication adherence in an
observational study of patients with HF. In hierarchical linear regression with
the final sample of 299, the interaction of medication regimen complexity and
depressive symptoms predicted medication adherence, p < .05. For individuals with
higher levels of depressive symptoms [1 standard deviation (SD) above the mean],
more regimen complexity was associated with lower adherence. For individuals with
low (1 SD below the mean) or average levels of depressive symptoms, regimen
complexity was unrelated to medication adherence. Care management strategies,
including pillboxes and caregiver involvement, may be valuable in HF patients
with depression.
DOI: 10.1007/s10865-017-9829-z
PMCID: PMC5873320

eCollection 2015.
Effect of a Multi-Dimensional and Inter-Sectoral Intervention on the Adherence of

Psychiatric Patients.
Pauly A(1), Wolf C(1), Mayr A(2), Lenz B(3), Kornhuber J(3), Friedland K(1).
Author information:
(1)Molecular & Clinical Pharmacy, Friedrich-Alexander University
Erlangen-Nürnberg (FAU), Erlangen, Germany.
(2)Department of Medical Informatics, Biometry and Epidemiology,
Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.
(3)Department of Psychiatry and Psychotherapy, Friedrich-Alexander University
Erlangen-Nürnberg (FAU), Erlangen, Germany.
BACKGROUND: In psychiatry, hospital stays and transitions to the ambulatory

sector are susceptible to major changes in drug therapy that lead to complex
medication regimens and common non-adherence among psychiatric patients. A
multi-dimensional and inter-sectoral intervention is hypothesized to improve the
adherence of psychiatric patients to their pharmacotherapy.
METHODS: 269 patients from a German university hospital were included in a
prospective, open, clinical trial with consecutive control and intervention
groups. Control patients (09/2012-03/2013) received usual care, whereas
intervention patients (05/2013-12/2013) underwent a program to enhance adherence
during their stay and up to three months after discharge. The program consisted
of therapy simplification and individualized patient education (multi-dimensional
component) during the stay and at discharge, as well as subsequent phone calls
after discharge (inter-sectoral component). Adherence was measured by the
"Medication Adherence Report Scale" (MARS) and the "Drug Attitude Inventory"
(DAI).
RESULTS: The improvement in the MARS score between admission and three months
after discharge was 1.33 points (95% CI: 0.73-1.93) higher in the intervention
group compared to controls. In addition, the DAI score improved 1.93 points (95%
CI: 1.15-2.72) more for intervention patients.
CONCLUSION: These two findings indicate significantly higher medication adherence
following the investigated multi-dimensional and inter-sectoral program.
TRIAL REGISTRATION: German Clinical Trials Register DRKS00006358.
PMCID: PMC4593549
912. Neurourol Urodyn. 2015 Jun;34(5):424-8. doi: 10.1002/nau.22605. Epub 2014 Apr
9.
Validation of a self-administered instrument to measure adherence to

anticholinergic drugs in women with overactive bladder.
Andy UU(1), Harvie HS(1), Smith AL(2), Propert KJ(3), Bogner HR(4), Arya LA(1).
Author information:
(1)Division of Urogynecology, Department of Obstetrics and Gynecology, University
of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
(2)Division of Urology, Department of Surgery, University of Pennsylvania School
of Medicine, Philadelphia, Pennsylvania.
(3)Department of Biostatistics and Epidemiology, University of Pennsylvania
(4)Department of Family Medicine and Community Health, University of Pennsylvania
AIM: To validate a self-administered instrument, the Medication Adherence

Self-Report Inventory (MASRI) for measuring adherence to anti-cholinergic
medication for overactive bladder (OAB).
METHODS: Prospective study in 131 women with OAB treated with fesoterodine.
Adherence was measured at 8 and 12 weeks using an interviewer administered brief
medication questionnaire (BMQ) that assesses barriers to adherence (criterion
standard), the MASRI, and pill count. Construct, concurrent and discriminant
validity of the MASRI was assessed. We hypothesized that women who were
non-adherent as measured by the MASRI would be more likely to have a belief
barrier than women who were adherent to medication.
RESULTS: Women diagnosed as non-adherent by the MASRI were more likely to report
a belief barrier to taking medication as compared to adherent women at 8 weeks
(80% vs. 38%, P < 0.001) and at 12 weeks (70% vs. 40%, P = 0.003). Significant
correlations were noted between adherence rates measured by the MASRI and the BMQ
at 8 weeks (r = 0.87, P < 0.001) and 12 weeks (r = 0.90, P < 0.001). Moderate
correlation was noted between the adherence rate as measured by the MASRI and
pill count at 8 weeks (r = 0.49, P = 0.02) but not at 12 weeks (r = 0.05,
P = 0.87). The MASRI correctly identified 93% and 96% of non-adherent women at 8
and 12 weeks, respectively. Sensitivity, specificity, and positive likelihood
ratio of the MASRI for predicting non-adherence was 91%, 82%, and 5.1 at 8 weeks
and 90%, 85% and 6.1 at 12 weeks.
CONCLUSIONS: The MASRI is a valid self-administered tool for measuring adherence
to anti-cholinergic medication in women with OAB.
DOI: 10.1002/nau.22605
PMCID: PMC4420725
913. JMIR Hum Factors. 2018 Feb 20;5(1):e7. doi: 10.2196/humanfactors.8948.
How Health Care Professionals Evaluate a Digital Intervention to Improve

Medication Adherence: Qualitative Exploratory Study.
Thomson K(1), Brouwers C(#)(2), Damman OC(2), de Bruijne MC(2), Timmermans DR(2),
Melles M(1).
Author information:
(1)Faculty of Industrial Design Engineering, Delft University of Technology,
Delft, Netherlands.
(2)Department of Public and Occupational Health and Amsterdam Public Health
Research Institute, VU University Medical Center, Amsterdam, Netherlands.
BACKGROUND: Medication nonadherence poses a serious and a hard-to-tackle problem

for many chronic diseases. Electronic health (eHealth) apps that foster patient
engagement and shared decision making (SDM) may be a novel approach to improve
OBJECTIVE: The aim of this study was to investigate the perspective of health
care professionals regarding a newly developed digital app aimed to improve
medication adherence. Familial hypercholesterolemia (FH) was chosen as a case
example.
METHODS: A Web-based prototype of the eHealth app-MIK-was codesigned with
patients and health care professionals. After user tests with patients, we
performed semistructured interviews and user tests with 12 physicians from 6
different hospitals to examine how the functionalities offered by MIK could
assist physicians in their consultation and how they could be integrated into
daily clinical practice. Qualitative thematic analysis was used to identify
themes that covered the physicians' evaluations.
RESULTS: On the basis of the interview data, 3 themes were identified, which were
(1) perceived impact on patient-physician collaboration; (2) perceived impact on
the patient's understanding and self-management regarding medication adherence;
and (3) perceived impact on clinical decisions and workflow.
CONCLUSIONS: The eHealth app MIK seems to have the potential to improve the
consultation between the patient and the physician in terms of collaboration and
patient engagement. The impact of eHealth apps based on the concept of SDM for
improving medication-taking behavior and clinical outcomes is yet to be
evaluated. Insights will be useful for further development of eHealth apps aimed
at improving self-management by means of patient engagement and SDM.
©Karen Thomson, Corline Brouwers, Olga C Damman, Martine C de Bruijne, Danielle

RM Timmermans, Marijke Melles. Originally published in JMIR Human Factors
(http://humanfactors.jmir.org), 20.02.2018.
DOI: 10.2196/humanfactors.8948
PMCID: PMC5840481
PMID: 29463494
914. Prim Care Diabetes. 2015 Apr;9(2):127-34. doi: 10.1016/j.pcd.2014.06.003. Epub

2014 Jul 22.
Improvements in illness self-management and psychological distress associated

with telemonitoring support for adults with diabetes.
Aikens JE(1), Rosland AM(2), Piette JD(3).
Author information:
(1)Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
Electronic address: aikensj@umich.edu.
(2)Division of General Internal Medicine, University of Michigan, Ann Arbor, MI,
USA; VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.
(3)VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA;
Department of Health Behavior and Health Education, School of Public Health,
University of Michigan, Ann Arbor, MI, USA.
OBJECTIVE: The objective of this observational open label trial was to

characterize changes in diabetes self-management and psychological distress
associated with a mobile health (mHealth) interactive voice response (IVR)
self-management support program.
METHODS: For 3-6 months, 301 patients with diabetes received weekly IVR calls
assessing health status and self-care and providing tailored pre-recorded
self-management support messages. Patients could participate together with an
informal caregiver who received suggestions on self-management support, and
patients' clinicians were notified automatically when patients reported
significant problems.
RESULTS: Patients completed 84% of weekly calls, providing 5682 patient-weeks of
data. Thirty-nine percent participated with an informal caregiver. Outcome
analyses adjusted for study design factors and sociodemographics indicated
significant pre-post improvement in medication adherence, physical functioning,
depressive symptoms, and diabetes-related distress (all p values <0.001).
Analyses of self-management problems indicated that as the intervention
proceeded, there were significant improvements in patients' IVR-reported
frequency of weekly medication adherence, SMBG performance, checking feet, and
frequency of abnormal self-monitored blood glucose readings (all p values
<0.001).
CONCLUSIONS: We conclude that the combined program of automated telemonitoring,
clinician notification, and informal caregiver involvement was associated with
consistent improvements in medication adherence, diabetes self-management
behaviors, physical functioning, and psychological distress. A randomized
controlled trial is needed to verify these encouraging findings.
Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All
rights reserved.
DOI: 10.1016/j.pcd.2014.06.003
PMCID: PMC4303563

eCollection 2018.
Understanding ethno-cultural differences in cardiac medication adherence

behavior: a Canadian study.
King-Shier K(1)(2), Quan H(2), Mather C(3), Chong E(4), LeBlanc P(1), Khan N(5).
Author information:
(1)Faculty of Nursing, University of Calgary, Calgary, Canada, kingk@ucalgary.ca.
(2)Department of Community Health Sciences, Cumming School of Medicine,
University of Calgary, Calgary, Canada, kingk@ucalgary.ca.
(3)Department of Anthropology, Faculty of Arts, University of Calgary, Calgary,
Canada.
(4)Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver,
Canada.
(5)Division of General Internal Medicine, Faculty of Medicine, University of
British Columbia, Vancouver, Canada.
Background: There are ethno-cultural differences in cardiac patients' adherence

to medications. It is unclear why this occurs. We thus aimed to generate an
in-depth understanding about the decision-making process and potential
ethno-cultural differences, of white, Chinese, and south Asian cardiac patients
when making the decision to adhere to a medication regimen.
Methods: A hierarchical descriptive decision-model was generated based on
previous qualitative work, pilot tested, and revised to be more parsimonious. The
final model was examined using a novel group of 286 cardiac patients, using their
self-reported adherence as the reference. Thereafter, each node was examined to
identify decision-making constructs that might be more applicable to white,
Chinese or south Asian groups.
Results: Non-adherent south Asians were most likely to identify a lack of receipt
of detailed medication information, and less confidence and trust in the health
care system and health care professionals. Both Chinese and south Asian
participants were less likely to be adherent when they had doubts about western
medicine (eg, the effects and safety of the medication). Being able to afford the
cost of medications was associated with increased adherence. Being away from home
reduced the likelihood of adherence in each group. The overall model had 67.1%
concordance with the participants' initial self-reported adherence, largely due
to participants' overreporting adherence.
Conclusion: These identified elements of the decision-making process are
generally not considered in traditionally used medication adherence
questionnaires. Importantly these elements are modifiable and ought to be the
focus of both interventions and measurement of medication adherence.
DOI: 10.2147/PPA.S169167
PMCID: PMC6135069
PMID: 30233153

916. J Gen Intern Med. 2015 Apr;30(4):469-75. doi: 10.1007/s11606-014-3139-8. Epub

2014 Dec 13.
Can phone-based motivational interviewing improve medication adherence to

antiplatelet medications after a coronary stent among racial minorities? A
randomized trial.
Palacio AM(1), Uribe C, Hazel-Fernandez L, Li H, Tamariz LJ, Garay SD,

Carrasquillo O.
Author information:
(1)Department of Medicine, University of Miami Miller School of Medicine, Miami,
FL, USA, APalacio2@med.miami.edu.
BACKGROUND: Minorities have lower adherence to cardiovascular medications and

have worst cardiovascular outcomes post coronary stent placement
OBJECTIVE: The aim of this study is to compare the efficacy of phone-delivered
Motivational Interviewing (MINT) to an educational video at improving adherence
to antiplatelet medications among insured minorities.
DESIGN: This was a randomized study.
PARTICIPANTS: We identified minorities with a recently placed coronary stent from
an administrative data set by using a previously validated algorithm.
INTERVENTIONS: MINT subjects received quarterly phone calls and the DVD group
received a one-time mailed video.
MAIN MEASURES: Outcome variables were collected at baseline and at 12-month
post-stent, using surveys and administrative data. The primary outcome was
antiplatelet (clopidogrel and prasugrel) adherence measured by Medication
Possession Ratio (MPR) and self- reported adherence (Morisky score). We also
measured appropriate adherence defined as an MPR ≥ 0.80.
KEY RESULTS: We recruited 452 minority subjects with a new coronary stent (44 %
Hispanics and 56 % Black). The patients had a mean age of 69.5 ± 8.8, 58 % were
males, 78 % had an income lower than $30,000 per year and only 22 % had achieved
high school education or higher. The MPR for antiplatelet medications was 0.77
for the MINT group compared to 0.70 for the DVD group (p < 0.05). The percentage
of subjects with adequate adherence to their antiplatelet medication was 64 % in
the MINT group and 50 % in the DVD group (p < 0.01). Self-reported adherence at
12 months was higher in the MINT group compared to the DVD group (p < 0.01).
Results were similar among drug-eluting stent (DES) recipients.
CONCLUSIONS: Among racial minorities, a phone-based motivational interview is
effective at improving adherence to antiplatelet medications post coronary stent
placement. Phone-based MINT seems to be a promising and cost-effective strategy
to modify risk behaviors among minority populations at high cardiovascular risk.
DOI: 10.1007/s11606-014-3139-8
PMCID: PMC4370989
917. Psychiatr Pol. 2015 May-Jun;49(3):649-52. doi: 10.12740/PP/43441.
Letter to Editor. New assessment of the validity of the Brief Measure to Assess
Perception of Self-Influence on the Disease Course: A Version for Schizophrenia.
Kokoszka A(1), Łukasiewicz A(2).

Author information:
(1)II Department of Psychiatry, Medical University of Warsaw.
(2)Psychiatric Day Ward, Masovian Brodno Hospital in Warsaw.
INTRODUCTION: Clinical observations suggest that the Brief Measure to Assess

Perception of Self-Influence on the Disease Course: A Version for Schizophrenia
has the better reliability, than presented in the original publication of the
scale [1]. It is used in research and their results indicate moderate relations
between the perception of the self-influence on schizophrenia course and social
functioning as well as adherence to the recommended treatment. These
circumstances justify and new assessment of the reliability of the scale.
MATERIAL AND METHODS: Detailed scale for competent judges, who had better
opportunity for the comprehensive examination of 59 participants, 27 men and 29
women of age 22-72 lat (M = 40.69; SD = 11.85).
RESULTS: The Spearman's correlation between the scores on the version for
schizophrenia of the Brief Measure to Assess Perception of Self-Influence on the
Disease Course and the assessment of the patients' perception of self-influence
on the schizophrenia course by the competent judges rho was 0.56. Whereas, in the
first study Pearson's r was 0.45.
CONCLUSIONS: Brief Measure to Assess Perception of Self-Influence on the Disease
Course - Version for Schizophrenia has good enough validity, as for so brief
scale. It can be used in research and clinical practice.
DOI: 10.12740/PP/43441
918. Chin Med J (Engl). 2016 Aug 20;129(16):1929-34. doi: 10.4103/0366-6999.187858.
Self-controlled Study of Onychomycosis Treated with Long-pulsed Nd:YAG 1064-nm

Laser Combined with Itraconazole.
Li Y(1), Xu J(2), Zhao JY(1), Zhuo FL(1).
Author information:
(1)Department of Dermatology, Beijing Friendship Hospital, Capital Medical
University, Beijing 100050, China.
(2)Department of Dermatology, Capital Institute of Pediatrics, Beijing 100020,
China.
BACKGROUND: Onychomycosis is a fungal infection of the nail plate and subungual

area. In this study, we examined the efficacy of laser treatment using
self-controlled study programs involving a long-pulsed Nd:YAG 1064-nm laser
combined with oral medication.
METHODS: Self-controlled strategies were followed in this study. The patients
received treatment with oral itraconazole in conjunction with long-pulsed Nd:YAG
1064-nm laser treatment at the nails of the unilateral limb once a week for a
total of four times. A total of 84 affected nails were divided into Group A (mild
to moderate) and Group B (severe) according to disease severity. Affected nails
with the same Scoring Clinical Index for Onychomycosis scores were selected to
compare the therapeutic effects of the pure medication treatment group and the
combination treatment group with a 24-week follow-up period.
RESULTS: In Group A, at the 8th, 16th, and 24th weeks of follow-up, the
efficacies in the pure medication treatment group were 81.0%, 81.0%, and 90.5%,
respectively, while those in the combination treatment group were 100%, 95.2%,
and 90.5%, respectively. The differences between groups were not significant (8th
week: χ2 = 4.421, P> 0.05; 16th week: χ2 = 2.043, P> 0.05; 24th week: χ2 = 0.00,
P > 0.05). In Group B, at the 8th, 16th, and 24th weeks of follow-up, the
efficacies in the pure medication treatment group were 61.9%, 66.7%, and 52.4%,
respectively, while those in the combination treatment group were 95.2%, 90.5%,
and 100%, respectively. The differences between groups at the 8th and 24th weeks
of follow-up were statistically significant (8th week: χ2 = 6.929, P< 0.05; 24th
week: χ2 = 13.125, P < 0.05).
CONCLUSIONS: For patients with mild or moderate onychomycosis, we recommended a
pure medication treatment or combination treatment with medication and laser. For
those patients with severe onychomycosis, we recommended a combination of
medication and laser therapy.
DOI: 10.4103/0366-6999.187858
PMCID: PMC4989423
919. AMIA Annu Symp Proc. 2017 Feb 10;2016:1959-1966. eCollection 2016.
Medication Harmony: A Framework to Save Time, Improve Accuracy and Increase

Patient Activation.
Pandolfe F(1), Crotty BH(1), Safran C(1).
Author information:
(1)Division of Clinical Informatics, Beth Israel Deaconess Medical Center,
Boston, MA; Harvard Medical School, Boston, MA.
Incompletely reconciled medication lists contribute to prescribing errors and

adverse drug events. Providers expend time and effort at every point of patient
contact attempting to curate a best possible medication list, and yet often the
list is incomplete or inaccurate. We propose a framework that builds upon the
existing infrastructure of a health information exchange (HIE), centralizes data
and encourages patient activation. The solution is a constantly accessible,
singular, patient-adjudicated medication list that incorporates useful
information and features into the list itself. We aim to decrease medication
errors across transitions of care, increase awareness of potential drug-drug
interactions, improve patient knowledge and self-efficacy regarding medications,
decrease polypharmacy, improve prescribing safety and ultimately decrease cost to
the health-care system.
PMCID: PMC5333345
920. Contraception. 2018 Feb;97(2):108-115. doi:

10.1016/j.contraception.2017.07.170.
Epub 2017 Aug 8.
Accompaniment of second-trimester abortions: the model of the feminist Socorrista

network of Argentina.
Zurbriggen R(1), Keefe-Oates B(2), Gerdts C(3).
Author information:
(1)La Revuelta, Neuquén, Patagonia, Argentina. Electronic address:
ruthlibertaria@gmail.com.
(2)Ibis Reproductive Health, 1330 Broadway Street, Suite 1100, Oakland, CA 94612,
USA. Electronic address: bkeefeoates@ibisreproductivehealth.org.
(3)Ibis Reproductive Health, 1330 Broadway Street, Suite 1100, Oakland, CA 94612,
USA. Electronic address: cgerdts@ibisreproductivehealth.org.
OBJECTIVE: Legal restrictions on abortion access impact the safety and timing of
abortion. Women affected by these laws face barriers to safe care that often
result in abortion being delayed. Second-trimester abortion affects vulnerable
groups of women disproportionately and is often more difficult to access. In
Argentina, where abortion is legally restricted except in cases of rape or threat
to the health of the woman, the Socorristas en Red, a feminist network, offers a
model of accompaniment wherein they provide information and support to women
seeking second-trimester abortions. This qualitative analysis aimed to understand
Socorristas' experiences supporting women who have second-trimester medication
abortion outside the formal health care system.
STUDY DESIGN: We conducted 2 focus groups with 16 Socorristas in total to
understand experiences accompanying women having second-trimester medication
abortion who were at 14-24 weeks' gestational age. We performed a thematic
analysis of the data and present key themes in this article.
RESULTS: The Socorristas strived to ensure that women had the power of choice in
every step of their abortion. These cases required more attention and logistical,
legal and medical risks than first-trimester care. The Socorristas learned how to
help women manage the possibility of these risks and were comfortable providing
this support. They understood their work as activism through which they aim to
destigmatize abortion and advocate against patriarchal systems denying the right
to abortion.
CONCLUSION: Socorrista groups have shown that they can provide supportive,
women-centered accompaniment during second-trimester medication abortions outside
the formal health care system in a setting where abortion access is legally
restricted.
IMPLICATIONS: Second-trimester self-use of medication abortion outside of the
formal health system supported by feminist activist groups could provide an
alternative model for second-trimester care worldwide. More research is needed to
document the safety and effectiveness of this accompaniment service-provision
model.
DOI: 10.1016/j.contraception.2017.07.170
921. Psychol Health. 2017 Feb;32(2):145-165. Epub 2016 Oct 24.
Motivational interviewing or reminders for glaucoma medication adherence: Results

of a multi-site randomised controlled trial.
Cook PF(1), Schmiege SJ(1), Mansberger SL(2), Sheppler C(2), Kammer J(3),
Fitzgerald T(4), Kahook MY(5).
Author information:
(1)a College of Nursing , University of Colorado , Aurora , CO , USA.
(2)b Devers Eye Institute, Legacy Health , Portland , OR , USA.
(3)c Vanderbilt Eye Institute , Vanderbilt University , Nashville , TN , USA.
(4)d Global Health Outcomes , Merck & Co. Inc. , White Horse Station , NJ , USA.
(5)e School of Medicine , University of Colorado , Aurora , CO , USA.
OBJECTIVE: Nonadherence reduces glaucoma treatment efficacy. Motivational

interviewing (MI) is a well-studied adherence intervention, but has not been
tested in glaucoma. Reminder interventions also may improve adherence.
DESIGN: 201 patients with glaucoma or ocular hypertension were urn-randomised to
receive MI delivered by an ophthalmic technician (OT), usual care or a minimal
behavioural intervention (reminder calls).
MAIN OUTCOME MEASURES: Outcomes included electronic monitoring with Medication
Event Monitoring System (MEMS) bottles, two self-report adherence measures,
patient satisfaction and clinical outcomes. Multilevel modelling was used to test
differences in MEMS results by group over time; ANCOVA was used to compare groups
on other measures.
RESULTS: Reminder calls increased adherence compared to usual care based on MEMS,
p = .005, and self-report, p = .04. MI had a nonsignificant effect but produced
higher satisfaction than reminder calls, p = .007. Treatment fidelity was high on
most measures, with observable differences in behaviour between groups. All
groups had high baseline adherence that limited opportunities for change.
CONCLUSION: Reminder calls, but not MI, led to better adherence than usual care.
Although a large literature supports MI, reminder calls might be a cost-effective
intervention for patients with high baseline adherence. Replication is needed
with less adherent participants.
DOI: 10.1080/08870446.2016.1244537
PMCID: PMC5560586

eCollection 2014.
Development of patient-centric linguistically tailored psychoeducational messages

to support nutrition and medication self-management in type 2 diabetes: a
feasibility study.
Ellis RJ(1), Connor U(2), Marshall J(2).
Author information:
(1)Indiana University School of Nursing, International Center for Intercultural
Communication, Indiana University, Indianapolis, IN, USA.
(2)Indiana University School of Liberal Arts, International Center for
Intercultural Communication, Indiana University, Indianapolis, IN, USA.
PURPOSE: This study evaluated the feasibility of developing linguistically

tailored educational messages designed to match the linguistic styles of patients
segmented into types with the Descriptor™, and to determine patient preferences
for tailored or standard messages based on their segments.
PATIENTS AND METHODS: Twenty patients with type 2 diabetes (T2DM) were recruited
from a diabetes health clinic. Participants were segmented using the Descriptor™,
a language-based questionnaire, to identify patient types based on their control
orientation (internal/external), agency (high/low), and affect
(positive/negative), which are well studied constructs related to T2DM
self-management. Two of the seven self-care behaviors described by the American
Association of Diabetes Educators (healthy eating and taking medication) were
used to develop standard messages and then linguistically tailored using features
of the six different construct segment types of the Descriptor™. A subset of
seven participants each provided feedback on their preference for standard or
linguistically tailored messages; 12 comparisons between standard and tailored
messages were made.
RESULTS: Overall, the tailored messages were preferred to the standard messages.
When the messages were matched to specific construct segment types, the tailored
messages were preferred over the standard messages, although this was not
CONCLUSION: Linguistically tailoring messages based on construct segments is
feasible. Furthermore, tailored messages were more often preferred over standard
messages. This study provides some preliminary evidence for tailoring messages
based on the linguistic features of control orientation, agency, and affect. The
messages developed in this study should be tested in a larger more representative
sample. The present study did not explore whether tailored messages were better
understood. This research will serve as preliminary evidence to develop future
studies with the ultimate goal to design intervention studies to investigate if
linguistically tailoring communication within the context of patient education
influences patient knowledge, motivation, and activation toward making healthy
behavior changes in T2DM self-management.
DOI: 10.2147/PPA.S69291
PMCID: PMC4199751
PMID: 25336928
923. Patient Educ Couns. 2014 Dec;97(3):418-25. doi: 10.1016/j.pec.2014.09.011.

Epub
2014 Sep 20.
Family involvement is helpful and harmful to patients' self-care and glycemic

control.
Mayberry LS(1), Osborn CY(2).
Author information:
(1)Department of Medicine, Vanderbilt University Medical Center, Nashville,
Tennessee, USA. Electronic address: lindsay.mayberry@vanderbilt.edu.
(2)Department of Medicine, Vanderbilt University Medical Center, Nashville,
Tennessee, USA; Department of Biomedical Informatics, Vanderbilt University
Medical Center, Nashville, Tennessee, USA; Center for Health Behavior and Health
Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
OBJECTIVE: We assessed the relationships between supportive and obstructive

family behaviors and patients' diabetes self-care activities and HbA1C, and
potential interaction effects and differences by demographic characteristics.
METHODS: In a cross-sectional study, 192 adults with type 2 diabetes completed
the Diabetes Family Behavior Checklist-II, the Summary of Diabetes Self-Care
Activities, and a glycemic control (HbA1C) test.
RESULTS: Participants reported similar rates of supportive and obstructive
behaviors that were positively correlated (rho=0.61, p<0.001). In adjusted
analyses, supportive family behaviors were associated with adherence to different
self-care behaviors (β=0.20 to 0.50, p<0.05), whereas obstructive family
behaviors were associated with less adherence to self-care behaviors (β=-0.28 to
-0.39, p<0.01) and worse HbA1C (β=0.18, p<0.05). Supportive behaviors protected
against the detrimental effect of obstructive behaviors on HbA1C (interaction
β=-0.22, p<0.001). Non-Whites reported more supportive and obstructive behaviors
than Whites, but race did not affect the relationships between family behaviors
and self-care or HbA1C.
CONCLUSION: Involving family members in patients' diabetes management may impede
patients' self-care and compromise their glycemic control unless family members
are taught to avoid obstructive behaviors.
PRACTICE IMPLICATIONS: Our findings endorse interventions that help family
members develop actionable plans to support patients' self-care and train them to
communicate productively about diabetes management.
DOI: 10.1016/j.pec.2014.09.011
PMCID: PMC4254324
924. Br J Gen Pract. 2015 Nov;65(640):e776-83. doi: 10.3399/bjgp15X687433.
Improving management and effectiveness of home blood pressure monitoring: a

qualitative UK primary care study.
Grant S(1), Greenfield SM(1), Nouwen A(2), McManus RJ(3).
Author information:
(1)Primary Care Clinical Sciences, University of Birmingham, Birmingham.
(2)Department of Psychology, School of Science and Technology, Middlesex
University London, London.
(3)Nuffield Department of Primary Care Health Sciences, NIHR School for Primary
Care Research, University of Oxford, Oxford.
BACKGROUND: Self-monitoring blood pressure (SMBP) is becoming an increasingly

prevalent practice in UK primary care, yet there remains little conceptual
understanding of why patients with hypertension engage in self-monitoring.
AIM: To identify psychological factors or processes prompting the decision to
self-monitor blood pressure.
DESIGN AND SETTING: A qualitative study of patients previously participating in a
survey study about SMBP from four general practices in the West Midlands.
METHOD: Taped and transcribed in-depth interviews with 16 patients (6 currently
monitoring, 2 used to self-monitor, and 8 had never self-monitored). Thematic
analysis was undertaken.
RESULTS: Three main themes emerged: 'self' and 'living with hypertension'
described the emotional element of living with an asymptomatic condition;
'self-monitoring behaviour and medication' described overall views about
self-monitoring, current practice, reasons for monitoring, and the impact on
medication adherence; and 'the GP-patient transaction' described the power
relations affecting decisions to self-monitor. Self-monitoring was performed by
some as a protective tool against the fears of a silent but serious condition,
whereas others self-monitor simply out of curiosity. People who self-monitored
tended not to discuss this with their nurse or GP, partly due to perceiving
minimal or no interest from their clinician about home monitoring, and partly due
to fear of being prescribed additional medication.
CONCLUSION: The decision to self-monitor appeared often to be an individual
choice with no schedule or systems to integrate it with other medical care.
Better recognition by clinicians that patients are self-monitoring, perhaps
utilising the results in shared decision-making, might help integrate it into
daily practice.
DOI: 10.3399/bjgp15X687433
PMCID: PMC4617273
925. AIDS Care. 2016 Jul;28(7):919-26. doi: 10.1080/09540121.2015.1124984. Epub

2016
Mar 24.
Side effects, adherence self-efficacy, and adherence to antiretroviral treatment:

a mediation analysis in a Chinese sample.
Zhang L(1), Li X(1)(2), Lin Z(1)(3), Jacques-Tiura AJ(1), Xu J(4), Zhou Y(5),
Qiao S(1)(2), Shen Z(5), Stanton B(1).
Author information:
(1)a The Carman and Ann Adams Department of Pediatrics , Wayne State University
School of Medicine , Detroit , MI , USA.
(2)b Arnold School of Public Health , University of South Carolina , Columbia ,
SC , USA.
(3)c Center for Health Policy Research , Nanjing Medical University , Nanjing ,
People's Republic of China.
(4)d Department of Family Medicine and Public Health Sciences , Wayne State
University School of Medicine , Detroit , MI , USA.
(5)e Guangxi Center for Disease Control and Prevention , Nanning , People's
Republic of China.
Antiretroviral therapy (ART) is a lifelong treatment. To date, ART adherence is

suboptimal for most patients in resource-poor settings. Previous research
indicates that medication side effects are perceived to be a significant barrier
of high ART adherence. Data regarding the role of adherence self-efficacy in
mediating the relationship between side effects from ART and adherence to ART are
limited; thus, this study examines this potential mediational role of
self-efficacy. A cross-sectional survey of 2987 people living with HIV aged ≥18
years was conducted in 2012-2013 in Guangxi Autonomous Region (Guangxi) which has
one of the fastest-growing HIV rates in China. Of the total sample, 2146 (72.1%)
participants had initiated ART. Participants reported the number of days of
completing the daily dose of ART in the past month; adherence was defined as
completing the daily dose at least 28 days in the last month (≥90%). Side effects
were significantly negatively related to adherence to ART. Mediation analyses
indicated that adherence self-efficacy significantly mediated the side
effects-adherence relationship. Future interventions to increase adherence
self-efficacy and effective coping with side effects among HIV patients are
needed in order to improve their ART adherence.
DOI: 10.1080/09540121.2015.1124984
PMCID: PMC6065505
926. BMC Psychiatry. 2014 Nov 21;14:324. doi: 10.1186/s12888-014-0324-6.
The relationship of psychological reactance, health locus of control and sense of

self-efficacy with adherence to treatment in psychiatric outpatients with
depression.
De Las Cuevas C(1)(2), Peñate W(3), Sanz EJ(4).
Author information:
(1)Professor of Psychiatry, Department of Internal Medicine, Dermatology and
Psychiatry, University of La Laguna, Canary Islands, Spain.
cdelascuevas@gmail.com.
(2)Red de Investigación en Servicios de Salud en Enfermedades Crónicas
(REDISSEC), Tenerife, Spain. cdelascuevas@gmail.com.
(3)Professor of Psychology, Department of Personality, Assessment and
Psychological Treatments, University of La Laguna, Canary Islands, Spain.
wpenate@ull.es.
(4)Professor of Clinical Pharmacology, Department of Physical Medicine and
Pharmacology, University of La Laguna, Canary Islands, Spain. ejsanz@gmail.com.
Comment in
Evid Based Nurs. 2015 Oct;18(4):113.
BACKGROUND: Although non-adherence to antidepressant medications is a significant
barrier to the successful treatment of depression in clinical practice, few
potentially modifiable predictors of poor adherence to antidepressant treatment
are known. The aim of this study was to examine the relationship of psychological
reactance, health locus of control and the sense of self-efficacy on adherence to
treatment regimen among psychiatric outpatients with depression.
METHODS: One hundred and forty-five consecutive psychiatric outpatients suffering
from depressive disorders were invited to participate in a cross-sectional study
and 119 accepted. Patients completed a series of self-reported questionnaires
assessing psychological reactance, health locus of control, self-efficacy, and
adherence to prescribed medication in addition to socio-demographic and clinical
variables. Logistic regression analyses were performed to determine which factors
better correlate to treatment adherence.
RESULTS: Age was found to be the best correlate of adherence to prescribed
treatment. As regards psychological dimension studied, medication adherence was
negatively associated with both cognitive and affective psychological reactance;
patients with higher psychological reactance were more likely to be noncompliant
than patients showing a low level of psychological reactance. Regarding health
locus of control, only the external dimension of doctor-attributed health locus
of control was positively associated with medications adherence. No effect on
adherence was observed for the self-efficacy scale.
CONCLUSIONS: Psychological reactance is an important correlate of adherence to
treatment in patients with depressive disorders and this needs to be considered
when giving clinical advice in order to avoid inducing reactance and thus
non-adherence to prescribed treatments. Mental health professionals need to learn
about communication techniques and counseling skills that enable them to deal
with the psychological reactance of their patients.
DOI: 10.1186/s12888-014-0324-6
PMCID: PMC4243370
927. J Am Pharm Assoc (2003). 2019 Jul - Aug;59(4):479-488.e1. doi:

10.1016/j.japh.2019.04.017. Epub 2019 May 22.
Assessment of symptom burden and adherence to respiratory medications in

individuals self-reporting a diagnosis of COPD within a community pharmacy
setting.
Bollmeier SG, Seaton TL, Prosser TR, Chou YT, Reckenberg K, Hahn B, Stanford RH,
Ray R.
OBJECTIVES: Data on symptom burden or medication adherence in patients with

chronic obstructive pulmonary disease (COPD) within a community pharmacy setting
are limited. This study assessed symptom burden and adherence to respiratory
medications in individuals reporting COPD, chronic bronchitis, or emphysema
diagnoses visiting community pharmacies.
DESIGN: This cross-sectional study enrolled participants visiting 35 community
pharmacies in Missouri (October 2016 to April 2017).
PARTICIPANTS: Eligible participants (aged 40 years or more with a self-reported
history of COPD, prescription for at least 1 COPD maintenance medication during
the previous 12 months, and able to complete an English questionnaire) were
identified from pharmacy dispensing records.
MAIN OUTCOME MEASURES: Participants completed a questionnaire assessing
demographics, clinical characteristics, health literacy, COPD Assessment Test
(CAT) modified Medical Research Council (mMRC) dyspnea scale scores, and
exacerbation history. Recent spirometry data were obtained, if available, from
participants' physicians. COPD was classified according to the Global Initiative
for Chronic Obstructive Lung Disease (GOLD) 2016 criteria. Medication adherence
was assessed as proportion of days covered (PDC) from dispensing records.
RESULTS: Of 682 participants (mean age 63.0 years; 57% female) with available
pharmacy data, 251 (36.8%) had available spirometry data. Most participants had
mMRC scores ≥ 2 (60.9%) and CAT scores ≥ 10 (90.2%); 57.2% reported at least 2
moderate or 1 or more severe exacerbations within the previous 12 months. GOLD
classifications varied depending on the scale used (mMRC vs. CAT); more
participants were classified as group C/D than group A/B, with the highest
proportion classified as group D (higher symptom burden and exacerbation risk).
Mean PDC was 0.46 ± 0.37; only 28.7% of participants were adherent (PDC ≥ 80%) to
at least 1 COPD maintenance medication.
CONCLUSION: Individuals self-reporting a COPD diagnosis receiving respiratory
medications from community pharmacies in Missouri have a high symptom burden and
low medication adherence. Further research should determine reasons for low
adherence and ways to reduce COPD symptoms.

DOI: 10.1016/j.japh.2019.04.017
PMID: 31126830
928. Int J Behav Med. 2017 Feb;24(1):42-53. doi: 10.1007/s12529-016-9582-7.
A Systematic Review and Meta-Analysis on Self-Management for Improving Risk

Factor Control in Stroke Patients.
Sakakibara BM(1)(2)(3), Kim AJ(3), Eng JJ(4)(5).
Author information:
(1)Department of Physical Therapy, Faculty of Medicine, University of British
Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3,
Canada.
(2)Faculty of Health Sciences, Simon Fraser University, c/o Healthy Heart
Program, St. Paul's Hospital 180 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6,
Canada.
(3)Rehabilitation Research Program, GF Strong Rehabilitation Research Lab,
Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC,
V5Z 2G9, Canada.
(4)Department of Physical Therapy, Faculty of Medicine, University of British
Columbia, 212 Friedman Building, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3,
Canada. janice.eng@ubc.ca.
(5)Rehabilitation Research Program, GF Strong Rehabilitation Research Lab,
Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC,
V5Z 2G9, Canada. janice.eng@ubc.ca.
PURPOSE: The aims of this review were to describe the self-management

interventions used to improve risk factor control in stroke patients and
quantitatively assess their effects on the following: 1) overall risk factor
control from lifestyle behaviour (i.e. physical activity, diet and nutrition,
stress management, smoking, alcohol, and medication adherence), and medical risk
factors (i.e. blood pressure, cholesterol, blood glucose) and (2) individual risk
factors.
METHOD: We systematically searched the PubMed, PsycINFO, CINAHL and Cochrane
Database of Systematic Reviews databases to September 2015 to identify relevant
randomized controlled trials investigating self-management to improve stroke risk
factors. The self-management interventions were qualitatively described, and the
data included in meta-analyses.
RESULTS: Fourteen studies were included for review. The model estimating an
effect averaged across all stroke risk factors was not significant, but became
significant when four low-quality studies were removed (SMD = 0.10 [95 %
CI = 0.02 to 0.17], I 2 = 0 %, p = 0.01). Subgroup analyses revealed a
significant effect of self-management interventions on lifestyle behaviour risk
factors (SMD = 0.15 [95 % CI = 0.04 to 0.25], I 2 = 0 %, p = 0.007) but not
medical risk factors. Medication adherence was the only individual risk factor
that self-management interventions significantly improved (SMD = 0.31 [95 %
CI = 0.07 to 0.56], I 2 = 0 %, p = 0.01).
CONCLUSION: Self-management interventions appear to be effective at improving
overall risk factor control; however, more high-quality research is needed to
corroborate this observation. Self-management has a greater effect on lifestyle
behaviour risk factors than medical risk factors, with the largest effect at
improving medication adherence.
DOI: 10.1007/s12529-016-9582-7
PMCID: PMC5762183
929. Pharmacy (Basel). 2017 Apr 6;5(2). pii: E20. doi: 10.3390/pharmacy5020020.
Quality of Life and Medication Adherence of Independently Living Older Adults

Enrolled in a Pharmacist-Based Medication Management Program.
Harlow C(1), Hanna C(2), Eckmann L(3), Gokun Y(4), Zanjani F(5), Blumenschein
K(6), Divine H(7).
Author information:
(1)St. Matthews Community Pharmacy, Louisville, KY 40207, USA.
cpharlow@gmail.com.
(2)American Pharmacy Services Corporation, Frankfort, KY 40601, USA.
channa@apscnet.com.
(3)Wheeler Pharmacy, Home Connection, Lexington, KY 40507, USA. eckmann8@aol.com.
(4)General Dynamics Information Technology, Little Rock, AR 72205, USA.
jane.gokun@gdit.com.
(5)Department of Behavioral and Community Health, University of Maryland School
of Public Health, College Park, MD 20742, USA. fzanjani@umd.edu.
(6)Department of Pharmacy Practice and Science, University of Kentucky College of
Pharmacy Lexington, KY 40536, USA. KBLUM1@uky.edu.
(7)Department of Pharmacy Practice and Science, University of Kentucky College of
Pharmacy Lexington, KY 40536, USA. holly.divine@uky.edu.
This study sought to understand the medication adherence and quality of life
(QOL) of recipients of a pharmacist-based medication management program among
independently living older adults. Using a cross-sectional, quasi-experimental
study design, we compared older adults enrolled in the program to older adults
not enrolled in the program. Data were collected via face-to-face interviews in
independent-living facilities and in participants' homes. Independently living
older adults who were enrolled in the medication management program (n = 38) were
compared to older adults not enrolled in the program (control group (n = 41)).
All participants were asked to complete questionnaires on health-related quality
of life (QOL, using the SF-36) and medication adherence (using the four-item
Morisky scale). The medication management program recipients reported
significantly more prescribed medications (p < 0.0001) and were more likely to
report living alone (p = 0.01) than the control group. The medication management
program recipients had a significantly lower SF-36 physical functioning score (p
= 0.03) compared to the control group, although other SF-36 domains and
self-reported medication adherence were similar between the groups. Despite
taking more medications and more commonly living alone, independent living older
adults enrolled in a pharmacist-based medication management program had similar
QOL and self-reported medication adherence when compared to older adults not
enrolled in the program. This study provides initial evidence for the
characteristics of older adults receiving a pharmacist-based medication
management program, which may contribute to prolonged independent living and
positive health outcomes.
DOI: 10.3390/pharmacy5020020
PMCID: PMC5597145
PMID: 28970432
930. Heart Lung. 2018 Jan - Feb;47(1):32-39. doi: 10.1016/j.hrtlng.2017.11.001.

Epub
2017 Nov 15.
Shared heart failure knowledge and self-care outcomes in patient-caregiver dyads.
Bidwell JT(1), Higgins MK(2), Reilly CM(3), Clark PC(4), Dunbar SB(5).
Author information:
(1)Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road,
Atlanta, GA, 30322, United States. Electronic address: jtbidwe@emory.edu.
Atlanta, GA, 30322, United States. Electronic address: mkhiggi@emory.edu.
Atlanta, GA, 30322, United States. Electronic address: cmill02@emory.edu.
(4)Georgia State University, Byrdine F. Lewis College of Nursing and Health
Professions, P.O. Box 3995, Atlanta, GA, 30302, United States. Electronic
address: pclark@gsu.edu.
Atlanta, GA, 30322, United States. Electronic address: sbdunba@emory.edu.
BACKGROUND: Patient's knowledge about heart failure (HF) contributes to

successful HF self-care, but less is known about shared patient-caregiver
knowledge.
OBJECTIVES: The purpose of this analysis was to: 1) identify configurations of
shared HF knowledge in patient-caregiver dyads; 2) characterize dyads within each
configuration by comparing sociodemographic factors, HF characteristics, and
psychosocial factors; and 3) quantify the relationship between configurations and
patient self-care adherence to managing dietary sodium and HF medications.
METHODS: This was a secondary analysis of cross-sectional data (N = 114 dyads,
53% spousal). Patient and caregiver HF knowledge was measured with the Atlanta
Heart Failure Knowledge Test. Patient dietary sodium intake was measured by 3-day
food record and 24 h urine sodium. Medication adherence was measured by
Medication Events Monitoring System caps. Patient HF-related quality of life was
measured by the Minnesota Heart Failure Questionnaire; caregiver health-related
quality of life was measured by the Short Form-12 Physical Component Summary.
Patient and caregiver depression were measured with the Beck Depression
Inventory-II. Patient and caregiver perceptions of caregiver-provided autonomy
support to succeed in heart failure self-care were measured by the Family Care
Climate Questionnaire. Multilevel and latent class modeling were used to identify
dyadic knowledge configurations. T-tests and chi-square tests were used to
characterize differences in sociodemographic, clinical, and psychosocial
characteristics by configuration. Logistic/linear regression were used to
quantify relationships between configurations and patient dietary sodium and
RESULTS: Two dyadic knowledge configurations were identified: "Knowledgeable
Together" (higher dyad knowledge, less incongruence; N = 85, 75%) and "Knowledge
Gap" (lower dyad knowledge, greater incongruence; N = 29, 25%). Dyads were more
likely to be in the "Knowledgeable Together" group if they were White and more
highly educated, if the patient had a higher ejection fraction, fewer depressive
symptoms, and better autonomy support, and if the caregiver had better quality of
life. In unadjusted comparisons, patients in the "Knowledge Gap" group were less
likely to adhere to HF medication and diet. In adjusted models, significance was
retained for dietary sodium only.
CONCLUSIONS: Dyads with higher shared HF knowledge are likely more successful
with select self-care adherence behaviors.
DOI: 10.1016/j.hrtlng.2017.11.001
PMCID: PMC5722704
931. J Behav Med. 2016 Apr;39(2):310-9. doi: 10.1007/s10865-015-9698-2. Epub 2015

Dec
8.
Understanding self-management behaviors in symptomatic adults with uncertain

etiology using an illness perceptions framework.
Leos C(1), Khan CM(2), Rini C(3)(4).
Author information:
(1)Department of Health Behavior, University of North Carolina at Chapel Hill,
312 Rosenau Hall, CB#7440, Chapel Hill, NC, 27599-7440, USA. cleos@email.unc.edu.
(2)Thurston Arthritis Research Center, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA.
(3)Department of Health Behavior, University of North Carolina at Chapel Hill,
312 Rosenau Hall, CB#7440, Chapel Hill, NC, 27599-7440, USA.
(4)Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA.
The self-management behaviors of individuals with medical conditions that have an

unknown etiology have not been studied. This study assesses the relationship
between illness perceptions and various illness self-management behaviors in
patients undergoing clinical genomic sequencing to identify a genetic cause for
their condition. Hierarchical linear regression, Poisson linear regression, and
logistic regression were used to assess the effect of illness perceptions (i.e.,
perceived consequences, timeline, personal control, treatment control, identity,
concern, understanding, emotional impact, and causal beliefs as measured by the
Brief Illness Perceptions Questionnaire) on healthcare use, prescription
medication use, and doctor recommended supplement use, respectively (n = 200).
Analyses revealed that (1) illness identity beliefs were positively associated
with healthcare use (β = 0.20, p = 0.04), (2) both treatment control beliefs (B =
0.03, p = 0.02) and genetic causal beliefs (B = 0.17, p = 0.049) were positively
associated with prescription medication use, and (3) both timeline beliefs (OR
1.23, p = 0.02) and emotional impact (OR 1.20, p = 0.02) were positively
associated with doctor recommended supplement use. These findings can be used to
inform the development of guidelines for treating patients who are seeking a
genetic diagnosis for their illness.
DOI: 10.1007/s10865-015-9698-2
PMCID: PMC4801749
932. Diabetes Technol Ther. 2014 Oct;16(10):653-60. doi: 10.1089/dia.2014.0045.
Epub
2014 Jul 3.
The Utah Remote Monitoring Project: improving health care one patient at a time.
Shane-McWhorter L(1), Lenert L, Petersen M, Woolsey S, McAdam-Marx C, Coursey JM,

Whittaker TC, Hyer C, LaMarche D, Carroll P, Chuy L.
Author information:
(1)1 Department of Pharmacotherapy, University of Utah College of Pharmacy , Salt
Lake City, Utah.
BACKGROUND: The expanding role of technology to augment diabetes care and

management highlights the need for clinicians to learn about these new tools. As
these tools continue to evolve and enhance improved outcomes, it is imperative
that clinicians consider the role of telemonitoring, or remote monitoring, in
patient care. This article describes a successful telemonitoring project in Utah.
SUBJECTS AND METHODS: This was a nonrandomized prospective observational
preintervention-postintervention study, using a convenience sample. Patients with
uncontrolled diabetes and/or hypertension from four rural and two urban primary
care clinics and one urban stroke center participated in a telemonitoring
program. The primary clinical outcome measures were changes in hemoglobin A1C
(A1C) and blood pressure. Other outcomes included fasting lipids, weight, patient
engagement, diabetes knowledge, hypertension knowledge, medication adherence, and
patient perceptions of the usefulness of the telemonitoring program.
RESULTS: Mean A1C decreased from 9.73% at baseline to 7.81% at the end of the
program (P<0.0001). Systolic blood pressure also declined significantly, from
130.7 mm Hg at baseline to 122.9 mm Hg at the end (P=0.0001). Low-density
lipoprotein content decreased significantly, from 103.9 mg/dL at baseline to 93.7
mg/dL at the end (P=0.0263). Other clinical parameters improved nonsignificantly.
Knowledge of diabetes and hypertension increased significantly (P<0.001 for
both). Patient engagement and medication adherence also improved, but not
significantly. Per questionnaires at study end, patients felt the telemonitoring
program was useful.
CONCLUSIONS: Telemonitoring improved clinical outcomes and may be a useful tool
to help enhance disease management and care of patients with diabetes and/or
hypertension.
DOI: 10.1089/dia.2014.0045
PMCID: PMC4183896
933. JAMA Intern Med. 2018 Aug 1;178(8):1069-1077. doi:

10.1001/jamainternmed.2018.2372.
Effect of Electronic Health Record-Based Medication Support and Nurse-Led

Medication Therapy Management on Hypertension and Medication Self-management: A
Randomized Clinical Trial.
Persell SD(1)(2), Karmali KN(3), Lazar D(4), Friesema EM(1)(2)(5), Lee JY(1),
Rademaker A(6), Kaiser D(7), Eder M(4)(8), French DD(9), Brown T(1), Wolf MS(1).
Author information:
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
(2)Center for Primary Care Innovation, Institute for Public Health and Medicine,
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
(3)Division of Cardiology, Department of Medicine, Feinberg School of Medicine,
Northwestern University, Chicago, Illinois.
(4)Access Community Health Network and the Access Center for Discovery and
Learning, Chicago, Illinois.
(5)Carlson School of Management, University of Minnesota, Minneapolis.
University, Chicago, Illinois.
(7)Information Services, Northwestern Memorial Healthcare, Chicago, Illinois.
(8)Center for Excellence in Primary Care, Department of Family Medicine and
Community Health, Medical School, University of Minnesota, Minneapolis.
(9)Department of Ophthalmology and Center for Healthcare Studies, Feinberg School
of Medicine, Northwestern University, Chicago, Illinois.
Comment in
JAMA Intern Med. 2018 Nov 1;178(11):1562-1563.
JAMA Intern Med. 2018 Nov 1;178(11):1563.
Importance: Complex medication regimens pose self-management challenges,

particularly among populations with low levels of health literacy.
Objective: To test medication management tools delivered through a commercial
electronic health record (EHR) with and without a nurse-led education
intervention.
Design, Setting, and Participants: This 3-group cluster randomized clinical trial
was performed in community health centers in Chicago, Illinois. Participants
included 794 patients with hypertension who self-reported using 3 or more
medications concurrently (for any purpose). Data were collected from April 30,
2012, through February 29, 2016, and analyzed by intention to treat.
Interventions: Clinics were randomly assigned to to groups: electronic health
record-based medication management tools (medication review sheets at visit
check-in, lay medication information sheets printed after visits; EHR-alone
group), EHR-based tools plus nurse-led medication management support (EHR plus
education group), or usual care.
Main Outcomes and Measures: Outcomes at 12 months included systolic blood
pressure (primary outcome), medication reconciliation, knowledge of drug
indications, understanding of medication instructions and dosing, and
self-reported medication adherence. Medication outcomes were assessed for all
hypertension prescriptions, all prescriptions to treat chronic disease, and all
medications.
Results: Among the 794 participants (68.6% women; mean [SD] age, 52.7 [9.6]
years), systolic blood pressure at 12 months was greater in the EHR-alone group
compared with the usual care group by 3.6 mm Hg (95% CI, 0.3 to 6.9 mm Hg).
Systolic blood pressure in the EHR plus education group was not significantly
lower compared with the usual care group (difference, -2.0 mm Hg; 95% CI, -5.2 to
1.3 mm Hg) but was lower compared with the EHR-alone group (-5.6 mm Hg; 95% CI,
-8.8 to -2.4 mm Hg). At 12 months, hypertension medication reconciliation was
improved in the EHR-alone group (adjusted odds ratio [OR], 1.8; 95% CI, 1.1 to
2.9) and the EHR plus education group (adjusted odds ratio [OR], 2.0; 95% CI, 1.3
to 3.3) compared with usual care. Understanding of medication instructions and
dosing was greater in the EHR plus education group than the usual care group for
hypertension medications (OR, 2.3; 95% CI, 1.1 to 4.8) and all medications
combined (OR, 1.7; 95% CI, 1.0 to 2.8). Compared with usual care, the EHR tools
alone and EHR plus education interventions did not improve hypertension
medication adherence (OR, 0.9; 95% CI, 0.6-1.4 for both) or knowledge of chronic
drug indications (OR for EHR tools alone, 1.0 [95% CI, 0.6 to 1.5] and OR for EHR
plus education, 1.1 [95% CI, 0.7-1.7]).
Conclusions and Relevance: The study found that EHR tools in isolation improved
medication reconciliation but worsened blood pressure. Combining these tools with
nurse-led support suggested improved understanding of medication instructions and
dosing but did not lower blood pressure compared with usual care.
Trial Registration: ClinicalTrials.gov identifier: NCT01578577.
DOI: 10.1001/jamainternmed.2018.2372
PMCID: PMC6143105
PMID: 29987324
934. Front Pharmacol. 2017 Dec 14;8:891. doi: 10.3389/fphar.2017.00891. eCollection

2017.
Pharmacist-Led Self-management Interventions to Improve Diabetes Outcomes. A

Systematic Literature Review and Meta-Analysis.
van Eikenhorst L(1), Taxis K(1), van Dijk L(2), de Gier H(1).
Author information:
(1)Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research
Institute of Pharmacy, University of Groningen, Groningen, Netherlands.
(2)Pharmaceutical Care, NIVEL, Netherlands Institute for Health Services
Research, Utrecht, Netherlands.
Background: Treatment of diabetes requires a strict treatment scheme which

demands patient self-management. Pharmacists are in a good position to provide
self-management support. This review examines whether pharmacist-led
interventions to support self-management in diabetes patients improve clinical
and patient-reported outcomes. Methods: This review was conducted according to
the PRISMA guidelines. An extended literature search was conducted with the
keywords "pharmacist," "diabetes," and "self-management" using the electronic
databases Pubmed, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane
Library from the beginning of the database through September 2017. In addition
reference lists of systematic reviews and included studies were searched.
Eligibility criteria included; self-management intervention tested with an RCT,
performed in an ambulatory care setting, led by a pharmacist and reporting at
least one clinical- or patient-reported outcome. Primary outcomes were HbA1c (-as
this is a clinical parameter for long-term diabetes follow-up), self-management
and components of intervention. Secondary outcomes were blood glucose, blood
pressure, BMI, lipids, adherence to medication, quality of life, and diabetes
knowledge. For the meta-analysis HbA1c values were pooled with a random-effects
model in Revman 5.3. Risk of bias was assessed with the Cochrane Risk of Bias
tool. Results: Twenty-four studies representing 3,610 patients were included.
Pharmacist-led self-management interventions included education on diabetes
complications, medication, lifestyle, and teaching of self-management skills.
Some studies focused on patient needs through a tailored intervention. No key
components for a successful self-management intervention could be identified.
Pharmacist-led self-management interventions improve HbA1c levels with a mean of
0.71% (CI -0.91, -0.51; overall effect P < 0.0001) and had a positive effect on
blood pressure (SBP -5.20 mm Hg [-7.58; -2.92], DBP -3.51 mmHg [-6.00; -1.01]),
BMI (-0.49 kg/m2 [-0.79; -0.19]), lipids (total cholesterol -0.19 mmol/l [-0.33;
-0.05], LDL-C mmol/l -0.16 [-0.26; -0.06], HDL-C 0.32 mmol/l [0.02; 0.61]),
self-management skill development, and adherence to medication. Conclusion:
Pharmacist-led self-management interventions significantly improve HbA1c values
in diabetes patients. These results underline the added value of pharmacists in
patient-related care. Pharmacists should offer self-management support to
diabetes patients in order to improve diabetes outcomes.
DOI: 10.3389/fphar.2017.00891
PMCID: PMC5735079
PMID: 29311916
935. JMIR Form Res. 2018 Jul 19;2(2):e14. doi: 10.2196/formative.9707.
Web-Based Tailored Intervention to Support Optimal Medication Adherence Among

Kidney Transplant Recipients: Pilot Parallel-Group Randomized Controlled Trial.
Côté J(1)(2)(3), Fortin MC(3)(4), Auger P(1)(3), Rouleau G(1)(3), Dubois S(2),
Boudreau N(4), Vaillant I(4), Gélinas-Lemay É(4).
Author information:
(1)Research Chair in Innovative Nursing Practices, Montreal, QC, Canada.
(2)Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.
(3)Research Centre of the Centre Hospitalier de l'Université de Montréal,
Montreal, QC, Canada.
(4)Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
BACKGROUND: Optimal immunosuppressive medication adherence is essential to graft

survival. Transplant-TAVIE is a Web-based tailored intervention developed to
promote this adherence.
OBJECTIVE: The objective of our study was to evaluate the Transplant-TAVIE
intervention's acceptability, feasibility, and preliminary efficacy.
METHODS: In a pilot, parallel-group, randomized controlled trial, we randomly
assigned a convenience sample of 70 kidney transplant patients on
immunosuppressive medication either to an experimental group (Transplant-TAVIE)
or to a control group (existing websites). Kidney transplant recipients had to be
older than 18 years, be taking immunosuppressant medication, and have access to
the internet to participate in this study. Transplant-TAVIE was composed of three
interactive Web-based sessions hosted by a virtual nurse. We documented user
appreciation of and exposure to the intervention. Furthermore, we assessed
medication adherence, medication self-efficacy, intake-related skills, and
medication side effects at baseline and 3 and 6 months later. Analyses of
variance were used to assess intergroup differences over time.
RESULTS: After baseline questionnaire completion, participants were randomly
assigned either to Transplant-TAVIE (n=35) or to the websites (n=35) group. All
participants had received their kidney graft <1 year to 32 years earlier (mean
6.8 years). Of the experimental group, 54% (19/35) completed the sessions of
Transplant-TAVIE. Users found the intervention to be acceptable-33% were
extremely satisfied (6/18), 39% were very satisfied (7/18), and 28% were
satisfied (5/18). At baseline and over time, both experimental and control groups
reported high medication adherence, high medication self-efficacy, and frequent
use of skills related to medication intake. No intergroup differences emerged
over time.
CONCLUSIONS: The results of this study support the feasibility and acceptability
of Transplant-TAVIE. It could constitute an accessible adjunct in support of
existing specialized services.
©José Côté, Marie-Chantal Fortin, Patricia Auger, Geneviève Rouleau, Sylvie

Dubois, Nathalie Boudreau, Isabelle Vaillant, Élisabeth Gélinas-Lemay. Originally
published in JMIR Formative Research (http://formative.jmir.org), 19.07.2018.
DOI: 10.2196/formative.9707
PMCID: PMC6334708
PMID: 30684400
936. BMC Health Serv Res. 2018 Jul 31;18(1):592. doi: 10.1186/s12913-018-3380-7.
Reliability and validity of a 12-item medication adherence scale for patients
with chronic disease in Japan.
Ueno H(1), Yamazaki Y(2), Yonekura Y(3), Park MJ(4), Ishikawa H(5)(6), Kiuchi
T(5).
Author information:
(1)Department of Health Communication, Graduate School of Medicine, The
University of Tokyo, Tokyo, Japan. uenoh-tky@umin.ac.jp.
(2)Faculty of Social Welfare, Nihon Fukushi University, Mihama, Japan.
(3)Graduate School of Nursing Science, St. Luke's International University,
Tokyo, Japan.
(4)College of Nursing, Konyang University, Daejeon, South Korea.
(5)Department of Health Communication, Graduate School of Medicine, The
University of Tokyo, Tokyo, Japan.
(6)Graduate School of Public Health, Teikyo University, Tokyo, Japan.
BACKGROUND: To improve and support medication adherence among patients with

chronic diseases, especially for long-term medication, it is important to
consider both their relationship with healthcare providers and their lifestyle.
We tested the reliability and validity of a modified 12-item Medication Adherence
Scale.
METHODS: We revised a 14-item measure of medication adherence, created in 2009,
to a more concise and clear 12-item version, and we verified the reliability and
validity of the 12-item scale. We included 328 patients with chronic diseases
participating in the Chronic Disease Self-Management Program in Japan from 2011
to 2014. Confirmatory factor analysis was used to assess whether the four factors
assessed were the same as the previous 14-item Medication Adherence Scale.
Cronbach's coefficient alpha was used to assess internal consistency reliability,
and the relationships between patient demographic characteristics and medication
adherence were compared with previous studies.
RESULTS: The 12 items were categorized into the four factors "medication
compliance", "collaboration with healthcare providers", "willingness to access
and use information about medication", and "acceptance to take medication and how
taking medication fits patient's lifestyle". Confirmatory factor analysis showed
χ2/df = 2.6, CFI = 0.94, and RMSEA = 0.069. Cronbach's alpha for the 12-item
scale was 0.78. Cronbach's alpha for the four subscales was 0.74, 0.81, 0.67, and
0.45. Higher medication adherence was significantly associated with being a
female patient, living with someone else, and age 40-49 years versus age
20-29 years. These relationships were the same as in previous studies.
CONCLUSIONS: We modified our original 14-item scale to a 12-item Medication
Adherence Scale for patients with chronic diseases, which considers their
relationship with healthcare providers and lifestyle. Refinement might be needed
because of the relatively low reliability of subscales. However, the modified
scale is expected to contribute to more effective self-management of medication
and to improving medication adherence, particularly among patients with chronic
diseases who require long-term medication not only in Japan but also in other
countries.
DOI: 10.1186/s12913-018-3380-7
PMCID: PMC6069892
937. Am J Manag Care. 2017 Sep 1;23(9):e280-e286.
Evaluation of a packaging approach to improve cholesterol medication adherence.
Bosworth HB(1), Brown JN, Danus S, Sanders LL, McCant F, Zullig LL, Olsen MK.
Author information:
(1)Durham Veterans Affairs Medical Center, 411 W Chapel Hill St, Ste 600, Durham,
NC 27701. E-mail: boswo001@mc.duke.edu.
OBJECTIVES: Elevated low-density lipoprotein cholesterol (LDL-C) is a major

modifiable risk factor for cardiovascular disease, a leading cause of death in
the United States. Our goal was to evaluate a simple, scalable, and affordable
medication packaging method for improving cholesterol medication adherence and
subsequently lowering LDL-C levels.
STUDY DESIGN: Mixed-method study.
METHODS: This mixed-method study involved US military veterans with LDL-C levels
greater than 130 mg/dL and/or less than 80% refill adherence of
cholesterol-lowering medication in the last 12 months; they were randomized to an
education-only (control) group or an adherence packaging intervention group.
Adherence packaging group participants' statin medication was provided in special
blister packaging labeled for daily use that included written reminder prompts.
Outcomes included 12-month cholesterol medication possession ratio (MPR) for
medication refills; baseline, 6-, and 12-month self-reported cholesterol
medication use; LDL-C and high-density lipoprotein cholesterol (HDL-C) levels;
and total cholesterol changes over 12 months. Qualitative evaluation of the
intervention is presented as well.
RESULTS: We enrolled 240 individuals (120 intervention, 120 control). Overall,
54.2% of the adherence packaging intervention group was adherent per MPR over 12
months compared with 46.6% of the education-only group (difference = 7.6%; 95%
confidence interval, -5% to 20%; P ≤.24). Both arms reported improvements in
self-reported cholesterol adherence at 12 months, and decreases in LDL-C, HDL-C,
and total cholesterol were observed, but differences in change between arms were
not statistically significant. Qualitatively, patients reported high levels of
satisfaction with the blister package.
CONCLUSIONS: In a sample of US veterans, prefilled calendared blister packaging
provided an inexpensive method for improving cholesterol medication adherence.
938. AIDS Behav. 2018 Oct;22(10):3373-3383. doi: 10.1007/s10461-017-2014-0.
Mobile Health Technology for Improving Symptom Management in Low Income Persons
Living with HIV.
Schnall R(1), Cho H(2), Mangone A(2), Pichon A(2), Jia H(2).
Author information:
(1)Columbia University School of Nursing, New York, NY, 10032, USA.
rb897@columbia.edu.
(2)Columbia University School of Nursing, New York, NY, 10032, USA.
Persons living with HIV (PLWH) are living longer but experiencing more adverse
symptoms associated with the disease and its treatment. This study aimed to
examine the impact of a mHealth application (app) comprised of evidence-based
self-care strategies on the symptom experience of PLWH. We conducted a 12-week
feasibility study with 80 PLWH who were randomized (1:1) to a mHealth app, mobile
Video Information Provider (mVIP), with self-care strategies for improving 13
commonly experienced symptoms in PLWH or to a control app. Intervention group
participants showed a significantly greater improvement than the control group in
5 symptoms: anxiety (p = 0.001), depression (p = 0.001), neuropathy (p = 0.002),
fever/chills/sweat (p = 0.037), and weight loss/wasting (p = 0.020). Participants
in the intervention group showed greater improvement in adherence to their
antiretroviral medications (p = 0.017) as compared to those in the control group.
In this 12-week trial, mVIP was associated with improved symptom burden and
increased medication adherence in PLWH.
DOI: 10.1007/s10461-017-2014-0
PMCID: PMC6034982
939. J Diabetes Sci Technol. 2015 Apr 30;9(6):1321-6. doi:

10.1177/1932296815585132.
A Taxonomic Integrative Review of Short Message Service (SMS) Methodology: A

Framework for Improved Diabetic Outcomes.
Holcomb LS(1).
Author information:
(1)College of Nursing and Health Professions, Valparaiso University, Valparaiso,
IN, USA Linda.Holcomb@valpo.edu.
BACKGROUND: To acquire self-management skills that affect clinical outcomes,

collaboration and communication with one's health care team is essential, yet
many health care systems are not designed adequately to be responsive to a
patient's efforts to self-manage. This review synthesizes the intervention
methodology of current studies facilitating the efforts of health care providers
who wish to design, develop, and implement evidence-based SMS programs for
patients with diabetes, focusing on clinical outcomes of A1C values, medication
adherence rates, and participant satisfaction.
METHODS: This integrative review was conducted using an integrative taxonomic
analysis approach. This approach involves creating a classification system with
domains or characteristics, defining the relationships between those domains, and
creating a foundation for new theories or constructs.
RESULTS: Synthesis of the evidence included in this integrated review suggests
the best design for a SMS diabetes management program aimed at improving A1C
levels, medication adherence rates, and participant satisfaction is an
intervention providing weekly SMS education, with 2-way message direction, that
is 3 months in length.
CONCLUSIONS: The studies in this review have demonstrated that SMS interventions
can be an important part of a viable and effective program in the effort to
better manage adults with type 2 diabetes.
© 2015 Diabetes Technology Society.
DOI: 10.1177/1932296815585132
PMCID: PMC4667321
940. Pan Afr Med J. 2015 Feb 25;20:177. doi: 10.11604/pamj.2015.20.177.4025.

eCollection 2015.
Patterns and obstacles to oral antidiabetic medications adherence among type 2

diabetics in Ismailia, Egypt: a cross section study.
Heissam K(1), Abuamer Z(1), El-Dahshan N(1).
Author information:
(1)Family Medicine Department, Faculty of Medicine, Suez Canal University,
Ismailia, Egypt.
INTRODUCTION: Diabetes is a costly and increasingly common chronic disease.

Effective management of diabetes to achieve glycemic control improves patient
quality of life. Adherence rates to drug regimens in patients with type 2
diabetes are relatively low and vary widely between populations. There are many
factors that could affect patient adherence to drug therapy. The aim of the
present study was assessing patterns and obstacles to adherence of type 2
diabetic patients to their oral hypoglycemic drugs.
METHODS: The present work is a descriptive cross section study, carried on type 2
diabetic patients who were on oral hypoglycemic drugs. Data concerning adherence
to drugs was assessed using measure treatment adherence scale (MTA).
RESULTS: A total of 372 (55.59% males and 44.41% females) patients with type-2
diabetes fulfilled the inclusion criteria and included in the study. Among the
participants, 26.1% were found to have good adherence, 47.9% had a fair
adherence, and 26% had poor adherence.
CONCLUSION: The overall rate of medication adherence among the diabetic patients
population was suboptimal and non-acceptable. Evaluation of adherence is vital
for patients with diabetes in order to determine factors and barriers affecting
the adherence and to manage them.
DOI: 10.11604/pamj.2015.20.177.4025
PMCID: PMC4469448
941. JMIR Mhealth Uhealth. 2018 May 23;6(5):e129. doi: 10.2196/mhealth.9527.
Identifying Medication Management Smartphone App Features Suitable for Young

Adults With Developmental Disabilities: Delphi Consensus Study.
Salgado TM(1), Fedrigon A(2), Riccio Omichinski D(3), Meade MA(3), Farris KB(4).
Author information:
(1)Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia
Commonwealth University, Richmond, VA, United States.
(2)College of Pharmacy, University of Michigan, Ann Arbor, MI, United States.
(3)Department of Physical Medicine & Rehabilitation, University of Michigan
Rehabilitation Engineering Research Center, University of Michigan, Ann Arbor,
MI, United States.
(4)Department of Clinical Pharmacy, College of Pharmacy, University of Michigan,
Ann Arbor, MI, United States.
BACKGROUND: Smartphone apps can be a tool to facilitate independent medication

management among persons with developmental disabilities. At present, multiple
medication management apps exist in the market, but only 1 has been specifically
designed for persons with developmental disabilities. Before initiating further
app development targeting this population, input from stakeholders including
persons with developmental disabilities, caregivers, and professionals regarding
the most preferred features should be obtained.
OBJECTIVE: The aim of this study was to identify medication management app
features that are suitable to promote independence in the medication management
process by young adults with developmental disabilities using a Delphi consensus
method.
METHODS: A compilation of medication management app features was performed by
searching the iTunes App Store, United States, in February 2016, using the
following terms: adherence, medication, medication management, medication list,
and medication reminder. After identifying features within the retrieved apps, a
final list of 42 features grouped into 4 modules (medication list, medication
reminder, medication administration record, and additional features) was included
in a questionnaire for expert consensus rating. A total of 52 experts in
developmental disabilities, including persons with developmental disabilities,
caregivers, and professionals, were invited to participate in a 3-round Delphi
technique. The purpose was to obtain consensus on features that are preferred and
suitable to promote independence in the medication management process among
persons with developmental disabilities. Consensus for the first, second, and
third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively.
RESULTS: A total of 75 responses were received over the 3 Delphi rounds-30 in the
first round, 24 in the second round, and 21 in the third round. At the end of the
third round, cumulative consensus was achieved for 60% (12/20) items in the
medication list module, 100% (3/3) in the medication reminder module, 67% (2/3)
in the medication administration record module, and 63% (10/16) in the additional
features module. In addition to the medication list, medication reminder, and
medication administration record features, experts selected the following top 3
most important additional features: automatic refills through pharmacies; ability
to share medication information from the app with providers; and ability to share
medication information from the app with family, friends, and caregivers. The top
3 least important features included a link to an official drug information
source, privacy settings and password protection, and prescription refill
reminders.
CONCLUSIONS: Although several mobile apps for medication management exist, few
are specifically designed to support persons with developmental disabilities in
the complex medication management process. Of the 42 different features assessed,
64% (27/42) achieved consensus for inclusion in a future medication management
app. This study provides information on the features of a medication management
app that are most important to persons with developmental disabilities,
caregivers, and professionals.
©Teresa M Salgado, Alexa Fedrigon, Donna Riccio Omichinski, Michelle A Meade,

Karen B Farris. Originally published in JMIR Mhealth and Uhealth
(http://mhealth.jmir.org), 23.05.2018.
PMCID: PMC5990856
PMID: 29792292
942. Biomed Res Int. 2015;2015:217047. doi: 10.1155/2015/217047. Epub 2015 Oct 11.
Medication Adherence Measures: An Overview.
Lam WY(1), Fresco P(2).
Author information:
(1)UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
(2)Department of Drug Sciences, Laboratory of Pharmacology, Faculty of Pharmacy,
University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
WHO reported that adherence among patients with chronic diseases averages only
50% in developed countries. This is recognized as a significant public health
issue, since medication nonadherence leads to poor health outcomes and increased
healthcare costs. Improving medication adherence is, therefore, crucial and
revealed on many studies, suggesting interventions can improve medication
adherence. One significant aspect of the strategies to improve medication
adherence is to understand its magnitude. However, there is a lack of general
guidance for researchers and healthcare professionals to choose the appropriate
tools that can explore the extent of medication adherence and the reasons behind
this problem in order to orchestrate subsequent interventions. This paper reviews
both subjective and objective medication adherence measures, including direct
measures, those involving secondary database analysis, electronic medication
packaging (EMP) devices, pill count, and clinician assessments and self-report.
Subjective measures generally provide explanations for patient's nonadherence
whereas objective measures contribute to a more precise record of patient's
medication-taking behavior. While choosing a suitable approach, researchers and
healthcare professionals should balance the reliability and practicality,
especially cost effectiveness, for their purpose. Meanwhile, because a perfect
measure does not exist, a multimeasure approach seems to be the best solution
currently.
DOI: 10.1155/2015/217047
PMCID: PMC4619779

eCollection 2017.
Depression, distress and self-efficacy: The impact on diabetes self-care

practices.
Devarajooh C(1), Chinna K(1).
Author information:
of Malaya, Jalan Universiti, Wilayah Persekutuan, Kuala Lumpur, Malaysia.
The prevalence of type 2 diabetes is increasing in Malaysia, and people with

diabetes have been reported to suffer from depression and diabetes distress which
influences their self-efficacy in performing diabetes self-care practices. This
interviewer administered, cross sectional study, conducted in the district of
Hulu Selangor, Malaysia, involving 371 randomly selected patients with type 2
diabetes, recruited from 6 health clinics, aimed to examine a conceptual model
regarding the association between depression, diabetes distress and self-efficacy
with diabetes self-care practices using the partial least square approach of
structural equation modeling. In this study, diabetes self-care practices were
similar regardless of sex, age group, ethnicity, education level, diabetes
complications or type of diabetes medication. This study found that self-efficacy
had a direct effect on diabetes self-care practice (path coefficient = 0.438,
p<0.001). Self-care was not directly affected by depression and diabetes
distress, but indirectly by depression (path coefficient = -0.115, p<0.01) and
diabetes distress (path coefficient = -0.122, p<0.001) via self-efficacy. In
conclusion, to improve self-care practices, effort must be focused on enhancing
self-efficacy levels, while not forgetting to deal with depression and diabetes
distress, especially among those with poorer levels of self-efficacy.
PMCID: PMC5376339
944. J Diabetes Metab Disord. 2018 Oct 25;17(2):165-172. doi:

10.1007/s40200-018-0356-4. eCollection 2018 Dec.
Adherence to medications, self-care activity, and HbA1c status among patients

with type 2 diabetes living in an urban area of Iran.
Jafarian-Amirkhizi A(1), Sarayani A(2), Gholami K(2), Taghizadeh-Ghehi M(2),
Heidari K(3), Jafarzadeh-Kohneloo A(3), Morisky DE(4).
Author information:
(1)1Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
(2)2Research Center for Rational Use of Drugs, Tehran University of Medical
Sciences, 4th floor, No 92, Karimkhan Zand Ave., Hafte Tir Sq., Tehran, Iran.
(3)3Department of Epidemiology and Biostatistics, Faculty of Health, Tehran
University of Medical Sciences, Tehran, Iran.
(4)4Department of Community Health Sciences UCLA Fielding School of Public
Health, Los Angeles, CA USA.
Background: Appropriate pharmacotherapy, self-care and adherence to medications

are crucial to diabetes control. We aimed to study the diabetes care and glycemic
control in patients with type two diabetes living in an urban area of Iran.
Methods: In this cross-sectional study, patients with type 2 diabetes who
attended a referral university affiliated community pharmacy and an accredited
pathobiology laboratory in the 17th district of Tehran were evaluated. Data
including demographics, medical and drug history were collected. Self-care
activity (Diabetes Self-care Activity Measurement Scale) and medication adherence
(8-item Morisky Medication Adherence scale) were also assessed. After completing
the questionnaires, the patients were referred to the laboratory for Hemoglobin
A1c test.
Results: Three hundred forty-eight patients (60.3% females) were recruited. The
mean (SD) of patients' age was 55.82 (12.72) and 75.3%of them were Illiterate or
had primary education. Mean (SD) of Hemoglobin A1c levels was 8.39 (2.03) and 33%
of patients had levels higher than 9%. Among study patients, 186 (53.4%) patients
received monotherapy for diabetes type 2 and 200 (57.5%) patients had low
adherence to medications. Physical activity, blood glucose self-monitoring and
foot care were domains of self-care with the fewest practice. Re-using a pen or
syringe needle more than once was reported by 83% of patients and mean (SD) time
of re-using a pen needle was 9.11 (8.74).
Conclusion: Poor glycemic control, low medication adherence, inadequate self-care
activities, signals of inappropriate pharmacotherapy and inadequate medical
visits and monitoring in the study patients highlight the importance of providing
accessible and affordable health care services in the region. Moreover,
educational needs of the patients should be considered especially in an area in
which the majority of patients are old and illiterate and have low socioeconomic
status.
DOI: 10.1007/s40200-018-0356-4
PMID: 30918851
Conflict of interest statement: Research Ethics Committee of Tehran University of

Medical Sciences approved this study.Not applicable.Morisky receives honorarium
for use of the MMAS. He was not involved in the data collection or evaluation
analyses. The other authors have nothing to declare.
945. J Am Geriatr Soc. 2017 Dec;65(12):2691-2696. doi: 10.1111/jgs.15079. Epub 2017

Sep 15.
Older Adults' Awareness of Deprescribing: A Population-Based Survey.
Turner JP(1)(2), Tannenbaum C(1)(2)(3).
Author information:
(1)Centre de Recherche, Institut Universitaire de Gériatrie de Montréal,
Montréal, Quebec, Canada.
(2)Faculté de Pharmacie, Université de Montréal, Montréal, Quebec, Canada.
(3)Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada.
OBJECTIVES: To determine older adults' awareness of the concept of

medication-induced harm and their familiarity with the term "deprescribing."
Secondary objectives were to ascertain determinants of self-initiated
deprescribing conversations and to identify how older adults seek information on
medication harms.
DESIGN: Cross-sectional population-based household telephone survey using
random-digit dialling.
SETTING: Canada.
PARTICIPANTS: Community-dwelling adults aged 65 and older (N = 2,665; n = 898
men, n = 1,767 women, mean age 74.9 ± 7.2, range 65-100).
MEASUREMENTS: Information was gathered on age; sex; awareness of the term
"deprescribing"; knowledge and information-seeking behaviors related to
medication harms; and previous initiation of a deprescribing conversation with a
healthcare professional. Three targeted classes of potentially inappropriate
prescriptions were asked about: sedative-hypnotics, glyburide, and proton pump
inhibitors. Descriptive statistics and regression analyses were used to quantify
associations.
RESULTS: Two-thirds (65.2%, 95% confidence interval (CI) = 63.4-67.0%) of
participants were familiar with the concept of medication-induced harms. Only
6.9% (95% CI = 5.9-7.8%) recognized the term deprescribing; 48% (95% CI = 46-50%)
had researched medication-related harms. Older adults most commonly sought
information from the Internet (35.5%, 95% CI = 33.4-37.6%), and from health care
professionals (32.2%, 95% CI = 30.1-34.3%). Patient-initiated deprescribing
conversations were associated with awareness of medication harms (odds ratio
(OR) = 1.74, 95% CI = 1.46-2.07), familiarity with the term deprescribing
(OR = 1.55, 95% CI = 1.13-2.12), and information-seeking behaviors (OR = 4.57,
95% CI = 3.84-5.45), independent of age and sex.
CONCLUSION: Healthcare providers can facilitate patient-initiated deprescribing
conversations by providing information on medication harms and using the term
"deprescribing."
© 2017 The Authors. Journal of the American Geriatrics Society published by Wiley
Periodicals, Inc. on behalf of The American Geriatrics Society.
DOI: 10.1111/jgs.15079
PMCID: PMC5763385
946. J Am Board Fam Med. 2017 Sep-Oct;30(5):624-631. doi:

10.3122/jabfm.2017.05.170030.
Use of Complementary Health Approaches Among Diverse Primary Care Patients with
Type 2 Diabetes and Association with Cardiometabolic Outcomes: From the SF Bay
Collaborative Research Network (SF Bay CRN).
Handley MA(1), Quan J(2), Chao MT(2), Ratanawongsa N(2), Sarkar U(2), Emmons-Bell
S(2), Schillinger D(2).
Author information:
(1)From General Internal Medicine and UCSF Center for Vulnerable Populations at
San Francisco Zuckerberg General Hospital and Trauma Center, University of
California, San Francisco, CA (MAH, JQ, MTC, NR, US, DS); the Department of
Epidemiology and Biostatistics, Division of Preventive Medicine and Public
Health, University of California, San Francisco (MAH, SE); and Osher Center for
Integrative Medicine, University of California, San Francisco (MTC).
margaret.handley@ucsf.edu.
(2)From General Internal Medicine and UCSF Center for Vulnerable Populations at
San Francisco Zuckerberg General Hospital and Trauma Center, University of
California, San Francisco, CA (MAH, JQ, MTC, NR, US, DS); the Department of
Epidemiology and Biostatistics, Division of Preventive Medicine and Public
Health, University of California, San Francisco (MAH, SE); and Osher Center for
Integrative Medicine, University of California, San Francisco (MTC).
PURPOSE: To describe use of complementary health approaches (CHAs) among patients

with type 2 diabetes, and independent associations between CHA use and Hemoglobin
A1c (A1C) and lower-density lipoprotein (LDL) cholesterol.
METHODS: Participants were enrolled onto the SMARTSteps Program, a diabetes
self-management support program conducted between 2009 and 2013 in San Francisco.
At the 6-month interview, CHA use in the prior 30 days was estimated using a
12-item validated instrument. Demographic and diabetes-related measures A1C were
assessed at baseline and 6-month followup. AIC and LDL values were ascertained
from chart review over the study period. Medication adherence was measured using
pharmacy claims data at 6 and 12 months.
RESULTS: Patients (n = 278) completed 6-month interviews: 74% were women and
71.9% were non-English speaking. Any CHA use was reported by 51.4% overall. CHA
modalities included vitamins/nutritional supplements (25.9%), spirituality/prayer
(21.2%), natural remedies/herbs (24.5%), massage/acupressure (11.5%), and
meditation/yoga/tai chi (10.4%). CHA costs per month were $43.86 (SD = 118.08).
Nearly one third reported CHA (30.0%) specifically for their type 2 diabetes. In
regression models, elevated A1C (>8.0%) was not significantly associated with
overall CHA use (odds ratio [OR] = 1.78; 95% confidence interval [CI], 0.7 to
4.52) whereas elevated LDL was (OR = 3.93; 95% CI, 1.57 to 9.81). With medication
adherence added in exploratory analysis, these findings were not significant.
CONCLUSIONS: CHA use is common among patients with type 2 diabetes and may be
associated with poor cardiometabolic control and medication adherence.
DOI: 10.3122/jabfm.2017.05.170030
947. J Gen Intern Med. 2015 Aug;30(8):1208-14. doi: 10.1007/s11606-015-3196-7. Epub

2015 Feb 10.
Pharmaceutical Cost-Saving Strategies and their Association with Medication

Adherence in a Medicare Supplement Population.
Musich S(1), Cheng Y, Wang SS, Hommer CE, Hawkins K, Yeh CS.
Author information:
(1)Advanced Analytics, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor,
MI, 48108, USA, shirley.musich@optum.com.
Comment in
J Gen Intern Med. 2015 Aug;30(8):1045-6.
BACKGROUND: On average, Medicare Supplement insureds take about seven unique

prescription medications each year, resulting in substantial out-of-pocket drug
copayments, in addition to Medicare Supplement and Part D premiums. To help
alleviate this financial burden, many individuals resort to cost-saving
strategies that are not trackable by Part D insurance plans, likely resulting in
an underestimation of medication adherence rates.
OBJECTIVE: We aimed to estimate utilization rates of cost-saving strategies,
measure member characteristics associated with these strategies and estimate if
these strategies are associated with medication adherence.
DESIGN: This was a cross-sectional analysis of a 2012-2013 survey of AARP®
Medicare Supplement plan insureds with Part D pharmaceutical coverage.
PARTICIPANTS: The study included 5,784 community-dwelling survey respondents ≥ 65
years of age, living in ten states and with self-reported use of prescription
medications.
MAIN MEASURES: Self-reported use of cost-saving strategies included: obtaining
free samples from physicians, splitting pills so medications lasted longer,
purchasing medications from other countries and/or over the internet, or
purchasing medications through the Veterans Administration. Propensity weighted
multivariate regressions were utilized to determine characteristics associated
with the use of such strategies and the association with medication adherence as
measured from Medicare Part D claims.
KEY RESULTS: Among those taking medications, 39.6% used cost-saving strategies.
Those using these strategies were significantly (p < 0.05) more likely to be
male, non-minority, have more comorbid conditions, have more disabilities and use
more medications. Few variables were significantly related to pharmaceutical
nonadherence, but those who were nonadherent were significantly more likely to
use more medications, split pills, obtain free samples from their physicians and
be male.
CONCLUSION: Cost-saving strategies are used extensively as a means to augment
Medicare Part D coverage. These strategies are associated with measured
medication nonadherence and likely result in underreporting of medication
adherence rates. Pharmacy management programs should consider these additional
medication sources in assisting plan members to problem solve cost-related
medication management issues.
DOI: 10.1007/s11606-015-3196-7
PMCID: PMC4510208
948. Int J Environ Res Public Health. 2017 Dec 6;14(12). pii: E1522. doi:
10.3390/ijerph14121522.
Association of Social Support and Medication Adherence in Chinese Patients with

Type 2 Diabetes Mellitus.
Gu L(1), Wu S(2), Zhao S(3), Zhou H(4), Zhang S(5), Gao M(6), Qu Z(7), Zhang
W(8), Tian D(9).
Author information:
(1)China Institute of Health, School of Social Development and Public Policy,
Beijing Normal University, 19 Xinjiekou Wai Street, Haidian District, Beijing
100875, China. gulinni@hotmail.com.
100875, China. wushaominsd@163.com.
(3)School of Public administration, Shandong Technology and Business University,
191 Binhaizhong Road, Yantai 264000, China. pingyuanzhaosan@163.com.
100875, China. chouhuixuan@live.cn.
100875, China. zhangshengfa1988@sina.com.
100875, China. vivianhbs@126.com.
100875, China. qzy@bnu.edu.cn.
100875, China. zwj@bnu.edu.cn.
100875, China. tian65216@hotmail.com.
The prevalence of diabetes is steadily increasing in China. When diabetes is

uncontrolled, it generates dire consequences for health and well-being. Numerous
studies have shown that health outcomes were associated with social support and
medication adherence. Previous study confirmed that social support was associated
with medication adherence in patients with heart failure, HIV diseases, and
first-episode psychosis. However, the relationship between social support and
medication adherence in patients with type 2 diabetes mellitus (T2DM) is remains
unclear. This study aims to examine whether social support is associated with
medication adherence in patients with T2DM. This study was conducted in the First
Affiliated Hospital of the General Hospital of the People's Liberation Army
(PLA). In Beijing, a systematic random sample of 412 patients with T2DM over 18
years was recruited at baseline, and demographic characteristics, clinical data
and their assessment of social support were collected from medical records and
self-reported questionnaires. 330 of these patients completed a self-report
measure of medication adherence at the sixth month after baseline data
collection. Regression analysis showed that social support presented a positive
effect on medication adherence, additionally, support utilization and the
subscale of social support exhibited a significantly strong influence on
medication adherence in patients with T2DM. Although medication adherence was
influenced by multiple factors, this finding confirmed that social support must
be recognized as a core element in interventions aimed at improving in the
management of patients with T2DM.
DOI: 10.3390/ijerph14121522
PMCID: PMC5750940
949. Lupus. 2018 Aug;27(9):1532-1541. doi: 10.1177/0961203318779710. Epub 2018 Jun

28.
Depression and medication nonadherence in childhood-onset systemic lupus

erythematosus.
Davis AM(1)(2), Graham TB(1)(2), Zhu Y(3)(4), McPheeters ML(4)(5).
Author information:
(1)1 Division of Pediatric Rheumatology, Monroe Carell Jr. Children's Hospital at
Vanderbilt, Nashville, TN, USA.
(2)2 Vanderbilt University Medical Center, Nashville, TN, USA.
(3)3 Department of Biostatistics, Vanderbilt University, Nashville, TN, USA.
(4)4 Vanderbilt University School of Medicine, Nashville, TN, USA.
(5)5 Department of Health Policy, Vanderbilt University School of Medicine,
Nashville, TN, USA.
Objectives Depression and medication nonadherence are important in managing

chronic diseases, but little is known about these factors in childhood-onset
systemic lupus erythematosus (cSLE). The objectives of this cross-sectional study
were to estimate prevalence of depression and medication nonadherence, describe
demographic and disease characteristics associated with depression and medication
nonadherence, and evaluate the association between depression and medication
nonadherence in cSLE patients. Methods Patients with cSLE ( n = 51) completed
validated screening questionnaires to identify depression and medication
nonadherence, Patient Health Questionnaire-9 and Medication Adherence Self-Report
Inventory, respectively. Demographic and disease characteristics were obtained
via chart abstraction, and compared between groups of depression or medication
nonadherence status. A multivariable linear regression model adjusting for
propensity scores was conducted to evaluate the association between depression
and medication nonadherence. Results The prevalence of a positive depression
screen was 58.8%, and seven patients reported suicidal ideation (13.7%). The
prevalence of self-reported medication nonadherence was 19.7%. No statistically
significant differences for demographic and disease characteristics were found
between patients with a positive vs. negative depression screen. Patients
reporting medication nonadherence were more likely to have longer disease
duration (4.8 vs. 2.6 years, p = 0.035). As the severity of depression symptoms
increased, the degree of medication nonadherence also increased (beta = -1.89;
p = 0.011). Conclusions The prevalence of depression and medication nonadherence
is high in cSLE, and these factors have a direct relationship. Interventions that
better recognize and treat depression and increase rates of medication adherence
are needed to improve outcomes in cSLE.
DOI: 10.1177/0961203318779710
PMCID: PMC6084794
950. World J Gastroenterol. 2017 Aug 7;23(29):5405-5411. doi:

10.3748/wjg.v23.i29.5405.
Transition clinic attendance is associated with improved beliefs and attitudes

toward medicine in patients with inflammatory bowel disease.
Fu N(1), Jacobson K(1), Round A(1), Evans K(1), Qian H(1), Bressler B(1).
Author information:
(1)Nancy Fu, Brian Bressler, Division of Gastroenterology, Department of
Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.
AIM: To evaluated the differences in knowledge, adherence, attitudes, and beliefs

about medicine in adolescents with inflammatory bowel disease (IBD) attending
transition clinics.
METHODS: We prospectively enrolled patients from July 2012 to June 2013. All
adolescents who attended a tertiary-centre-based dedicated IBD transition clinic
were invited to participate. Adolescent controls were recruited from
university-affiliated gastroenterology offices. Participants completed
questionnaires about their disease and reported adherence to prescribed therapy.
Beliefs in Medicine Questionnaire was used to evaluate patients' attitudes and
beliefs. Beliefs of medication overuse, harm, necessity and concerns were rated
on a Likert scale. Based on necessity and concern ratings, attitudes were then
characterized as accepting, ambivalent, skeptical and indifferent.
RESULTS: One hundred and twelve adolescents were included and 59 attended
transition clinics. Self-reported adherence rates were poor, with only 67.4% and
56.8% of patients on any IBD medication were adherent in the transition and
control groups, respectively. Adolescents in the transition cohort held
significantly stronger beliefs that medications were necessary (P = 0.0035).
Approximately 20% of adolescents in both cohorts had accepting attitudes toward
their prescribed medicine. However, compared to the control group, adolescents in
the transition cohort were less skeptical of (6.8% vs 20.8%) and more ambivalent
(61% vs 34%) (OR = 0.15; 95%CI: 0.03-0.75; P = 0.02) to treatment.
CONCLUSION: Attendance at dedicated transition clinics was associated with
differences in attitudes in adolescents with IBD.
DOI: 10.3748/wjg.v23.i29.5405
PMCID: PMC5550790
Conflict of interest statement: Conflict-of-interest statement: All authors

declare no conflicts of interest.
951. Pediatr Endocrinol Diabetes Metab. 2017;23(1):23-29. doi:

10.18544/PEDM-23.01.0070.
Environmental factors affecting management of type 1 diabetes in children below

the age of 10.
Piechowiak K(1), Zduńczyk B(2), Szypowska A(1).
Author information:
(1)Department of Pediatrics, Medical University of Warsaw, Warsaw.
(2)Clinical Pediatric Hospital, Warsaw.
INTRODUCTION: The way parents manage diabetes of their small children and
environmental influence are crucial for maintaining glycemic control. The aim of
the study was to assess environmental factors affecting metabolic control of
young children with T1D treated with insulin pumps.
MATERIAL AND METHODS: Parents of children with T1D under the age of 10 years
completed: General Self-Efficacy Scale, Parental Diabetes Quality of Life
Questionnaire, Beck Depression Inventory and a questionnaire on socioeconomic
factors.
RESULTS: There were analyzed 165 questionnaires. 66% of children achieved HbA1c
<7.5% (<58mmol/mol). Factors associated with HbA1c≥7.5% (≥58mmol/mol) in the
multiple logistic regression: single-parent families (p=0.003), low income
<250EURO (p=0.017), parental education (p<0.05), snacking without parents'
permission (p=0.0006) and in parents of children ≥6 year of age - quality of life
(p=0.037). In families of children <6 year of age, parents had higher
self-efficacy than parents of children ≥6 year of age (p=0.046).
CONCLUSIONS: Parents of young children are not homogeneous group and face
different challenges. Young children of parents withlower education level and
living in single-parent families are at high risk of poor diabetes management.
More attention should be paid to the problem of young children snacking without
parents' permission.
ABBREVIATIONS: BDI - Beck Depression Inventory, CI-Confidence Intervals, GSES -
General Self-Efficacy Scale, HbA1c - glycated hemoglobin, OR- Odds Ratio, PDQOLQ
- Parental Diabetes Quality of Life Questionnaire, T1D - type 1 diabetes.
Publisher: Wstęp. Wyrównanie metaboliczne małych dzieci chorujących na cukrzycę

typu 1 (T1D) zależy od rodziców i środowiska, w jakim dziecko funkcjonuje. Celem
pracy jest ocena czynników środowiskowych wpływających na wyrównanie metaboliczne
małych dzieci chorujących na T1D leczonych przy pomocy pompy insulinowej.
Materiały i metody. Rodzice dzieci poniżej 10 roku życia wypełniali
kwestionariusze: Skalę uogólnionej własnej skuteczności, Miarę jakości życia
pacjenta z cukrzycą–wariant dla rodzica, Skalę depresji Becka oraz kwestionariusz
oceniający czynniki socjoekonomiczne. Wyniki. Zanalizowano 165 kwestionariuszy. U
66% dzieci stwierdzono HbA1c<7.5% (<58mmol/mol). W regresji logistycznej wykazano
następujące czynniki związane z HbA1c ≥7.5% (≥58mmol/mol): niepełna rodzina
(p=0.003), niski dochód <250EURO (p=0.017), wykształcenie rodzica (p<0.05),
podjadanie (p=0.0006), u rodziców dzieci ≥6 roku życia jakość życia (p=0.037). U
rodziców dzieci <6 roku życia stwierdzono wyższy poziom własnej skuteczności w
porównaniu do rodziców dzieci ≥6 roku życia (p=0.046). Wnioski. Rodzice małych
dzieci nie są jednorodną grupą. Niższy poziom wykształcenia i samotne
rodzicielstwo stanowi ryzyko gorszego wyrównania metabolicznego. Więcej uwagi
należy zwrócić na problem podjadania. Skróty: BDI – Skala Depresji Becka,
CI–przedział ufności, GSES – Skala Uogólnionej Własnej Skuteczności, HbA1c –
hemoglobina glikowana, OR- iloraz szans, PDQOLQ –Miara jakości pacjenta z
cukrzycą-wariant dla rodzica, T1D – cukrzyca typu 1.
© Polish Society for Pediatric Endocrinology and Diabetology.
DOI: 10.18544/PEDM-23.01.0070
952. Ment Health Clin. 2016 May 6;6(3):142-153. doi: 10.9740/mhc.2016.05.142.

Using Photovoice to explore patients' experiences with mental health medication:

A pilot study.
Werremeyer AB(1), Aalgaard-Kelly G(2), Skoy E(3).
Author information:
(1)Associate Professor of Practice, Department of Pharmacy Practice, North Dakota
State University, Fargo, North Dakota, amy.werremeyer@ndsu.edu.
(2)Assistant Professor, Department of Sociology, North Dakota State University,
Fargo, North Dakota.
(3)Associate Professor of Practice, Department of Pharmacy Practice, North Dakota
State University, Fargo, North Dakota.
Introduction: The objective of this research is to explore and share the

medication experience of those with a mental illness in order to gain
understanding of the patient's medication perceptions as well as the impact of
medication upon patients' lives.
Methods: Patients with a mental disorder were given cameras and asked to capture
the experience of "living with my medication." Using Photovoice methodology,
participants reflected on their photos individually and in focus groups.
Conceptual themes were drawn from the data.
Results: Five participants captured an average of 14 photos each. Self-efficacy
with mental illness, mental and physical health connections, and education were
the 3 most prominent themes. Aspects of medications were interwoven within these
themes but were not the primary focus of the participants.
Discussion: Medication experiences of patients with mental illness may encompass
much more than the medications themselves.
DOI: 10.9740/mhc.2016.05.142
PMCID: PMC6007651
PMID: 29955462
Conflict of interest statement: Disclosures: This research was supported by seed

grant funds from the Department of Pharmacy Practice, North Dakota State
University.
eCollection 2015.
Skills-based medication training program for patients with schizophrenic

disorders: a rater-blind randomized controlled trial.
Schirmer UB(1), Steinert T(2), Flammer E(2), Borbé R(2).
Author information:
(1)Centre for Psychiatry South-Wuerttemberg, Ravensburg, Germany.
(2)Centre for Psychiatry South-Wuerttemberg, Ravensburg, Germany ; Ulm
University, Department Psychiatry I, Ravensburg, Germany.
BACKGROUND: The long-term course of schizophrenia is often characterized by

relapses, induced by poor medication adherence. Early nonadherence after
discharge is frequent.
OBJECTIVE: To evaluate a skills-based inpatient training program for medication
intake.
METHODS: We developed a manual-based inpatient medication training program to be
carried out by nurses and focusing on practical skills enabling autonomous intake
of medication. Medication adherence was measured by three different methods: pill
count, determination of serum levels, and self-assessment by the patient. The
raters were blinded.
RESULTS: Four weeks after discharge, 98% of the patients in the intervention
group (N=52) were rated as adherent by pill count versus 76% in the control group
(N=50; P<0.01). By measurement of serum level, 88.5% versus 70% were adherent
(P<0.05).
CONCLUSION: The inpatient medication training program carried out by nurses seems
to be an effective intervention for enhancing medication adherence after hospital
discharge.
DOI: 10.2147/PPA.S75616
PMCID: PMC4386772
PMID: 25848233

eCollection 2018.
Utilizing the common sense model to explore African Americans' perception of type
2 diabetes: A qualitative study.
Shiyanbola OO(1), Ward EC(2), Brown CM(3).
Author information:
(1)Division of Social and Administrative Sciences, University of
Wisconsin-Madison, Madison, WI, United States of America.
(2)Department of Nursing, University of Wisconsin-Madison, Madison, WI, United
States of America.
(3)Division of Health Outcomes and Pharmacy Practice, University of Texas-Austin,
Austin, TX, United States of America.
Illness perceptions, which are likely influenced by patients' cultural contexts,

are associated with disease self-management and adherence. African American
patients perceptions of type 2 diabetes is not well understood and no known
studies has used a comprehensive evidence-based theoretical framework to explore
what AAs with type 2 diabetes know, believe, and think about type 2 diabetes.
Understanding perceptions of an illness shared by a group of people will be
useful in developing culturally-appropriate interventions targeted to the needs
of the community. The purpose of this study is to explore African Americans'
perceptions of type 2 diabetes based on the common sense model of illness and
self-regulation. Using a phenomenology qualitative approach and purposive
sampling, 40 African American men and women, age 45-60 years old with diagnosed
type 2 diabetes at least one year prior, and who took at least one prescription
diabetes medication, participated in six semi-structured 90-minute focus groups
conducted in a private space. Qualitative content analysis was conducted to
explore African Americans beliefs about type 2 diabetes. Participants expressed
that historical issues, e.g., slavery, healthcare providers, the government, and
God influenced how they developed diabetes. Participants reported a loss of
autonomy, a change of their identity as an employee, a social individual and
sexual person, as well as anger and frustration due to having diabetes. Diabetes
made the African American family bonding experience of eating difficult, and the
disease diminished their cultural experiences. Concerns about diabetes ranged
from fear of death and amputations to the inability to prevent the disease among
their children/grandchildren. Participants perceived that medications, faith in
God, and positive thinking about survival helped control diabetes. Conclusions:
Improved diabetes self-management and medication adherence may depend on the
meaning African Americans attach to diabetes, available psychosocial support for
managing diabetes, and African Americans experience with diabetes.
PMCID: PMC6248983

interests exist.
955. Eur J Cancer Care (Engl). 2017 Jan;26(1). doi: 10.1111/ecc.12348. Epub 2015
Aug
4.
From a reactive to a proactive safety approach. Analysis of medication errors in

chemotherapy using general failure types.
Fyhr A(1), Ternov S(2), Ek Å(1).
Author information:
(1)Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of
Engineering, Lund University, Lund, Sweden.
(2)Ternova Lund, Blentarp, Sweden.
A better understanding of why medication errors (MEs) occur will mean that we can
work proactively to minimise them. This study developed a proactive tool to
identify general failure types (GFTs) in the process of managing cytotoxic drugs
in healthcare. The tool is based on Reason's Tripod Delta tool. The GFTs and
active failures were identified in 60 cases of MEs reported to the Swedish
national authorities. The most frequently encountered GFTs were defences,
procedures, organisation and design. Working conditions were often the common
denominator underlying the MEs. Among the active failures identified, a majority
were classified as slips, one-third as mistakes, and for a few no active failure
or error could be determined. It was found that the tool facilitated the
qualitative understanding of how the organisational weaknesses and local
characteristics influence the risks. It is recommended that the tool be used
regularly. We propose further development of the GFT tool. We also propose a tool
to be further developed into a proactive self-evaluation tool that would work as
a complement to already incident reporting and event and risk analyses.
© 2015 The Authors. European Journal of Cancer Care Published by John Wiley &
Sons Ltd.
DOI: 10.1111/ecc.12348
PMCID: PMC5298025
956. Cancer Nurs. 2016 Sep-Oct;39(5):423-4. doi: 10.1097/NCC.0000000000000408.
Do We Have a Clue: The Treatment Burden for the Patient With Cancer?
Given BA(1), Given CW, Vachon E, Hershey D.
Author information:
(1)Author Affiliations: Department of Family Medicine, College of Human Medicine
(Dr C. W. Given), and College of Nursing (Drs B. A. Given and Hershey and Mr
Vachon), Michigan State University, East Lansing.
DOI: 10.1097/NCC.0000000000000408
PMCID: PMC4994973
957. Clin Ophthalmol. 2015 Nov 25;9:2209-12. doi: 10.2147/OPTH.S93038. eCollection

2015.
Pediatric glaucoma medical therapy: who more accurately reports medication

adherence, the caregiver or the child?
Moore DB(1), Neustein RF(2), Jones SK(1), Robin AL(3), Muir KW(4).
Author information:
(1)Duke Eye Center, Duke University Medical Center, Durham, NC, USA.
(2)Emory School of Medicine, Atlanta, GA, USA.
(3)Department of Ophthalmology, Johns Hopkins School of Medicine and
International Health, Bloomberg School of Public Health, Baltimore, MD, USA.
(4)Duke Eye Center, Duke University Medical Center, Durham, NC, USA ; Health
Services Research & Development, Durham VA Medical Center, Durham, NC, USA.
As they grow older, most children with glaucoma must eventually face the
transition to self-administering medications. We previously reported factors
associated with better or worse medication adherence in children with glaucoma,
using an objective, electronic monitor. Utilizing the same data set, the purpose
of the current study was to determine whose report (the caregiver's or the
child's) corresponded better with electronically monitored adherence. Of the 46
participants (22 girls), the mean age of children primarily responsible, and
caregiver primarily responsible for medication administration was 15±2 and 10±2
years, respectively. For the children whose caregiver regularly administered the
eyedrops, the caregiver's assessment of drop adherence was associated with
measured adherence (P=0.012), but the child's was not (P=0.476). For the children
who self-administered eyedrops, neither the child's (P=0.218) nor the caregiver's
(P=0.395) assessment was associated with measured percent adherence. This study
highlights potential errors when relying on self-reporting of compliance in
patients and caregivers with pediatric glaucoma, particularly when the child is
responsible for administering their own eyedrops. Frank discussions about the
importance of medication adherence and how to improve compliance may help both
the child and caregiver better communicate with the treating provider.
DOI: 10.2147/OPTH.S93038
PMCID: PMC4664503
PMID: 26648687
958. Cardiovasc J Afr. 2019 Mar/Apr 23;30(2):113-119. doi: 10.5830/CVJA-2018-050.

Epub
2019 Jan 23.
Assessment of adherence to medication for cardiovascular diseases: measurement

tools.
Uchmanowicz B(1), Szymańska-Chabowska A(2), Jankowska-Polańska B(1).
Author information:
(1)Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical
University, Wroclaw, Poland.
(2)Department of Internal Medicine, Occupational Diseases, Hypertension and
Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland. Email:
aszyman@mp.pl.
The effectiveness of treatment and prevention of chronic illnesses can be

optimised with adherence to medication treatment. This is very often assessed by
means of a self-report. However, the challenge here is to choose the most
suitable questionnaire or the one that is best overall in a given situation. The
aim of this systematic review was to assess existing self-reported medication
adherence scales, which measure adherence to treatment for cardiovascular
disease. The review demonstrated that relatively few disease-specific adherence
scales exist. Generic questionnaires and those specific to adherence to
hypertension treatment are the most numerous. Questionnaires specifically
measuring adherence to anti-haemorrhage treatment for atrial fibrillation are
particularly necessary and noticeably absent. The two most important aspects that
need to be taken into account when selecting the most appropriate scale in a
given context are the subject of the measurement (what) and the method of
validation (how).
DOI: 10.5830/CVJA-2018-050
PMID: 30720844

eCollection 2017.
The mediatory role of medication adherence in improving patients' medication

experience through patient-physician communication among older hypertensive
patients.
Lee W(1), Noh Y(1), Kang H(1), Hong SH(1).
Author information:
(1)Research Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul
National University, Seoul, Korea.
BACKGROUND: Understanding how patient-physician communication affects patients'

medication experience would help hypertensive patients maintain their regular
long-term medication therapy. This study aimed to examine whether
patient-physician communication (information and interpersonal treatment) affects
patients' medication experience directly or indirectly through changing
medication adherence for each of the two communication domains.
METHODS: A self-administered cross-sectional survey was conducted for older
patients who had visited a community senior center as a member. Two communication
domains were assessed using two subscales of the Primary Care Assessment Survey.
Medication adherence and experience were measured using the Morisky Medication
Adherence Scale and a five-point Likert scale, respectively. Mediatory effects
were assessed via Baron and Kenny's procedure and a Sobel test.
RESULTS: Patient-physician communication had a positive prediction on patients'
medication experience (β=0.25, P=0.03), and this was fully mediated by medication
adherence (z=3.62, P<0.001). Of the two components of patient-physician
communication, only informative communication showed a mediatory effect (z=2.21,
P=0.03).
CONCLUSION: Patient-physician communication, specifically informative
communication, had the potential to improve patients' medication experience via
changes in medication adherence. This finding can inform health care stakeholders
of the mediatory role of medication adherence in ensuring favorable medication
experience for older hypertensive patients by fostering informative
patient-physician communication.
DOI: 10.2147/PPA.S137263
PMCID: PMC5505608
PMID: 28740366

A Web-Based and Mobile Health Social Support Intervention to Promote Adherence to

Inhaled Asthma Medications: Randomized Controlled Trial.
Koufopoulos JT(1), Conner MT, Gardner PH, Kellar I.
Author information:
(1)School of Psychology, Faculty of Medicine and Health, University of Leeds,
Leeds, United Kingdom.
BACKGROUND: Online communities hold great potential as interventions for health,

particularly for the management of chronic illness. The social support that
online communities can provide has been associated with positive treatment
outcomes, including medication adherence. There are few studies that have
attempted to assess whether membership of an online community improves health
outcomes using rigorous designs.
OBJECTIVE: Our objective was to conduct a rigorous proof-of-concept randomized
controlled trial of an online community intervention for improving adherence to
asthma medicine.
METHODS: This 9-week intervention included a sample of asthmatic adults from the
United Kingdom who were prescribed an inhaled corticosteroid preventer.
Participants were recruited via email and randomized to either an "online
community" or "no online community" (diary) condition. After each instance of
preventer use, participants (N=216) were required to report the number of doses
of medication taken in a short post. Those randomized to the online community
condition (n=99) could read the posts of other community members, reply, and
create their own posts. Participants randomized to the no online community
condition (n=117) also posted their medication use, but could not read others'
posts. The main outcome measures were self-reported medication adherence at
baseline and follow-up (9 weeks postbaseline) and an objective measure of
adherence to the intervention (visits to site).
RESULTS: In all, 103 participants completed the study (intervention: 37.8%,
39/99; control: 62.2%, 64/117). MANCOVA of self-reported adherence to asthma
preventer medicine at follow-up was not significantly different between
conditions in either intention-to-treat (P=.92) or per-protocol (P=.68) analysis.
Site use was generally higher in the control compared to intervention conditions.
CONCLUSIONS: Joining an online community did not improve adherence to preventer
medication for asthma patients. Without the encouragement of greater community
support or more components to sustain engagement over time, the current findings
do not support the use of an online community to improve adherence.
CLINICALTRIAL: International Standard Randomized Controlled Trial Number
(ISRCTN): 29399269; http://www.isrctn.com/ISRCTN29399269/29399269 (Archived by
WebCite at http://www.webcitation.org/6fUbEuVoT).
DOI: 10.2196/jmir.4963
PMCID: PMC4923591
961. Clin Ther. 2015 Sep 1;37(9):1945-1954.e6. doi:

10.1016/j.clinthera.2015.07.008.
Epub 2015 Aug 14.
Patient and Physician Perspectives on Mode of Administration of the PCSK9

Monoclonal Antibody Alirocumab, an Injectable Medication to Lower LDL-C Levels.
Roth EM(1), Bujas-Bobanovic M(2), Louie MJ(3), Cariou B(4).
Author information:
(1)The Sterling Research Group and University of Cincinnati, Cincinnati, Ohio.
Electronic address: eroth@sterlingresearch.org.
(2)Sanofi, Paris, France.
(3)Regeneron Pharmaceuticals, Inc, Tarrytown, New York.
(4)Department of Endocrinology, l'Institut du Thorax, Nantes University Hospital,
Nantes, France.
PURPOSE: Clinical trials of the PCSK9 inhibitor alirocumab, an every 2 week

injectable monoclonal antibody, have shown significant reductions in
LDL-cholesterol. However, many patients requiring lipid-lowering therapy are not
experienced with self-injected medication. This study assessed patient and
physician perceptions of 2 alirocumab delivery devices.
METHODS: 400 participants (200 physicians, 200 patients) were included from 6
countries. Physicians (99 primary care physicians [PCPs]; 101 specialists) had
mean practice experience of 17.8 years and an average of 797 hypercholesterolemic
patients. Participating patients had LDL-C levels above their goal and at least
one of the following: familial hypercholesterolemia, statin intolerance, high
cardiovascular risk, and/or diabetes. Mean patient age was 58.5 years, 51% were
female, and 25.5% had injectable medication experience. Following device
instruction and demonstration, participants tested either a pre-filled pen or
pre-filled syringe, using both 75 and 150 mg doses of single-blinded placebo into
a prosthetic pad. Data were collected by self-administered questionnaire.
FINDINGS: Participant acceptance of both devices was positive, with 83-100%
agreeing with ease-of-use statements. After testing, physicians estimated that
66% (pen) and 58% (syringe) of their patients would be willing to self-inject
using the device (relative increases from pre-testing of 22% and 16%,
respectively; both P<0.05). Specialist estimates were higher than PCP estimates:
for the pen, 60% versus 47% (pre-testing), respectively, and 72% versus 61%
(post-testing); for the syringe, 57% versus 43% (pre-testing), 63% versus 54%
(post-testing; all P<0.05, specialist vs PCP). After testing, 72% (pen) and 63%
(syringe) of patient-participants were very willing to self-inject (relative
increases from pre-testing of 26% [P<0.05] and 11%, respectively); 96% (pen) and
93% (syringe) were either very willing or somewhat willing to self-inject. The
proportion of patients aged <60 years who were very willing to self-inject with
either device was numerically (but not statistically) higher compared with those
≥60 years. Initially, patients with injectable medication experience were
generally more willing to use the pen than injection-naive patients; after
testing there was no difference between groups. No significant differences were
observed in responses to the 2 different doses.
IMPLICATIONS: Responses from physicians and patients to pre-filled pen and
syringe devices were positive. Devices were considered easy to operate, with most
patients willing to use and accept self-injection. Patient willingness to
self-inject increased after demonstration and testing. Results suggest that, in
clinical practice, alirocumab administration by either pre-filled pen or syringe
would not deter most physicians from prescribing or most patients from
self-administering.
DOI: 10.1016/j.clinthera.2015.07.008
962. Blood Press. 2014 Oct;23(5):288-95. doi: 10.3109/08037051.2014.883203. Epub

2014
Feb 24.
Developing an interactive mobile phone self-report system for self-management of

hypertension. Part 1: patient and professional perspectives.
Bengtsson U(1), Kasperowski D, Ring L, Kjellgren K.
Author information:
(1)Institute of Health and Care Science, Sahlgrenska Academy, University of
Gothenburg , Sweden.
Low adherence remains a struggle in hypertension management, despite improvement

efforts. Presuming that increased patient participation is a possible approach,
we collaborated with patients and healthcare professionals to design a
self-report system to support self-management. The study aimed to explore and
describe relevant aspects of hypertension and hypertension treatment, for use in
the development of an interactive mobile phone self-report system. It further
aimed to suggest which clinical measures, lifestyle measures, symptoms and
side-effects of treatment would be meaningful to include in such a system. Five
focus group interviews were performed with 15 patients and 12 healthcare
professionals, and data was analysed using thematic analysis. Patients suggested
trust, a good relationship with caregivers, and well-being as important aspects
of hypertension self-management. Furthermore, they regarded blood pressure,
dizziness, stress, headache and tiredness as important outcomes to include.
Patients sought to understand interconnections between symptoms and variations in
blood pressure, whilst healthcare professionals doubted patients' ability to do
so. Healthcare professionals emphasized accessibility, clear and consistent
counselling, complication prevention and educational efforts. The study presents
aspects of importance for follow-up to understand the interplay between blood
pressure and daily life experiences for patients with hypertension.
DOI: 10.3109/08037051.2014.883203
PMCID: PMC4196574
963. Int J Environ Res Public Health. 2019 Apr 6;16(7). pii: E1226. doi:
10.3390/ijerph16071226.
Impact of a Culturally Tailored mHealth Medication Regimen Self-Management

Program upon Blood Pressure among Hypertensive Hispanic Adults.
Chandler J(1), Sox L(2), Kellam K(3), Feder L(4), Nemeth L(5), Treiber F(6).
Author information:
(1)College of Nursing, Medical University of South Carolina, Charleston, SC
29425, USA. chandlje@musc.edu.
29425, USA. soxl@musc.edu.
29425, USA. kellam@musc.edu.
29425, USA. feder@musc.edu.
29425, USA. nemethl@musc.edu.
29425, USA. treiberf@musc.edu.
Background: Uncontrolled hypertension (HTN) and medication nonadherence are more

prominent among Hispanics compared to non-Hispanic whites and African Americans.
Advances in wireless health technology enable real-time monitoring of medication
adherence (MA) and blood pressure (BP), facilitating timely patient⁻provider
communication including tailored reinforcement/motivational feedback to patients
and quicker titration changes by providers. The purpose of the current study was
to conduct a 9-month smartphone-enabled efficacy trial addressing MA and BP
control among Hispanic adults with uncontrolled HTN and poor MA. Methods: The
research design was a 9-month, two-arm efficacy trial including an experimental
(Smartphone Med Adherence Stops Hypertension, SMASH) group and an enhanced
standard care (ESC) group. SMASH participants utilized a SMASH app which
interfaced with a Bluetooth-enabled BP monitor for BP self-monitoring and an
electronic medication tray. The ESC participants received text messages including
links to PDFs and brief video clips containing healthy lifestyle tips for
attention control. Results: Participants were 54 Hispanic adults (mean age: 46.5
years) with uncontrolled HTN. They were randomly assigned to either the SMASH (n
= 26) or ESC group (n = 28). At baseline, no participants had controlled systolic
BP (SBP). Baseline group averages for SBP between the SC and SMASH groups did not
differ (150.7 and 152.3 mmHg, respectively; p = 0.53). At the 1, 3, 6, and
9-month time points, SBP averages were significantly lower in the SMASH versus SC
groups (month 1: 125.3 vs. 140.6; month 3: 120.4 vs. 137.5, month 6: 121.2 vs.
145.7 mmHg; month 9: 121.8 vs. 145.7, respectively; all p-values <0.01). At
months 3, 6, and 9 there was a significant difference between the percentage of
participants meeting the 7th Joint National Committee cutoffs for SBP control in
the SC and SMASH groups (month 3: 62.5 vs. 92.0%; month 6: 57.9 and 94.4%, month
9: 27.8 and 92.3%, respectively; all p-values ≤0.01). Average medical regimen
adherence, as indicated by timestamped medication intake and BP monitoring for
the SMASH group, ranged from 89.1 to 95.2% across the 9-month trial. Conclusion:
Our findings indicate that our culturally tailored smartphone-enabled medical
regimen self-management program may be an effective solution for the promotion of
MA, resulting in statistically and clinically significant reductions in SBP among
Hispanic adults with uncontrolled HTN.
DOI: 10.3390/ijerph16071226
PMCID: PMC6479738

eCollection 2018.
"I did not want to take that medicine": African-Americans' reasons for diabetes
medication nonadherence and perceived solutions for enhancing adherence.
Shiyanbola OO(1), Brown CM(2), Ward EC(3).
Author information:
of Wisconsin-Madison, Madison, WI, USA.
(2)Division of Health Outcomes and Pharmacy Practice, College of Pharmacy,
University of Texas at Austin, Austin, TX, USA.
(3)School of Nursing, University of Wisconsin-Madison, Madison, WI, USA.
Background: Diabetes is disproportionally burdensome among African-Americans

(AAs) and medication adherence is important for optimal outcomes. Limited studies
have qualitatively examined reasons for nonadherence among AAs with type 2
diabetes, though AAs are less adherent to prescribed medications compared to
whites. This study explored the reasons for medication nonadherence and adherence
among AAs with type 2 diabetes and examined AAs' perceived solutions for
enhancing adherence.
Methods: Forty AAs, age 45-60 years with type 2 diabetes for at least 1 year
prior, taking at least one prescribed diabetes medication, participated in six
semistructured 90-minute focus groups. Using a phenomenology qualitative
approach, reasons for nonadherence and adherence, as well as participants'
perceived solutions for increasing adherence were explored. Qualitative content
analysis was conducted.
Results: AAs' reasons for intentional nonadherence were associated with 1) their
perception of medicines including concerns about medication side effects, as well
as fear and frustration associated with taking medicines; 2) their perception of
illness (disbelief of diabetes diagnosis); and 3) access to medicines and
information resources. Participants reported taking their medicines because they
valued being alive to perform their social and family roles, and their belief in
the doctor's recommendation and medication helpfulness. Participants provided
solutions for enhancing adherence by focusing on the roles of health care
providers, patients, and the church. AAs wanted provider counseling on the
necessity of taking medicines and the consequences of not taking them, indicating
the need for the AA community to support and teach self-advocacy in diabetes
self-management, and the church to act as an advocate in ensuring medication use.
Conclusion: Intentional reasons of AAs with type 2 diabetes for not taking their
medicines were related to their perception of medicines and illness. Solutions
for enhancing diabetes medication adherence among AAs should focus on the roles
of providers, patients, and the church.
DOI: 10.2147/PPA.S152146
PMCID: PMC5865580
PMID: 29593383


eCollection 2018.
What are the implications for practice that arise from studies of medication
taking? A systematic review of qualitative research.
Rashid MA(1), Llanwarne N(2), Heyns N(2), Walter F(2), Mant J(2).
Author information:
(1)UCL Medical School, Royal Free Hospital, Hampstead, London, United Kingdom.
(2)Primary Care Unit, Department of Public Health & Primary Care, University of
Cambridge, Strangeways Research Laboratory, Cambridge, United Kingdom.
BACKGROUND: Despite several decades of evidence supporting the benefits of taking

medications in various diseases and healthcare settings, a significant proportion
of prescribed treatments are not taken. This review sought to synthesise
qualitative research exploring experiences of medication taking around the world,
and to determine whether there were consistent messages arising from these
studies.
METHODS AND FINDINGS: 5 databases (MEDLINE, PsycINFO, EMBASE, SCOPUS, CINAHL)
were systematically searched to identify published research papers using
qualitative methodologies, which explored medication-taking experiences in
patients, citizens, carers, relatives and clinicians. Data were extracted
independently by at least two clinician reviewers. Implications for practice from
individual papers were charted and coded using thematic content analysis. These
were then cross-tabulated with research paper categories to explore emergent
patterns with particular implications for practice. 192 papers from 34 different
countries were included in the review. Implications for practice fitted into 11
categories: increase family involvement, increase clinician involvement, promote
personalised management, address practical barriers, provide ongoing support,
promote self-management, adopt a patient-centred approach, improve patient
education, address system barriers, increase access to non-prescribing clinicians
and improve clinician training. These implications for practice were generally
evenly spread across research paper categories.
CONCLUSIONS: Implications for practice from the published qualitative literature
exploring medication-taking are notably consistent across research methods,
disease categories and geographical settings. More recent clinical trials of
interventions to improve adherence have started to draw on these findings by
focussing on improving clinical interactions and involving patients in healthcare
decisions. Promoting patient education and self-management have been widely
advocated, and improvements at a system level have been frequently cited in
studies from developing countries and those relating to communicable diseases.
Regardless of the setting, clinicians and policymakers around the world can focus
efforts to improve medication-taking by considering a number of consistently
emerging findings.
PMCID: PMC5955529
966. JMIR Mhealth Uhealth. 2016 Feb 2;4(1):e12. doi: 10.2196/mhealth.4966.
A Mobile App for Hypertension Management Based on Clinical Practice Guidelines:

Development and Deployment.
Kang H(1), Park HA.
Author information:
(1)Systems Biomedical Informatics Research Center, College of Nursing, Seoul
National University, Seoul, Republic Of Korea.
BACKGROUND: Hypertension is a chronic and lifestyle-related disease that requires
continuous preventive care. Although there are many evidence-based clinical
practice guidelines (CPGs) for hypertension management, applying them to daily
management can be difficult for patients with hypertension. A mobile app, based
on CPGs, could help patients with hypertension manage their disease.
OBJECTIVE: To develop a mobile app for hypertension management based on CPGs and
evaluate its effectiveness in patients with hypertension with respect to
perceived usefulness, user satisfaction, and medication adherence.
METHODS: The hypertension management app (HMA) was developed according to the
Web-Roadmap methodology, which includes planning, analysis, design,
implementation, and evaluation phases. The HMA was provided to individuals (N=38)
with hypertension. Medication adherence was measured before and after using the
HMA for 4 weeks. The perceived usefulness and user satisfaction were surveyed in
the patients who completed the medication adherence survey.
RESULTS: Of the 38 study participants, 29 (76%) participated in medical adherence
assessment. Medication adherence, as measured by the Modified Morisky Scale, was
significantly improved in these patients after they had used the HMA (P=.001).
The perceived usefulness score was 3.7 out of 5. The user satisfaction scores,
with respect to using the HMA for blood pressure recording, medication recording,
data sending, alerting, recommending, and educating about medication were 4.3,
3.8, 3.1, 3.2, 3.4, and 3.8 out of 5, respectively, in the 19 patients.
CONCLUSIONS: This study showed that a mobile app for hypertension management
based on CPGs is effective at improving medication adherence.
PMCID: PMC4756253
PMID: 26839283
967. Dig Dis Sci. 2017 Feb;62(2):543-549. doi: 10.1007/s10620-016-4391-z. Epub 2016
Dec 8.
Factors Associated with Medication Non-adherence in Patients with End-Stage Liver

Disease.
Kuo SZ(1), Haftek M(1), Lai JC(2).
Author information:
(1)Division of Gastroenterology/Hepatology, Department of Medicine, University of
California, San Francisco, 513 Parnassus Ave, Med Sci, San Francisco, CA, 94143,
USA.
(2)Division of Gastroenterology/Hepatology, Department of Medicine, University of
California, San Francisco, 513 Parnassus Ave, Med Sci, San Francisco, CA, 94143,
USA. Jennifer.lai@ucsf.edu.
BACKGROUND: Low medication adherence is known to contribute to worse health

outcomes in the general population.
AIM: We aimed to evaluate the medication regimen and determine the adherence
levels among patients with end-stage liver disease.
METHODS: We measured adherence in patients awaiting liver transplantation at a
single center using the 8-item Morisky Medication Adherence Scale (MMAS-8), with
a score <8 classified as low adherence. Medication regimen complexity was
assessed using the Medication Regimen Complexity Index (MRCI) tool. Factors
associated with low adherence were identified by logistic regression.
RESULTS: Of 181 patients, 33% were female, median age was 62, and model for
end-stage liver disease (MELD) score was 13. The median (IQR) number of
medications was 10 (7-13), and the MRCI was 19 (13-27). In total, 54 (30%) were
high adherers, and 127 (70%) were low adherers. In total, 42% reported sometimes
forgetting to take their medication and 22% reported intermittent adherence
within the past 2 weeks. The most common reasons for low adherence were:
forgetfulness (27%) and side effects (14%). Compared to high adherence, low
adherence was associated with higher number of medications, medication
complexity, and diabetes, but lower rates of hepatocellular carcinoma and
self-perceived health. In univariable logistic regression, total medication
number (OR 1.08), MRCI (OR 1.04), diabetes (OR 2.38), HCC (OR 0.38), and lower
self-perceived health (OR 1.37), were statistically significant factors
associated with non-adherence. In multivariate analysis, only medication number
without supplements (OR 1.14) remained significantly associated with medication
non-adherence.
CONCLUSION: A majority of patients awaiting liver transplantation demonstrated
low medication adherence. Total number of medications and regimen complexity were
strong correlates of low adherence. Our data underscores the need for chronic
liver disease management programs to improve medication adherence in this
vulnerable population.
DOI: 10.1007/s10620-016-4391-z
PMCID: PMC5263169
Conflict of interest statement: None to disclose
968. Am J Hypertens. 2014 Nov;27(11):1339-45. doi: 10.1093/ajh/hpu062. Epub 2014

Apr
26.
Self-monitoring of blood pressure for improving adherence to antihypertensive

medicines and blood pressure control: a randomized controlled trial.
Hosseininasab M(1), Jahangard-Rafsanjani Z(1), Mohagheghi A(2), Sarayani A(3),

Rashidian A(4), Javadi M(1), Ahmadvand A(3), Hadjibabaie M(5), Gholami K(6).
Author information:
(1)Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of
Medical Sciences, Tehran, Iran;
(2)Department of Cardiology, Shariati Hospital, Tehran University of Medical
Sciences, Tehran, Iran;
Sciences, Tehran, Iran;
(4)Department of Health Management and Economics, School of Public Health, Tehran
University of Medical Sciences, Tehran, Iran; Knowledge Utilization Research
Center, Tehran University of Medical Sciences, Tehran, Iran.
Medical Sciences, Tehran, Iran; Research Center for Rational Use of Drugs, Tehran
University of Medical Sciences, Tehran, Iran;
Medical Sciences, Tehran, Iran; Research Center for Rational Use of Drugs, Tehran
University of Medical Sciences, Tehran, Iran; khgholami@tums.ac.ir.
BACKGROUND: Self-monitoring is reported to have limited efficacy for hypertension

management in high-income countries. In this study, we aimed to evaluate the
effect of self-monitoring on blood pressure (BP) control in an Iranian
population.
METHODS: A randomized controlled trial was conducted on 196 mild to moderate
hypertensive patients in an outpatient cardiovascular clinic. Patients in the
intervention group received a wrist self-monitoring device and were educated to
measure and document their BP daily during the study period (24 weeks). Patients
in the control group received usual care. Three follow-up visits with the
physician were scheduled for all patients (weeks 4, 12, and 24), and the
investigator assessed adherence to medications after each visit (pill counting).
The primary outcome (BP) was compared between groups using repeated-measure
analysis of variance.
RESULTS: One hundred ninety patients completed the study. Systolic BP (144.4±7.4
vs 145.9±6.4mm Hg) and diastolic BP (85.5±6.9 vs. 85.1±7.7mm Hg) were similar
between groups at baseline. The trend of BP was not significantly different
between groups during the study period. Systolic and diastolic BP decreased
significantly in both groups at the first follow-up visit (systolic BP: 132.6 vs.
133.4mm Hg; diastolic BP: 77.4 vs. 77.2mm Hg). In the intervention group, we
observed a small continued decrease in diastolic BP up to week 24 BP (P = 0.01).
Both groups showed adherence rates >95% during the study period.
CONCLUSIONS: Our study could not confirm that self-monitoring can improve BP
control in patients with frequent medical visits.
© American Journal of Hypertension, Ltd 2014. All rights reserved. For

Permissions, please email: journals.permissions@oup.com.
DOI: 10.1093/ajh/hpu062
PMCID: PMC4263942
969. J Med Internet Res. 2019 Jan 9;21(1):e10421. doi: 10.2196/10421.
Identifying Brief Message Content for Interventions Delivered via Mobile Devices
to Improve Medication Adherence in People With Type 2 Diabetes Mellitus: A Rapid
Systematic Review.
Long H(1), Bartlett YK(1), Farmer AJ(2), French DP(1).
Author information:
(1)Manchester Centre for Health Psychology, School of Health Sciences, University
of Manchester, Manchester, United Kingdom.
Oxford, United Kingdom.
BACKGROUND: Current interventions to support medication adherence in people with

type 2 diabetes are generally resource-intensive and ineffective. Brief messages,
such as those delivered via short message service (SMS) systems, are increasingly
used in digital health interventions to support adherence because they can be
delivered on a wide scale and at low cost. The content of SMS text messages is a
crucial intervention feature for promoting behavior change, but it is often
unclear what the rationale is for chosen wording or any underlying mechanisms
targeted for behavioral change. There is little guidance for developing and
optimizing brief message content for use in mobile device-delivered
interventions.
OBJECTIVE: This review aimed to (1) identify theoretical constructs (ie, the
targets that interventions aim to change) and behavioral strategies (ie, features
of intervention content) found to be associated with medication adherence in
patients with type 2 diabetes and (2) map these onto a standard taxonomy for
behavior change techniques (BCTs, that is, active ingredients of interventions
used to promote behavioral change, to produce an evidence-based set of approaches
that have shown promise of improving adherence in previous studies and which
could be further tested in digital health interventions.
METHODS: A rapid systematic review of existing relevant systematic reviews was
conducted. MEDLINE and PsycINFO databases were searched from inception to April
10, 2017. Inclusion criteria were (1) systematic reviews of quantitative data if
the studies reviewed identified predictors of or correlates with medication
adherence or evaluated medication adherence-enhancing interventions and included
adult participants taking medication to manage a chronic physical health
condition, and (2) systematic reviews of qualitative studies of experiences of
medication adherence for adult participants with type 2 diabetes. Data were
extracted on review characteristics and BCTs, theoretical constructs, or
behavioral strategies associated with improved adherence. Constructs and
strategies were mapped onto the BCT version 1 taxonomy.
RESULTS: A total of 1701 references were identified; 25 systematic reviews (19
quantitative reviews, 3 qualitative reviews, and 3 mixed-method reviews) were
included. Moreover, 20 theoretical constructs (eg, self-efficacy) and 19
behavioral strategies (eg, habit analysis) were identified in the included
reviews. In total, 46 BCTs were identified as being related to medication
adherence in type 2 diabetes (eg, habit formation, prompts or cues, and
information about health consequences).
CONCLUSIONS: We identified 46 promising BCTs related to medication adherence in
type 2 diabetes on which the content of brief messages delivered through mobile
devices to improve adherence could be based. By using explicit systematic review
methods and linking our findings to a standardized taxonomy of BCTs, we have
described a novel approach for the development of digital message content. Future
brief message interventions that aim to support medication adherence could
incorporate the identified BCTs.
©Hannah Long, Yvonne K Bartlett, Andrew J Farmer, David P French. Originally

published in the Journal of Medical Internet Research (http://www.jmir.org),
09.01.2019.
DOI: 10.2196/10421
PMCID: PMC6329430
PMID: 30626562
970. Int J Clin Pract. 2019 Jan;73(1):e13260. doi: 10.1111/ijcp.13260. Epub 2018
Sep
21.
Establishing US norms for the Adult ADHD Self-Report Scale (ASRS-v1.1) and
characterising symptom burden among adults with self-reported ADHD.
Adler LA(1), Faraone SV(2), Sarocco P(3), Atkins N(3), Khachatryan A(3).
Author information:
(1)Departments of Psychiatry and Child and Adolescent Psychiatry, NYU School of
Medicine, New York City, New York.
(2)Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York.
(3)Global Health Economics and Outcomes Research, Shire, LLC, Cambridge,
Massachusetts.
AIMS: To estimate Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist

normative total scores among the US adult general population and to evaluate
overall attention-deficit hyperactivity disorder (ADHD) symptom burden among US
adults with ADHD.
METHODS: Prior 2012 and 2013 US National Health and Wellness Survey respondents
were re-contacted. Demographics, comorbidities, and ASRS-v1.1 data were
collected. ASRS-v1.1 scores were compared by sex, age, ADHD diagnosis, and ADHD
medication use. Group differences were evaluated using chi-square tests and
independent samples t-tests for categorical and continuous variables,
respectively.
RESULTS: Of 22 397 respondents, 465 self-reported being diagnosed with ADHD by a
physician; of these, 174 self-reported using ADHD medication. The mean ASRS-v1.1
total score was 2.0 (SD = 3.2); scores differed by age and sex (all, P < 0.001).
ADHD (vs no ADHD) was associated with depression (58.1% vs 18.0%), anxiety (53.1%
vs 16.0%), and sleep difficulties (37.0% vs 14.0%) (all, P < 0.001). ADHD
medication use (vs no use) was associated with depression (68.4% vs 51.9%),
anxiety (67.2% vs 44.7%), panic disorder (25.9% vs 17.2%), and insomnia (27.6% vs
19.6%) (all, P < 0.05). ADHD (vs no ADHD) respondents scored higher on all 18
ASRS-v1.1 items (all, P < 0.05). Medication users (vs non-users) scored higher on
six items (all, P < 0.05).
DISCUSSION: Adult ADHD may be undertreated or sub-optimally treated, despite a
high symptom burden. Normative data will allow comparisons with individuals'
scores to support the assessment of ADHD symptom burden among adults.
CONCLUSION: Findings highlight the importance of assessing ADHD symptom burden,
especially among adults presenting with comorbidities.
© 2018 The Authors. International Journal of Clinical Practice Published by John

Wiley & Sons Ltd.
DOI: 10.1111/ijcp.13260
PMCID: PMC6585602

eCollection 2016.
Systematic Analysis of Self-Reported Comorbidities in Large Cohort Studies - A

Novel Stepwise Approach by Evaluation of Medication.
Lucke T(1)(2), Herrera R(1)(3), Wacker M(4), Holle R(4), Biertz F(5), Nowak
D(1)(2), Huber RM(2)(6), Söhler S(7), Vogelmeier C(7), Ficker JH(8)(9), Mückter
H(10), Jörres RA(1)(2); COSYCONET-Consortium.
Author information:
(1)Institute and Outpatient Clinic for Occupational, Social and Environmental
Medicine, University Hospital LMU Munich, München, Germany.
(2)Comprehensive Pneumology Center Munich, DZL, German Center for Lung Research,
München, Germany.
(3)Center for International Health, Ludwig-Maximilian University Munich, München,
Germany.
(4)German Research Center for Environmental Health, Institute of Health Economics
and Health Care Management, Member of the German Center for Lung Research,
Comprehensive Pneumology Center Munich (CPC-M), Neuherberg, Germany.
(5)Institute for Biostatistics, Hannover Medical School, Hannover, Germany.
(6)Thoracic Oncology Center Munich (TOM), University Hospital LMU Munich,
München, Germany.
(7)Pulmonary and Critical Care Medicine, Department of Medicine, University
Medical Centre Giessen and Marburg, Philipps-University, Marburg, Germany.
(8)Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum
Nuremberg, Nürnberg, Germany.
(9)Paracelsus Medical University Nuremberg, Nürnberg, Germany.
(10)Walther-Straub-Institute for Pharmacology and Toxicology, Ludwig-Maximilian
University Munich, München, Germany.
OBJECTIVE: In large cohort studies comorbidities are usually self-reported by the

patients. This way to collect health information only represents conditions
known, memorized and openly reported by the patients. Several studies addressed
the relationship between self-reported comorbidities and medical records or
pharmacy data, but none of them provided a structured, documented method of
evaluation. We thus developed a detailed procedure to compare self-reported
comorbidities with information on comorbidities derived from medication
inspection. This was applied to the data of the German COPD cohort COSYCONET.
METHODS: Approach I was based solely on ICD10-Codes for the diseases and the
indications of medications. To overcome the limitations due to potential
non-specificity of medications, Approach II was developed using more detailed
information, such as ATC-Codes specific for one disease. The relationship between
reported comorbidities and medication was expressed by a four-level concordance
score.
RESULTS: Approaches I and II demonstrated that the patterns of concordance scores
markedly differed between comorbidities in the COSYCONET data. On average,
Approach I resulted in more than 50% concordance of all reported diseases to at
least one medication. The more specific Approach II showed larger differences in
the matching with medications, due to large differences in the
disease-specificity of drugs. The highest concordance was achieved for diabetes
and three combined cardiovascular disorders, while it was substantial for
dyslipidemia and hyperuricemia, and low for asthma.
CONCLUSION: Both approaches represent feasible strategies to confirm
self-reported diagnoses via medication. Approach I covers a broad spectrum of
diseases and medications but is limited regarding disease-specificity. Approach
II uses the information from medications specific for a single disease and
therefore can reach higher concordance scores. The strategies described in a
detailed and reproducible manner are generally applicable in large studies and
might be useful to extract as much information as possible from the available
data.
PMCID: PMC5085029

interests exist.
972. J Am Pharm Assoc (2003). 2016 Jul-Aug;56(4):450-454.e1. doi:

10.1016/j.japh.2016.03.017.
Kidney transplant recipients' attitudes about using mobile health technology for
managing and monitoring medication therapy.
Browning RB, McGillicuddy JW, Treiber FA, Taber DJ.
OBJECTIVES: To assess smartphone ownership, use of mobile health (mHealth)

applications, and willingness to use this technology to facilitate medication
management after kidney transplantation.
METHODS: A survey was developed with the use of previously validated questions
and administered to stable adult kidney recipients from May to July 2015.
Descriptive and comparative statistics were used to assess willingness to utilize
mHealth technology as it related to sociodemographics, medication adherence, and
medication side effects. Comparisons were also made to a survey administered in
2012. The primary outcome was the incidence of cell phone and smartphone
ownership, willingness to use mHealth, immunosuppressant side effects, and
self-reported nonadherence.
RESULTS: A total of 142 patients were approached, and 139 (98%) agreed to
participate; 96% of respondents indicated mobile phone ownership, 61% owned a
smartphone, 30% had prior knowledge of mHealth, and 7% were already using an
mHealth app; 78% reported a positive attitude toward the use of mHealth for
medication management. Smartphone ownership has nearly doubled since 2012 (61%
vs. 35%; P <0.001). Patients <55 years of age were more likely to own smartphones
(75% vs. 46%; P <0.001) and to strongly agree with the use of mHealth (62% vs.
36%; P = 0.015). Self-reported nonadherence or severe medication side effects did
not appreciably influence a patient's willingness to use mHealth.
CONCLUSION: Among recipients of kidney transplants, smartphone ownership has
dramatically increased, and recipients have a positive attitude toward the use of
mHealth for medication management.
DOI: 10.1016/j.japh.2016.03.017
PMCID: PMC4968877
973. J Manag Care Spec Pharm. 2017 May;23(5):566-572. doi:

10.18553/jmcp.2017.23.5.566.
Exploring Electronic Medical Record and Self-Administered Medication Risk

Screening Tools in a Primary Care Clinic.
Makowsky MJ(1), Cor K(1), Wong T(2).
Author information:
(1)1 Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta,
Edmonton, Alberta, Canada.
(2)2 Grey Nuns Community Hospital, Edmonton, Alberta, Canada.
BACKGROUND: Electronic medical record (EMR) screening for indicators of

medication risk could improve efficiency in identifying primary care clinic
patients in need of clinical pharmacist care compared with patient
self-reporting.
OBJECTIVES: To (a) compare the performance of an EMR medication risk assessment
questionnaire (MRAQ) with a self-administered (SA) MRAQ and (b) explore each
tool's ability to predict indicators of health behavior, health status, and
health care utilization.
METHODS: A prospective cohort study was conducted with 143 adults who attended an
academic family medicine center and were taking ≥ 2 medications. All participants
completed the 10-item SA-MRAQ, Morisky Medication Adherence Scale, Chew's health
literacy screener, Stanford Health Distress Scale, and SF-36 overall rating of
health. A blinded investigator completed the EMR-MRAQ and a chart review to
ascertain 6 months of health care utilization. Outcome measures included the
following: (a) scores from the 5- and 10-item SA-MRAQs and 5-item EMR-MRAQ; (b)
sensitivity and specificity to determine the accuracy of the 5-item EMR versus
the 5-item SA risk scores; (c) correlations between risk assessments and health
behavior/status scales; and (d) area under the receiver operator curve to
determine how well a high-risk score predicted health care utilization.
RESULTS: The 5-item SA-MRAQ, the 5-item EMR-MRAQ, and the 10-item SA-MRAQ
categorized 52.9% (55/104), 69.2% (99/143), and 17.6% (18/102) of participants as
high risk, respectively. For the 104 participants who completed both 5-item MRAQ
tools, the EMR-MRAQ had a sensitivity of 81.8% and specificity of 49.0% in
detecting a high-risk SA-MRAQ score. Both 5-item risk assessments showed weak
correlations with health distress and overall health, while the 10-item SA-MRAQ
additionally showed weak correlations with medication adherence. The EMR-MRAQ was
most effective in predicting all-cause emergency room visits/hospitalization
(c-statistic = 0.69; 95% CI=0.57-0.81) and high clinic utilization (≥ 4 visits
per 6 months; c-statistic = 0.77; 95% CI = 0.69-0.85). The EMR-MRAQ had high
sensitivities but low specificities for these health care utilization outcomes,
respectively (82.6% and 33.3%; 88.9% and 42.7%).
CONCLUSIONS: This pilot study suggests that EMR-MRAQ screening has high
sensitivity but low specificity in comparison with self-reporting and was able to
discriminate between those who would and would not experience health care
utilization outcomes. These results justify further development and validation of
an automated EMR-based tool to predict patient-important consequences of
medication-related problems.
DISCLOSURES: This work was funded by the Canadian Society of Hospital Pharmacists
Research and Education Foundation, which had no role in the analysis or
interpretation of data or the decision to submit the manuscript for publication.
The authors have no conflict of interests, potential or otherwise, to report.
Makowsky had full access to all of the data in the study and takes responsibility
for the integrity of the data and the accuracy of the data analysis. Study
concept and design were contributed by Makowsky and Cor. Makowsky and Wong
collected the data, and data interpretation was performed by Makowsky, Cor, and
Wong. The manuscript was written by Makowsky and was critically reviewed for
intellectual content by Makowsky, Cor, and Wong.
DOI: 10.18553/jmcp.2017.23.5.566
974. JMIR Res Protoc. 2014 Dec 23;3(4):e79. doi: 10.2196/resprot.4041.
Improving outcomes in cancer patients on oral anti-cancer medications using a

novel mobile phone-based intervention: study design of a randomized controlled
trial.
Agboola S(1), Flanagan C, Searl M, Elfiky A, Kvedar J, Jethwani K.
Author information:
(1)Partners Healthcare Center for Connected Health, Boston, MA, United States.
sagboola@partners.org.
BACKGROUND: The widespread and increasing use of oral anti-cancer medications has
been ushered in by a rapidly increasing understanding of cancer pathophysiology.
Furthermore, their popular ease of administration and potential cost savings has
highlighted their central position in the health care system as a whole. These
facts have heightened appreciation of the unique challenges associated with the
use of oral anti-cancer medications; especially in the long-term use of these
medications and the associated side effects that may impede optimal adherence to
their use. Therefore, we developed ChemOtheRapy Assistant, CORA, a personalized
mobile phone-based self-management application to help cancer patients on oral
anti-cancer medications.
OBJECTIVE: Our objective is to evaluate the effect of CORA on adherence to oral
anti-cancer medications and other clinically relevant outcomes in the management
of patients with renal and prostate cancer.
METHODS: The study will be implemented as a 2-parallel group randomized
controlled trial in 104 patients with renal or prostate cancer on oral
anti-cancer medications over a 3-month study period. The intervention group will
use CORA in addition to usual care for self-management while the control group
will continue care as usual. Medication adherence will be measured objectively by
a Medication Event Monitoring System device and is defined as the percentage of
prescribed doses taken. We will also assess the effect of the intervention on
cancer-related symptoms measured by the MD Anderson Symptom Inventory and
unplanned hospital utilizations. Other outcomes that will be measured at study
start, midpoint, and endpoint are health-related quality of life, cancer-related
fatigue, and anxiety. Group differences in medication adherence will be examined
by t tests or by non-parametric Mann-Whitney tests if the data are not normally
distributed. Logistic regression will be used to identify potential predictors of
adherence.
RESULTS: We expect to have results for this study before the end of 2016.
CONCLUSIONS: This novel mobile phone-enabled, multimodal self-management and
educational intervention could lead to improvements in clinical outcomes and
serve as a foundation for future mHealth research in improving outcomes for
patients on oral anti-cancer medications.
PMCID: PMC4296099
PMID: 25537463
975. J Clin Diagn Res. 2016 Nov;10(11):LC01-LC05. doi:

10.7860/JCDR/2016/15079.8845.
Epub 2016 Nov 1.
Validation of Malaysian Versions of Perceived Diabetes Self-Management Scale

(PDSMS), Medication Understanding and Use Self-Efficacy Scale (MUSE) and
8-Morisky Medication Adherence Scale (MMAS-8) Using Partial Credit Rasch Model.
Al Abboud SA(1), Ahmad S(2), Bidin MB(3), Ismail NE(2).
Author information:
(1)Clinical BioPharmaceutics Research Group (CBRG), Faculty of Pharmacy,
Universiti Teknologi MARA , Puncak Alam Campus, 42300 Bandar Puncak Alam,
Selangor, Malaysia .
(2)Faculty of Pharmacy, Level 9, Pharmacy Building, MAHSA University , Jalan SP2,
Bandar Saujana Putra, 42610 Jenjarom, Kuala Langat, Selangor, Malaysia .
(3)Endocrine Unit, Medical Department, Hospital Kuala Lumpur , 50586 Jalan
Pahang, Kuala Lumpur, Malaysia .
INTRODUCTION: The Diabetes Mellitus (DM) is a common silent epidemic disease with
frequent morbidity and mortality. The psychological and psychosocial health
factors are negatively influencing the glycaemic control in diabetic patients.
Therefore, various questionnaires were developed to address the psychological and
psychosocial well-being of the diabetic patients. Most of these questionnaires
were first developed in English and then translated into different languages to
make them useful for the local communities.
AIM: The main aim of this study was to translate and validate the Malaysian
versions of Perceived Diabetes Self-Management Scale (PDSMS), Medication
Understanding and Use Self-Efficacy Scale (MUSE), and to revalidate 8-Morisky
Medication Adherence Scale (MMAS-8) by Partial Credit Rasch Model (Modern Test
Theory).
MATERIALS AND METHODS: Permission was obtained from respective authors to
translate the English versions of PDSMS, MUSE and MMAS-8 into Malay language
according to established standard international translation guidelines. In this
cross-sectional study, 62 adult DM patients were recruited from Hospital Kuala
Lumpur by purposive sampling method. The data were extracted from the
self-administered questionnaires and entered manually in the Ministeps (Winsteps)
software for Partial Credit Rasch Model. The item and person reliability,
infit/outfit Z-Standard (ZSTD), infit/outfit Mean Square (MNSQ) and point measure
correlation (PTMEA Corr) values were analysed for the reliability analyses and
construct validation.
RESULTS: The Malay version of PDSMS, MUSE and MMAS-8 found to be valid and
reliable instrument for the Malaysian diabetic adults. The instrument showed good
overall reliability value of 0.76 and 0.93 for item and person reliability,
respectively. The values of infit/outfit ZSTD, infit/outfit MNSQ, and PTMEA Corr
were also within the stipulated range of the Rasch Model proving the valid item
constructs of the questionnaire.
CONCLUSION: The translated Malay version of PDSMS, MUSE and MMAS-8 was found to
be a highly reliable and valid questionnaire by Partial Credit Model. The Malay
version was conceptually equivalent to original version, easy to understand and
can be used for the Malaysian adult diabetic patients for future studies.
DOI: 10.7860/JCDR/2016/15079.8845
PMCID: PMC5198358
PMID: 28050405

eCollection 2014.
Concordance between patient self-reports and claims data on clinical diagnoses,

medication use, and health system utilization in Taiwan.
Wu CS(1), Lai MS(2), Gau SS(3), Wang SC(4), Tsai HJ(5).
Author information:
(1)Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City,
Taiwan; College of Public Health, National Taiwan University, Taipei, Taiwan;
Department of Psychiatry, National Taiwan University Hospital and College of
Medicine, National Taiwan University, Taipei, Taiwan.
(2)College of Public Health, National Taiwan University, Taipei, Taiwan.
(3)College of Public Health, National Taiwan University, Taipei, Taiwan;
Department of Psychiatry, National Taiwan University Hospital and College of
Medicine, National Taiwan University, Taipei, Taiwan.
(4)Center of Neuropsychiatric Research, National Health Research Institutes,
Zhunan, Taiwan.
(5)Division of Biostatistics and Bioinformatics, Institute of Population Health
Sciences, National Health Research Institutes, Zhunan, Taiwan; Department of
Medical Genetics, College of Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan; Department of Pediatrics, Feinberg School of Medicine, Northwestern
University, Chicago, Illinois, United States of America.
PURPOSE: The aim of this study was to evaluate the concordance between claims
records in the National Health Insurance Research Database and patient
self-reports on clinical diagnoses, medication use, and health system
utilization.
METHODS: In this study, we used the data of 15,574 participants collected from
the 2005 Taiwan National Health Interview Survey. We assessed positive agreement,
negative agreement, and Cohen's kappa statistics to examine the concordance
between claims records and patient self-reports.
RESULTS: Kappa values were 0.43, 0.64, and 0.61 for clinical diagnoses,
medication use, and health system utilization, respectively. Using a strict
algorithm to identify the clinical diagnoses recorded in claims records could
improve the negative agreement; however, the effect on positive agreement and
kappa was diverse across various conditions.
CONCLUSION: We found that the overall concordance between claims records in the
National Health Insurance Research Database and patient self-reports in the
Taiwan National Health Interview Survey was moderate for clinical diagnosis and
substantial for both medication use and health system utilization.
PMCID: PMC4251897
977. J Curr Glaucoma Pract. 2015 May-Aug;9(2):33-7. doi:

10.5005/jp-journals-10008-1181. Epub 2015 Sep 25.
How 'Drug Aware' are our Glaucoma Patients?
Mohindroo C(1), Ichhpujani P(2), Kumar S(3).
Author information:
(1)Final Year Student, Department of Ophthalmology, Glaucoma Service, Government
Medical College and Hospital, Chandigarh, India.
(2)Assistant Professor, Department of Ophthalmology, Glaucoma Service, Government
(3)Associate Professor, Department of Ophthalmology, Glaucoma Service, Government
BACKGROUND: Poor knowledge, attitude and self-care practices (KAP) as regards

medication compliance is a major concern in the management of glaucoma. This
study aims to evaluate the knowledge, attitude regarding eyedrop instillation and
self-care practices pertaining to eyedrops in diagnosed glaucoma patients.
METHODS: In this cross-sectional, open-ended questionnaire-based study, 101
consecutive glaucoma patients on medication were recruited from an urban tertiary
care hospital of North India. A self-designed 10-point KAP questionnaire that
addressed patient-, medication-, environment- and physicians related factors was
used. For each desirable answer, the participant gives a score of 1 was given and
for each undesirable answer a score of '0' was given for each question. The total
scores for each domain were calculated separately along with the total score. The
association between the individual domain scores, the total score and various
sociodemographic parameters were compared using unpaired t-test. Analysis of
variance (ANOVA) test was used to compare the means, where the exposure variable
had more than two categories.
RESULTS: Out of 101 participants, 98% knew the reason why they were instilling
the medicine. Only 61.4% subjects knew that the eyedrops should be stored in cool
and dry place. Nearly 30% participants believed that two eyedrops could be
instilled back to back. Half of the participants (55.4%) did not consider missing
a dose of medicine to be significant. Majority (89.1%) of the participants asked
the doctor about the drug dosage and timings and 71.3% of them did not use the
eyedrops beyond 40 days after opening the vial. 37.6% participants believed that
the medicine could be discontinued without asking the doctor, once the symptoms
are relieved. Eighty percent patients checked the vial for correct drug name and
expiry date before buying. 57.4% of the participants washed their hands before
instilling the eyedrops. Only 23.8% patients asked their doctor for alternate
medication name, in case they do not get the primary medication. There were no
statistically significant differences in the mean domain and total scores between
males and females and between urban and rural patients. There were no
statistically significant differences in knowledge (p = 0.059) and attitude (p =
0.809) scores in people with different educational qualification. But education
had a statistically significant relation with the practice scores (p = 0.004) and
total scores (p = 0.047).
CONCLUSION(S): There exists marked variation in the reported practices, even in
the very basic prerequisites of instilling eye-drops like washing of hands,
checking the expiry date before the usage of eyedrops. The findings in our study
suggest a need to better educate our patients by providing them detailed
information about eyedrop and its administration. This would help to reduce
patients' frustration, improve compliance and increase the efficacy of
anti-glaucoma therapy. How to cite this article: Mohindroo C, Ichhpujani P, Kumar
S. How 'Drug Aware' are our Glaucoma Patients? J Curr Glaucoma Pract
2015;9(2):33-37.
DOI: 10.5005/jp-journals-10008-1181
PMCID: PMC4750024
PMID: 26997832
978. Pediatr Rheumatol Online J. 2016 Oct 19;14(1):57.
"Sometimes I feel like a pharmacist": identity and medication use among

adolescents with juvenile arthritis.
McDonagh JE(1), Shaw KL(2), Prescott J(3), Smith FJ(4), Roberts R(5), Gray NJ(6).
Author information:
(1)Centre for Musculoskeletal Research, Stopford Building, University of
Manchester, Oxford Rd, Manchester, England, M13 9PT, UK.
janet.mcdonagh@manchester.ac.uk.
(2)NIHR CLAHRC West Midlands, University of Birmingham, Birmingham, UK.
(3)School of Education and Psychology, University of Bolton, Bolton, England, UK.
(4)UCL School of Pharmacy, London, England, UK.
(5)Pharmacy Research UK, London, England, UK.
(6)Green Line Consulting Limited, Manchester, England, UK.
BACKGROUND: Taking medicines as intended is difficult for everybody, but young

people going through adolescence have greater problems than adults and younger
children. One of the most important things that happen during the teenage years
is the development of individual identities, which might not remain constant
during this time and can be affected deeply by the diagnosis of a long-term
condition. The aim of this study was to examine the relationships between
identity and medication use among young people with juvenile arthritis.
METHODS: A prospective qualitative study was undertaken to collect private online
'blog' style data from young people (aged 11-19 years) with juvenile arthritis,
and their parents, to examine their views about their condition, identity,
medication and use of health services. Participants were identified from a large
paediatric hospital in the UK.
RESULTS: Young people (n = 21) with a median age 14 years (range 11-17 years)
posted a median (range) of 8 (1-36) blogs and parents (n = 6) posted 4 (1-12)
blogs. Young people gave a strong sense of both private and public identity that
was intertwined with their arthritis and treatment. It was evident that young
people's self-care was intrinsically linked to their attempts to maintain a sense
of individually and socially constructed definitions of normality. The act of
taking medication, and the consequences (positive or negative) of that act, had
an impact both personally and socially.
CONCLUSIONS: Young people with juvenile arthritis reflect on their medication as
a factor affecting their perception of themselves. Acknowledging the roles of
both personal and social identity will be important in any strategies to support
optimal medication use. This includes an understanding of the identity
transformations that young people can experience and how decision-making may be
affected by their attempts to retain pre-diagnosis identities and/or develop new
social identities.
DOI: 10.1186/s12969-016-0117-1
PMCID: PMC5070126
979. J Am Pharm Assoc (2003). 2018 Jan - Feb;58(1):61-66.e7. doi:

10.1016/j.japh.2017.09.059. Epub 2017 Nov 9.
Characterization of actions taken during the delivery of medication therapy

management: A time-and-motion approach.
Chang AC, Lincoln J, Lantaff WM, Gernant SA, Jaynes HA, Doucette W, Snyder ME.
Erratum in
J Am Pharm Assoc (2003). 2018 Mar 29;:.
OBJECTIVES: To characterize actions performed by pharmacists and support staff

during provision of medication therapy management (MTM) and to compare actions
performed according to practice characteristics.
METHODS: A purposeful sample of 7 MTM practices (2 call centers and 5 community
practices) was identified and visited by investigators. Pharmacists and support
staff were observed during their routine provision of MTM. Investigators
characterized "major" (e.g., preparation for a comprehensive medication review)
and "minor" (i.e., specific steps in overarching major action) actions with the
use of a time-and-motion approach.
RESULTS: A total of 32 major and 469 minor actions were observed. Practices were
characterized as Later Maturity Level or Early Maturity Level on the basis of
their self-reported MTM appointment volume, self-assessment of the extent of
integration of chronic care model principles, and payer mix. Later Maturity Level
practices were more likely to deliver follow-up medication therapy reviews and
comprehensive medication reviews (CMRs) as opposed to targeted medication reviews
(TMRs) and to receive physician referrals for MTM. Later Maturity Level practices
were also more likely to use paid interns than pharmacy rotation students. CMR
activities observed at Later Maturity Level practices lasted a median of 30.8
minutes versus 20.3 minutes for CMR activities at Early Maturity Level practices.
Similarly, TMR activities observed at Later Maturity Level practices were longer:
a median of 31.0 minutes versus 12.3 minutes. At Later Maturity Level practices,
pharmacists spent a greater proportion of time providing patient education, while
support staff spent a greater proportion of time on tasks such as capturing
demographics and introducing or explaining MTM.
CONCLUSION: MTM activities were longer at Later Maturity Level practices, and
these practices were more likely to use paid pharmacy interns and to receive
physician referrals for MTM. This work provides a foundation for future research.

DOI: 10.1016/j.japh.2017.09.059
PMCID: PMC5748350
980. Can J Hosp Pharm. 2017 Jul-Aug;70(4):263-269. Epub 2017 Aug 31.
Reliability of Best Possible Medication Histories Completed by Non-admitted

Patients in the Emergency Department.
MacDonald N(1), Manuel L(2), Brennan H(3), Musgrave E(4), Wanbon R(5), Stoica
G(6).
Author information:
(1), BSc(Pharm), ACPR, is with the Health Sciences Centre, Eastern Health, St
John's, Newfoundland and Labrador.
(2), BSc(Chem), BSc(Pharm), PharmD, ACPR, is with Horizon Health Network - The
Moncton Hospital, Moncton, New Brunswick.
(3), BSc(Pharm), ACPR, is with Horizon Health Network - The Moncton Hospital,
Moncton, New Brunswick.
(4), MN, RN, ENC(C), is with Horizon Health Network - The Moncton Hospital,
Moncton, New Brunswick.
(5), BSc(Pharm), ACPR, PharmD, is with Vancouver Island Health Authority - Royal
Jubilee Hospital, Victoria, British Columbia.
(6), PhD (Statistics), PhD (Mathematics), is with Horizon Health Network - Saint
John Regional Hospital, Saint John, New Brunswick.
BACKGROUND: Accreditation standards have outlined the need for staff in emergency
departments to initiate the medication reconciliation process for patients who
are at risk of adverse drug events. The authors hypothesized that a guided form
could be used by non-admitted patients in the emergency department to assist with
completion of a best possible medication history (BPMH).
OBJECTIVE: To determine the percentage of patients in the non-acute care area of
the emergency department who could complete a guided BPMH form with no clinically
significant discrepancies (defined as no major discrepancies and no more than 1
moderate discrepancy).
METHODS: This prospective exploratory study was conducted over 4 weeks in
February and March 2016. Data were collected using the self-administered BPMH
form, patient interviews, and a data collection form. After completion of the
guided BPMH form, patients were randomly selected for interview by a pharmacy
team member to ensure their self-completed BPMH forms were complete and accurate.
Eligible patients were those with non-acute needs who had undergone triage to the
waiting room. Patients who were already admitted and those with immediate triage
to the acute care or trauma area of the emergency department were excluded.
RESULTS: Of the 160 patients who were interviewed, 146 (91.3%) completed the form
with no more than 1 moderate discrepancy (but some number of minor
discrepancies). There were no discrepancies in 31 (19.4%) of the BPMH forms, and
101 (63.1%) of the forms had only minor discrepancies.
CONCLUSIONS: Most of the patients interviewed by the pharmacy team were able to
complete the BPMH form with no clinically significant discrepancies. The
self-administered BPMH form would be a useful tool to initiate medication
reconciliation in the emergency department for this patient population, but used
on its own, it would not be a reliable source of BPMH information, given the
relatively low number of patients who completed the form with no discrepancies.
Publisher: Les normes d’agrément ont souligné la nécessité pour le personnel des
services des urgences d’amorcer le processus de bilan comparatif des médicaments
chez les patients à risque d’événements indésirables liés aux médicaments. Les
auteurs ont avancé que des patients au service des urgences ne requérant pas une
hospitalisation pourraient remplir un formulaire dirigé et ainsi aider à établir
leur meilleur schéma thérapeutique possible (MSTP).Déterminer le pourcentage de
patients dans l’aire de soins non urgents du service des urgences qui sont en
mesure de remplir un formulaire dirigé de MSTP sans divergence cliniquement
significative (c’est-à-dire aucune divergence majeure et pas plus d’une
divergence modérée).La présente étude préliminaire prospective a été menée sur
une période de quatre semaines en février et en mars 2016. Les données ont été
recueillies à l’aide d’un formulaire autoadministré de MSTP, d’entrevue avec les
patients et d’un formulaire de collecte de données. Une fois les formulaires
dirigés de MSTP remplis, des patients ont été sélectionnés aléatoirement et
interrogés par un des membres de l’équipe de pharmacie afin de s’assurer de
l’exhaustivité et de l’exactitude des renseignements fournis de soi-même. Les
patients admissibles à l’étude étaient ceux ne nécessitant pas de soins urgents
et ayant passé au triage dans la salle d’attente. Les patients déjà hospitalisés
et ceux dirigés immédiatement après le triage dans l’aire de soins urgents ou de
trauma du service des urgences ont été exclus.Parmi les 160 patients interrogés,
146 (91,3 %) avaient rempli le formulaire avec au plus une divergence modérée
(mais un certain nombre de divergences mineures). Dans 31 (19,4 %) des
formulaires de MSTP, il n’y avait aucune divergence et, dans 101 (63,1 %) des
formulaires, il n’y avait que des divergences mineures.La plupart des patients
interrogés par l’équipe de pharmacie étaient en mesure de remplir le formulaire
de MSTP sans qu’apparaisse de divergence cliniquement significative. Le
formulaire autoadministré de MSTP serait un outil pratique pour établir un bilan
comparatif des médicaments dans le service des urgences pour cette population de
patients, mais employé seul, il ne représenterait pas une source fiable
d’information sur le MSTP, compte tenu du nombre relativement restreint de
patients ayant rempli le formulaire sans qu’apparaisse de divergence.
DOI: 10.4212/cjhp.v70i4.1675
PMCID: PMC5587038
PMID: 28894309
981. AIDS Behav. 2015 Jan;19(1):93-103. doi: 10.1007/s10461-014-0806-z.
Correlation between use of antiretroviral adherence devices by HIV-infected youth

and plasma HIV RNA and self-reported adherence.
Saberi P(1), Mayer K, Vittinghoff E, Naar-King S; Adolescent Medicine Trials

Network for HIV/AIDS Interventions.
Author information:
(1)Department of Medicine, University of California, UCSF Box 0886, 50 Beale St.,
Suite 1300, San Francisco, CA, 94105, USA, parya.saberi@ucsf.edu.
Our objective was to investigate antiretroviral adherence device use by

HIV-infected youth and assess associations of device use with viral suppression
and self-reported adherence. This cross-sectional, multisite, clinic-based study
included data from 1,317 HIV-infected individuals 12-24 years of age that were
prescribed antiretroviral therapy. Mean adherence in the past 7 days was 86.1 %
and 50.5 % had an undetectable HIV RNA. Pillbox was the most commonly endorsed
device. No specific device was independently associated with higher odds of 100 %
adherence. Paradoxically, having an undetectable HIV RNA was inversely associated
with use of adherence devices (OR 0.80; p = 0.04); however, among those with <100
% adherence, higher adherence was associated with use of one or more adherence
devices (coefficient = 7.32; p = 0.003). Our data suggest that adolescents who
experienced virologic failure often used adherence devices which may not have
been sufficiently effective in optimizing adherence. Therefore, other tailored
adherence-enhancing methods need to be considered to maximize virologic
suppression and decrease drug resistance and HIV transmission.
DOI: 10.1007/s10461-014-0806-z
PMCID: PMC4250439
982. BMC Cancer. 2017 Nov 9;17(1):739. doi: 10.1186/s12885-017-3735-1.
Prevalence and associated factors of medication non-adherence in

hematological-oncological patients in their home situation.
Bouwman L(1), Eeltink CM(2)(3), Visser O(1), Janssen JJWM(1), Maaskant JM(4)(5).
Author information:
(1)Department of Hematology, VU University Medical Center, Amsterdam, the
Netherlands.
(2)Department of Hematology, VU University Medical Center, Amsterdam, the
Netherlands. c.eeltink@vumc.nl.
(3)Cancer Center Amsterdam, VU University Medical Center, De Boelelaan 1117,
1081, HV, Amsterdam, The Netherlands. c.eeltink@vumc.nl.
(4)Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.
(5)Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical
Faculty, Academic Medical Center and University of Amsterdam, Amsterdam, the
Netherlands.
BACKGROUND: Medication non-adherence is associated with poor health outcomes and

increased health care costs. Depending on definitions, reported non-adherence
rates in cancer patients ranges between 16 and 100%, which illustrates a serious
problem. In malignancy, non-adherence reduces chances of achievement of treatment
response and may thereby lead to progression or even relapse. Except for Chronic
Myeloid Leukemia (CML), the extent of non-adherence has not been investigated in
hematological-oncological patients in an outpatient setting. In order to explore
ways to optimize cancer treatment results, this study aimed to assess the
prevalence of self-administered medication non-adherence and to identify
potential associated factors in hematological-oncological patients in their home
situation.
METHODS: This is an exploratory cross-sectional study, carried out at the
outpatient clinic of the Department of Hematology at the VU University medical
center, Amsterdam, the Netherlands between February and April 2014.
Hematological-oncological outpatients were sent questionnaires retrieving
information on patient characteristics, medication adherence, beliefs about
medication, anxiety, depression, coping, and quality of life. We performed uni-
and multivariable analysis to identify predictors for medication non-adherence.
RESULTS: In total, 472 participants were approached of which 259 (55%) completed
the questionnaire and met eligibility criteria. Prevalence of adherence in this
group (140 male; 54,1%; median age 60 (18-91)) was 50%. In univariate analysis,
(lower) age, (higher) education level, living alone, working, perception of
receiving insufficient social support, use of bisphosphonates, depression,
helplessness (ICQ), global health, role function, emotional function, cognitive
function, social functioning, fatigue, dyspnea, diarrhea were found to be
significantly related (p = <0.20) to medication non-adherence. In multivariable
analysis, younger age, (higher) education level and fatigue remained
significantly related (p = <0.10) to medication non-adherence.
CONCLUSIONS: This cross-sectional study shows that 50% of the participants were
non-adherent. Lower age, living alone and perception of insufficient social
support were associated factors of non-adherence in hematological-oncological
adult patients in their home-situation.
DOI: 10.1186/s12885-017-3735-1
PMCID: PMC5679497
983. Malar J. 2018 Oct 29;17(1):396. doi: 10.1186/s12936-018-2546-4.
Low uptake of malaria testing within 24 h of fever despite appropriate

health-seeking among migrants in Myanmar: a mixed-methods study.
Hein KT(1), Maung TM(2), Htet KKK(2), Shewade HD(3)(4), Tripathy JP(3)(4), Oo
SM(5), Lin Z(6), Thi A(7).
Author information:
(1)Department of Medical Research, Ministry of Health and Sports, Yangon,
Myanmar. hein.z.ze@gmail.com.
(2)Department of Medical Research, Ministry of Health and Sports, Yangon,
Myanmar.
(3)International Union Against Tuberculosis and Lung Disease (The Union),
South-East Asia Office, New Delhi, India.
(4)International Union Against Tuberculosis and Lung Disease (The Union), Paris,
France.
(5)Population Services International, Yangon, Myanmar.
(6)Vector Borne Disease Control Program, Ministry of Health and Sports, Nay Pyi
Taw, Myanmar.
(7)National Malaria Control Program, Ministry of Health and Sports, Nay Pyi Taw,
Myanmar.
BACKGROUND: There is limited information on uptake of malaria testing among

migrants who are a 'high-risk' population for malaria. This was an explanatory
mixed-methods study. The quantitative component (a cross sectional analytical
study-nation-wide migrant malaria survey in 2016) assessed the knowledge;
health-seeking; and testing within 24 h of fever and its associated factors. The
qualitative component (descriptive design) explored the perspectives of migrants
and health care providers [including village health volunteers (VHV)] into the
barriers and suggested solutions to increase testing within 24 h. Quantitative
data analysis was weighted for the three-stage sampling design of the survey.
Qualitative data analysis involved manual descriptive thematic analysis.
RESULTS: A total of 3230 households were included in the survey. The mean
knowledge score (maximum score 11) for malaria was 5.2 (0.95 CI 5.1, 5.3). The
source of information about malaria was 80% from public health facility staff and
21% from VHV. Among 11 193 household members, 964 (8.6%) had fever in last
3 months. Health-seeking was appropriate for fever in 76% (0.95 CI 73, 79);
however, only 7% (0.95 CI 5, 9) first visited a VHV while 19% (0.95 CI 16, 22)
had self-medication. Of 964, 220 (23%, 0.95 CI 20, 26) underwent malaria blood
testing within 24 h. Stable migrants, high knowledge score and appropriate
health-seeking were associated with testing within 24 h. Qualitative findings
showed that low testing within 24 h despite appropriate health-seeking was due to
lack of awareness among migrants regarding diagnosis services offered by VHV,
delayed health-seeking at public health facilities and not all cases of fever
being tested by VHV and health staff. Providing appropriate behaviour change
communication for migrants related to malaria, provider's acceptance for malaria
testing for all fever cases and mobile peer volunteer under supervision were
suggested to overcome above barriers.
CONCLUSIONS: Providers were not testing all migrant patients with fever for
malaria. Low uptake within 24 h was also due to poor utilization of services
offered by VHV. The programme should seriously consider addressing these barriers
and implementing the recommendations if Myanmar is to eliminate malaria by 2030.
DOI: 10.1186/s12936-018-2546-4
PMCID: PMC6206677
984. BMC Public Health. 2015 Jan 29;15:29. doi: 10.1186/s12889-015-1437-7.
Tuberculosis treatment delays and associated factors within the Zimbabwe national
tuberculosis programme.
Takarinda KC(1)(2), Harries AD(3)(4), Nyathi B(5), Ngwenya M(6), Mutasa-Apollo

T(7), Sandy C(8).
Author information:
(1)AIDS and TB Department, Zimbabwe Ministry of Health and Child Care, P. O Box
CY 1122, Causeway, Harare, Zimbabwe. ktakarinda@theunion.org.
(2)International Union Against Tuberculosis and Lung Disease, Paris, France.
ktakarinda@theunion.org.
(3)International Union Against Tuberculosis and Lung Disease, Paris, France.
adharries@theunion.org.
(4)Department of Clinical Research, London School of Hygiene and Tropical
Medicine, London, UK. adharries@theunion.org.
(5)TB CARE Project, International Union Against Tuberculosis and Lung Disease,
Harare, Zimbabwe. bnyathi@mweb.co.zw.
CY 1122, Causeway, Harare, Zimbabwe. mkhongwenya@gmail.com.
CY 1122, Causeway, Harare, Zimbabwe. tsitsiapollo@gmail.com.
CY 1122, Causeway, Harare, Zimbabwe. dr.c.sandy@gmail.com.
BACKGROUND: Delayed presentation of pulmonary TB (PTB) patients for treatment

from onset of symptoms remains a threat to controlling individual disease
progression and TB transmission in the community. Currently, there is
insufficient information about treatment delays in Zimbabwe, and we therefore
determined the extent of patient and health systems delays and their associated
factors in patients with microbiologically confirmed PTB.
METHODS: A structured questionnaire was administered at 47 randomly selected
health facilities in Zimbabwe by trained health workers to all patients aged
≥18 years with microbiologically confirmed PTB who were started on TB treatment
and entered in the health facility TB registers between 01 January and 31 March
2013. Multivariate logistic regression was used to calculate adjusted odds ratios
(aOR) and 95% confidence intervals (CIs) for associations between patient/health
system characteristics and patient delay >30 days or health system delay >4 days.
RESULTS: Of the 383 recruited patients, 211(55%) were male with an overall median
age of 34 years (IQR, 28-43). There was a median of 28 days (IQR, 21-63) for
patient delays and 2 days (IQR, 1-5) for health system delays with 184 (48%) and
118 (31%) TB patients experiencing health system delays >30 days and health
system delays >4 days respectively. Starting TB treatment at rural primary
healthcare vs district/mission facilities [aOR 2.70, 95% CI 1.27-5.75, p = 0.01]
and taking self-medication [aOR 2.33, 95% CI 1.23-4.43, p = 0.01] were associated
with encountering patient delays. Associated with health system delays were
accessing treatment from lower level facilities [aOR 2.67, 95% CI 1.18-6.07,
p = 0.019], having a Gene Xpert TB diagnosis [aOR 0.21, 95% CI 0.07-0.66,
p = 0.008] and >4 health facility visits prior to TB diagnosis [(aOR) 3.34, 95%
CI 1.11-10.03, p = 0.045].
CONCLUSION: Patient delays were longer and more prevalent, suggesting the need
for strategies aimed at promoting timely seeking of appropriate medical
consultation among presumptive TB patients. Health system delays were uncommon,
suggesting a fairly efficient response to microbiologically confirmed PTB cases.
Identified risk factors should be explored further and specific strategies aimed
at addressing these factors should be identified in order to lessen patient and
health system delays.
DOI: 10.1186/s12889-015-1437-7
PMCID: PMC4314739

eCollection 2017.
The role of Patient Health Engagement Model (PHE-model) in affecting patient

activation and medication adherence: A structural equation model.
Graffigna G(1), Barello S(1), Bonanomi A(2).
Author information:
(1)Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
(2)Department of Statistical Sciences, Università Cattolica del Sacro Cuore,
Milan, Italy.
BACKGROUND: Increasing bodies of scientific research today examines the factors

and interventions affecting patients' ability to self-manage and adhere to
treatment. Patient activation is considered the most reliable indicator of
patients' ability to manage health autonomously. Only a few studies have tried to
assess the role of psychosocial factors in promoting patient activation. A more
systematic modeling of the psychosocial factors explaining the variance of
patient activation is needed.
OBJECTIVE: To test the hypothesized effect of patient activation on medication
adherence; to test the the hypothesized effects of positive emotions and of the
quality of the patient/doctor relationship on patient activation; and to test the
hypothesized mediating effect of Patient Health Engagement (PHE-model) in this
pathway.
MATERIAL AND METHODS: This cross-sectional study involved 352 Italian-speaking
adult chronic patients. The survey included measures of i) patient activation
(Patient Activation Measure 13 -short form); ii) Patient Health Engagement model
(Patient Health Engagement Scale); iii) patient adherence (4 item-Morinsky
Medication Adherence Scale); iv) the quality of the patients' emotional feelings
(Manikin Self Assessment Scale); v) the quality of the patient/doctor
relationship (Health Care Climate Questionnaire). Structural equation modeling
was used to test the hypotheses proposed.
RESULTS: According to the theoretical model we hypothesized, research results
confirmed that patients' activation significantly affects their reported
medication adherence. Moreover, psychosocial factors, such as the patients'
quality of the emotional feelings and the quality of the patient/doctor
relationship were demonstrated to be factors affecting the level of patient
activation. Finally, the mediation effect of the Patient Health Engagement model
was confirmed by the analysis.
CONCLUSIONS: Consistently with the results of previous studies, these findings
demonstrate that the Patient Health Engagement Model is a critical factor in
enhancing the quality of care. The Patient Health Engagement Model might acts as
a mechanism to increase patient activation and adherence.
PMCID: PMC5487073
986. AIDS Behav. 2016 May;20(5):1084-96. doi: 10.1007/s10461-015-1209-5.
Psychosocial Characteristics Associated with Both Antiretroviral Therapy

Adherence and Risk Behaviors in Women Living with HIV.
Holstad MM(1), Spangler S(2), Higgins M(2), Dalmida SG(2), Sharma S(3).
Author information:
(1)Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road,
Atlanta, GA, USA. nurmmcd@emory.edu.
(2)Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road,
Atlanta, GA, USA.
(3)School of Medicine, Emory University, 1520 Clifton Road, Atlanta, GA, USA.
The purpose of this study was to identify key psychosocial characteristics of

HIV-infected women who exhibit different levels of both ART adherence and risk
behaviors. We analyzed baseline data from 193 predominately African American
HIV-infected women participating in a behavioral clinical trial. Women were
categorized into high/low groups based on levels of adherence and risky
behaviors. There was a significant interaction effect for internal motivation for
adherence. Women at high risk for poor health and transmitting HIV (low
adherence/high risk group) had the lowest levels of internal motivation and also
reported more difficult life circumstances. Gender roles, caretaking and reliance
on men for economic and other support may promote external versus internal
motivation as well as riskier behaviors in this group. The highest levels of
internal motivation were found in those with High Adherence/High Risk behaviors.
This group was highly knowledgeable about HIV and had the lowest VL. Compared to
others, this group seems to tolerate risky behaviors given their high level of
adherence. Adherence and risk reduction behaviors are key to individual and
public health. Motivation and risk compensation should be addressed when
providing interventions to women living with HIV.
DOI: 10.1007/s10461-015-1209-5
PMCID: PMC4826632
987. Respir Care. 2015 May;60(5):744-8. doi: 10.4187/respcare.04088. Epub 2015 Apr
14.
Year in review 2014: asthma.
Deakins KM(1).
Author information:
(1)Pediatric Respiratory Care Department, University Hospitals Rainbow Babies and
Children's Hospital, Cleveland, Ohio. kathleen.deakins@uhhospitals.org.
Asthma continues to be recognized as a well-known respiratory disease requiring

complex management. Asthma is assessed and treated by clinicians across the
continuum. The interest in evidence-based recommendations for diagnosis,
treatment, and long-term management is ongoing and essential for aligning
clinical practice with its changes. The purpose of this review is to provide
updates from recent literature on asthma for clinicians.
Use of a patient-centred educational exchange (PCEE) to improve patient's

self-management of medicines after a stroke: a randomised controlled trial study
protocol.
Coombes JA(1)(2), Rowett D(3)(4), Whitty JA(1)(5), Cottrell WN(1).
Author information:
(1)School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
(2)Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland,
Australia.
(3)School of Pharmacy and Medical Sciences, University of South Australia,
Adelaide, South Australia, Australia.
(4)DATIS, Southern Adelaide Local Health Network, Flinders Medical Centre,
(5)Norwich Medical School, University of East Anglia, Norwich, UK.
INTRODUCTION: National and international guidelines make recommendations for

secondary prevention of stroke including the use of medications. A strategy which
engages patients in a conversation to personalise evidence-based educational
material (patient-centred educational exchange; PCEE) may empower patients to
better manage their medications.
METHODS AND ANALYSIS: This protocol outlines a non-blinded randomised controlled
trial. Consenting patients admitted with a diagnosis of stroke or transient
ischaemic attack will be randomised 1:1 to receive either a PCEE composed of two
sessions, one at the bedside before discharge and one by telephone at least 10
days after discharge from hospital in addition to usual care (intervention) or
usual care alone (control). The primary aim of this study is to determine whether
a PCEE improves adherence to antithrombotic, antihypertensive and lipid-lowering
medications prescribed for secondary prevention of stroke over the 3 months after
discharge, measured using prescription-refill data. Secondary aims include
investigation of the impact of the PCEE on adherence over 12 months using
prescription-refill data, self-reported medication taking behaviour,
self-reported clinical outcomes (blood pressure, cholesterol, adverse medication
events and readmission), quality of life, the cost utility of the intervention
and changes in beliefs towards medicines and illness.
ETHICS AND DISSEMINATION: Communication of the trial results will provide
evidence to aid clinicians in conversations with patients about medication taking
behaviour related to stroke prevention. The targeted audiences will be health
practitioners and consumers interested in medication taking behaviour in chronic
diseases and in particular those interested in secondary prevention of stroke.The
trial has ethics approval from Metro South Human Research Ethics Committee
(HREC/15/QPAH/531) and The University of Queensland Institutional Human Research
Ethics (2015001612).
TRIAL REGISTRATION NUMBER: ACTRN12615000888561; Pre-results.

DOI: 10.1136/bmjopen-2018-022225
PMCID: PMC6119418
PMID: 30166304
989. Int J Cardiol. 2017 Jun 1;236:462-465. doi: 10.1016/j.ijcard.2017.02.105. Epub

2017 Feb 22.
Insurance, self-reported medication adherence and LDL cholesterol: The REasons

for Geographic And Racial Differences in Stroke study.
Mefford M(1), Safford MM(2), Muntner P(1), Durant RW(3), Brown TM(4), Levitan
EB(5).
Author information:
AL, USA.
(2)Department of Internal Medicine, Weill Cornell Medicine, Cornell University,
New York, NY, USA.
(3)Division of Preventive Medicine, School of Medicine, University of Alabama at
(4)Division of Cardiovascular Disease, School of Medicine, University of Alabama
at Birmingham, Birmingham, AL, USA.
AL, USA. Electronic address: elevitan@uab.edu.
BACKGROUND: Lack of health insurance may adversely impact medication adherence

and the control of cardiovascular risk factors. We examined if the association
between insurance and LDL-C is due to self-reported low medication adherence.
METHODS: This cross-sectional study included 8685 black and white men and women
aged 45 and older who participated in the REasons for Geographic And Racial
Differences in Stroke (REGARDS) cohort and used statins. Medication adherence was
assessed using the 4-item Morisky Medication Adherence Scale (MMAS-4). Mean
differences in LDL-C between participants with and without insurance were
calculated using generalized linear models before and after adjustment for
MMAS-4. Subgroups stratified by age, annual household income, diabetes, and CHD
were compared. Separately, individual MMAS-4 questions were examined for
mediation effects.
RESULTS: After multivariable adjustment but without MMAS-4, LDL-C was 2.5mg/dL
(95% CI -0.6, 5.6) higher among uninsured versus insured participants. After
further adjustment for MMAS-4, LDL-C was 2.6mg/dL (95% CI -0.5, 5.6) higher.
Stratified analyses produced similar results. No mediating effect was observed
when each MMAS-4 question was examined separately.
CONCLUSION: High medication adherence does not mediate the association between
having health insurance and lower LDL-C.
DOI: 10.1016/j.ijcard.2017.02.105
PMCID: PMC5411175
990. Malar J. 2017 Nov 13;16(1):462. doi: 10.1186/s12936-017-2113-4.
Understanding malaria treatment-seeking preferences within the public sector

amongst mobile/migrant workers in a malaria elimination scenario: a mixed-methods
study.
Win AYN(1)(2), Maung TM(3), Wai KT(4), Oo T(4), Thi A(5), Tipmontree R(6),
Soonthornworasiri N(1), Kengganpanich M(7), Kaewkungwal J(8).
Author information:
(1)Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol
University, Bangkok, Thailand.
(2)Epidemiology Research Division, Department of Medical Research, No. 5 Ziwaka
Road, Yangon, Myanmar.
(3)Medical Statistics Division, Department of Medical Research, No. 5 Ziwaka
Road, Yangon, Myanmar.
(4)Department of Medical Research, No. 5 Ziwaka Road, Yangon, Myanmar.
(5)National Malaria Control Programme, Department of Public Health, NayPyiTaw,
Myanmar.
(6)Bureau of Vector Borne Diseases, Department of Disease Control, Ministry of
Public Health, Bangkok, Thailand.
(7)Department of Health Education and Behavior Sciences, Faculty of Public
Health, Mahidol University, Bangkok, Thailand.
(8)Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol
University, Bangkok, Thailand. jaranitk@biophics.org.
BACKGROUND: Migration flows and the emerging resistance to artemisinin-based

combination therapy in the Greater Mekong Sub-region (GMS) create programmatic
challenges to meeting the AD 2030 malaria elimination target in Myanmar. The
National Malaria Control Programme (NMCP) targeted migrant workers based mainly
on the stability of their worksites (categories 1: permanent work-setting;
categories 2 and 3: less stable work-settings). This study aims to assess the
migration patterns, malaria treatment-seeking preferences, and challenges
encountered by mobile/migrant workers at remote sites in a malaria-elimination
setting.
METHODS: A mixed-methods explanatory sequential study retrospectively analysed
the secondary data acquired through migrant mapping surveys (2013-2015) in six
endemic regions (n = 9603). A multivariate logistic regression model was used to
ascertain the contributing factors. A qualitative strand (2016-2017) was added by
conducting five focus-group discussions (n = 50) and five in-depth interviews
with migrant workers from less stable worksites in Shwegyin Township, Bago
Region. The contiguous approach was used to integrate quantitative and
qualitative findings.
RESULTS: Among others, migrant workers from Bago Region were significantly more
likely to report the duration of stay ≥ 12 months (63% vs. 49%) and high seasonal
mobility (40% vs. 35%). Particularly in less stable settings, a very low
proportion of migrant workers (17%) preferred to seek malaria treatment from the
public sector and was significantly influenced by the worksite stability
(adjusted OR = 1.4 and 2.3, respectively for categories 2 and 1); longer duration
of stay (adjusted OR = 3.5); and adjusted OR < 2 for received malaria messages,
knowledge of malaria symptoms and awareness of means of malaria diagnosis.
Qualitative data further elucidated their preference for the informal healthcare
sector, due to convenience, trust and good relations, and put migrant workers at
risk of substandard care. Moreover, the availability of cheap anti-malarial in
unregistered small groceries encouraged self-medication. Infrequent or no contact
with rural health centres and voluntary health workers worsened the situation.
CONCLUSIONS: Mitigating key drivers that favour poor utilization of public-sector
services among highly mobile migrant workers in less stable work-settings should
be given priority in a malaria-elimination setting. These issues are challenging
for the NMCP in Myanmar and might be generalized to other countries in the GMS to
achieve malaria-elimination goals. Further innovative out-reach programmes
designed and implemented specific to the nature of mobile/migrant workers is
crucial.
DOI: 10.1186/s12936-017-2113-4
PMCID: PMC5683526
991. PLoS Med. 2017 Jul 18;14(7):e1002347. doi: 10.1371/journal.pmed.1002347.

eCollection 2017 Jul.
Prescription medicine use by pedestrians and the risk of injurious road traffic
crashes: A case-crossover study.
Née M(1)(2), Avalos M(1)(3), Luxcey A(1)(2), Contrand B(1)(2), Salmi LR(1)(2)(4),
Fourrier-Réglat A(5)(6)(7), Gadegbeku B(8)(9)(10), Lagarde E(1)(2), Orriols
L(1)(2).
Author information:
(1)Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED),
Université de Bordeaux, Bordeaux, France.
(2)Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM,
Université de Bordeaux, Bordeaux, France.
(3)Team Biostatistique, Bordeaux Population Health Research Center, UMR U1219,
INSERM, Université Bordeaux, Bordeaux, France.
(4)Service d'Information Médicale, Pôle de Santé Publique, Centre Hospitalier
Universitaire de Bordeaux, Bordeaux, France.
(5)Team Pharmacoepidemiology, Bordeaux Population Health Research Center, UMR
U1219, INSERM, Université Bordeaux, Bordeaux, France.
(6)Pharmacologie Medicale, Pôle de Santé Publique, Centre Hospitalier
(7)Centre d'Investigation Clinique Bordeaux, INSERM CIC 1401, Centre Hospitalier
(8)Université de Lyon, Lyon, France.
(9)UMRESTTE, UMR T9405, l'Institut Français des Sciences et Technologies des
Transports, de l'Aménagement et des Réseaux (IFSTTAR), Bron, France.
(10)UMRESTTE, Université Lyon 1, Lyon, France.
BACKGROUND: While some medicinal drugs have been found to affect driving ability,
no study has investigated whether a relationship exists between these medicines
and crashes involving pedestrians. The aim of this study was to explore the
association between the use of medicinal drugs and the risk of being involved in
a road traffic crash as a pedestrian.
METHODS AND FINDINGS: Data from 3 French nationwide databases were matched. We
used the case-crossover design to control for time-invariant factors by using
each case as its own control. To perform multivariable analysis and limit
false-positive results, we implemented a bootstrap version of Lasso. To avoid the
effect of unmeasured time-varying factors, we varied the length of the washout
period from 30 to 119 days before the crash. The matching procedure led to the
inclusion of 16,458 pedestrians involved in an injurious road traffic crash from
1 July 2005 to 31 December 2011. We found 48 medicine classes with a positive
association with the risk of crash, with median odds ratios ranging from 1.12 to
2.98. Among these, benzodiazepines and benzodiazepine-related drugs,
antihistamines, and anti-inflammatory and antirheumatic drugs were among the 10
medicines most consumed by the 16,458 pedestrians. Study limitations included
slight overrepresentation of pedestrians injured in more severe crashes, lack of
information about self-medication and the use of over-the-counter drugs, and lack
of data on amount of walking.
CONCLUSIONS: Therapeutic classes already identified as impacting the ability to
drive, such as benzodiazepines and antihistamines, are also associated with an
increased risk of pedestrians being involved in a road traffic crash. This study
on pedestrians highlights the necessity of improving awareness of the effect of
these medicines on this category of road user.
DOI: 10.1371/journal.pmed.1002347
PMCID: PMC5515401

eCollection 2019.
Using the Medication Adherence Reasons Scale (MAR-Scale) to identify the reasons
for non-adherence across multiple disease conditions.
Unni EJ(1), Sternbach N(2), Goren A(2).
Author information:
(1)College of Pharmacy, Roseman University of Health Sciences, South Jordan, UT,
USA.
(2)Kantar Health , New York, NY, USA.
Purpose: With more than 50% of the individuals on chronic conditions not taking
medicines as prescribed, it is essential for health care providers to understand
the reasons, so that adherence-related conversations can be initiated and focused
appropriately. Measuring medication non-adherence is complex, because patients
are often on multiple medications and take them via various modes of
administration such as orally, by injection, or topically, and at various
frequencies such as daily or weekly. The Medication Adherence Reasons Scale
(MAR-Scale) is a twenty-item, self-reported, comprehensive scale developed to
measure two aspects of medication non-adherence: the extent or frequency of
non-adherence and reasons for non-adherence. The objective of this study was to
identify the top reasons, in 17 distinct chronic disease conditions, reported by
patients for being non-adherent across various modes and frequencies of the
corresponding medications. Internal reliability of the MAR-Scale was also
assessed in each condition. Patients and methods: Results were derived from
Kantar Health's US 2017 National Health and Wellness Survey (NHWS), a
self-administered, annual, Internet-based cross-sectional survey of 75,000 adults
(≥18 years). The survey sample was drawn from an Internet panel and was
stratified according to age, gender, and ethnicity in order to represent the US
adult population based on the US Census Bureau. Respondents to the 2017 NHWS who
self-reported taking prescription medication(s) to treat one of the 17 conditions
were invited to complete the MAR-Scale in a follow-up online survey, reporting on
reasons for non-adherence in the past 7 days (daily medications) or four weeks
(weekly), with non-adherence defined as any reported non-adherence in the
corresponding timeframe for medicines taken orally, by injection, and topically.
Results: MAR-Scale data were obtained from 15,672 respondents in one or more
conditions, modes, and frequencies. MAR-Scale reliability ranged from Cronbach's
alpha of 0.861 in multiple sclerosis to 0.973 in psoriasis. For daily orals,
non-adherence ranged from 25.2% in diabetes to 63.7% in eczema. The most common
reasons across conditions were "simply missed it," "side effects," and "concern
about long-term effects." Conclusion: The MAR-Scale demonstrates acceptable
reliability in multiple chronic disease conditions and across modes and
frequencies of administration.
DOI: 10.2147/PPA.S205359
PMCID: PMC6612984
PMID: 31308635
Conflict of interest statement: At the time of the study, Amir Goren and
Nikoletta Sternbach were employees of Kantar Health, which provided funding and
support for fielding the current version of the MAR-Scale. The authors report no
other conflicts of interest in this work.
993. World J Diabetes. 2018 May 15;9(5):72-79. doi: 10.4239/wjd.v9.i5.72.
Adherence to self-care practices, glycemic status and influencing factors in

diabetes patients in a tertiary care hospital in Delhi.
Basu S(1), Garg S(2), Sharma N(2), Singh MM(2), Garg S(3).
Author information:
(1)Department of Community Medicine, Maulana Azad Medical College, New Delhi
110002, India. saurav.basu.mph@gmail.com.
110002, India.
(3)Department of Medicine, Maulana Azad Medical College, New Delhi 110002, India.
AIM: To assess the adherence to self-care practices, glycemic status and

influencing factors in diabetes patients.
METHODS: This was a cross-sectional observational analysis of baseline data from
a quasi-experimental study conducted among 375 diabetic patients aged between 18
to 65 years at a major public tertiary care centre in New Delhi, India during
February-September' 2016. The Summary of Diabetes Self-care activities measure
was used to assess medical adherence in diabetic patients. Open ended questions
were used to identify facilitators and inhibitors of medical adherence.
RESULTS: Mean age of the study subjects was 49.7 ± 10.2 years. A total of 201 men
and 174 women were enrolled in the study. Three hundred nine (82.4%) subjects
were adherent to their intake of anti-diabetic medication. On binary logistic
regression, education level below primary school completion and absence of
hypertension comorbidity were found to be independent predictors of medication
non-adherence. Sociocultural resistance was an important factor impeding outdoor
exercise among younger women. Knowledge of diabetes in the study subjects was low
with mean score of 3.1 ± 2 (maximum score = 10). Suboptimal glycemic control was
found in 259 (69%) subjects which was significantly more likely in patients on
Insulin therapy compared to those on Oral Hypoglycemic agents alone (P <
0.006).DISCUSSIONOur study found a large gap existed between self-reported
medication adherence and glycemic control. This suggests the need for enhanced
physician focus for diabetic patient management.
DOI: 10.4239/wjd.v9.i5.72
PMCID: PMC6033702
PMID: 29988911
Conflict of interest statement: Conflict-of-interest statement: Dr. Basu has

nothing to disclose.
994. Clin Exp Rheumatol. 2015 Mar-Apr;33(2 Suppl 89):S-185-6. Epub 2015 May 26.
The relationship between peer support, medication adherence, and quality of life
among patients with vasculitis.
Alexander DS(1), Hogan SL(2), Jordan JM(3), DeVellis RF(3), Carpenter DM(1).
Author information:
(1)University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy,
Division of Pharmaceutical Outcomes and Policy, Asheville, NC, USA.
(2)UNC Kidney Center, University of North Carolina, Chapel Hill, NC, USA.
NC, USA.
PMCID: PMC4879819

eCollection 2018.
Predictors of medication nonadherence in patients with systemic lupus

erythematosus in Sichuan: a cross-sectional study.
Xie X(1), Yang H(1), Nie A(1), Chen H(1), Li J(1).
Author information:
(1)West China School of Nursing and Department of Nursing, West China Hospital,
Sichuan University, Chengdu, China, 1366109878@qq.com.
Purpose: The aim of this study was to determine the prevalence and predictors of
medication nonadherence among patients with systemic lupus erythematosus (SLE) in
Sichuan.
Patients and methods: A cross-sectional investigation was performed. Participants
were recruited by consecutive sampling from the Rheumatic Clinic of a university
hospital between June and September 2016. Patients' self-reported medication
adherence was assessed by the eight-item Morisky Medication Adherence Scale.
Additional surveys included patients' demographics, and clinical and treatment
characteristics. Logistic regression analysis was used to identify the predictors
of medication nonadherence.
Results: A total of 140 patients were included in analysis. The percentage of
patients classified as nonadherent to medication was 75%. Low education, rural
residency, childlessness, limited comprehension of medication instructions, side
effects experienced, dissatisfaction with treatment and better physical health
were associated with an increased risk of nonadherence.
Conclusion: This study demonstrated a high prevalence of medication nonadherence
among SLE patients in Sichuan, and factors associated with the nonadherence are
multifaceted. Interventions for these factors, such as appropriate adjustment of
the service resources for patients with rheumatic disease in rural communities
and improved communication between the health care providers and the patients,
may contribute to improve the medication adherence of this cohort.
DOI: 10.2147/PPA.S169776
PMCID: PMC6112788
PMID: 30197502


eCollection 2018.
Psychometric evaluation of the Chinese version of the fear of intimacy with

helping professionals scale.
Lau Y(1), Chan KS(2).
Author information:
(1)Department of Alice Lee Centre for Nursing Studies, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore.
(2)Faculty of Social Sciences and Humanities, the University of Macau, Macau
Special Administration Region, China.
Erratum in
PLoS One. 2018 Sep 17;13(9):e0204440.
OBJECTIVES: This study aimed to evaluate the internal consistency, reliability,

convergent validity, known-group comparisons, and structural validity of the
Chinese version of Fear of Intimacy with Helping Professionals (C-FIS-HP) scale
in Macau.
METHODS: A cross-sectional design was used on a sample of 593 older people in 6
health centers. We used Chinese version of Exercise of Self-Care Agency Scale
(C-ESCAS) and Morisky 4-item medication adherence scale to evaluate self-care
actions and medication adherence. The internal consistency and reliability of
C-FIS-HP were analyzed using the Spearman-Brown split-half reliability,
Cronbach's alpha, and test-retest reliability. Convergent validity was tested the
construct of C-FIS-HP and self-care actions. Known-group comparisons
differentiated predefined groups in an expected direction. Two separated samples
were used to test the structural validity. An exploratory factor analysis (EFA)
tested the factor structure of C-FISHP using the principal axis factoring. A
confirmatory factor analysis (CFA) was further conducted to confirm the factor
structure constructed in the prior EFA.
RESULTS: The C-FIS-HP had a Spearman-Brown split-half coefficient, Cronbach's
alpha, and intraclass correlation coefficient of 0.96, 0.93, and 0.96,
respectively. Convergent validity was satisfactory with significantly
correlations between the C-FIS-HP and C-ESCAS. C-FIS-HP to differentiate the
differences between high-, moderate-, and low- medication adherence groups. EFA
demonstrated a two-factor structure among 297 older people. A first-order CFA was
performed to confirm the construct dimensionality of C-FIS-HP with satisfactory
fit indices (NFI = 0.92; IFI = 0.95; TLI = 0.94; CFI = 0.95 and RMSEA = 0.07)
among 296 older people.
CONCLUSIONS: C-FIS-HP is a reliable and valid test for assessing helping
relationships in older Chinese people. Health professionals can use C-FIS-HP as a
clinical tool to assess the comfort level of patients in a helping relationship,
and use this information to develop culturally sensitive therapeutic
interventions and treatment plans. Further studies need to be conducted
concerning the different psychometric properties, as well as the application of
C-FIS-HP in various regions.
PMCID: PMC5967800

interests exist.
997. Healthcare (Basel). 2015 May 27;3(2):351-63. doi: 10.3390/healthcare3020351.
Relationship between High School Mathematics Grade and Number of Attempts

Required to Pass the Medication Calculation Test in Nurse Education: An
Explorative Study.
Alteren J(1), Nerdal L(2).
Author information:
(1)Faculty of Professional Studies, University of Nordland, Campus Helgeland,
Postboks 614, N-8607 Mo i Rana, Norway. Johanne.Alteren@uin.no.
(2)Faculty of Professional Studies, University of Nordland, Campus Helgeland,
Postboks 614, N-8607 Mo i Rana, Norway. Lisbeth.Nerdal@uin.no.
In Norwegian nurse education, students are required to achieve a perfect score in

a medication calculation test before undertaking their first practice period
during the second semester. Passing the test is a challenge, and students often
require several attempts. Adverse events in medication administration can be
related to poor mathematical skills. The purpose of this study was to explore the
relationship between high school mathematics grade and the number of attempts
required to pass the medication calculation test in nurse education. The study
used an exploratory design. The participants were 90 students enrolled in a
bachelor's nursing program. They completed a self-report questionnaire, and
statistical analysis was performed. The results provided no basis for the
conclusion that a statistical relationship existed between high school
mathematics grade and number of attempts required to pass the medication
calculation test. Regardless of their grades in mathematics, 43% of the students
passed the medication calculation test on the first attempt. All of the students
who had achieved grade 5 had passed by the third attempt. High grades in
mathematics were not crucial to passing the medication calculation test.
Nonetheless, the grade may be important in ensuring a pass within fewer attempts.
DOI: 10.3390/healthcare3020351
PMCID: PMC4939530
PMID: 27417767
998. Interact J Med Res. 2016 May 16;5(2):e14. doi: 10.2196/ijmr.5462.

An Observational Study to Evaluate the Usability and Intent to Adopt an
Artificial Intelligence-Powered Medication Reconciliation Tool.
Long J(1), Yuan MJ, Poonawala R.
Author information:
(1)McCoy College of Business Administration, Department of Computer Information
Systems and Quantitative Methods, Texas State University, San Marcos, TX, United
States. jl38@txstate.edu.
BACKGROUND: Medication reconciliation (the process of creating an accurate list

of all medications a patient is taking) is a widely practiced procedure to reduce
medication errors. It is mandated by the Joint Commission and reimbursed by
Medicare. Yet, in practice, medication reconciliation is often not effective
owing to knowledge gaps in the team. A promising approach to improve medication
reconciliation is to incorporate artificial intelligence (AI) decision support
tools into the process to engage patients and bridge the knowledge gap.
OBJECTIVE: The aim of this study was to improve the accuracy and efficiency of
medication reconciliation by engaging the patient, the nurse, and the physician
as a team via an iPad tool. With assistance from the AI agent, the patient will
review his or her own medication list from the electronic medical record (EMR)
and annotate changes, before reviewing together with the physician and making
decisions on the shared iPad screen.
METHODS: In this study, we developed iPad-based software tools, with AI decision
support, to engage patients to "self-service" medication reconciliation and then
share the annotated reconciled list with the physician. To evaluate the software
tool's user interface and workflow, a small number of patients (10) in a primary
care clinic were recruited, and they were observed through the whole process
during a pilot study. The patients are surveyed for the tool's usability
afterward.
RESULTS: All patients were able to complete the medication reconciliation process
correctly. Every patient found at least one error or other issues with their EMR
medication lists. All of them reported that the tool was easy to use, and 8 of 10
patients reported that they will use the tool in the future. However, few
patients interacted with the learning modules in the tool. The physician and
nurses reported the tool to be easy-to-use, easy to integrate into existing
workflow, and potentially time-saving.
CONCLUSIONS: We have developed a promising tool for a new approach to medication
reconciliation. It has the potential to create more accurate medication lists
faster, while better informing the patients about their medications and reducing
burden on clinicians.
DOI: 10.2196/ijmr.5462
PMCID: PMC4904823
PMID: 27185210
999. LGBT Health. 2017 Jun;4(3):181-187. doi: 10.1089/lgbt.2017.0003. Epub 2017 May
12.
Factors Associated with Antiretroviral Therapy Adherence Among Transgender Women

Receiving HIV Medical Care in the United States.
Mizuno Y(1), Beer L(1), Huang P(1), Frazier EL(1).
Author information:
(1)Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention ,
Atlanta, Georgia .
PURPOSE: We examined factors associated with antiretroviral therapy (ART)
adherence among transgender women living with HIV (TWLWH).
METHODS: We used combined data from the 2009 to 2013 cycles of Medical Monitoring
Project, an HIV surveillance system designed to produce nationally representative
estimates of the characteristics of HIV-infected adults receiving HIV medical
care in the United States. Rao-Scott chi-square tests and multivariable logistic
regression were used to identify factors associated with dose adherence (defined
as taking 100% of prescribed ART doses in the past 3 days).
RESULTS: Among TWLWH who reported current ART use, an estimated 80.5%
self-reported dose adherence. Multivariable factors independently associated with
lower (<100%) dose adherence were younger age (30-39 vs. 40 and over), not having
health insurance coverage, depression, lower self-efficacy to take medication as
prescribed, and having greater than one daily ART dose.
CONCLUSION: Our findings suggest several ways to potentially improve ART
adherence of TWLWH including tailoring efforts to address the needs of TWLWH
under age 40, increasing access to health insurance coverage, addressing mental
health morbidities, building skills to improve medication adherence
self-efficacy, and simplifying ART regimens when possible.
DOI: 10.1089/lgbt.2017.0003
PMCID: PMC6711391

eCollection 2016.
High Concordance between Self-Reported Adherence, Treatment Outcome and

Satisfaction with Care Using a Nine-Item Health Questionnaire in InfCareHIV.
Marrone G(1)(2), Mellgren Å(3), Eriksson LE(4)(5)(6), Svedhem V(5)(7).
Author information:
(1)Department of Infectious Diseases and Clinical Virology, Karolinska University
Hospital, Stockholm, Sweden.
(2)Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden.
(3)Clinic of Infectious Diseases, South Älvsborg Hospital, Borås, Sweden.
(4)Department of Learning, Informatics, Management and Ethics, Karolinska
Institutet, Solna, Sweden.
(5)Department of Infectious Diseases, Karolinska University Hospital, Stockholm,
Sweden.
(6)School of Health Sciences, City University London, London, United Kingdom.
(7)Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska
BACKGROUND: In this cross-sectional study we present an integrated analysis of a

self-reported Health Questionnaire and socio-demographic and treatment outcome
data from the national Swedish HIV cohort, InfCareHIV.
OBJECTIVES: To evaluate the Health Questionnaire and identify the main
determinants of adherence.
METHODS: A total of 2,846 patients answered a nine-item disease-specific Health
Questionnaire between 2012 and 2014, corresponding to 44% of all active patients
in the national InfCareHIV cohort. The questionnaire assessed patient related
outcome measures (PROMs) regarding health and antiretroviral treatment (ART) and
patient related experience measures (PREMs) regarding involvement in care and
satisfaction with the care provider.
RESULT: We found the Health Questionnaire to be valid and reliable when used in
ordinary clinical practice. There was a high concordance between self-reported
adherence to ART in the past seven days and treatment outcome, with 94% of
patients who reported optimal adherence having a viral load <50 copies/ml. The
main determinants of optimal adherence were heterosexual transmission path, being
born in Sweden, being male, not reporting experience of ART side effects and
being fully satisfied with care.
CONCLUSION: The nine-item Health Questionnaire can identify patients at risk of
treatment failure, those in need of clinical assessment of adverse events and
those with impaired physical health.
PMCID: PMC4911158
1001. J Health Care Poor Underserved. 2017;28(1):499-513. doi:

10.1353/hpu.2017.0036.
Financial strain is associated with medication nonadherence and worse self-rated

health among cardiovascular patients.
Osborn CY, Kripalani S, Goggins KM, Wallston KA.
Non-traditional indicators of socioeconomic status (SES; e.g., home ownership)

may be just as or even more predictive of health outcomes as traditional
indicators of SES (e.g., income). This study tested whether financial strain
(i.e., difficulty paying monthly bills) predicted medication non-adherence and
worse self-rated health. Research assistants administered surveys to 1,527
patients with acute coronary syndromes or acute decom-pensated heart failure. In
adjusted models, having a higher income was associated with being more adherent
(p < .001), but was non-significant when adjusted for financial strain.
Education, income, less financial strain, and being employed were each associated
with better self-rated health (p < .001). Financial strain was associated with
less adherence (β =-.17, p < .001) and worse self-rated health (β = -.23, p
< .001), and mediated the effect of income on adherence (coeff = .078 [BCa 95%
CI: .051 to .108]). Future research should further explore the nuanced link
between SES and health behaviors and outcomes.
DOI: 10.1353/hpu.2017.0036
PMCID: PMC5492520
1002. J Immunol. 2016 Apr 1;196(7):2965-72. doi: 10.4049/jimmunol.1500460. Epub

2016
Feb 19.
Vitamin D [1,25(OH)2D3] Differentially Regulates Human Innate Cytokine Responses

to Bacterial versus Viral Pattern Recognition Receptor Stimuli.
Fitch N(1), Becker AB(2), HayGlass KT(3).
Author information:
(1)Department of Immunology, Children's Hospital Research Institute of Manitoba,
University of Manitoba, Winnipeg, Manitoba R3E 0T5, Canada; and.
University of Manitoba, Winnipeg, Manitoba R3E 0T5, Canada; and Department of
Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba,
University of Manitoba, Winnipeg, Manitoba R3E 0T5, Canada.
University of Manitoba, Winnipeg, Manitoba R3E 0T5, Canada; and Department of
Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba,
University of Manitoba, Winnipeg, Manitoba R3E 0T5, Canada
kent.hayglass@umanitoba.ca.
Vitamin D plays multiple roles in regulation of protective and maladaptive

immunity. Although epidemiologic studies link poor in vivo 25(OH)D status to
increased viral respiratory infections, we poorly understand how vitamin D
affects viral pattern recognition receptor (PRR)-driven cytokine production. In
this study, we hypothesized that the biologically active metabolite of vitamin D,
1,25(OH)2D3, inhibits human proinflammatory and anti-inflammatory innate cytokine
responses stimulated by representative bacterial or viral PRR ligands. Fresh
PBMCs or CD14(+) monocytes were stimulated with TLR4, TLR7/8-selective ligands,
or respiratory syncytial virus (RSV) ± 1,25(OH)2D3. Proinflammatory and
anti-inflammatory responses resulting from TLR4 stimulation were inhibited ∼50%
in the presence of 1,25(OH)2D3. Conversely, its usage at physiologic through
pharmacologic concentrations inhibited neither proinflammatory nor
anti-inflammatory responses evoked by viral PRR ligands or infectious RSV. This
differential responsiveness was attributed to the finding that TLR7/8, but not
TLR4, stimulation markedly inhibited vitamin D receptor mRNA and protein
expression, selectively reducing the sensitivity of viral PRR responses to
modulation. 1,25(OH)2D3 also enhanced expression of IkBa, a potent negative
regulator of NF-κB and cytokine production, in TLR4-stimulated monocytes while
not doing so upon TLR7/8 stimulation. Thus, 1,25(OH)2D3 inhibits both
proinflammatory and a broad panel of anti-inflammatory responses elicited by TLR4
stimulation, arguing that the common view of it as an anti-inflammatory immune
response modifier is an oversimplification. In viral responses, it consistently
fails to modify TLR7/8- or RSV-stimulated innate cytokine production, even at
supraphysiologic concentrations. Collectively, the data call into question the
rationale for increasingly widespread self-medication with vitamin D supplements.
Copyright © 2016 by The American Association of Immunologists, Inc.
DOI: 10.4049/jimmunol.1500460
1003. AIDS Care. 2015;27(3):322-6. doi: 10.1080/09540121.2014.969676. Epub 2014 Oct

22.
Factors associated with self-reported adherence among adolescents on

antiretroviral therapy in Zimbabwe.
Gross R(1), Bandason T, Langhaug L, Mujuru H, Lowenthal E, Ferrand R.
Author information:
(1)a Center for Clinical Epidemiology & Biostatistics (CCEB), Perelman School of
Medicine , University of Pennsylvania , Philadelphia , PA , USA.
Nonadherence to medication is the key obstacle to human immunodeficiency virus

(HIV) treatment success. The group at highest risk of nonadherence is
adolescents, but relatively little is known about risk factors for and protective
factors against poor adherence in this age group. We undertook a cross-sectional
study of 262 HIV-infected adolescents aged 10-19 years on antiretroviral therapy
at two clinics in Harare, Zimbabwe, to investigate personal and system-level
factors associated with optimal self-reported adherence. Suboptimal adherence was
common with only 101 (39%) reporting "excellent" adherence. Having the guardian
present at each clinical encounter, comfort with asking questions to the health
provider and participating in group sessions led by a professional facilitator
were all significantly associated with excellent adherence (p < 0.05).
Strengthening the parent-child dyad and professional-led groups as strategies to
improve adherence should be evaluated.
DOI: 10.1080/09540121.2014.969676
PMCID: PMC4305494

eCollection 2015.
Medication adherence in patients with psychotic disorders: an observational

survey involving patients before they switch to long-acting injectable
risperidone.
Baylé FJ(1), Tessier A(2), Bouju S(3), Misdrahi D(2).
Author information:
(1)Sainte-Anne Hospital (SHU), Paris V-Descartes University, Paris, France.
(2)Hôpital Charles Perrens, Pôle de Psychiatrie Adulte, Bordeaux University,
Bordeaux, France ; CNRS UMR 5287-INCIA, Bordeaux University, Bordeaux, France.
(3)Janssen-Cilag France, Issy Les Moulineaux, Paris, France.
BACKGROUND: Maintaining antipsychotic therapy in psychosis is important in

preventing relapse. Long-acting depot preparations can prevent covert
non-adherence and thus potentially contribute to better patient outcomes. In this
observational survey the main objective is to evaluate medication adherence and
its determinants for oral treatment in a large sample of patients with psychosis.
METHODS: In this cross-sectional survey medication adherence for oral treatment
was assessed by patients using the patient-rated Medication Adherence
Questionnaire (MAQ). Data were collected by physicians on patients with a recent
acute psychotic episode before switching to long-acting injectable risperidone.
Other evaluations included disease severity (Clinical Global Impression -
Severity), patients' insight (Positive and Negative Syndrome Scale item G12),
treatment acceptance (clinician-rated Compliance Rating Scale), and therapeutic
alliance (patient-rated 4-Point ordinal Alliance Scale).
RESULTS: A total of 399 psychiatrists enrolled 1,887 patients (mean age 36.8±11.9
years; 61.6% had schizophrenia). Adherence to oral medication was "low" in 53.2%
of patients, "medium" in 29.5%, and "high" in 17.3%. Of patients with
psychiatrist-rated active acceptance of treatment, 70% had "medium" or "high" MAQ
scores (P<0.0001). Medication adherence was significantly associated with
therapeutic alliance (4-Point ordinal Alliance Scale score; P<0.0001). Patient
age was significantly associated with adherence: mean age increased with greater
adherence (35.6, 36.7, and 38.6 years for patients with "low", "medium", and
"high" levels of adherence, respectively; P=0.0007), while age <40 years was
associated with "low" MAQ classification (P=0.0003). Poor adherence was also
associated with a diagnosis of schizophrenia (P=0.0083), more severe disease
(Clinical Global Impression - Severity ≥4; P<0.0001), and lower insight (Positive
and Negative Syndrome Scale-G12 ≥4; P<0.0001).
CONCLUSION: Self-reported adherence was low in most patients, with a strong
positive association between self-reported adherence and psychiatrists'
assessment of treatment acceptance. Understanding factors associated with poor
medication adherence may help physicians to better manage their patients, thereby
improving outcomes.
DOI: 10.2147/PPA.S89748
PMCID: PMC4577258
PMID: 26396505
eCollection 2016.
Quality of Diabetes Care in Germany Improved from 2000 to 2007 to 2014, but
Improvements Diminished since 2007. Evidence from the Population-Based KORA
Studies.
Laxy M(1)(2), Knoll G(1)(3), Schunk M(1), Meisinger C(2)(4), Huth C(2)(4), Holle
R(1)(2).
Author information:
(1)Institute of Health Economics and Health Care Management, Helmholtz Zentrum
München, Neuherberg, Germany.
(2)German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
(3)Institute for Medical Informatics, Biometrics and Epidemiology,
Ludwig-Maximilians- Universität München, Munich, Germany.
(4)Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany.
OBJECTIVE: Little is known about the development of the quality of diabetes care
in Germany. The aim of this study is to analyze time trends in patient
self-management, physician-delivered care, medication, risk factor control,
complications and quality of life from 2000 to 2014.
METHODS: Analyses are based on data from individuals with type 2 diabetes of the
population-based KORA S4 (1999-2001, n = 150), F4 (2006-2008, n = 203), FF4
(2013/14, n = 212) cohort study. Information on patient self-management,
physician-delivered care, medication, risk factor control and quality of life
were assessed in standardized questionnaires and examinations. The 10-year
coronary heart disease (CHD) risk was calculated using the UKPDS risk engine.
Time trends were analyzed using multivariable linear and logistic regression
models adjusted for age, sex, education, diabetes duration, and history of
cardiovascular disease.
RESULTS: From 2000 to 2014 the proportion of participants with type 2 diabetes
receiving oral antidiabetic/cardio-protective medication and of those reaching
treatment goals for glycemic control (HbA1c<7%, 60% to 71%, p = 0.09), blood
pressure (<140/80 mmHg, 25% to 69%, p<0.001) and LDL cholesterol (<2.6 mmol/l,
13% to 27%, p<0.001) increased significantly. However, improvements were
generally smaller from 2007 to 2014 than from 2000 to 2007. Modeled 10-year CHD
risk decreased from 30% in 2000 to 24% in 2007 to 19% in 2014 (p<0.01). From 2007
to 2014, the prevalence of microvascular complications decreased and quality of
life increased, but no improvements were observed for the majority of indicators
of self-management.
CONCLUSION: Despite improvements, medication and risk factor control has remained
suboptimal. The flattening of improvements and deteriorations in quality of
(self-) care since 2007 indicate that more effort is needed to improve quality of
care and patient self-management. Due to selection or lead time bias an
overestimation of quality of care improvements cannot be ruled out.
PMCID: PMC5066975

interests exist.
1006. J Child Adolesc Psychiatr Nurs. 2015 May;28(2):109-17. doi:

10.1111/jcap.12113.
Factors affecting medication adherence in children receiving outpatient
pharmacotherapy and parental adherence.
Nagae M(1), Nakane H(2), Honda S(3), Ozawa H(4), Hanada H(1).
Author information:
(1)Department of Nursing, Nagasaki University Graduate School of Biomedical
Sciences, Nagasaki, Japan.
(2)Department of Psychiatric Rehabilitation Sciences, Nagasaki University
Graduate School of Biomedical Sciences, Nagasaki, Japan.
(3)Department of Community-Based Rehabilitation Sciences, Nagasaki University
Graduate School of Biomedical Sciences, Nagasaki, Japan.
(4)Department of Neuropsychiatry, Nagasaki University Graduate School of
Biomedical Sciences, Nagasaki, Japan.
PROBLEM: Although pharmacotherapy is an effective treatment for many psychiatric

disorders in children and adolescents, medication adherence rates among children
are low. This study clarifies factors affecting children's medication adherence
and the role of parental involvement.
METHOD: Patients aged 7-17 years with a history of psychotropic medication
treatment and their mothers were included in this study. Each mother and child
completed self-administered questionnaires. Thirty mother-child pairs who fully
completed the questionnaires were included in the analysis.
RESULTS: Medication adherence was greater in children and mothers when mothers
felt that "children's symptoms improved with treatment and medication."
Medication adherence in children and mothers significantly correlated with the
child's reported trust in their parent.
CONCLUSIONS: The results suggest the need for psychosocial support that considers
the influence of mothers on medication adherence in children treated in child
psychiatry departments.
DOI: 10.1111/jcap.12113
PMCID: PMC6088225
1007. J Rural Med. 2015;10(2):79-83. doi: 10.2185/jrm.2900. Epub 2015 Dec 23.
Comprehensive medication management services influence medication adherence among

Japanese older people.
Hirakawa Y(1), Hilawe EH(1), Chiang C(1), Kawazoe N(1), Aoyama A(1).
Author information:
(1)Department of Public Health and Health Systems, Nagoya University Graduate
School of Medicine, Japan.
OBJECTIVE: Assistance from health professionals is very important to ensure

medication adherence among older people. The present study aimed to assess the
relationship between receipt of comprehensive medication management services by
primary care physicians and medication adherence among community-dwelling older
people in rural Japan.
METHODS: Data including medication adherence and whether or not a doctor knew all
the kinds of medicines being taken were obtained from individuals aged 65 years
or older who underwent an annual health checkup between February 2013 and March
2014 at a public clinic in Asakura. The subjects were divided into 2 groups:
adherent (always) and non-adherent (not always). A logistic regression analysis
was performed to assess the association between the presence of a doctor who was
fully responsible for medication adherence and self-reported adherence.
Predictors that exhibited significant association (p-value < 0.05) with
medication adherence in a univariate analysis were entered in the model as
possible confounding factors. The results were presented as odds ratios (OR) and
95% confidence intervals (CI).
RESULTS: Among four-hundred ninety-seven subjects in total, the adherent group
included 430 subjects (86.5%), and its members were older than those of the
non-adherent group. Significant predictors of good medication adherence included
older age, no discomforting symptoms, eating regularly, diabetes mellitus and
having a doctor who knew all the kinds of medicines being taken. After being
adjusted for confounding variables, the subjects with a doctor who knew all the
kinds of medicines they were taking were three times more likely to be adherent
to medication (OR 3.01, 95% CI 1.44-6.99).
CONCLUSION: Receipt of comprehensive medication management services for older
people was associated with medication adherence.
DOI: 10.2185/jrm.2900
PMCID: PMC4689736
PMID: 26705432
1008. Psychiatr Serv. 2014 Oct;65(10):1218-25. doi: 10.1176/appi.ps.201300092.
Educational gradients in psychotropic medication use among older adults in Costa

Rica and the United States.
Domino ME, Dow WH, Coto-Yglesias F.
OBJECTIVE: The relationship of education, psychiatric diagnoses, and use of

psychotropic medication has been explored in the United States, but little is
known about this relationship in poorer countries, despite the high burden of
mental illness in these countries. This study estimated educational gradients in
diagnosis and psychotropic drug use in the United States and Costa Rica, a
middle-income country with universal health insurance.
METHODS: Analyses were conducted by using data of older adults (≥60) from the
2005 U.S. Medical Expenditure Panel Survey (N=4,788) and the 2005 Costa Rican
Longevity and Healthy Aging Study (N=2,827). Logistic regressions examined the
effect of education level (low, medium, or high) and urban residence on the rates
of self-reported mental health diagnoses, screening diagnosis, and psychotropic
medication use with and without an associated psychiatric diagnosis.
RESULTS: Rates of self-reported diagnoses were lower in the United States (12%)
than in Costa Rica (20%), possibly reflecting differences in survey wording. In
both countries, the odds of having depression were significantly lower among
persons with high education. In Costa Rica, use of psychotropic medication among
persons with self-reported diagnoses increased by education level.
CONCLUSIONS: The educational gradients in medication use were different in the
United States and Costa Rica, and stigma and access to care in these countries
may play an important role in these differences, although type of insurance did
not affect educational gradients in the United States. These analyses increase
the evidence of the role of education in use of the health care system.
DOI: 10.1176/appi.ps.201300092
PMCID: PMC4183704
1009. J Diabetes Sci Technol. 2015 Jan;9(1):86-90. doi: 10.1177/1932296814554260.

Epub
2014 Oct 14.
Hypoglycemia prediction using machine learning models for patients with type 2
diabetes.
Sudharsan B(1), Peeples M(1), Shomali M(2).
Author information:
(1)WellDoc, Inc, Baltimore, MD, USA.
(2)WellDoc, Inc, Baltimore, MD, USA mshomali@welldocinc.com.
Minimizing the occurrence of hypoglycemia in patients with type 2 diabetes is a

challenging task since these patients typically check only 1 to 2 self-monitored
blood glucose (SMBG) readings per day. We trained a probabilistic model using
machine learning algorithms and SMBG values from real patients. Hypoglycemia was
defined as a SMBG value < 70 mg/dL. We validated our model using multiple data
sets. In addition, we trained a second model, which used patient SMBG values and
information about patient medication administration. The optimal number of SMBG
values needed by the model was approximately 10 per week. The sensitivity of the
model for predicting a hypoglycemia event in the next 24 hours was 92% and the
specificity was 70%. In the model that incorporated medication information, the
prediction window was for the hour of hypoglycemia, and the specificity improved
to 90%. Our machine learning models can predict hypoglycemia events with a high
degree of sensitivity and specificity. These models-which have been validated
retrospectively and if implemented in real time-could be useful tools for
reducing hypoglycemia in vulnerable patients.
DOI: 10.1177/1932296814554260
PMCID: PMC4495530

eCollection 2017.
Medication adherence and persistence in type 2 diabetes mellitus: perspectives of

patients, physicians and pharmacists on the Spanish health care system.
Labrador Barba E(1), Rodríguez de Miguel M(1), Hernández-Mijares A(2)(3),

Alonso-Moreno FJ(4), Orera Peña ML(1), Aceituno S(5), Faus Dader MJ(6).
Author information:
(1)Department of Medicine, Mylan, Madrid.
(2)Department of Endocrinology and Nutrition, Doctor Peset University Hospital,
Valencia.
(3)Department of Medicine, University of Valencia, Valencia.
(4)Department for Primary Health Care, Centro de Salud Sillería, Toledo.
(5)Outcomes'10, Castellon.
(6)Department of Biochemistry and Molecular Biology, Faculty of Pharmacy,
University of Granada, Granada, Spain.
OBJECTIVE: A good relationship between diabetes patients and their health care
team is crucial to ensure patients' medication adherence and self-management. To
this end, we aimed to identify and compare the views of type 2 diabetes mellitus
(T2DM) patients, physicians and pharmacists concerning the factors and strategies
that may be associated with, or could improve, medication adherence and
persistence.
METHODS: An observational, cross-sectional study was conducted using an
electronic self-administered questionnaire comprising 11 questions (5-point
Likert scale) concerning factors and strategies related to medication adherence.
The survey was designed for T2DM patients and Spanish National Health System
professionals.
RESULTS: A total of 963 T2DM patients, 998 physicians and 419 pharmacists
participated in the study. Overall, a lower proportion of pharmacists considered
the proposed factors associated with medication adherence important as compared
to patients and physicians. It should be noted that a higher percentage of
physicians in comparison to pharmacists perceived that "complexity of medication"
(97% vs 76.6%, respectively) and "adverse events" (97.5% vs 72.2%, respectively)
were important medication-related factors affecting adherence. In addition, both
patients (80.8%) and physicians (80.8%) agreed on the importance of "cost and
co-payment" for adherence, whereas only 48.6% of pharmacists considered this
factor important. It is also noteworthy that nearly half of patients (43%) agreed
that "to adjust medication to activities of daily living" was the best strategy
to reduce therapeutic complexity, whereas physicians believed that "reducing the
frequency of administration" (47.9%) followed by "reducing the number of tablets"
(28.5%) was the most effective strategy to improve patients' adherence.
CONCLUSION: Our results highlight the need for pharmacists to build a stronger
relationship with physicians in order to improve patients monitoring and
adherence rates. Additionally, these findings may help to incorporate greater
patient-centeredness when developing management strategies, focusing on adjusting
medication regimens to patients' daily lives.
DOI: 10.2147/PPA.S122556
PMCID: PMC5388272
PMID: 28435229

1011. Res Nurs Health. 2015 Aug;38(4):289-300. doi: 10.1002/nur.21663. Epub 2015
May
11.
Predictors of medication nonadherence differ among black and white patients with
heart failure.
Dickson VV(1), Knafl GJ(2), Riegel B(3).
Author information:
(1)Assistant Professor College of Nursing, New York University, 433 First Avenue,
#742, New York, NY, 10010.
(2)Professor School of Nursing, University of North Carolina, Chapel Hill, NC.
(3)Professor and Edith Clemmer Steinbright Chair of Gerontology School of
Nursing, University of Pennsylvania, Philadelphia, PA.
Heart failure (HF) is a global public health problem, and outcomes remain poor,
especially among ethnic minority populations. Medication adherence can improve
heart failure outcomes but is notoriously low. The purpose of this secondary
analysis of data from a prospective cohort comparison study of adults with heart
failure was to explore differences in predictors of medication nonadherence by
racial group (Black vs. White) in 212 adults with heart failure. Adaptive
modeling analytic methods were used to model HF patient medication nonadherence
separately for Black (31.7%) and White (68.3%) participants in order to
investigate differences between these two racial groups. Of the 63 Black
participants, 33.3% had low medication adherence, compared to 27.5% of the 149
White participants. Among Blacks, 16 risk factors were related to adherence in
bivariate analyses; four of these (more comorbidities, lower serum sodium, higher
systolic blood pressure, and use of fewer activities compensating for
forgetfulness) jointly predicted nonadherence. In the multiple risk factor model,
the number of risk factors in Black patients ranged from 0 to 4, and 76.2% had at
least one risk factor. The estimated odds ratio for medication nonadherence was
increased 9.34 times with each additional risk factor. Among White participants,
five risk factors were related to adherence in bivariate analyses; one of these
(older age) explained the individual effects of the other four. Because Blacks
with HF have different and more risk factors than Whites for low medication
adherence, interventions are needed that address unique risk factors among Black
patients with HF.
DOI: 10.1002/nur.21663
PMCID: PMC4503510
1012. Clin Interv Aging. 2018 Oct 8;13:1919-1927. doi: 10.2147/CIA.S178393.

eCollection
2018.
Capability for self-care of patients with heart failure.
Mlynarska A(1)(2), Golba KS(2)(3), Mlynarski R(2).
Author information:
(1)Department of Internal Nursing, School of Health Sciences, Medical University
of Silesia, Katowice, Poland, mlynarska83@gmail.com.
(2)Department of Electrocardiology, Upper Silesian Heart Centre, Katowice,
Poland, mlynarska83@gmail.com.
(3)Department of Electrocardiology and Heart Failure, School of Health Sciences,
Medical University of Silesia, Katowice, Poland.
Background: A thorough analysis of the capability for self-care in patients with

heart failure (HF) reduces the frequency of hospitalizations that are caused by
decompensation. The aim of the study was to assess the effect of the method of
therapy for HF, the degree of the acceptance of illness, and the occurrence of
frailty syndrome on adherence to the therapeutic recommendations and self-care in
patients with HF.
Methods: The study included 180 patients who were hospitalized after being
diagnosed with HF. In all, we used the Polish versions of three validated
instruments: the nine-item European Heart Failure Self-care Behavior Scale,
Illness Acceptance Scale, and The Tilburg Frailty Indicator.
Results: The capability for self-care of patients with HF was 27.8%. More than
65% of the patients followed the recommendations for taking medication and also
followed a low-sodium diet, while only 5.5% of the patients followed the
recommendations for physical exercise. Positive correlations were found between
the capability for self-care and frailty syndrome and its components: general
frailty components vs the capability for self-care: r=0.4449, P=0.0000; physical
frailty components vs the capability for self-care: r=0.3974, P=0.0000; emotional
frailty components vs the capability for self-care: r=0.2831, P=0.0001; social
frailty components vs the capability for self-care: r=0.2180, P=0.0032, and a
negative correlation between the capability for self-care and the degree of the
acceptance of the illnesses (r=-0.4662, P=0.0000).
Conclusion: A relatively low capability for self-care was found in patients with
HF. The presence of frailty syndrome and a low level of the acceptance of illness
are connected with a low capability for self-care.
DOI: 10.2147/CIA.S178393
PMCID: PMC6183697

Validating the Modified Drug Adherence Work-Up (M-DRAW) Tool to Identify and
Address Barriers to Medication Adherence.
Lee S(1), Bae YH(2), Worley M(3), Law A(4).
Author information:
(1)College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766,
USA. slee22@westernu.edu.
(2)School of Pharmacy, University of Southern California, Los Angeles, CA 90089,
USA. jaehee616@gmail.com.
(3)College of Pharmacy, Ohio State University, Columbus, OH 43210, USA.
worley.18@osu.edu.
(4)College of Pharmacy, Western University of Health Sciences, Pomona, CA 91766,
USA. alaw@westernu.edu.
Barriers to medication adherence stem from multiple factors. An effective and

convenient tool is needed to identify these barriers so that clinicians can
provide a tailored, patient-centered consultation with patients. The Modified
Drug Adherence Work-up Tool (M-DRAW) was developed as a 13-item checklist
questionnaire to identify barriers to medication adherence. The response scale
was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often).
The checklist was accompanied by a GUIDE that provided corresponding motivational
interview-based intervention strategies for each identified barrier. The current
pilot study examined the psychometric properties of the M-DRAW checklist
(reliability, responsiveness and discriminant validity) in patients taking one or
more prescription medication(s) for chronic conditions. A cross-sectional sample
of 26 patients was recruited between December 2015 and March 2016 at an academic
medical center pharmacy in Southern California. A priming question that assessed
self-reported adherence was used to separate participants into the control group
of 17 "adherers" (65.4%), and into the intervention group of nine "unintentional
and intentional non-adherers" (34.6%). Comparable baseline characteristics were
observed between the two groups. The M-DRAW checklist showed acceptable
reliability (13 item; alpha = 0.74) for identifying factors and barriers leading
to medication non-adherence. Discriminant validity of the tool and the priming
question was established by the four-fold number of barriers to adherence
identified within the self-selected intervention group compared to the control
group (4.4 versus 1.2 barriers, p < 0.05). The current study did not investigate
construct validity due to small sample size and challenges on follow-up with
patients. Future testing of the tool will include construct validation.
DOI: 10.3390/pharmacy5030052
PMCID: PMC5622364
PMID: 28970464

1014. J Adolesc Health. 2016 Oct;59(4):465-71. doi:
10.1016/j.jadohealth.2016.05.016.
Epub 2016 Jul 27.
The Detroit Young Adult Asthma Project: Pilot of a Technology-Based Medication

Adherence Intervention for African-American Emerging Adults.
Kolmodin MacDonell K(1), Naar S(2), Gibson-Scipio W(3), Lam P(4), Secord E(2).
Author information:
(1)Department of Family Medicine and Public Health Sciences, Wayne State
University School of Medicine, Detroit, Michigan. Electronic address:
kkolmodin@med.wayne.edu.
(2)Department of Family Medicine and Public Health Sciences, Wayne State
University School of Medicine, Detroit, Michigan.
(3)College of Nursing, Wayne State University, Detroit, Michigan.
(4)University of Windsor, Faculty of Arts, Humanities, and Social Sciences,
Windsor, Ontario, Canada.
PURPOSE: To conduct a randomized controlled pilot of a multicomponent,

technology-based intervention promoting adherence to controller medication in
African-American emerging adults with asthma. The intervention consisted of two
computer-delivered sessions based on motivational interviewing combined with text
messaged reminders between sessions.
METHODS: Participants (N = 49) were 18-29 years old, African-American, with
persistent asthma requiring controller medication. Participants had to report
poor medication adherence and asthma control. Youth were randomized to receive
the intervention or an attention control. Data were collected through
computer-delivered self-report questionnaires at baseline, 1, and 3 months.
Ecological Momentary Assessment via two-way text messaging was also used to
collect "real-time" data on medication use and asthma control.
RESULTS: The intervention was feasible and acceptable to the target population,
as evidenced by high retention rates and satisfaction scores. Changes in study
outcomes from pre- to postintervention favored the intervention, particularly for
decrease in asthma symptoms, t (42) = 2.22, p < .05 (Cohen's d = .071).
CONCLUSIONS: Results suggest that the intervention is feasible and effective.
However, findings are preliminary and should be replicated with a larger sample
and more sophisticated data analyses.

DOI: 10.1016/j.jadohealth.2016.05.016
PMCID: PMC5035614
1015. Saudi Med J. 2019 Mar;40(3):246-251. doi: 10.15537/smj.2019.3.23960.
Knowledge, attitude and practice on medication error reporting among health

practitioners in a tertiary care setting in Saudi Arabia.
Alsulami SL(1), Sardidi HO, Almuzaini RS, Alsaif MA, Almuzaini HS, Moukaddem AK,
Kharal MS.
Author information:
(1)College of Medicine, King Saud bin Abdulaziz University for Health Sciences,
Riyadh, Kingdom of Saudi Arabia. E-mail:. alsulamisalma994@gmail.com.
OBJECTIVES: To assess knowledge, attitudes and practices towards the reporting of
medication errors among health practitioners at King Abdulaziz Medical city in
Riyadh, Kingdom of Saudi Arabia. Methods: A cross-sectional study using a
self-administered questionnaire was conducted in a convenient sample of 62
physicians and 303 nurses, between June and September 2017 at King Abdulaziz
Medical City, Riyadh, Kingdom of Saudi Arabia. Results: The sample consisted of
365 subjects, with a response rate of 73%. Approximately 97% had
sufficient knowledge and a favorable attitude (90%) towards medication error
reporting. With regard to reporting practices, some participants (21.6%)
preferred to educate those who made a medication error, rather than reporting it.
Approximately 44.8% had not reported medication errors during their work
experience. Conclusion: Study participants demonstrated a sufficient knowledge
base with regard to medication error reporting. Despite sufficient knowledge and
favorable attitudes towards medication error reporting, there is still an
under-reporting of medication errors when it comes to practice. We recommend the
establishment of frequent medication safety courses as a prerequisite for all
health care providers. We also advocate the application of error detecting alarms
such as digital programs to minimize medication errors.
DOI: 10.15537/smj.2019.3.23960
PMCID: PMC6468206
1016. J Pak Med Assoc. 2016 Jul;66(7):853-8.
Translation, validation and effectiveness of self-care inventory in assessing

adherence to diabetes treatment.
Mumtaz T(1), Haider SA(1), Malik JA(1), La Greca AM(2).
Author information:
(1)National Institute of Psychology, Center of Excellence, Quaid-i-Azam
University, Islamabad, Pakistan.
(2)Professor of Psychology, Director of Clinical Training, University of Miami,
Coral Gables, USA.
OBJECTIVE: To evaluate the efficacy of an Urdu translation of Self Care Inventory

for measuring adherence to diabetes treatment.
METHODS: The correlational cross-sectional study was conducted in October and
November, 2011, and data was collected from outpatient department of
public-sector hospitals of Rawalpindi and Islamabad, Pakistan. Patients included
had diabetes type1 or type 2, while those with severe diabetic complications,
including nephropathy, neuropathy, diabetic foot, and renal disease or any
psychiatric comorbidity, were excluded.
RESULTS: Of the 300 patients, 165(55%) were women. The overall age of the sample
ranged between 19 and 72 years. The translated version of Self Care Inventory
showed Chronbach's alpha ranging from 0.73 to 0.80 for four sub-scales, and 0.78
for the overall measure of adherence. In support of predictive validity, the
inventory correlated negatively with fasting blood glucose level (r = -0.12 to
-0.17; p<0.05) and positively with the problem areas in diabetes score (r= 0.15
to 0.24; p<0.01). Confirmatory factor analysis presented a good fit of the model
to the data with all recommended items loading well on respective scales (lambda
ranging from 0.42 to 0.86).
CONCLUSIONS: The self care inventory is an effective measure for assessing
adherence to diabetes treatment. The Urdu version of the inventory appeared to be
a valid and reliable instrument and is ready to be used in clinical and research
setting.
Use of simulation from high fidelity to low fidelity in teaching of

safe-medication practices.
Onturk ZK(1), Ugur E(1), Kocatepe V(1), Ates E(1), Ocaktan N(1), Unver V(1),
Karabacak U(1).
Author information:
(1)Acibadem Mehmet Ali Aydinlar University, Faculty of Health Sciences, Nursing
Department, Turkey.
OBJECTIVE: To evaluate the effects of simulation techniques on learning outcomes

in the teaching of safe drug applications to first year nursing students.
METHODS: The semi-experimental study was conducted from February to April 2017,
and comprised nursing students of Acibadem Mehmet Ali Aydinlar University. This
student satisfaction and selfconfidence in learning scale, medication practice
via oral route checklist, and pre- and post-test for safe drug application
knowledge Assessment were used for data collection. Following the theoretical
lectures, case studies, task trainer practices and scenario with standardised
patient were carried out. Baseline knowledge, during-the-scenario performanceand
post-scenario level of student's satisfaction and self-confidence were evaluated.
Data was analysed using SPSS 18.
RESULTS: Of the 58 subjects, 51(87.9%) were female. The overall mean age of the
sample was 20.69±1.02 years. There was a statistically significant difference
between students' knowledge levels before and after the scenario (p<0.05). Mean
performance scoreon safe medication practice was 65.70±5.83. A significant weak
positive correlation was found between the students' scores on satisfaction with
the simulation and knowledge levels as well as the performance and
self-confidence scores (p<0.05 each). Also, there was a strong correlation
between the scores on self-confidence scale and the knowledge levels (p<0.01).
CONCLUSIONS: Simulation had a positive effect on learning outcomes..
PMID: 30804583
1018. Addict Biol. 2017 Nov;22(6):1515-1527. doi: 10.1111/adb.12425. Epub 2016 Jul
14.
Effects of naltrexone on alcohol self-administration and craving: meta-analysis

of human laboratory studies.
Hendershot CS(1)(2)(3)(4), Wardell JD(1), Samokhvalov AV(2)(4)(5), Rehm

J(1)(2)(4)(6)(7).
Author information:
(1)Campbell Family Mental Health Research Institute, Centre for Addiction and
Mental Health, Canada.
(2)Department of Psychiatry, University of Toronto, Canada.
(3)Department of Psychology, University of Toronto, Canada.
(4)Institute for Mental Health Policy Research, Centre for Addiction and Mental
Health, Canada.
(5)Institute for Medical Sciences, University of Toronto, Canada.
(6)Dalla Lana School of Public Health, University of Toronto, Canada.
(7)Technische Universität, Germany.
Randomized clinical trials have established the efficacy of naltrexone for

reducing quantity of alcohol consumption and incidence of relapse to heavy
drinking. To evaluate putative treatment mechanisms, human laboratory studies
have examined naltrexone's effects on alcohol responses and self-administration
during short-term medication protocols. Results from these studies are
inconsistent and have yet to be examined in aggregate. This meta-analysis aimed
to quantify naltrexone's effects on alcohol self-administration and craving in
the context of placebo-controlled human laboratory trials. Potential moderators
of medication effects were also examined. Meta-analyses of alcohol
self-administration (k = 9, N = 490) and craving (k = 16, N = 748) confirmed
that, under controlled experimental conditions, naltrexone reduces the quantity
of consumption (Hedges' g = -.277, SE = .074, 95 percent CI = -.421, -.133,
p < .001) and magnitude of self-reported craving (g = -.286, SE = .066, 95
percent CI = -.416, -.156, p < .001) relative to placebo. Subgroup and moderation
analyses found no evidence that effect sizes differed by study population
(dependent versus non-dependent drinkers), laboratory paradigm or duration of
medication exposure. These results substantiate prior evidence for reductions in
event-level craving and consumption as potential treatment mediators, also
establishing effect sizes to inform future human laboratory trials. From a
clinical perspective, these results may provide additional evidence regarding
naltrexone's efficacy in the context of acute or subacute dosing regimens.
DOI: 10.1111/adb.12425
PMCID: PMC6139429
1019. J Med Internet Res. 2018 Mar 27;20(3):e105. doi: 10.2196/jmir.8666.
Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2

Diabetes Patients and Their Health Care Providers: Qualitative Study on User
Requirements.
Bernhard G(1), Mahler C(1), Seidling HM(2)(3), Stützle M(2)(3), Ose D(1)(4),
Baudendistel I(1), Wensing M(1), Szecsenyi J(1).
Author information:
(1)Department of General Practice and Health Services Research, Heidelberg
University Hospital, Heidelberg, Germany.
(2)Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital,
Heidelberg, Germany.
(3)Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg
University Hospital, Heidelberg, Germany.
(4)Division of Cancer Population Sciences, Department of Population Health
Sciences, University of Utah, Salt Lake City, UT, United States.
BACKGROUND: Information technology tools such as shared patient-centered,

Web-based medication platforms hold promise to support safe medication use by
strengthening patient participation, enhancing patients' knowledge, helping
patients to improve self-management of their medications, and improving
communication on medications among patients and health care professionals (HCPs).
However, the uptake of such platforms remains a challenge also due to inadequate
user involvement in the development process. Employing a user-centered design
(UCD) approach is therefore critical to ensure that user' adoption is optimal.
OBJECTIVE: The purpose of this study was to identify what patients with type 2
diabetes mellitus (T2DM) and their HCPs regard necessary requirements in terms of
functionalities and usability of a shared patient-centered, Web-based medication
platform for patients with T2DM.
METHODS: This qualitative study included focus groups with purposeful samples of
patients with T2DM (n=25), general practitioners (n=13), and health care
assistants (n=10) recruited from regional health care settings in southwestern
Germany. In total, 8 semistructured focus groups were conducted. Sessions were
audio- and video-recorded, transcribed verbatim, and subjected to a
computer-aided qualitative content analysis.
RESULTS: Appropriate security and access methods, supported data entry, printing,
and sending information electronically, and tracking medication history were
perceived as the essential functionalities. Although patients wanted automatic
interaction checks and safety alerts, HCPs on the contrary were concerned that
unspecific alerts confuse patients and lead to nonadherence. Furthermore, HCPs
were opposed to patients' ability to withhold or restrict access to information
in the platform. To optimize usability, there was consensus among participants to
display information in a structured, chronological format, to provide information
in lay language, to use visual aids and customize information content, and align
the platform to users' workflow.
CONCLUSIONS: By employing a UCD, this study provides insight into the desired
functionalities and usability of patients and HCPs regarding a shared
patient-centered, Web-based medication platform, thus increasing the likelihood
to achieve a functional and useful system. Substantial and ongoing engagement by
all intended user groups is necessary to reconcile differences in requirements of
patients and HCPs, especially regarding medication safety alerts and access
control. Moreover, effective training of patients and HCPs on medication
self-management (support) and optimal use of the tool will be a prerequisite to
unfold the platform's full potential.
©Gerda Bernhard, Cornelia Mahler, Hanna Marita Seidling, Marion Stützle, Dominik
Ose, Ines Baudendistel, Michel Wensing, Joachim Szecsenyi. Originally published
in the Journal of Medical Internet Research (http://www.jmir.org), 27.03.2018.
DOI: 10.2196/jmir.8666
PMCID: PMC5893891
1020. Hosp Pharm. 2017 Apr;52(4):308-315. doi: 10.1310/hpj5204-308.
A Just Culture Approach to Managing Medication Errors.
Rogers E, Griffin E, Carnie W, Melucci J, Weber RJ.
Medication errors continue to be a concern of health care providers and the

public, in particular how to prevent harm from medication mistakes. Many health
care workers are afraid to report errors for fear of retribution including the
loss of professional licensure and even imprisonment. Most health care workers
are silent, instead of admitting their mistake and discussing it openly with
peers. This can result in further patient harm if the system causing the mistake
is not identified and fixed; thus self-denial may have a negative impact on
patient care outcomes. As a result, pharmacy leaders, in collaboration with
others, must put systems in place that serve to prevent medication errors while
promoting a "Just Culture" way of managing performance and outcomes. This culture
must exist across disciplines and departments. Pharmacy leaders need to
understand how to classify behaviors associated with errors, set realistic
expectations, instill values for staff, and promote accountability within the
workplace. This article reviews the concept of Just Culture and provides ways
that pharmacy directors can use this concept to manage the degree of error in
patient-centered pharmacy services.
DOI: 10.1310/hpj5204-308
PMCID: PMC5424837
PMID: 28515512
1021. Int J Hypertens. 2018 Feb 13;2018:9752736. doi: 10.1155/2018/9752736.

eCollection
2018.
Factors Predicting Self-Care Behaviors among Low Health Literacy Hypertensive

Patients Based on Health Belief Model in Bushehr District, South of Iran.
Larki A(1), Tahmasebi R(2), Reisi M(1).
Author information:
(1)Department of Health Education and Health Promotion, Bushehr University of
Medical Sciences, Bushehr, Iran.
(2)Department of Biostatistics, Bushehr University of Medical Sciences, Bushehr,
Iran.
The aim of this study was to determine the factors influencing adherence to
self-care behaviors among low health literacy hypertensive patients based on
health belief model. A cross-sectional study was conducted among 152 hypertensive
patients with low health literacy. Patients with limited health literacy were
identified by S-TOFHLA. The data were collected using H-scale for assessing
self-care behaviors and, HK-LS for assessing knowledge of hypertension. A
researcher-made questionnaire was applied for collecting data of health belief
model constructs. Data were analyzed by SPSS version 22 with using multiple
logistic regression analyses. Perceived self-efficacy was associated with all
self-care behaviors except medication regimens. There was a significant
association between perceived susceptibility and adherence to both low-salt diet
(OR = 3.47) and nonsmoking behavior (OR = 1.10). Individuals who had more
perceived severity (OR = 1.82) had significantly greater adherence to their
medication regimens. Perceived benefits and barriers were not significantly
associated with either type of hypertension self-care behaviors. It seems that
designing and implementation of educational programs to increase self-efficacy of
patients and promote their beliefs about perceived susceptibility and severity of
complications may improve self-care behaviors among low health literacy
hypertensive patients.
DOI: 10.1155/2018/9752736
PMCID: PMC5893004
PMID: 29780639

eCollection 2017.
Correction: Validity and Reliability of a Self-Reported Measure of

Antihypertensive Medication Adherence in Uganda.
PLOS ONE Staff.
Erratum for
PLoS One. 2016 Jul 01;11(7):e0158499.
[This corrects the article DOI: 10.1371/journal.pone.0158499.].

PMCID: PMC5663509
PMID: 29088305
1023. BMC Res Notes. 2019 Feb 14;12(1):86. doi: 10.1186/s13104-019-4125-3.
Prevalence and predictors of self care practices among hypertensive patients at

Jimma University Specialized Hospital, Southwest Ethiopia: cross-sectional study.
Labata BG(1), Ahmed MB(2), Mekonen GF(3), Daba FB(4).
Author information:
(1)Pharmacy Department, Wollega University, Nekemte, Ethiopia.
bushagemechu1@gmail.com.
(2)Department of Epidemiology, Jimma University, Jimma, Ethiopia.
(3)Pharmacy Department, Wollega University, Nekemte, Ethiopia.
(4)Pharmacy Department, Jimma University, Jimma, Ethiopia.
OBJECTIVE: Hypertension is a major risk factor and precursor of myocardial

infarction, chronic kidney disease, heart failure and premature death. These
vascular events increased costs of hypertension management. Self-care Practices
were recommended to control blood pressure among hypertensive patients.
Therefore, the objective of this study is to assess predictors of self-care
practices among hypertensive patients at Jimma University Specialized Hospital.
RESULTS: A 341-hypertensive patients participated in the study. The mean age of
the participants was 54.35 ± 12.48 years with range of 26 to 89 years. One
hundred seventy-seven (51.9%) respondents were males and male to female ratio is
1.08. About 61.9% of respondents were adherent to medication usage and 30.5%,
44.9%, 88.3%, 93.5% and 56.9% of respondents were adherent to low salt diet,
physical activity, non-alcohol drinking, nonsmoking and weight management
respectively. Normal weight (AOR = 1.822, 95% CI 1.073-3.093) was independent
predictor of medication usage whereas good self-efficacy (AOR = 2.584, 95% CI
1.477-4.521) and being female (AOR = 0.517, 95% CI 0.301-0.887) were independent
predictor of low salt diet and physical activity respectively. Also being female
(AOR = 3.626, 95% CI 1.211-10.851) was independent predictors of non-smoking.
DOI: 10.1186/s13104-019-4125-3
PMCID: PMC6376695
1024. J Behav Med. 2016 Dec;39(6):1104-1114. doi: 10.1007/s10865-016-9745-7. Epub

2016
May 11.
Health care providers' support of patients' autonomy, phosphate medication

adherence, race and gender in end stage renal disease.
Umeukeje EM(1)(2), Merighi JR(3), Browne T(4), Wild M(1)(2), Alsmaan H(5),
Umanath K(5), Lewis JB(1)(2), Wallston KA(6), Cavanaugh KL(7)(8).
Author information:
(1)Division of Nephrology and Hypertension, Vanderbilt University Medical Center,
1161 21st Avenue MCN S-3223, Nashville, TN, 37232, USA.
(2)Vanderbilt Center for Kidney Disease, Nashville, TN, USA.
(3)School of Social Work, University of Minnesota, Saint Paul, MN, USA.
(4)College of Social Work, University of South Carolina, Columbia, SC, USA.
(5)Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI,
USA.
(6)Vanderbilt University School of Nursing, Nashville, TN, USA.
(7)Division of Nephrology and Hypertension, Vanderbilt University Medical Center,
1161 21st Avenue MCN S-3223, Nashville, TN, 37232, USA.
(8)Vanderbilt Center for Kidney Disease, Nashville, TN, USA.
Erratum in
J Behav Med. 2019 Jan 8;:.
This study was designed to assess dialysis subjects' perceived autonomy support
association with phosphate binder medication adherence, race and gender. A
multi-site cross-sectional study was conducted among 377 dialysis subjects. The
Health Care Climate (HCC) Questionnaire assessed subjects' perception of their
providers' autonomy support for phosphate binder use, and adherence was assessed
by the self-reported Morisky Medication Adherence Scale. Serum phosphorus was
obtained from the medical record. Regression models were used to examine
independent factors of medication adherence, serum phosphorus, and differences by
race and gender. Non-white HCC scores were consistently lower compared with white
subjects' scores. No differences were observed by gender. Reported phosphate
binder adherence was associated with HCC score, and also with phosphorus control.
No significant association was found between HCC score and serum phosphorus.
Autonomy support, especially in non-white end stage renal disease subjects, may
be an appropriate target for culturally informed strategies to optimize mineral
bone health.
DOI: 10.1007/s10865-016-9745-7
PMCID: PMC5512866
1025. Diabet Med. 2014 Oct;31(10):1237-44. doi: 10.1111/dme.12453. Epub 2014 Apr
18.
Development and validation of the Diabetes Medication System Rating

Questionnaire-Short Form.
Peyrot M(1), Xu Y, Rubin RR.
Author information:
(1)Department of Sociology, Loyola University Maryland, Baltimore, MD, USA.
AIMS: To develop and validate a short form of the 54-item Diabetes Medication
System Rating Questionnaire that maintains the domains and performance
characteristics of the long-form questionnaire.
METHODS: Data from the Diabetes Medication System Rating Questionnaire validation
study were analysed to select items representing the nine scales (convenience,
negative events, interference, self-monitoring of blood glucose burden, efficacy,
social burden, psychological well-being, treatment satisfaction and treatment
preference). The resulting 20-item Diabetes Medication System Rating
Questionnaire Short-Form was administered online, with validated criterion
measures of treatment satisfaction and medication adherence, with a retest within
2 weeks. Participants were US adults (N = 413) with Type 2 diabetes using oral
agents alone; insulin by syringe and/or pen with or without oral agents; or
glucagon-like peptide-1 agents. Most participants (82%) completed the retest.
RESULTS: The median inter-item agreement of scales was 0.76 and the total
composite (mean of all items except treatment preference) was 0.88. The median
test-retest reliability of scales was 0.86, and of the total composite was 0.95.
All statistically significant correlations between Diabetes Medication System
Rating Questionnaire Short-Form scales and criterion measures of treatment
satisfaction and adherence were in the expected direction. The median correlation
of the Diabetes Medication System Rating Questionnaire Short-Form with
corresponding criterion measures of treatment satisfaction was 0.59; the mean
correlation of the same Diabetes Medication System Rating Questionnaire
Short-Form measures with adherence was 0.42. The Diabetes Medication System
Rating Questionnaire Short-Form scales were more powerful predictors of adherence
than were the criterion measures of treatment satisfaction. The Diabetes
Medication System Rating Questionnaire Short-Form scales differentiated between
those taking different medications and between those using different insulin
delivery devices.
CONCLUSIONS: This study suggests that the Diabetes Medication System Rating
Questionnaire Short-Form provides a comprehensive set of measures with acceptable
reliability and validity and a reduced burden of administration.
© 2014 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on
behalf of Diabetes UK.
DOI: 10.1111/dme.12453
PMCID: PMC4232890
1026. J Cyst Fibros. 2016 Sep;15(5):696-702. doi: 10.1016/j.jcf.2016.02.011. Epub

2016
Mar 17.
Disease disclosure in individuals with cystic fibrosis: Association with

psychosocial and health outcomes.
Borschuk AP(1), Everhart RS(2), Eakin MN(3), Rand-Giovannetti D(4), Borrelli

B(5), Riekert KA(6).
Author information:
(1)Department of Psychology, Virginia Commonwealth University, P.O. Box 842018,
Richmond, VA 23284-2018, United States. Electronic address: apborschuk@vcu.edu.
(2)Department of Psychology, Virginia Commonwealth University, P.O. Box 842018,
Richmond, VA 23284-2018, United States. Electronic address: reverhart@vcu.edu.
(3)Division of Pulmonary and Critical Care Medicine, Johns Hopkins Adherence
Research Center, Johns Hopkins School of Medicine, United States. Electronic
address: meakin1@jhmi.edu.
address: drandgio@gmail.com.
(5)Department of Health Policy & Health Services Research, Boston University, 560
Harrison Avenue, Boston, MA 02118, United States. Electronic address:
belindab@bu.edu.
address: riekert@jhmi.edu.
BACKGROUND: This study aimed to quantify cystic fibrosis (CF) disclosure and
examine associations between disclosure and psychosocial and health outcomes.
METHODS: Participants completed measures assessing disease disclosure and
psychosocial outcomes. Data from chart reviews and pharmacy records were
obtained.
RESULTS: Participants (N=128; ages 16-63) were more likely to disclose to
romantic partners (97%) and close friends (94%) than to casual friends (79%),
bosses (71%), or co-workers (53%). Participants reported more comfort discussing
CF with and doing treatments in front of romantic partners and close friends than
other groups. Disclosure was associated with higher social support, social
functioning, and medication adherence self-efficacy. Lower lung-function was
associated with disclosure to bosses and co-workers.
CONCLUSIONS: Clinicians should consider discussing disclosure with patients, as
limited disclosure may have a negative impact on psychosocial outcomes.
rights reserved.
DOI: 10.1016/j.jcf.2016.02.011
PMCID: PMC6512333
1027. J Pharmacol Pharmacother. 2016 Apr-Jun;7(2):72-9. doi: 10.4103/0976-

500X.184770.
Factors influencing adherence to anti-craving medications and drinking outcomes

in patients with alcohol dependence: A hospital-based study.
Lohit K(1), Kulkarni C(2), Galgali RB(3).
Author information:
(1)Department of Pharmacology, Sri Siddhartha Medical College, Tumakuru,
Karnataka, India.
(2)Division of Clinical Pharmacology, St. John's Medical College and Hospital,
Bengaluru, Karnataka, India.
(3)Department of Psychiatry, St. John's Medical College and Hospital, Bengaluru,
Karnataka, India.
OBJECTIVE: To examine the factors influencing the pattern and extent of

anti-craving medication adherence and drinking outcomes in alcohol-dependent
patients.
MATERIALS AND METHODS: Demographic data from 102 inpatients were collected at
discharge from hospital. The pattern of anti-craving medication, extent of
adherence, and drinking outcome was collected at 1(st), 3(rd), 8(th), and 12(th)
week follow-up. Patients' self-reported adherence, medication diary, and
simplified medication adherence questionnaire were used and data were analyzed
using SPSS.
RESULTS: Majority (99%) were male patients with a mean age of 41.17 ± 9.86 years
and 70% belonged to middle socioeconomic status. There was a decrease in the
number of patients coming for follow-up over time from 99.01% to 77.45% on day
90. Acamprosate was used in 74% and naltrexone and disulfiram in 7% of patients
each. A significant reduction in adherence to acamprosate and naltrexone (P <
0.001) was associated with simultaneous decrease in days to alcohol abstinence
and increase in relapse rate compared to adherent group (P < 0.001). Main
barriers to adherence included younger age (odds ratio = 1.05 95% [1.01-1.09]; P
< 0.01), self-decision, emotional factors, and adverse effects.
CONCLUSIONS: The study demonstrated the need for safer therapeutic options along
with suitable intervention at grass root level for sustenance of adherence to
anti-craving medication among young adults to prevent relapse and achieve
near-complete abstinence from alcohol dependence.
DOI: 10.4103/0976-500X.184770
PMCID: PMC4936082
PMID: 27440951
1028. Diabetes Technol Ther. 2015 Feb;17(2):80-7. doi: 10.1089/dia.2014.0166. Epub
2014
Oct 31.
Quantifying direct effects of social determinants of health on glycemic control

in adults with type 2 diabetes.
Walker RJ(1), Gebregziabher M, Martin-Harris B, Egede LE.
Author information:
(1)1 Health Equity and Rural Outreach Innovation Center, Charleston Veterans
Affairs Health Services Research and Development Service Center of Innovation,
Ralph H. Johnson Veterans Administration Medical Center , Charleston, South
Carolina.
BACKGROUND: The aim of this study was to investigate if self-care is the pathway
through which social determinants of health impact diabetes outcomes by analyzing
the direct and indirect effects of socioeconomic and psychosocial factors on
self-care and glycemic control.
SUBJECTS AND METHODS: Six hundred fifteen adults were recruited from two primary
care clinics in the southeastern United States. A series of confirmatory factor
analyses identified the latent factors underlying social status, psychosocial
determinants (psychological distress, self-efficacy, and social support), and
self-care (diet, exercise, foot care, glucose testing, and medication adherence).
Structured equation modeling investigated the relationship among social
determinants, self-care and glycemic control.
RESULTS: Latent variables were created for diabetes self-care, psychological
distress, self-efficacy, social support, and social status. The final model
[χ(2)(275)=450.07, P<0.001, R(2)=99, root mean square error of
approximation=0.03, comparative fit index=0.98] showed lower psychological
distress (r=-0.13, P=0.012), higher social support (r=0.14, P=0.01), and higher
self-efficacy (r=0.47, P<0.001) were significantly related to diabetes self-care.
Lower psychological distress (r=0.10, P=0.03), lower social support (r=0.10,
P=0.02), and higher self-efficacy (r=-0.37, P<0.001) were significantly related
to lower glycemic control. When social determinants of health variables were
included in the model, self-care was no longer significantly associated with
glycemic control (r=0.01, P=0.83).
CONCLUSIONS: This study suggests a direct relationship between psychosocial
determinants of health and glycemic control. Although associated with self-care,
the relationship between social determinants of health and glycemic control is
not mediated by self-care. Development of interventions should take psychosocial
factors into account as independent influences on diabetes outcomes, rather than
as indirect influences via self-care behavior.
DOI: 10.1089/dia.2014.0166
PMCID: PMC4322090
1029. J Am Pharm Assoc (2003). 2016 May-Jun;56(3):310-5. doi:

10.1016/j.japh.2016.01.005. Epub 2016 Apr 1.
Medication adherence and activity patterns underlying uncontrolled hypertension:

Assessment and recommendations by practicing pharmacists using digital health
care.
Noble K, Brown K, Medina M, Alvarez F, Young J, Leadley S, Kim Y, DiCarlo L.

OBJECTIVES: This report summarizes the first use of a digital health feedback
system (DHFS) by practicing pharmacists to establish evidence-based blood
pressure (BP) management recommendations.
SETTING: Fifteen commercial pharmacies and 39 patients in the Isle of Wight
participated.
PRACTICE DESCRIPTION: The pharmacists were experienced in providing New Medicine
Services to patients in their communities.
PRACTICE INNOVATION: The pharmacists utilized a commercially available DHFS. The
DHFS utilized FDA-cleared and CE-marked class 2 medical devices passively
captured and shared information about medication-taking using an ingestible
sensor, and daily patterns of rest, activity, and exercise using a wearable patch
that incorporates an accelerometer.
INTERVENTIONS: Pharmacists provided targeted counselling for BP management as
guided by the digital information.
EVALUATION: Blood pressure was measured serially, and patient and provider
experiences with DHFS use were assessed using satisfaction surveys.
RESULTS: The mean change in SBP over the 2-week evaluation period was -7.9 ±
22.1; mean change in DBP was -2.8 ± 12.9. A root cause for persistent
hypertension was determined for all of these 34 patients: 68% had pharmaceutical
resistance, and 32% had inadequate medication use. Specifically, 29% were found
to be capable to achieving blood pressure control on their currently prescribed
medications, 68% were found to have a need for additional pharmacological
treatment, and 3% needed additional adherence support. Pharmacists found that the
DHFD helped in targeting specific recommendations, and to create a collaborative
experience with their patients. Patients found the experience to be positive and
helpful.
CONCLUSION: DHFS that provides confirmation of medication taking and objective
measures of lifestyle patterns can help pharmacists to identify specific factors
contributing to uncontrolled hypertension, to make evidence-based prescribing and
lifestyle recommendations for achieving treatment goals, and to create a
collaborative experience for patients in the management of their self-care.

DOI: 10.1016/j.japh.2016.01.005
1030. Arthritis Care Res (Hoboken). 2014 Oct;66(10):1551-9. doi: 10.1002/acr.22336.
Medication adherence in gout: a systematic review.
De Vera MA(1), Marcotte G, Rai S, Galo JS, Bhole V.
Author information:
(1)University of British Columbia Vancouver, and Arthritis Research Centre of
Canada, Richmond, British Columbia, Canada.
OBJECTIVE: Recent data suggesting the growing problem of medication nonadherence

in gout have called for the need to synthesize the burden, determinants, and
impacts of the problem. Our objective was to conduct a systematic review of the
literature examining medication adherence among patients with gout in real-world
settings.
METHODS: We conducted a search of Medline, Embase, International Pharmaceutical
Abstracts, PsycINFO, and CINAHL databases and selected studies of gout patients
and medication adherence in real-world settings. We extracted information on
study design, sample size, length of followup, data source (e.g., prescription
records versus electronic monitoring versus self-report), type of nonadherence
problem evaluated, adherence measures and reported estimates, and determinants of
adherence reported in multivariable analyses.
RESULTS: We included 16 studies that we categorized according to methods used to
measure adherence, including electronic prescription records (n = 10), clinical
records (n = 1), electronic monitoring devices (n = 1), and self-report (n = 4).
The burden of nonadherence was reported in all studies, and among studies based
on electronic prescription records, adherence rates were all below 0.80 and the
proportion of adherent patients ranged from 10-46%. Six studies reported on
determinants, with older age and having comorbid hypertension consistently shown
to be positively associated with better adherence. One study showed the impact of
adherence on achieving a serum uric acid target.
CONCLUSION: With less than half of gout patients in real-world settings adherent
to their treatment, this systematic review highlights the importance of health
care professionals discussing adherence to medications during encounters with
patients.
Copyright © 2014 by the American College of Rheumatology.
DOI: 10.1002/acr.22336
1031. Seizure. 2018 Jul;59:82-89. doi: 10.1016/j.seizure.2018.05.003. Epub 2018 May

16.
The preconception care experiences of women with epilepsy on sodium valproate.
Lawther L(1), Dolk H(2), Sinclair M(2), Morrow J(3).
Author information:
(1)Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, County
Antrim, BT37 0QB, United Kingdom. Electronic address: l.lawther@qub.ac.uk.
(2)Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, County
Antrim, BT37 0QB, United Kingdom.
(3)Belfast Health and Social Care Trust, Royal Victoria Hospital, 274 Grosvenor
Road, Belfast, BT12 6BA, United Kingdom.
PURPOSE: To understand the preconception experiences of women with epilepsy who

have been taking the teratogenic drug valproate.
METHODS: Seven women were recruited, three from a preconception clinic and four
from an antenatal clinic in a region of the UK. All had taken valproate
preconceptionally. Three preconception clinic encounters were observed and
audio-recorded. Interviews with all women were analysed using Interpretative
Phenomenological Analysis (IPA).
RESULTS: Women experienced a "trajectory of balance". Women moved from
"maintaining balance" by using valproate to control seizures, to a "shattering of
harmony" at the prospect of changing medication and as a result of the physical
and mental effects of changing medication, to "restoring balance" which could
involve "a new self" due to dramatic changes. Women balanced their health needs
with those of their baby, and took responsibility for medication decision-making.
They found it difficult to see "who is looking after me" in the healthcare
system, either to access preconception care, or to support them through the
stress of changing medication. Their journey ended with coming to terms with a
variety of experiences: choosing not to have a baby due to unsuccessful change
from valproate, recognising that a child from a previous pregnancy had been
harmed by valproate or that the current pregnancy might be at risk, or successful
medication change in preparation for pregnancy.
CONCLUSION: A clear and adequately funded preconception care pathway is needed
from epilepsy diagnosis, including support for stress. Understanding what
influences maternalisation may help understand uptake of preconception care.

rights reserved.
DOI: 10.1016/j.seizure.2018.05.003
1032. NPJ Prim Care Respir Med. 2017 Jul 20;27(1):46. doi: 10.1038/s41533-017-0046-
6.
Self-management behaviour and support among primary care COPD patients:

cross-sectional analysis of data from the Birmingham Chronic Obstructive
Pulmonary Disease Cohort.
Khan A(1), Dickens AP(2), Adab P(3), Jordan RE(3).
Author information:
(1)Public Health, Solihull Metropolitan Borough Council, Solihull, B91 3QB, UK.
(2)Institute of Applied Health Research, University of Birmingham, Birmingham,
B15 2TT, UK. a.p.dickens@bham.ac.uk.
(3)Institute of Applied Health Research, University of Birmingham, Birmingham,
B15 2TT, UK.
Self-management support for chronic obstructive pulmonary disease (COPD) patients

is recommended by UK national guidelines, but extent of implementation is
unknown. We aimed to describe self-management behaviour and support among COPD
patients and explore behaviour associated with having a self-management plan. We
undertook cross-sectional analysis of self-reported data from diagnosed COPD
patients in the Birmingham COPD Cohort study. Questionnaire items relevant to
self-management behaviour, knowledge of COPD, receipt of self-management plans
and advice from healthcare professionals were examined. Multiple regression
models were used to identify behaviour associated with having a self-management
plan. One-thousand seventy-eight participants (676 males, 62.7%, mean age 69.8
(standard deviation 9.0) years) were included. The majority reported taking
medications as instructed (940, 94.0%) and receiving annual influenza
vaccinations (962, 89.2%). Only 400 (40.4%) participants had self-management
plans, 538 (49.9%) reported never having received advice on diet/exercise and 110
(42.7%) current smokers had been offered practical help to stop smoking in the
previous year. General knowledge about COPD was moderate (mean total Bristol COPD
Knowledge Questionnaire score: 31.5 (standard deviation 10.7); max score 65),
corresponding to 48.5% of questions answered correctly. Having a self-management
plan was positively associated with self-reported adherence to medication (odds
ratio 3.10, 95% confidence interval 1.43 to 6.72), attendance at a training
course (odds ratio 2.72, 95% confidence interval 1.81 to 4.12), attendance at a
support group (odds ratio 6.28, 95% confidence interval 2.96 to 13.35) and better
disease knowledge (mean difference 4.87, 95% confidence interval 3.16 to 6.58).
Primary care healthcare professionals should ensure more widespread
implementation of individualised self-management plans for all patients and
improve the lifestyle advice provided.CHRONIC LUNG DISEASE: CALL FOR WIDER
IMPLEMENTATION OF SELF-MANAGEMENT PLANS: Health professionals should ensure all
patients with chronic lung disease receive individualized self-management plans
and lifestyle advice. UK national guidelines state that patients with chronic
obstructive pulmonary disease (COPD) should receive personalized self-management
plans and comprehensive support to help them manage their disease. Ainee Khan and
colleagues at the University of Birmingham analyzed patient questionnaire data
gathered during the Birmingham COPD Cohort study to explore self-management
behavior, receipt of self-management plans and advice, and patient knowledge of
COPD. Of 1,078 participants, only 400 had self-management plans, and less than
half reported receiving lifestyle advice or support. Those with plans were more
likely to adhere to medication, had greater knowledge about COPD and were more
likely to attend support groups and training courses. The authors recommend
carefully-planned, wider implementation of COPD self-management plans and
associated support.
DOI: 10.1038/s41533-017-0046-6
PMCID: PMC5519687
1033. Front Pharmacol. 2019 Mar 7;10:210. doi: 10.3389/fphar.2019.00210.

eCollection
2019.
The Cost-Effectiveness of an Intervention Program to Enhance Adherence to

Antihypertensive Medication in Comparison With Usual Care in Community
Pharmacies.
Bosmans JE(1), van der Laan DM(2), Yang Y(2), Elders PJM(3), Boons CCLM(2),
Nijpels G(3), Hugtenburg JG(2).
Author information:
(1)Department of Health Sciences, Faculty of Science, Amsterdam Public Health
Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
(2)Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health
Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam,
Netherlands.
(3)Department of General Practice & Elderly Care Medicine, Amsterdam Public
Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam,
Amsterdam, Netherlands.
Introduction: Hypertension is considered an important public health issue.

Inadequate disease management and non-adherence to antihypertensive medication
may result in suboptimal clinical outcomes thereby imposing a financial burden on
society. This study evaluates the cost-effectiveness of a patient-tailored,
pharmacist-led intervention program aimed to enhance adherence to
antihypertensive medication in comparison with usual care. Materials and Methods:
An economic evaluation was conducted alongside a pragmatic randomized controlled
trial with 9-months follow-up among 170 patients using antihypertensive
medication. Effect outcomes included self-reported adherence (MARS-5), beliefs
about medicines (BMQ Concern and Necessity scales) and quality-adjusted
life-years (QALYs). Costs were measured from a societal perspective. Missing cost
and effect data were imputed using multiple imputation. Bootstrapping was used to
estimate uncertainty around the cost-differences and the incremental
cost-effectiveness ratios. Cost-effectiveness planes and acceptability curves
were estimated. Results: There were no significant differences in costs or
effects between the intervention program and usual care. The probability of
cost-effectiveness of the intervention in comparison with usual care was 0.27 at
a willingness-to-pay value of 0 €/unit of effect gained. At a willingness-to-pay
value of 20,000 €/unit of effect gained, the probability of cost-effectiveness
was 0.70, 0.27, 0.64, 0.87, and 0.36 for the continuous MARS-5 score,
dichotomized MARS-5 score, BMQ Concern scale, BMQ Necessity scale and QALYs,
respectively. Discussion: In patients with hypertension, the patient-tailored,
pharmacist-led intervention program to enhance medication adherence was not
considered cost-effective as compared to usual care with regard to self-reported
medication adherence, beliefs about medicines and QALYs.
DOI: 10.3389/fphar.2019.00210
PMCID: PMC6416217
PMID: 30899223
1034. Front Psychiatry. 2017 Feb 17;8:28. doi: 10.3389/fpsyt.2017.00028.

eCollection
2017.
Psychotropic Medication and Substance Use during Pregnancy by Women with Severe
Mental Illness.
Brameld KJ(1), Jablensky A(2), Griffith J(3), Dean J(3), Morgan VA(2).
Author information:
(1)Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical
Neurosciences, The University of Western Australia, Crawley, WA, Australia;
Centre for Population Health Research, Faculty of Health Sciences, Curtin
University, Perth, WA, Australia.
Neurosciences, The University of Western Australia, Crawley, WA, Australia;
Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and
Clinical Neurosciences, The University of Western Australia, Crawley, WA,
Australia.
Neurosciences, The University of Western Australia , Crawley, WA , Australia.
BACKGROUND: Sociodemographic factors, alcohol and drug intake, and maternal

health are known to be associated with adverse outcomes in pregnancy for women
with severe mental illness in addition to their use of psychotropic medication.
In this study, we describe the demographic characteristics of women hospitalized
for severe mental illness along with their use of medication and other drugs
during the pregnancy period.
METHODS: A clinical case note review of women with psychosis who were
hospitalized at the State Psychiatric Hospital in Western Australia during
1966-1996, gave birth between 1980 and 1992, and received psychiatric treatment
during the pregnancy period. The mother's clinical information was available from
the case notes and the midwives record. The demographic characteristics of the
mothers were described together with their hospitalization pattern and their
medication and substance use during the pregnancy period.
RESULTS: A total of 428 mothers with a history of severe mental illness were
identified who gave birth during 1980-1992. Of these, 164 mothers received
psychiatric care during the pregnancy period. One hundred thirty-two had taken
psychotropic medication during this period. Mothers who were married, of
aboriginal status or living in regional and remote areas appeared less likely to
be hospitalized during the pregnancy period, while older mothers and those with a
diagnosis of schizophrenia were more likely to be hospitalized. The number of
mothers taking psychotropic medication in the first trimester of pregnancy was
reduced compared to the previous 6 months. The decline in the number taking
substances over the same period was not significant. In all, 16% of the women
attempted suicide during the pregnancy period and 10% non-suicidal self-injury.
CONCLUSION: The women demonstrate a pattern of decreased use of psychotropic
medication use from the period before pregnancy to the first trimester of
pregnancy. Our data highlight the importance of women with severe mental illness
receiving regular ongoing monitoring and support from their psychiatrist during
pregnancy regarding the level of medication required as well as counseling with
regard to substance use, non-suicidal self-injury, and attempted suicide.
DOI: 10.3389/fpsyt.2017.00028
PMCID: PMC5313501
PMID: 28261117
1035. BMJ Open. 2017 Sep 1;7(8):e014435corr1. doi: 10.1136/bmjopen-2016-

014435corr1.
Correction: Factors predicting self-reported medication low adherence in a large

sample of adults in the US general population: a cross-sectional study.
[No authors listed]
Erratum for
BMJ Open. 2017 Jun 23;7(6):e014435.
DOI: 10.1136/bmjopen-2016-014435corr1
PMCID: PMC5624126
PMID: 28864490
1036. J Am Pharm Assoc (2003). 2018 Jul - Aug;58(4):395-403. doi:

10.1016/j.japh.2018.03.005.
A community pharmacy intervention for opioid medication misuse: A pilot

randomized clinical trial.
Cochran G, Field C, Karp J, Seybert AL, Chen Q, Ringwald W, Hruschak V,

Chickering S, Kincman J, Jaber A, Tarter R.
OBJECTIVES: Community pharmacy continues to play a crucial role in the national

response to the opioid epidemic. The purpose of this article is to describe the
protocol for a pilot study that is examining the feasibility and acceptability of
the Motivational Intervention-Medication Therapy Management (MI-MTM) model. This
study also examines the preliminary clinical effect of MI-MTM for improving
opioid medication misuse and patient activation in self-management of health
conditions that increase risk for misuse.
DESIGN: MI-MTM is a pharmacy-based integrated care model made up of 4
evidence-based practices: medication therapy management; brief motivational
intervention; patient navigation; and naloxone training and referral. To test
MI-MTM compared with Standard Medication Counseling (SMC), we are conducting a
2-group randomized single-blinded controlled trial with assessments at 3 time
points.
SETTING AND PARTICIPANTS: The study is being conducted within a western
Pennsylvania university-based community pharmacy with 46 patients with opioid
misuse (MI-MTM = 23; SMC = 23).
MAIN OUTCOME MEASURES: Feasibility will be measured by capturing patient
completion rate of MI-MTM sessions. Acceptability will be measured by
administering satisfaction surveys regarding pharmacist and patient navigator
services. Acceptability will also be captured by conducting intensive qualitative
interviews. Preliminary effect of the intervention on misuse will be measured
with the use of the Prescription Opioid Misuse Index and the Opioid Compliance
Checklist. Activation in self-management will be measured with the use of the
Patient Activation Measure.
RESULTS: This project is currently recruiting, and results are to come.
CONCLUSION: This study is the first in the United States to implement an
evidence-based integrated behavioral intervention into the community pharmacy
setting to address opioid medication misuse among pharmacy patients. The results
of this study will provide necessary foundational data that allow further testing
of this intervention model in a larger trial.

DOI: 10.1016/j.japh.2018.03.005
PMCID: PMC6035879
PMID: 29691197
1037. Clin Kidney J. 2016 Dec;9(6):858-865. Epub 2016 Aug 31.
An observational study of health literacy and medication adherence in adult

kidney transplant recipients.
Demian MN(1), Shapiro RJ(2), Thornton WL(1).
Author information:
(1)Department of Psychology, Simon Fraser University, 8888 University Drive,
Burnaby, BC V5A 1S6, Canada.
(2)Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
BACKGROUND: There is a high prevalence of non-adherence to immunosuppressants in

kidney transplant recipients. Although limited health literacy is common in
kidney recipients and is linked to adverse outcomes in other medical populations,
its effect on medication adherence in kidney transplant recipients remains poorly
understood. The objective was to investigate the effect of lower health literacy
on immunosuppressant adherence.
METHODS: Kidney recipients who were at least 6 months post-transplant and
outpatients of Vancouver General Hospital in B.C., Canada were recruited through
invitation letters. A total of 96 recipients completed the Health Literacy
Questionnaire, which provides a multifactorial profile of self-reported health
literacy and the Transplant Effects Questionnaire-Adherence subscale measuring
self-reported immunosuppressant adherence. Hierarchical linear regression was
used to analyze the association between health literacy and adherence after
controlling for identified risk factors of non-adherence.
RESULTS: Our sample was on average 53 years old, 56% male and 9 years
post-transplant. Kidney recipients reported low levels of health literacy on
scales measuring active health management and critical appraisal of information
and 75% reported non-perfect adherence. Worse adherence was associated with
poorer overall health literacy (ΔR2 = 0.08, P = 0.004) and lower scores on six of
nine of the health literacy factors.
CONCLUSIONS: Poorer health literacy is associated with lower immunosuppressant
adherence in adult kidney transplant recipients suggesting the importance of
considering a recipient's level of health literacy in research and clinical
contexts. Medication adherence interventions can target the six factors of health
literacy identified as being risk factors for lower medication adherence.
DOI: 10.1093/ckj/sfw076
PMCID: PMC5162408
PMID: 27994867
1038. Res Social Adm Pharm. 2015 May-Jun;11(3):e110-20. doi:

10.1016/j.sapharm.2012.11.004. Epub 2012 Dec 6.
Medication adherence challenges among patients experiencing homelessness in a

behavioral health clinic.
Coe AB(1), Moczygemba LR(2), Gatewood SB(2), Osborn RD(3), Matzke GR(2), Goode
JV(2).
Author information:
(1)School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street,
PO Box 980533, Richmond, VA 23298-0533, United States. Electronic address:
abcoe@vcu.edu.
(2)School of Pharmacy, Virginia Commonwealth University, 410 North 12th Street,
PO Box 980533, Richmond, VA 23298-0533, United States.
(3)Daily Planet, Richmond, Virginia, United States.
BACKGROUND: Behavioral health medication nonadherence is associated with poor

health outcomes and increased healthcare costs. Little is known about reasons for
nonadherence with behavioral health medications among homeless people.
OBJECTIVES: To identify reasons for medication nonadherence including the
sociodemographic, health-related factors, and behavioral health conditions
associated with medication nonadherence among behavioral health patients served
by a Health Care for the Homeless center (HCH) in Virginia.
METHODS: The study sample was selected from an existing database that included
sociodemographic, health-related information, and medication-related problems
identified during a pharmacist-provided medication review conducted during
October 2008-September 2009. Patients experiencing or at risk of homelessness who
were ≥18 years old with at least one behavioral health condition who had a
medication review were eligible for the study. A qualitative content analysis of
the pharmacist documentation describing the patient's reason(s) for medication
nonadherence was conducted. The Behavioral Model for Vulnerable Populations was
the theoretical framework. The outcome variable was self-reported medication
nonadherence. Descriptive and multivariate (logistic regression) statistics were
used.
RESULTS: A total of 426 individuals met study criteria. The mean age was
44.7 ± 10.2 years. Most patients were African-American (60.5%) and female
(51.6%). The content analysis identified patient-related factors (74.8%),
therapy-related factors (11.8%), and social or economic factors (8.8%) as the
most common reasons for patients' medication nonadherence. Patients with
post-traumatic stress disorder (PTSD) (adjusted odds ratio: 0.4; 95% CI:
0.19-0.87) were less likely to have a medication adherence problem identified
during the medication review.
CONCLUSIONS: The content analysis identified patient-related factors as the most
common reason for nonadherence with behavioral health medications. In the
quantitative analysis, patients with a PTSD diagnosis were less likely to have
nonadherence identified which may be related to their reluctance to self-report
nonadherence and their diagnosis, which warrants further study.
DOI: 10.1016/j.sapharm.2012.11.004
PMCID: PMC3733792
1039. World J Gastroenterol. 2017 Oct 28;23(40):7321-7331. doi:

10.3748/wjg.v23.i40.7321.
Medication beliefs predict medication adherence in ambulatory patients with

decompensated cirrhosis.
Hayward KL(1), Valery PC(2), Martin JH(3), Karmakar A(4), Patel PJ(5), Horsfall
LU(5), Tallis CJ(6), Stuart KA(6), Wright PL(6), Smith DD(7), Irvine KM(5),
Powell EE(5), Cottrell WN(8).
Author information:
(1)Pharmacy Department, Princess Alexandra Hospital, The Centre for Liver Disease
Research, Translational Research Institute, The University of Queensland,
Woolloongabba, Queensland 4102, Australia.
(2)Cancer and Chronic Disease Research Group, QIMR Berghofer Medical Research
Institute, Herston, Queensland 4006, Australia.
(3)School of Medicine and Public Health, The University of Newcastle, Callaghan,
New South Wales 2308, Australia.
(4)The Centre for Liver Disease Research, Translational Research Institute, The
University of Queensland, Woolloongabba, Queensland 4102, Australia.
The Centre for Liver Disease Research, Translational Research Institute, The
University of Queensland, Woolloongabba, Queensland 4102, Australia.
Woolloongabba, Queensland 4102, Australia.
(7)Statistics Unit, QIMR Berghofer Medical Research Institute, Herston,
Queensland 4006, Australia.
(8)School of Pharmacy, The University of Queensland, Woolloongabba, Queensland
4102, Australia. n.cottrell@uq.edu.au.
AIM: To investigate the impact of medication beliefs, illness perceptions and

quality of life on medication adherence in people with decompensated cirrhosis.
METHODS: One hundred adults with decompensated cirrhosis completed a structured
questionnaire when they attended for routine outpatient hepatology review.
Measures of self-reported medication adherence (Morisky Medication Adherence
Scale), beliefs surrounding medications (Beliefs about Medicines Questionnaire),
perceptions of illness and medicines (Brief Illness Perception Questionnaire),
and quality of life (Chronic Liver Disease Questionnaire) were examined. Clinical
data were obtained via patient history and review of medical records. Least
absolute shrinkage and selection operator and stepwise backwards regression
techniques were used to construct the multivariable logistic regression model.
Statistical significance was set at alpha = 0.05.
RESULTS: Medication adherence was "High" in 42% of participants, "Medium" in 37%,
and "Low" in 21%. Compared to patients with "High" adherence, those with "Medium"
or "Low" adherence were more likely to report difficulty affording their
medications (P < 0.001), lower perception of treatment helpfulness (P = 0.003)
and stronger medication concerns relative to medication necessity beliefs (P =
0.003). People with "Low" adherence also experienced greater symptom burden and
poorer quality of life, including more frequent abdominal pain (P = 0.023),
shortness of breath (P = 0.030), and emotional disturbances (P = 0.050).
Multivariable analysis identified having stronger medication concerns relative to
necessity beliefs (Necessity-Concerns Differential ≤ 5, OR = 3.66, 95%CI:
1.18-11.40) and more frequent shortness of breath (shortness of breath score ≤ 3,
OR = 3.87, 95%CI: 1.22-12.25) as independent predictors of "Low"adherence.
CONCLUSION: The association between "Low" adherence and patients having strong
concerns or doubting the necessity or helpfulness of their medications should be
explored further given the clinical relevance.
DOI: 10.3748/wjg.v23.i40.7321
PMCID: PMC5677197
Conflict of interest statement: Conflict-of-interest statement: None.
1040. Neuroscience. 2016 Jun 2;324:367-76. doi: 10.1016/j.neuroscience.2016.03.002.

Epub 2016 Mar 7.
Attenuation of cocaine self-administration by chronic oral phendimetrazine in
rhesus monkeys.
Czoty PW(1), Blough BE(2), Fennell TR(2), Snyder RW(2), Nader MA(3).
Author information:
(1)Department of Physiology and Pharmacology, Wake Forest School of Medicine,
Winston-Salem, NC 27157, United States. Electronic address:
pczoty@wakehealth.edu.
(2)Discovery Sciences, Research Triangle Institute, Research Triangle Park, NC
27709, United States.
(3)Department of Physiology and Pharmacology, Wake Forest School of Medicine,
Winston-Salem, NC 27157, United States; Department of Radiology, Wake Forest
School of Medicine, Winston-Salem, NC 27157, United States.
Chronic treatment with the monoamine releaser d-amphetamine has been consistently
shown to decrease cocaine self-administration in laboratory studies and clinical
trials. However, the abuse potential of d-amphetamine is an obstacle to
widespread clinical use. Approaches are needed that exploit the efficacy of the
agonist approach but avoid the abuse potential associated with dopamine
releasers. The present study assessed the effectiveness of chronic oral
administration of phendimetrazine (PDM), a pro-drug for the monoamine releaser
phenmetrazine (PM), to decrease cocaine self-administration in four rhesus
monkeys. Each day, monkeys pressed a lever to receive food pellets under a
50-response fixed-ratio (FR) schedule of reinforcement and self-administered
cocaine (0.003-0.56 mg/kg per injection, i.v.) under a progressive-ratio (PR)
schedule in the evening. After completing a cocaine self-administration
dose-response curve, sessions were suspended and PDM was administered (1.0-9.0
mg/kg, p.o., b.i.d.). Cocaine self-administration was assessed using the PR
schedule once every 7 days while food-maintained responding was studied daily.
When a persistent decrease in self-administration was observed, the cocaine
dose-effect curve was re-determined. Daily PDM treatment decreased cocaine
self-administration by 30-90% across monkeys for at least 4 weeks. In two
monkeys, effects were completely selective for cocaine. Tolerance developed to
initial decreases in food-maintained responding in the third monkey and in the
fourth subject, fluctuations were observed that were lower in magnitude than
effects on cocaine self-administration. Cocaine dose-effect curves were shifted
down and/or rightward in three monkeys. These data provide further support for
the use of agonist medications for cocaine abuse, and indicate that the promising
effects of d-amphetamine extend to a more clinically viable pharmacotherapy.
Copyright © 2016 IBRO. Published by Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.neuroscience.2016.03.002
PMCID: PMC4838503
1041. Rheumatology (Oxford). 2015 Oct;54(10):1780-91. doi:

10.1093/rheumatology/kev105.
Epub 2015 May 13.
The influence of behavioural and psychological factors on medication adherence

over time in rheumatoid arthritis patients: a study in the biologics era.
Morgan C(1), McBeth J(2), Cordingley L(3), Watson K(1), Hyrich KL(4), Symmons
DP(4), Bruce IN(5).
Author information:
(1)Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal
Research, Institute of Inflammation and Repair, University of Manchester,
Manchester Academic Health Science Centre, Manchester.
Manchester Academic Health Science Centre, Manchester, Research Institute for
Primary Care & Health Sciences, Keele University, Keele.
(3)Institute of Inflammation & Repair, University of Manchester, Manchester
Academic Health Science Centre and.
Manchester Academic Health Science Centre, Manchester, NIHR Manchester
Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital
NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Manchester Academic Health Science Centre, Manchester, NIHR Manchester
Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital
NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
Ian.bruce@manchester.ac.uk.
OBJECTIVES: To investigate levels of self-reported adherence to biologic

treatment and establish the contribution of demographic, physical and
psychological factors to biologic medication adherence in an RA cohort.
METHODS: Adalimumab-treated patients were recruited through the British Society
for Rheumatology Biologics Register for RA between May 2007 and April 2009.
Demographic and baseline psychological measures including illness and medication
beliefs were collected. Disease activity (28-item DAS), physical function (HAQ)
and quality of life (36-item Short Form Health Survey) were also measured at
baseline and at 6, 12 and 18 months. Adherence was assessed at each follow-up
using the patient self-completed Compliance Questionnaire for Rheumatology (CQR).
Multilevel mixed effects modelling analysis was performed to investigate
predictors of adherence.
RESULTS: Of the 329 Adalimumab-treated patients included, low adherence (CQR
score <65) was reported in 23%, with 41% reporting low adherence at at least one
time point. After controlling for age and disease duration, factors independently
predictive of increased adherence were increased belief in medication necessity,
with baseline effect diminishing over time [β coefficient 1.68 (s.e. 0.19), P =
0.0001], lower medication concerns [0.50 (0.15), P = 0.001], with this effect
remaining throughout follow-up, increased professional or family member support
[0.81 (0.32), P = 0.01], strong views of illness being chronic [0.32 (0.14), P =
0.025] and increased treatment control [0.41 (0.19), P = 0.032].
CONCLUSION: Wider recognition of the importance of psychological factors,
particularly medication beliefs, in driving medication adherence could have
substantial clinical and health economic benefits in RA. The psychological
factors we have identified are putative targets for strategies to improve
adherence in RA.
Society for Rheumatology.
DOI: 10.1093/rheumatology/kev105
PMCID: PMC4571488
1042. Adv Biomed Res. 2015 Sep 28;4:204. doi: 10.4103/2277-9175.166140. eCollection
2015.
Effect of self-care education on lifestyle modification, medication adherence and
blood pressure in hypertensive adults: Randomized controlled clinical trial.
Golshahi J(1), Ahmadzadeh H(2), Sadeghi M(2), Mohammadifard N(3), Pourmoghaddas

A(4).
Author information:
(1)Isfahan Cardiovascular Research Center, Cardiovascular Research Institute,
Isfahan University of Medical Sciences, Isfahan, Iran.
(2)Cardiac Rehabilitation Research Center, Cardiovascular Research Institute,
(3)Hypertension Research Center, Cardiovascular Research Institute, Isfahan
(4)Heart Failure Research Centre, Cardiovascular Research Institute, Isfahan
BACKGROUND: Self-care management has recently been suggested as an effective

approach for secondary prevention of hypertension. This study was conducted to
examine whether self-care behaviors could modulate blood pressure levels and also
comparing the different training methods of self-care on patients' adherence and
controlling hypertension.
MATERIALS AND METHODS: This study was a prospective randomized controlled
clinical trial, conducted on 180 hypertensive patients referring to four centers
in Isfahan, Iran, between July and December 2013. Block randomization method were
applied to divide eligible subjects into four equal groups, including group A in
which the patients and their family were educated by cardiology resident about
self-care behaviors through eight sessions, group B and group C were obtained
self-care education through four pamphlets or eight short message services (SMS),
respectively and group D were obtained only usual care of hypertension without
any training about self-care management.
RESULTS: Increasing vegetable intake and frequency of subject who took
antihypertensive medication regularly and the reduction in the frequency of
subjects who consumed high salt were significantly more in group A than the
others (P = 0.001, P < 0.001 and P < 0.001, respectively). The systolic and
diastolic blood pressure had significantly more reduction in the group A than the
other groups (-8.18 ± 18.3 and - 3.89 ± 4.1; P < 0.001, respectively).
CONCLUSIONS: The self-care management education integration into the usual care
along with using SMS and other educational materials may improve the efficient
and effective adherence strategies.
DOI: 10.4103/2277-9175.166140
PMCID: PMC4620611
PMID: 26601092
1043. Nicotine Tob Res. 2018 Sep 4;20(10):1163-1172. doi: 10.1093/ntr/ntx210.
Adherence to Pharmacological Smoking Cessation Interventions: A Literature Review

and Synthesis of Correlates and Barriers.
Pacek LR(1), McClernon FJ(1), Bosworth HB(1)(2)(3).
Author information:
(1)Department of Psychiatry and Behavioral Sciences, Duke University School of
Medicine, Durham, NC.
(2)Department of Medicine, Division of General Medicine, Duke University School
of Medicine, Durham, NC.
(3)Center for Health Services Research in Primary Care, Durham VAMC, Durham, NC.
Introduction: Efficacious pharmacological interventions for smoking cessation are
available, but poor adherence to these treatments may limit these interventions
overall impact. To improve adherence to smoking cessation interventions, it is
first necessary to identify and understand smoker-level characteristics that
drive nonadherence (ie, nonconformance with a provider's recommendation of
timing, dosage, or frequency of medication-taking during the prescribed length of
time).
Methods: We present a literature review of studies examining correlates of, or
self-reported reasons for, nonadherence to smoking cessation pharmacotherapies.
Studies were identified through PubMed-using MeSH terms, Embase-using Emtree
terms, and ISI Web of Science.
Results and Conclusions: This literature review included 50 studies that examined
nonpreventable (eg, sociodemographics) and preventable (eg, forgetfulness)
factors associated with adherence to smoking cessation medication and suggestions
for overcoming some of the identified barriers. Systematic study of this topic
would be facilitated by consistent reporting of adherence and correlates thereof
in the literature, development of consistent definitions of medication adherence
across studies, utilization of more objective measures of adherence (eg, blood
plasma levels vs. self-report) in addition to reliance on self-reported
adherence.
Implications: This article provides the most comprehensive review to date on
correlates of adherence to pharmacological smoking cessation interventions.
Challenges and specific gaps in the literature that should be a priority for
future research are discussed. Future priorities include additional research,
particularly among vulnerable populations of smokers, developing standardized
definitions of adherence and methods for measuring adherence, regular assessment
of cessation pharmacotherapy adherence in the context of research and clinical
practice, and development of novel treatments aimed at preventable barriers to
DOI: 10.1093/ntr/ntx210
PMCID: PMC6121917
PMID: 29059394
1044. Int J Rheumatol. 2019 Mar 4;2019:4709645. doi: 10.1155/2019/4709645.

eCollection
2019.
Medication Adherence and Coping Strategies in Patients with Rheumatoid Arthritis:

A Cross-Sectional Study.
Berner C(1), Erlacher L(1), Fenzl KH(1), Dorner TE(2).
Author information:
(1)2nd Medical Division, Rheumatology, Kaiser Franz Josef Hospital, SMZ-Süd,
Kundratstrasse 3, 1100 Vienna, Karl Landsteiner Society of Autoimmunology and
Rheumatism, Austria.
(2)Institute of Social Medicine, Centre for Public Health, Medical University of
Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria.
Objectives: The aim of this study was to determine if strategies for coping with
illnesses, demographic factors, and clinical factors were associated with
medication adherence among patients with rheumatoid arthritis (RA).
Methods: This cross-sectional study was conducted at a Viennese rheumatology
outpatient clinic on RA patients. Medication adherence was assessed using the
Medication Adherence Report Scale. Strategies for coping with illness were
assessed using the Freiburg Questionnaire for Coping with Illness.
Results: Half (N=63, 52.5%) of the 120 patients included in the study were
considered completely medication adherent. Female sex (odds ratio [OR]: 4.57, 95%
confidence interval [CI]: 1.14 - 18.42), older age (54-65 yr vs. <45 yr OR: 9.2,
CI:2.0-40.70; >65 yr vs. <45 yr OR 6.93, CI:1,17 - 40.87), middle average income
(middle average income vs. lowest income class OR= 0.06, CI= 0.01-0.43), and
shorter disease duration (5-10 yr vs. >10 yr OR= 3.53, CI= 1.04-11.95; 1-4 yr vs.
>10 yr OR=3.71, CI= 1.02-13.52) were associated with higher medication adherence.
Levels of active coping (15.57 vs. 13.47, p=0.01) or diversion and
self-encouragement (16.10 vs. 14.37, p=0.04) were significantly higher among
adherent as opposed to less adherent participants. However, in multivariate
regression models, coping strategies were not significantly associated with
adherence.
Conclusions: Age, sex, monthly net income, and disease duration were found to be
associated with an increased risk for medication nonadherence among patients with
RA. Coping strategies such as active coping, diversion, and self-encouragement
were associated with adherence in univariate models, but not when adjusted for
demographic and clinical factors.
DOI: 10.1155/2019/4709645
PMCID: PMC6425297
PMID: 30949207
1045. Subst Abus. 2018;39(4):404-409. doi: 10.1080/08897077.2018.1439798. Epub 2018

Apr
4.
Overcoming medication stigma in peer recovery: A new paradigm.
Krawczyk N(1)(2), Negron T(1), Nieto M(1), Agus D(1)(2), Fingerhood MI(1)(3).
Author information:
(1)a Department of Mental Health , Johns Hopkins Bloomberg School of Public
Health , Baltimore , Maryland , USA.
(2)b Behavioral Health Leadership Institute , Baltimore , Maryland , USA.
(3)c Johns Hopkins University School of Medicine , Baltimore , Maryland , USA.
BACKGROUND: Treatment for opioid use disorder involving opioid-based

pharmacotherapies is considered most effective when accompanied by psychosocial
interventions. Peer-led support groups are widely available and have been
described by many as fundamental to the recovery process. However, some
individuals using medications face stigma in these settings, which can be
contradictory and counterproductive to their recovery.
METHODS: This paper describes the development of the "Ability, Inspiration and
Motivation" or "AIM" group, an alternative peer support group that aims to remove
medication stigma from peer recovery. Qualitative interviews with staff, peers,
and clients of a community-based buprenorphine treatment program were used to
establish the core components of the curriculum to support client needs.
RESULTS: Staff, peers, and clients of the buprenorphine program indicated a need
and desire to establish a peer recovery group that recognizes persons on
medication as being in recovery and destigmatizes use of medication to treat
opioid addiction. A respectful environment, holistic perspective on health,
spirituality, sharing, and celebration were all established as necessary pillars
of the AIM group curriculum.
CONCLUSIONS: The community-based effort to establish and develop the AIM group
demonstrates that combining the strengths of a peer support with evidence-based
medication treatment is both possible and desirable. Shifting the culture of peer
recovery groups to support the use of medications may have implications for
improving treatment retention and should be considered as a potential strategy to
reduce the burden of the opioid epidemic.
DOI: 10.1080/08897077.2018.1439798
PMCID: PMC6087684
Adherence to anti diabetic medication among patients with diabetes in eastern

Uganda; a cross sectional study.
Bagonza J(1), Rutebemberwa E(2), Bazeyo W(3).
Author information:
(1)Department of Health Policy, Planning and Management, School of Public Health,
Makerere University College of Health Sciences, Kampala, Uganda.
jbagonza@musph.ac.ug.
(2)Department of Health Policy, Planning and Management, School of Public Health,
Makerere University College of Health Sciences, Kampala, Uganda.
ellie@musph.ac.ug.
(3)Department of Disease Control and Environmental Health, School of Public
Health, Makerere University College of Health Sciences, Kampala, Uganda.
wbazeyo@musph.ac.ug.
BACKGROUND: Lack of adherence to anti diabetic medication causes suboptimal blood

sugar control among patients with diabetes and can lead to treatment failures,
accelerated development of complications and increased mortality. This study
assessed factors associated with adherence to anti diabetic medication in rural
eastern Uganda.
METHODS: A cross sectional study was conducted among 521 patients with diabetes
in Iganga and Bugiri hospitals between October 2012 and January 2013. Respondents
were patients who were18 years and above and had been on diabetic treatment for
not less than a month. Pretested questionnaires were used. Variables that were
collected included socio-demographic characteristics, possible barriers to
adherence, and self management efforts. Adherence was assessed using self
reports. Descriptive and inferential statistics were done to determine adherence
to anti diabetic medication and the associated factors.
RESULTS: The level of adherence to anti diabetic medication was 83.3% and factors
that were independently associated with adherence were; having been on anti
diabetic drugs for at least three years (OR = 1.89, 95% CI = 1.11 - 3.22),
availability of diabetic drugs (OR = 2.59, 95% CI = 1.54 - 3.70), and having ever
had diabetic health education (OR = 4.24, 95% CI =1.15 - 15.60).
CONCLUSION: About four in five patients adhere to anti-diabetic treatment.
Strategies aimed at improving anti diabetic drug availability and providing
health education could improve adherence.
DOI: 10.1186/s12913-015-0820-5
PMCID: PMC4405852
1047. Obesity (Silver Spring). 2016 Oct;24(10):2210-6. doi: 10.1002/oby.21600. Epub

2016 Sep 7.
The role of prescription medications in the association of self-reported sleep

duration and obesity in U.S. adults, 2007-2012.
Lawman HG(1), D Fryar C(2), Gu Q(2), Ogden CL(2).

Author information:
(1)Centers for Disease Control and Prevention, National Center for Health
Statistics, Hyattsville, Maryland, USA. hannah.lawman@phila.gov.
(2)Centers for Disease Control and Prevention, National Center for Health
Statistics, Hyattsville, Maryland, USA.
OBJECTIVE: Previous research has not investigated the role of prescription

medication in sleep-obesity associations despite the fact that 56% of U.S. adults
take at least one prescription medication.
METHODS: Data from n = 16,622 adults in the National Health and Nutrition
Examination Survey (2007-2012) were used to examine how the association between
obesity and self-reported sleep duration varied by total number of prescription
medications used in the past 30 days and by select classes of prescription
medications including anxiolytics/sedatives/hypnotics, antidepressants, sleep
aids, anticonvulsants, thyroid agents, and metabolic agents.
RESULTS: Logistic regression analyses showed a significant inverse linear
association of sleep duration and obesity, regardless of the total number of
prescription medications individuals were taking. Each additional hour of sleep
was associated with a 10% decrease in the odds of obesity. Results suggest that
increased sleep duration is associated with lower odds of having obesity overall,
even for long-duration sleepers (≥9 h), and this association does not differ for
those taking antidepressants, thyroid agents, metabolic agents, and multiple
prescription medications.
CONCLUSIONS: The relationship between sleep duration and obesity was similar
among all prescription medication users and nonusers. The potential for a
nonlinear association between sleep duration and obesity may be important to
examine in some specific prescription medication classes.
© 2016 The Obesity Society.
DOI: 10.1002/oby.21600
PMCID: PMC6467537
1048. AIDS Behav. 2014 Dec;18(12):2349-58.
Cognitive and field testing of a new set of medication adherence self-report

items for HIV care.
Wilson IB, Fowler FJ Jr, Cosenza CA, Michaud J, Bentkover J, Rana A, Kogelman L,
Rogers WH.
We conducted four rounds of cognitive testing of self-report items that included

66 sociodemographically diverse participants, then field tested the three best
items from the cognitive testing in a clinic waiting room (N = 351) and in an
online social networking site for men who have sex with men (N = 6,485). As part
of the online survey we conducted a randomized assessment of two versions of the
adherence questionnaire-one which asked about adherence to a specific
antiretroviral medication, and a second which asked about adherence to their "HIV
medicines" as a group. Participants were better able to respond using adjectival
and adverbial scales than visual analogue or percent items. The internal
consistency reliability of the three item adherence scale was 0.89. Mean scores
for the two different versions of the online survey were similar (91.0 vs. 90.2,
p < 0.05), suggesting that it is not necessary, in general, to ask about
individual medications in an antiretroviral therapy regimen when attempting to
describe overall adherence.
DOI: 10.1007/s10461-013-0610-1
PMCID: PMC4000749
1049. Am J Pharm Educ. 2016 May 25;80(4):70. doi: 10.5688/ajpe80470.
Integrating Medication Therapy Management Education into a Core Pharmacy

Curriculum.
Poole TM(1), Kodali L(1), Pace AC(1).
Author information:
(1)Belmont University College of Pharmacy, Nashville, Tennessee.
Objective. To describe the design of a core course directed at improving

confidence and competence of students to perform medication therapy management
(MTM) services. Design. Using the American Pharmacists Association (APhA)
certificate training program framework, a core course was developed to teach MTM
concepts to third-year student pharmacists. Using deep learning and authentic
assignments, course instructors attempted to improve student confidence and
readiness to provide MTM services. Assessment. Student ability to meet course
objectives was evaluated by examinations and the APhA MTM program
self-assessment. Students had an overall success rate of 93% on all three
assessments. Student perceptions of confidence, competence, and importance of
performing MTM services were measured using a survey instrument with 56
Likert-type items. Students completing both surveys reported significantly
increased confidence and competence. Conclusion. Integrating MTM-specific
education into the core curriculum increased student pharmacists' perceived
competence and confidence to perform MTM services.
DOI: 10.5688/ajpe80470
PMCID: PMC4891868
1050. Clin Psychopharmacol Neurosci. 2019 May 31;17(2):273-278. doi:

10.9758/cpn.2019.17.2.273.
Association between Therapeutic Alliance and Adherence in Outpatient

Schizophrenia Patients.
Chang JG(1)(2), Roh D(3), Kim CH(4)(2).
Author information:
(1)Department of Psychiatry, Myongi Hospital, Hanyang University College of
Medicine.
(2)Department of Psychiatry, Yonsei University College of Medicine.
(3)Department of Psychiatry, Hallym University College of Medicine.
(4)Institute of Behavioral Science in Medicine.
Objective: Although various clinical factors that affect medication adherence in

schizophrenia have been studied, the role of the therapeutic alliance has not
been studied in detail. Accordingly, we investigated the association between
medication adherence and therapeutic alliance in patients with schizophrenia
treated in a community outpatient clinic in Korea.
Methods: In this cross-sectional study, 81 outpatients who met the DSM-IV-TR
criteria for schizophrenia were analyzed. Therapeutic alliance was measured via
patient-self-report questionnaires consisting of 12 questions, which evaluate
both affective bond and collaborative bond of alliance. We investigated the
relationship between medication adherence and therapeutic alliance through
correlation and regression analyses.
Results: Overall therapeutic alliance was weakly associated with medication
adherence (r=0.268, p＜0.05). Among two factors of therapeutic alliance,
affective bond was associated with adherence (r=0.302, p＜0.05), but
collaborative was not. Regression analysis showed that therapeutic alliance
significantly predicted medication adherence even after adjustment for duration
of treatment, insight, and symptom severity.
Conclusion: Maintaining a favorable therapeutic alliance is associated with
medication adherence in schizophrenia. Further, treating patients in a frank and
genuine manner might be important to improve adherence.
DOI: 10.9758/cpn.2019.17.2.273
PMCID: PMC6478080
PMID: 30905127
1051. BMC Pulm Med. 2015 Feb 25;15:17. doi: 10.1186/s12890-015-0007-1.
Evaluation of a web-based asthma self-management system: a randomised controlled

pilot trial.
Wiecha JM(1), Adams WG(2), Rybin D(3), Rizzodepaoli M(4), Keller J(5), Clay
JM(6).
Author information:
(1)Boston University School of Medicine, 72 East Concord St., B2900, Boston, MA,
02118-2518, USA. john383@bu.edu.
(2)Department of Pediatrics, Boston Medical Center, 1 BMC Place, Boston, MA,
02118, USA. Bill.Adams@bmc.org.
(3)Boston University School of Public Health, 715 Albany St, Boston, MA, 02118,
USA. Rybin@Bu.edu.
(4)Department of Family Medicine, Boston Medical Center, 1 BMC Place, Boston, MA,
02118, USA. Maria.Rizzodepaoli@Bmc.org.
(5)Windsor Street Health Center/Cambridge Health Alliance, 119 Windsor Street,
Cambridge, MA, 02139, USA. jeremyikeller@gmail.com.
(6)Department of Obstetrics and Gynecology, Indiana University School of
Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA. jmurlidh@iu.edu.
BACKGROUND: Asthma is the most common chronic condition of childhood and

disproportionately affects inner-city minority children. Low rates of asthma
preventer medication adherence is a major contributor to poor asthma control in
these patients. Web-based methods have potential to improve patient knowledge and
medication adherence by providing interactive patient education, monitoring of
symptoms and medication use, and by facilitation of communication and teamwork
among patients and health care providers. Few studies have evaluated web-based
asthma support environments using all of these potentially beneficial
interventions. The multidimensional website created for this study,
BostonBreathes, was designed to intervene on multiple levels, and was evaluated
in a pilot trial.
METHODS: An interactive, engaging website for children with asthma was developed
to promote adherence to asthma medications, provide a platform for teamwork
between caregivers and patients, and to provide primary care providers with
up-to-date symptom information and data on medication use. Fifty-eight (58)
children primarily from inner city Boston with persistent-level asthma were
randomised to either usual care or use of BostonBreathes. Subjects completed
asthma education activities, and reported their symptoms and medication use.
Primary care providers used a separate interface to monitor their patients'
website use, their reported symptoms and medication use, and were able to
communicate online via a discussion board with their patients and with an asthma
specialist.
RESULTS: After 6-months, reported wheezing improved significantly in both
intervention and control groups, and there were significant improvements in the
intervention group only in night-time awakening and parental loss of sleep, but
there were no significant differences between intervention and control groups in
these measures. Emergency room or acute visits to a physician for asthma did not
significantly change in either group. Among the subgroup of subjects with low
controller medication adherence at baseline, adherence improved significantly
only in the intervention group. Knowledge of the purpose of controller medicine
increased significantly in the intervention group, a statistically significant
improvement over the control group.
CONCLUSIONS: This pilot study suggests that a multidimensional web-based
educational, monitoring, and communication platform may have positive influences
on pediatric patients' asthma-related knowledge and use of asthma preventer
medications.
DOI: 10.1186/s12890-015-0007-1
PMCID: PMC4355974
1052. AIDS Patient Care STDS. 2017 May;31(5):227-236. doi: 10.1089/apc.2017.0009.
90-90-90-Plus: Maintaining Adherence to Antiretroviral Therapies.
Corless IB(1), Hoyt AJ(1), Tyer-Viola L(2), Sefcik E(3), Kemppainen J(4),
Holzemer WL(5), Eller LS(5), Nokes K(6), Phillips JC(7), Dawson-Rose C(8),
Rivero-Mendez M(9), Iipinge S(10), Chaiphibalsarisdi P(11), Portillo CJ(8), Chen
WT(12), Webel AR(13), Brion J(14), Johnson MO(15), Voss J(13), Hamilton MJ(16),
Sullivan KM(17), Kirksey KM(18), Nicholas PK(1).
Author information:
(1)1 MGH Institute of Health Professions School of Nursing , Boston,
Massachusetts.
(2)2 Texas Children's Pavillion for Women , Houston, Texas.
(3)3 Texas A&M University-Corpus Christi , Corpus Christi, Texas.
(4)4 University of North Carolina-Wilmington School of Nursing , Wilmington,
North Carolina.
(5)5 Rutgers College of Nursing , Newark, New Jersey.
(6)6 Hunter-Bellevue School of Nursing , CUNY, New York, New York.
(7)7 University of Ottawa , Ottawa, Canada .
(8)8 UCSF School of Nursing , San Francisco, California.
(9)9 University of Puerto Rico , San Juan, Puerto Rico .
(10)10 University of Namibia , Windhoek, Namibia .
(11)11 Faculty of Nursing, Saint Louis College , Bangkok, Thailand .
(12)12 School of Nursing, Yale University , New Haven, Connecticut.
(13)13 Bolton School of Nursing, Case Western University , Cleveland, Ohio.
(14)14 College of Nursing, The Ohio State University , Columbus, Ohio.
(15)15 UCSF , San Francisco, California.
(16)16 Texas A&M University-Corpus Christi , Corpus Christi, Texas.
(17)17 University of Hawaii School of Nursing , Honolulu, Hawaii.
(18)18 Harris Health System , Houston, Texas.
Medication adherence is the "Plus" in the global challenge to have 90% of

HIV-infected individuals tested, 90% of those who are HIV positive treated, and
90% of those treated achieve an undetectable viral load. The latter indicates
viral suppression, the goal for clinicians treating people living with HIV
(PLWH). The comparative importance of different psychosocial scales in predicting
the level of antiretroviral adherence, however, has been little studied. Using
data from a cross-sectional study of medication adherence with an international
convenience sample of 1811 PLWH, we categorized respondent medication adherence
as None (0%), Low (1-60%), Moderate (61-94%), and High (95-100%) adherence based
on self-report. The survey contained 13 psychosocial scales/indices, all of which
were correlated with one another (p < 0.05 or less) and had differing degrees of
association with the levels of adherence. Controlling for the influence of race,
gender, education, and ability to pay for care, all scales/indices were
associated with adherence, with the exception of Berger's perceived stigma scale.
Using forward selection stepwise regression, we found that adherence
self-efficacy, depression, stressful life events, and perceived stigma were
significant predictors of medication adherence. Among the demographic variables
entered into the model, nonwhite race was associated with double the odds of
being in the None rather than in the High adherence category, suggesting these
individuals may require additional support. In addition, asking about
self-efficacy, depression, stigma, and stressful life events also will be
beneficial in identifying patients requiring greater adherence support. This
support is essential to medication adherence, the Plus to 90-90-90.
DOI: 10.1089/apc.2017.0009
PMCID: PMC5446604
1053. JAMA Intern Med. 2018 Jun 1;178(6):802-809. doi:

Association of a Smartphone Application With Medication Adherence and Blood

Pressure Control: The MedISAFE-BP Randomized Clinical Trial.
Morawski K(1)(2), Ghazinouri R(1), Krumme A(1), Lauffenburger JC(1), Lu Z(1),

Durfee E(3), Oley L(3), Lee J(1), Mohta N(1), Haff N(1), Juusola JL(3), Choudhry
NK(1).
Author information:
(1)Center for Healthcare Delivery Sciences (C4HDS) and Division of
Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and
Women's Hospital and Harvard Medical School, Boston, Massachusetts.
(2)Department of Internal Medicine, Atrius Health, Boston, Massachusetts.
(3)Evidation Health, San Mateo, California.
Erratum in
JAMA Intern Med. 2018 Jun 1;178(6):876.
Comment in
JAMA Intern Med. 2018 Jun 1;178(6):809-811.
Importance: Medication nonadherence accounts for up to half of uncontrolled

hypertension. Smartphone applications (apps) that aim to improve adherence are
widely available but have not been rigorously evaluated.
Objective: To determine if the Medisafe smartphone app improves self-reported
medication adherence and blood pressure control.
Design, Setting, and Participants: This was a 2-arm, randomized clinical trial
(Medication Adherence Improvement Support App For Engagement-Blood Pressure
[MedISAFE-BP]). Participants were recruited through an online platform and were
mailed a home blood pressure cuff to confirm eligibility and to provide follow-up
measurements. Of 5577 participants who were screened, 412 completed consent, met
inclusion criteria (confirmed uncontrolled hypertension, taking 1 to 3
antihypertensive medications), and were randomized in a ratio of 1:1 to
intervention or control.
Interventions: Intervention arm participants were instructed to download and use
the Medisafe app, which includes reminder alerts, adherence reports, and optional
peer support.
Main Outcomes and Measures: Co-primary outcomes were change from baseline to 12
weeks in self-reported medication adherence, measured by the Morisky medication
adherence scale (MMAS) (range, 0-8, with lower scores indicating lower
adherence), and change in systolic blood pressure.
Results: Participants (n = 411; 209 in the intervention group and 202 controls)
had a mean age of 52.0 years and mean body mass index, calculated as weight in
kilograms divided by height in meters squared, of 35.5; 247 (60%) were female,
and 103 (25%) were black. After 12 weeks, the mean (SD) score on the MMAS
improved by 0.4 (1.5) among intervention participants and remained unchanged
among controls (between-group difference: 0.4; 95% CI, 0.1-0.7; P = .01). The
mean (SD) systolic blood pressure at baseline was 151.4 (9.0) mm Hg and 151.3
(9.4) mm Hg, among intervention and control participants, respectively. After 12
weeks, the mean (SD) systolic blood pressure decreased by 10.6 (16.0) mm Hg among
intervention participants and 10.1 (15.4) mm Hg among controls (between-group
difference: -0.5; 95% CI, -3.7 to 2.7; P = .78).
Conclusions and Relevance: Among individuals with poorly controlled hypertension,
patients randomized to use a smartphone app had a small improvement in
self-reported medication adherence but no change in systolic blood pressure
compared with controls.
Trial Registration: clinicaltrials.gov Identifier: NCT02727543.
PMCID: PMC6145760
1054. Front Psychiatry. 2019 Jun 28;10:444. doi: 10.3389/fpsyt.2019.00444.

eCollection
2019.
Information Needs of Patients About Immunosuppressive Medication in a German

Kidney Transplant Sample: Prevalence and Correlates.
Klewitz F(1)(2), Nöhre M(1)(2), Bauer-Hohmann M(1)(2), Tegtbur U(2)(3), Schiffer

L(2)(4), Pape L(2)(5), Schiffer M(2)(6), de Zwaan M(1)(2).
Author information:
(1)Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical
School, Hannover, Germany.
(2)Project Kidney Transplantation 360° (NTX 360°), Hannover Medical School,
Hannover, Germany.
(3)Department of Sports Medicine, Hannover Medical School, Hannover, Germany.
(4)Department of Nephrology and Hypertension, Hannover Medical School, Hannover,
Germany.
(5)Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical
School, Hannover, Germany.
(6)Department of Nephrology and Hypertension, University Hospital Erlangen,
Erlangen, Germany.
Background: Worldwide clinical guidelines for the care of kidney transplant (KT)
recipients recognize the importance of health care providers imparting
appropriate immunosuppressive medication (ISM) information for the facilitation
of safe medication self-management. The extent of medication information made
available is, however, not necessarily what patients require to know about their
prescribed medicines. A useful indicator for determining the quality of
prescription practice is to what degree the provided information meets the
personal needs of patients. No previous studies have focused on the ISM
information needs of KT patients. This study aims to investigate how satisfied KT
patients are with the provided ISM information and to examine the association
between satisfaction levels and socio-demographic, psychosocial, and
transplant-related variables. Materials and Methods: KT patients (n = 440) were
asked to complete a series of self-report questionnaires to evaluate the
variables adherence, ISM experience, perceived social support, symptoms of
anxiety, and depression, and transplant-related information (e.g., donation
type). ISM information needs were assessed with the Satisfaction with Information
about Medicines Scale (SIMS-D). Results: On average, 35.9% of the answers to the
SIMS-D items indicated dissatisfaction with the received information;
dissatisfaction was more prevalent for the SIMS-D subscale "potential problems"
(46.1%) than the SIMS-D subscale "action and usage" (26.7%). On an individual
item level, the dissatisfaction with information concerning ISM side effects on
drowsiness (57.1%) and sex life (56.3%) was most notable. Higher satisfaction
with ISM information was correlated with higher age, better adherence, higher
perceived social support, and lower anxiety levels. Multiple linear regression
analyses revealed that adherence, perceived social support, and age were
independently associated with ISM information satisfaction. No associations were
found with sex, educational level, partnership status, symptoms of depression,
experience of side effects, and transplant-related variables. Discussion: The
data indicate that a substantial proportion of KT patients have unmet ISM
information needs, especially with regard to potential problems of ISM.
Dissatisfaction with ISM information is a potential amendable risk factor for KT
patients engaging in non-adherent behavior, thus justifying further research in
this area. ISM information should be tailored to meet the individual needs of KT
patients in order to promote optimal medication self-management and adherence
behavior.
DOI: 10.3389/fpsyt.2019.00444
PMCID: PMC6609567
PMID: 31316406
1055. Biomed Res Int. 2015;2015:874067. doi: 10.1155/2015/874067. Epub 2015 Oct 11.
Medication Lists and Brown Bag Reviews: Potential Positive and Negative Impacts
on Patients Beliefs about Their Medicine.
Jäger C(1), Steinhaeuser J(2), Freund T(1), Szecsenyi J(1), Goetz K(1).
Author information:
(1)Department of General Practice and Health Services Research, University
Hospital Heidelberg, Voßstraße 2, Geb. 37, 69115 Heidelberg, Germany.
(2)Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus
Lübeck, Ratzeburger Allee 160, Haus 50, 23538 Lübeck, Germany.
INTRODUCTION: Medication lists and structured medication counselling (SMC)

including "brown bag reviews" (BBR) are important instruments for medication
safety. The aim of this study was to explore whether patients' use of a
medication list is associated with their beliefs about their medicine and their
memory of SMC.
METHODS: Baseline data of 344 patients enrolled into the "Polypharmacy in
Multimorbid Patients study" were analysed. Linear regression models were
calculated for the "specific necessity subscale" (SNS) and the "specific concerns
subscale" (SCS) of the German "Beliefs About Medicine Questionnaire," including
self-developed variables assessing patients' use of a medication list, their
memory of SMC, and sociodemographic data.
RESULTS: 62.8% (n = 216) remembered an appointment for SMC and 32.0% (n = 110)
BBR. The SNS correlated positively with regular receipt of a medication list (β =
0.286, p < 0.01) and negatively with memory of a BBR (β = -0.268; p < 0.01). The
SCS correlated positively with memory of a BBR (β = 0.160, p = 0.02) and
negatively with the comprehensiveness of the mediation list (β = -0.224; p <
0.01).
CONCLUSIONS: A comprehensive medication list may reduce patients' concerns and
increase the perceived necessity of their medication. A potential negative impact
of BBR on patients' beliefs about their medicine should be considered and quality
standards for SMC developed.
DOI: 10.1155/2015/874067
PMCID: PMC4619852
1056. Int J STD AIDS. 2017 Oct;28(12):1247-1254. doi: 10.1177/0956462417696431.

Epub
2017 Mar 3.
Antiretroviral therapy adherence and self-efficacy among people living with HIV
and a history of drug use in Vietnam.
Li L(1), Lin C(1), Lee SJ(1), Tuan LA(2), Feng N(1), Tuan NA(2).
Author information:
(1)1 Semel Institute for Neuroscience and Human Behavior, Center for Community
Health, University of California, Los Angeles, CA, USA.
(2)2 National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
People living with HIV with a history of drug use face additional psychosocial
challenges that could compromise their adherence to antiretroviral therapy (ART).
This study examined ART treatment adherence and adherence self-efficacy among
people living with HIV with a history of drug use in Vietnam. We used
cross-sectional baseline data collected between October 2014 and February 2015
from a randomized controlled trial in Vietnam. Of the 900 persons with a history
of drug use in the trial, a sample of 109 people living with HIV currently on ART
were included in the study. The vast majority (92%) of the participants reported
not missing any medications in the past 30 days. Multiple regression results
indicated that social support was positively associated with adherence
self-efficacy (β = 0.420, P < 0.001) and general adherence to ART (β = 0.201,
P = 0.0368). General adherence to ART was negatively associated with depressive
symptoms (β = -0.188, P = 0.046) and current heroin use (β = -0.196, P = 0.042).
These findings underscore the importance of addressing mental health and social
challenges facing people living with HIV with a history of drug use to promote
ART treatment adherence. Clinical management of HIV should identify and address
concurrent substance use behaviors to maximize adherence and treatment outcomes.
DOI: 10.1177/0956462417696431
PMCID: PMC5494003
1057. Open Heart. 2018 Dec 16;5(2):e000877. doi: 10.1136/openhrt-2018-000877.

eCollection 2018.
Predictors of β-blocker adherence in cardiac inherited disease.
O'Donovan CE(1), Waddell-Smith KE(2)(3), Skinner JR(2)(3), Broadbent E(1).

Author information:
(1)Department of Psychological Medicine, The University of Auckland, Auckland,
New Zealand.
(2)Green Lane Paediatric and Congenital Cardiac Services, Starship Children's
Hospital, Auckland, New Zealand.
(3)Department of Paediatrics: Child and Youth Health, The University of Auckland,
Auckland, New Zealand.
Objective: The cardiac inherited disease (CID) population has suboptimal

adherence to long-term β-blocker therapy, which is known to be a risk for sudden
cardiac death. This study aimed to identify the clinical and psychosocial
variables associated with non-adherence in this population.
Methods: 130 individuals (aged 16-81 years, median: 54) from the New Zealand
Cardiac Inherited Disease Registry taking β-blockers participated: 65 (50%) long
QT syndrome, 42 (32%) hypertrophic cardiomyopathy and 23 (18%) other.
Participants completed one questionnaire recording self-reported adherence,
anxiety, depression, confidence in taking medication, illness perceptions and
medication beliefs. Demographic and clinical variables were taken from the
registry.
Results: 21 participants (16%) were classed as non-adherent. Bivariate analysis
showed that self-reported adherence was worse in those who were younger
(p<0.001), had a channelopathy not cardiomyopathy (p<0.01), reported lower
confidence in taking β-blockers (p<0.001), had high concerns (p<0.05) and low
necessity beliefs about their β-blocker (p<0.001), a poorer understanding of
their CID (p<0.01), and lower treatment control beliefs (p<0.01). These variables
accounted for 37% of the variance in adherence in a linear regression model.
Stronger beliefs around medication necessity and higher confidence in their
ability to take their medication predicted β-blocker adherence.
Conclusions: Factors associated with β-blocker non-adherence in patients with CID
include young age, having a channelopathy, negative medication beliefs, low
confidence in taking medication and poor illness perceptions. These findings
present an opportunity to develop targeted interventions to improve adherence.
DOI: 10.1136/openhrt-2018-000877
PMCID: PMC6307606
PMID: 30613409
1058. Arq Bras Cardiol. 2014 Dec;103(6):503-12. doi: 10.5935/abc.20140151. Epub

2014
Oct 14.
Improving post-discharge medication adherence in patients with CVD: a pilot

randomized trial.
Oliveira-Filho AD(1), Morisky DE(2), Costa FA(3), Pacheco ST(1), Neves SF(1),
Lyra DP Jr(4).
Author information:
(1)Universidade Federal de Alagoas, Maceió, AL, Brazil.
(2)University of California Los Angeles, Los Angeles, EUA.
(3)Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brazil.
(4)Universidade Federal de Sergipe, Aracaju, SE, Brazil.
Comment in
Arq Bras Cardiol. 2015 Jan;104(1):3-4.
BACKGROUND: Effective interventions to improve medication adherence are usually

complex and expensive.
OBJECTIVE: To assess the impact of a low-cost intervention designed to improve
medication adherence and clinical outcomes in post-discharge patients with CVD.
METHOD: A pilot RCT was conducted at a teaching hospital. Intervention was based
on the four-item Morisky Medication Adherence Scale (MMAS-4). The primary outcome
measure was medication adherence assessed using the eight-item MMAS at baseline,
at 1 month post hospital discharge and re-assessed 1 year after hospital
discharge. Other outcomes included readmission and mortality rates.
RESULTS: 61 patients were randomized to intervention (n = 30) and control (n =
31) groups. The mean age of the patients was 61 years (SD 12.73), 52.5% were
males, and 57.4% were married or living with a partner. Mean number of prescribed
medications per patient was 4.5 (SD 3.3). Medication adherence was correlated to
intervention (p = 0.04) and after 1 month, 48.4% of patients in the control group
and 83.3% in the intervention group were considered adherent. However, this
difference decreased after 1 year, when adherence was 34.8% and 60.9%,
respectively. Readmission and mortality rates were related to low adherence in
both groups.
CONCLUSION: The intervention based on a validated patient self-report instrument
for assessing adherence is a potentially effective method to improve adherent
behavior and can be successfully used as a tool to guide adherence counseling in
the clinical visit. However, a larger study is required to assess the real impact
of intervention on these outcomes.
DOI: 10.5935/abc.20140151
PMCID: PMC4290741
1059. Adv Ther. 2017 Jan;34(1):91-108. doi: 10.1007/s12325-016-0441-3. Epub 2016

Nov
16.
Impact of Treatment-Related Beliefs on Medication Adherence in Immune-Mediated

Inflammatory Diseases: Results of the Global ALIGN Study.
Michetti P(1), Weinman J(2), Mrowietz U(3), Smolen J(4)(5), Peyrin-Biroulet L(6),
Louis E(7), Schremmer D(8), Tundia N(9), Nurwakagari P(10), Selenko-Gebauer
N(11).
Author information:
(1)Crohn and Colitis Centre, Gastro-entérologie La Source-Beaulieu and Division
of Gastroenterology, Centre Hospitalier Universitaire Vaudois, 1004, Lausanne,
Switzerland. pmichetti@gesb.ch.
(2)Institute of Pharmaceutical Sciences, King's College London, London, UK.
(3)Psoriasis-Center at the Department of Dermatology, Venereology and
Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel,
Germany.
(4)Division of Rheumatology, Department of Medicine 3, Medical University of
Vienna, Vienna, Austria.
(5)2nd Department of Medicine, Center for Rheumatic Diseases, Hietzing Hospital,
Vienna, Austria.
(6)Inserm U954 and Department of Gastroenterology, Université de Lorraine,
Vandoeuvre-les-Nancy, France.
(7)CHU de Liège et Université de Liège, Liège, Belgium.
(8)GKM Gesellschaft für Therapieforschung mbH, Munich, Germany.
(9)AbbVie Inc., North Chicago, IL, USA.
(10)Medical Department, AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany.
(11)Global Medical Affairs, AbbVie Inc., North Chicago, IL, USA.
Comment in
Adv Ther. 2017 Sep;34(9):2173-2176.
INTRODUCTION: Medication adherence is critical in chronic immune-mediated

inflammatory diseases (IMIDs) and could be affected by patients'
treatment-related beliefs. The objective of this study was to determine beliefs
about systemic medications in patients with IMIDs and to explore the association
of those beliefs and other factors with adherence.
METHODS: This was a multi-country, cross-sectional, self-administered survey
study. Included were adults diagnosed with one of six IMIDs receiving
conventional systemic medications and/or tumor necrosis factor inhibitors (TNFi).
Patients' necessity beliefs/concerns towards and adherence to treatments were
assessed by the Beliefs about Medicines Questionnaire and four-item Morisky
Medication Adherence Scale. Correlation of patients' beliefs about treatment and
other factors with adherence were evaluated by multivariable regression analyses.
RESULTS: Among studied patients (N = 7197), 32.0% received TNFi monotherapy,
27.7% received TNFi-conventional combination therapy, and 40.3% received
conventional medications. Across IMIDs, high adherence to systemic treatment was
more prevalent in TNFi groups (61.3-80.7%) versus corresponding conventional
treatment groups (28.4-64.7%). In at least four IMIDs, greater perception of the
illness continuing forever (P < 0.001), of the treatment helping (P < 0.001), and
more concerns about the illness (P < 0.01), but not clinical parameters, were
associated with higher treatment necessity beliefs. Higher treatment necessity
beliefs, older age, Caucasian race, and TNFi therapy were associated with high
medication adherence in at least four IMIDs.
CONCLUSIONS: Treatment necessity beliefs were higher than concerns about current
medication in patients with IMID. Illness perceptions had a greater impact on
treatment necessity beliefs than clinical parameters. Older age, greater
treatment necessity beliefs, and TNFi therapy were associated with high
self-reported medication adherence in at least four IMIDs.
TRIAL REGISTRATION: ACTRN12612000977875.
FUNDING: AbbVie.
DOI: 10.1007/s12325-016-0441-3
PMCID: PMC5216107
1060. AIDS Care. 2016 Dec;28(12):1559-1565. Epub 2016 Jun 20.
High levels of self-reported prescription opioid use by HIV-positive individuals.
Turner AN(1), Maierhofer C(1), Funderburg NT(2), Snyder B(1), Small K(1), Clark
J(1), Bazan JA(1), Kwiek NC(3), Kwiek JJ(4)(5).
Author information:
(1)a Division of Infectious Diseases , College of Medicine, the Ohio State
University , Columbus , OH , USA.
(2)b Division of Medical Laboratory Science , School of Health and Rehabilitation
Sciences, the Ohio State University , Columbus , OH , USA.
(3)c Division of Pharmacology , College of Pharmacy, the Ohio State University ,
Columbus , OH , USA.
(4)d Department of Microbial Infection and Immunity , College of Medicine ,
Columbus , OH , USA.
(5)e Department of Microbiology , College of Arts and Sciences, the Ohio State
University , Columbus , OH , USA.
Prescription medication use (other than antiretroviral therapy (ART)) is highly

prevalent among people living with HIV. Prescription medications may be used
medically or non-medically: non-medical use includes using more medication than
prescribed, using medication prescribed to someone else, or using medication for
a purpose other than its prescribed use. During 12 weeks in 2014-2015, we
characterized medical and non-medical prescription medication use among
HIV-positive patients attending an academic medical center (n = 149) and a
community clinic (n = 105). Separately for the past year and the past month,
these 254 participants self-reported their use of prescription opioids,
sedatives, stimulants, anti-anxiety medications, antipsychotic medications, and
erectile dysfunction medications. Respondents were largely male (91%), aged 40 or
older (61%), identified as gay or bisexual (79%), and were men who have sex with
men (85%). ART use was nearly universal (95%). Nearly half (43%) of participants
reported medical use of prescription opioids; 11% of the opioid use was reported
as non-medical use. Anti-anxiety medication use was also frequent, and differed
by site: 41% of community-clinic responders reported medical use of anti-anxiety
medications compared to 23% of hospital clinic respondents who reported medical
use. Prescription sedative use was also approximately twice as high among
community-clinic participants, with medical use reported by 43% of respondents
and non-medical use by 12%; in comparison, at the hospital clinic, sedative use
was reported by 18% (medical) and 7% (non-medical) of participants. Stimulant use
was rare in both sites. No demographic characteristic was significantly
associated with medical or non-medical use of any prescription medication. The
current focus of many studies on only non-medical prescription medication use not
only underestimates the widespread exposure of HIV-positive individuals to these
drugs, but may also underestimate potential adverse effects of prescription
medications in this population.
DOI: 10.1080/09540121.2016.1198746
PMCID: PMC5137247
1061. BMC Fam Pract. 2018 Sep 24;19(1):160. doi: 10.1186/s12875-018-0846-y.
Rationale and design of a pragmatic clinical trial to assess the impact of

self-monitoring blood pressure at home and self-titration of antihypertensive
medication in poorly controlled hypertension: the ADAMPA study protocol.
Sanfélix-Genovés J(1)(2)(3)(4), Rodríguez-Bernal CL(5)(6), Marco-Moreno I(7),

Martinez-Ibañez P(7), Martinez-Ibañez L(7), Bóveda-García M(7), Barreira-Franch
I(7), Calleja-Del Ser M(7), Borrás-Moreno G(7), Avelino-Hidalgo E(7),
Escrig-Veses M(7), Lauriano M(7), Giménez-Loreiro M(7), Bellot-Pujalte L(7),
García-Sempere A(5)(6), Peiró S(5)(6), Sanfélix-Gimeno G(5)(6); ADAMPA group.
Collaborators: Abad-Carrasco J, Agudo-Escagüés MV, Alvarez-Martinez M,

Bartual-Penella RM, Carrión-Villanueva R, Checa-Sanz E, Costa-Alcaraz A,
Cristófol-López I, Duque-Valencia A, González-Candelas R, González-Espadas R,
González-Luján L, Gosalbes V, Guinot-Martínez E, López-Torres EL, Molla-LLosa S,
Moreno-Comins V, Moreno-Prat M, Puchades-Company MJ, Ramos-García Á, Ramos-Ruiz
P, Robles-Pastor E, Roca-Navarro P, Saiz-Rodriguez R, Salanova-Chilet JL,
Tchang-Sanchez A, Torres F, Uribes-Fillol R, Valle-García C, Villar-Ruiz M,
Vivas-Miquel C.
Author information:
(1)Centro de Salud de Nazaret, Departamento de Salud de Valencia Clínic-La
Malvarrosa, Valencia, Spain. sanfelix_jos@gva.es.
(2)Health Services Research Unit, FISABIO, Valencia, Spain. sanfelix_jos@gva.es.
(3)Spanish Network of Chronic Care and Health Services Research (REDISSEC),
Valencia, Spain. sanfelix_jos@gva.es.
(4)Health Research Institute (INCLIVA), Valencia, Spain. sanfelix_jos@gva.es.
(5)Health Services Research Unit, FISABIO, Valencia, Spain.
(6)Spanish Network of Chronic Care and Health Services Research (REDISSEC),
Valencia, Spain.
(7)Health Research Institute (INCLIVA), Valencia, Spain.
BACKGROUND: Lack of control of hypertension is one of the most prevalent problems

encountered by general practitioners (GPs). Self-measured blood pressure
monitoring at home (SMBP) and self-titration of medication could be a good
strategy to improve hypertension management, however, evidence is limited and not
conclusive. We aimed to assess the effectiveness, in the primary care setting, of
an intervention that includes educational components, SMBP and self-titration of
antihypertensive medication to decrease systolic blood pressure compared to usual
care, in a population with poorly controlled hypertension, during a 12-month
period.
METHODS: Pragmatic, controlled, randomized, unblinded clinical trial with two
parallel groups assigned in a ratio of 1:1 to self-management (which includes
educational components, SBMP and self-titration of antihypertensive medication
based on a patient's GP's pre-established adjustment plan) or to usual care (with
educational components too).
DISCUSSION: If the data from this trial show positive results, the study may
contribute to a change of strategy in the treatment of hypertension, focusing on
the patient as the main actor to achieve blood pressure control. Furthermore,
this approach might contribute to the financial sustainability of the National
Health Service.
TRIAL REGISTRATION: This trial has been registered in the database with reference
number EudraCT: 2016-003986-25. Registered 05 May 2017,
https://www.clinicaltrialsregister.eu/ctr-search/search?query=2016-003986-25.
DOI: 10.1186/s12875-018-0846-y
PMCID: PMC6154875
PMID: 30249203
1062. J Clin Rheumatol. 2018 Oct;24(7):368-374. doi: 10.1097/RHU.0000000000000794.
Depressive Symptoms Are Associated With Low Treatment Adherence in African

American Individuals With Systemic Lupus Erythematosus.
Heiman E(1), Lim SS(2), Bao G(2), Drenkard C(2).
Author information:
(1)From the Divisions of General Medicine and Geriatrics and.
(2)Rheumatology, Department of Medicine, Emory University, Atlanta, GA.
OBJECTIVE: African American (AA) people with systemic lupus erythematosus (SLE)
are at high morbidity and mortality risk, and they often require multiple
medications. Low medication adherence is a highly prevalent, multidimensional
problem associated with poor outcomes in people with SLE. Depression, a predictor
of low adherence in people with chronic conditions, has been described in over
35% of AAs with SLE. We hypothesized that depressive symptoms would be
increasingly associated with low adherence in this population.
METHODS: Research subjects predominantly belong to the Georgians Organized
Against Lupus cohort, a population-based cohort of predominantly AA individuals
with SLE in the Atlanta metropolitan area. Medication adherence and severity of
depressive symptoms were measured using validated self-reported tools: the 8-item
Morisky Medication Adherence Scale and the 9-item Patient Health Questionnaire,
respectively. We used univariate and multivariate logistic regression to examine
the odds ratios of low medication adherence across individuals with increasing
severity of depressive symptoms.
RESULTS: Among 632 AA SLE participants, 336 (54%) reported low medication
adherence and 217 (34.6%) reported "moderate" or "severe" depressive symptoms. In
univariate logistic regression, significant risk factors for low adherence were
depressive symptoms, low self-efficacy, poor satisfaction with care, female sex,
younger age, hurried patient-physician communication, poorer shared
decision-making, less compassionate physician communication style, poor/fair
health, and higher disease activity score. In multivariate regression, younger
age, female sex, and more severe depressive symptoms were associated with low
CONCLUSIONS: This is the first study to examine factors associated with low
medication adherence among a population-based cohort of AA individuals with SLE.
Depression was a strong correlate of low medication adherence. Mental health
interventions aiming to address and treat depression may increase medication
adherence.
DOI: 10.1097/RHU.0000000000000794
PMCID: PMC6487191
1063. JMIR Mhealth Uhealth. 2017 Jun 12;5(6):e76. doi: 10.2196/mhealth.6998.
Direct Adherence Measurement Using an Ingestible Sensor Compared With

Self-Reporting in High-Risk Cardiovascular Disease Patients Who Knew They Were
Being Measured: A Prospective Intervention.
Thompson D(1), Mackay T(2), Matthews M(2), Edwards J(2), Peters NS(3), Connolly
SB(3).
Author information:
(1)International Centre for Circulatory Health, National Heart and Lung
Institute, Imperial College London, London, United Kingdom.
(2)Imperial College Healthcare NHS Trust, London, United Kingdom.
(3)National Heart and Lung Institute, Imperial College London, London, United
Kingdom.
Erratum in
JMIR Mhealth Uhealth. 2018 Apr 27;6(4):e13.
BACKGROUND: Use of appropriate cardioprotective medication is a cornerstone of

cardiovascular disease prevention, but less-than-optimal patient adherence is
common. Thus, strategies for improving adherence are recommended to adopt a
multifaceted approach.
OBJECTIVE: The objective of our study was to test a system comprising a
biodegradable, ingestible sensor for direct measurement of medication ingestion
in a group of patients at elevated cardiovascular risk attending a cardiac
prevention and rehabilitation program.
METHODS: In this prospective intervention trial in a single group of 21 patients
running from April 2014 to June 2015, we measured adherence by self-report and
adherence determined objectively by the system. The sensor emits a signal when it
encounters the acidic environment of the stomach, detectable by an externally
worn patch and linked software app. Longitudinal adherence data in the form of
daily progress charts for sensed dosing events as compared with scheduled dosing
are visible to patients on their tablet computer's medication dosing app, thus
providing patients with continuous medication adherence feedback. We sought
feedback on patient acceptability by questionnaire assessment. Participants used
the system for the 12-week period of their cardiac prevention and rehabilitation
program.
RESULTS: Only 1 patient at initial assessment and 1 patient at end-of-program
assessment reported often missing medication. The remaining patients reported
never missing medication or had missing data. Only 12 (57%) of patients overall
achieved system-determined adherence of 80% or more, and 3 patients had scores
below 40%. Participants reported high levels of acceptability.
CONCLUSIONS: This integrated system was well tolerated in a group of 21 patients
over an appreciable time frame. Its ability to measure adherence reveals the
sizeable disconnect between patient self-reported adherence and actual medication
taking and has promising potential for clinical use as a tool to encourage better
medication-taking behavior due to its ability to provide continuous patient-level
feedback.
©David Thompson, Teresa Mackay, Maria Matthews, Judith Edwards, Nicholas Peters,
Susan B Connolly. Originally published in JMIR Mhealth and Uhealth
(http://mhealth.jmir.org), 12.06.2017.
PMCID: PMC5484791
PMID: 28606895

eCollection 2019.
Potential for physician communication to build favorable medication beliefs among

older adults with hypertension: A cross-sectional survey.
Hong SH(1)(2).
Author information:
(1)Social and Administrative Pharmacy, College of Pharmacy, Seoul National
University, Seoul, Korea.
(2)Research Institute of Pharmaceutical Sciences, Seoul National University,
Seoul, Korea.
Older adults suffering from hypertension form firm medication beliefs through
lifetime medication management, which significantly affect their medication
adherence and treatment outcomes. Understanding whether the patient-physician
communication has the potential to change medication beliefs will help design an
effective communication strategy to foster favorable medication beliefs. This
study aims to determine whether the patient-physician communication is associated
with medication beliefs among older adults with hypertension and controls
socio-demographics and clinical characteristics. Further, it examines how the
association varies with two different types of medication beliefs (medication
overuse and harm) for each domain of communication (informative and
interpersonal). A self-administered cross-sectional survey was conducted for
members of seven senior centers in a metropolitan area of the United States
between August and December of 2013. A total of 211 senior members suffering from
hypertension completed the questionnaire, which included the Primary Care
Assessment Survey (PCAS) and the Beliefs about Medicines Questionnaire (BMQ). The
former had two domains of patient-physician communication-informative and
interpersonal-while the latter measured medication harm and overuse beliefs.
Interpersonal patient-physician communication significantly explained the
medication overuse beliefs (β = -0.28, p < 0.05), whereas neither interpersonal
nor informative communication significantly explained the medication harm
beliefs. Females (β = 1.29, p < 0.01) and participants with higher education (β =
2.66, p = 0.02) more strongly believed that medications are overprescribed.
However, participants with low income more strongly believed that medications are
harmful. Patient-physician communication, if it touches upon interpersonal
aspects, has the potential to change medication overuse beliefs among older
adults with hypertension. Identification of the significant factors which affect
medication beliefs, will inform the design of a patient-centric communication
program that fosters favorable medication beliefs among geriatric hypertensive
patients.
PMCID: PMC6322726
PMID: 30615656

interests exist.
1065. Contraception. 2017 Dec;96(6):453-459. doi:

10.1016/j.contraception.2017.08.013.
Epub 2017 Sep 4.
Measuring oral contraceptive adherence using self-report versus pharmacy claims

data.
Nelson HN(1), Borrero S(2), Lehman E(3), Velott DL(3), Chuang CH(4).
Author information:
(1)Penn State College of Medicine. Electronic address:
hnelson1@pennstatehealth.psu.edu.
(2)Division of General Internal Medicine, University of Pittsburgh; Center for
Health Equity Research and Promotion, VA Pittsburgh Healthcare System.
(3)Department of Public Health Sciences, Penn State College of Medicine.
(4)Division of General Internal Medicine, Penn State College of Medicine;
Department of Public Health Sciences, Penn State College of Medicine.
OBJECTIVE: Proportion of Days Covered (PDC) is a measure of medication adherence

that uses prescription claims data to describe the proportion of days that the
patient possessed medication. The objective of this study is to compare PDC and
self-report as measures of oral contraceptive pills (OCPs) adherence and to
identify individual-level predictors of adherence.
STUDY DESIGN: In a sample of 384 OCP users, self-report was compared with PDC as
measures of adherence over the past 3 months. Patient-level variables were
examined for associations with adherence using multivariable logistic regression
models.
RESULTS: High adherence, defined as missing ≤1 pill per month, was 76%, 68% and
54% as measured by self-report, PDC and both measures, respectively. Younger
women (ages 18-25 and 26-33 years) were significantly less likely to have high
adherence on both measures than women in the 34-40 age group [adjusted odds ratio
(OR) 0.20, 95% confidence interval (CI) 0.08-0.51 and adjusted OR 0.26, 95% CI
0.11-0.62, respectively). Other predictors of high adherence on both self-report
and PDC measures included being in a relationship (adjusted OR 2.30, 95% CI
1.14-4.64, compared with unpartnered women), Protestant religion (adjusted OR
2.08, 95% CI 1.07-4.06, compared with women with no religious affiliation) and
higher contraceptive self-efficacy (adjusted OR 1.63, 95% CI 1.03-2.58).
CONCLUSION: PDC derived from pharmacy claims, or a combination of PDC and
self-report measures, may be an alternative to self-report alone for measuring
OCP adherence.
IMPLICATIONS: PDC may be a potential tool for measuring women's adherence to OCPs
and should be validated in future studies.
PMCID: PMC6540974
1066. Psychol Health Med. 2016;21(1):60-6. doi: 10.1080/13548506.2015.1051060. Epub

2015 Jun 12.
The association of tanning behavior with psycho-tropic medication use among young
adult women.
Heckman CJ(1), Munshi T(1), Darlow S(1), Kloss JD(2), Manne SL(3), Perlis C(4),
Oslin D(5).
Author information:
(1)a Cancer Prevention and Control Program , Fox Chase Cancer Center ,
Philadelphia , PA , USA.
(2)b Department of Psychology , Drexel University , 3141 Chestnut St,
Philadelphia , PA 19104 , USA.
(3)c Cancer Prevention and Control Program , Rutgers Cancer Institute of New
Jersey , New Brunswick , NJ , USA.
(4)d Department of Dermatology , Fox Chase Cancer Center , Philadelphia , PA ,
USA.
(5)e Department of Psychiatry , University of Pennsylvania School of Medicine ,
Philadelphia , PA , USA.
Despite its known association with skin cancer, tanning remains popular among
young adult women. Indoor tanning behavior has been found to be associated with
affective and addictive disorders. To better understand potential psychological
and biological mechanisms of tanning behavior, we investigated associations
between tanning and medication (psychotropic and other) use among young women.
Two hundred and fifty-three women age 18-29 years old were recruited from two
northeastern university campus communities. Women self-reported tanning frequency
and chronic medication use. In both univariate and multivariate analyses, indoor
tanning ≥12 times last year was significantly associated with use of psychotropic
medication and anti-depressants in particular. Sunbathing was not associated with
medication use. Potential reasons for associations between tanning and
psychotropic medication use are discussed. Indoor tanners should be warned that
some psychotropic medications are photosensitizing, thus increasing risk for
burns and other skin damage from indoor tanning.
DOI: 10.1080/13548506.2015.1051060
PMCID: PMC4469946
1067. Clin Interv Aging. 2016 Oct 13;11:1441-1450. eCollection 2016.
Do empowered stroke patients perform better at self-management and functional

recovery after a stroke? A randomized controlled trial.
Sit JW(1), Chair SY(1), Choi KC(1), Chan CW(1), Lee DT(1), Chan AW(1), Cheung
JL(1), Tang SW(2), Chan PS(2), Taylor-Piliae RE(3).
Author information:
(1)The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin,
New Territories.
(2)Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong
Kong Hospital Authority, Causeway Bay, Hong Kong, People's Republic of China.
(3)College of Nursing, The University of Arizona, Tucson, AZ, USA.
BACKGROUND: Self-management after a stroke is a challenge because of multifaceted

care needs and complex disabling consequences that cause further hindrance to
patient participation. A 13-week stroke patient empowerment intervention (Health
Empowerment Intervention for Stroke Self-management [HEISS]) was developed to
enhance patients' ability to participate in self-management.
PURPOSE: To examine the effects of the empowerment intervention on stroke
patients' self-efficacy, self-management behavior, and functional recovery.
METHODS: This is a single-blind randomized controlled trial with stroke survivors
assigned to either a control group (CG) receiving usual ambulatory rehabilitation
care or the HEISS in addition to usual care (intervention group [IG]). Outcome
data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months
(T3) postintervention. Data were analyzed on the intention-to-treat principle.
The generalized estimating equation model was used to assess the differential
change of self-efficacy in illness management, self-management behaviors
(cognitive symptom management, communication with physician, medication
adherence, and self-blood pressure monitoring), and functional recovery (Barthel
and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months =
T2, and 6 months = T3 postintervention) between the two groups.
RESULTS: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors
(mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63%
tactile sensory deficit) were enrolled in the study. Those in IG reported better
self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012)
postintervention, along with better self-management behaviors at all follow-up
time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG
had significantly better functional recovery (Barthel, all P<0.05; Lawton, all
P<0.001), compared to CG. The overall dropout rate was 16.7%.
CONCLUSION: Patient empowerment intervention (HEISS) may influence self-efficacy
in illness management and improve self-management behavior and functional
recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel
with existing ambulatory stroke rehabilitation services and provide added value
in sustaining stroke self-management and functional improvement in the long term.
DOI: 10.2147/CIA.S109560
PMCID: PMC5072569

this work.
1068. Front Endocrinol (Lausanne). 2018 Oct 18;9:489. doi:

10.3389/fendo.2018.00489.
eCollection 2018.
Self-Care and Self-Management Among Adolescent T2DM Patients: A Review.
Eva JJ(1), Kassab YW(2), Neoh CF(1)(3), Ming LC(4)(5), Wong YY(6), Abdul Hameed
M(1), Hong YH(7), Sarker MMR(8).
Author information:
(1)Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia.
(2)Faculty of Pharmacy, Cyberjaya University College of Medical Sciences,
Cyberjaya, Malaysia.
(3)Collaborative Drug Discovery Research Group, Pharmaceutical and Life Sciences
Community of Research, Universiti Teknologi MARA, Shah Alam, Malaysia.
(4)School of Pharmacy, KPJ Healthcare University College, Negeri Sembilan,
Malaysia.
(5)Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia.
(6)Faculty of Pharmacy, Universiti Teknologi MARA, Bertam, Malaysia.
(7)Department of Physiology, Faculty of Medicine, University of Malaya, Kuala
Lumpur, Malaysia.
(8)Department of Pharmacy, State University of Bangladesh, Dhaka, Bangladesh.
Uncontrolled hyperglycaemia can lead to macro- and microvascular complications.

Adolescents with T2DM develop similar complications as in adults, including
cardiovascular disease, stroke, myocardial infarction, renal insufficiency, and
chronic renal failure. Although regular medical follow-up is essential to avoid
long-term complications, patients with diabetes mellitus need to perform holistic
self-care activities such as opting for a healthy diet, physical activity,
self-monitoring, and proper medication. To the best of our knowledge, only a
limited number of studies have focused on self-care activities and
self-management, including self-care practices, supportive networks, and
self-care education programs in adolescent with T2DM. Some of the studies focused
on the appreciation of self-care in adolescents with T2DM. This review aimed to
analyse self-care and self-management among adolescents with T2DM, and discuss
the impact of self-care and self-management on glycaemic control. The
difficulties faced by adolescents in self-managing their disease are also
highlighted. Such information is essential for healthcare providers in promoting
self-care practices among adolescents with T2DM. A thorough search of the
literature was performed using three databases: Medline, Google Scholar, and
Scopus. The articles focused on self-care and self-management of adolescents
patients with T2DM aged between 12 and 19 years old were included. Findings from
this review reveal that healthy food adaptation, adequate physical activity,
proper medication practices, and regular glucose monitoring are the most common
self-care practices. Parental involvement and clinician encouragement also
contribute toward the practice of self-care and self-management among the
adolescents with T2DM. In conclusion, independent self-management regimens and
supportive networks for appropriate administration are vital factors to enhance
clinical outcomes of adolescents with T2DM.
DOI: 10.3389/fendo.2018.00489
PMCID: PMC6232899
PMID: 30459707
1069. Front Pharmacol. 2018 Jun 5;9:488. doi: 10.3389/fphar.2018.00488. eCollection

2018.
The Effect of Quality of Life on Medication Compliance Among Dialysis Patients.
Nagasawa H(1)(2), Tachi T(2), Sugita I(2), Esaki H(2), Yoshida A(2), Kanematsu
Y(2), Noguchi Y(2), Kobayashi Y(3), Ichikawa E(4), Tsuchiya T(2)(5), Teramachi
H(2)(6).
Author information:
(1)Department of Pharmacy, Secomedic Hospital, Funabashi, Japan.
(2)Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.
(3)Department of Pharmacy, Chiba Central Medical Center, Chiba, Japan.
(4)Department of Pharmacy, Chuno Kosei Hospital, Gifu, Japan.
(5)Community Health Support and Research Center, Gifu, Japan.
(6)Laboratory of Community Healthcare Pharmacy, Gifu Pharmaceutical University,
Gifu, Japan.
Dialysis treatment is known to lead to reduced quality of life (QOL) among
patients. This decreased QOL is believed to influence medication compliance,
although this effect has not yet been clarified. In this study, we investigated
whether decreased QOL due to dialysis treatment does in fact influence medication
compliance. Participants were 92 patients who self-managed their medication and
were receiving dialysis treatment at Secomedic Hospital or Chiba Central Medical
Center. We surveyed their age, sex, dialysis period, and medication management
situation, and administered the EQ-5D and Kidney Disease Quality of Life
Instrument-Short Form. A multiple logistic regression analysis with medication
compliance as the dependent variable and QOL as the independent variable was
conducted. The recovery rate and effective response rate were both 100%. The
results indicated that patients with good sleep QOL (mean or above) had higher
odds of medication compliance (odds ratio, 3.36; 95% confidence interval,
1.26-8.96; P = 0.016). Therefore, improving the quality of sleep of dialysis
patients might help to improve their medication compliance.
DOI: 10.3389/fphar.2018.00488
PMCID: PMC6008555
PMID: 29950988
1070. Diabetes Spectr. 2015 Nov;28(4):252-7. doi: 10.2337/diaspect.28.4.252.
Does Kindness Matter? Diabetes, Depression, and Self-Compassion: A Selective

Review and Research Agenda.
Friis AM(1), Consedine NS(1), Johnson MH(1).
Author information:
(1)University of Auckland, Auckland, New Zealand.
Depression and severe psychological distress are frequently comorbid with

diabetes and are associated with reduced adherence to medication and healthy
lifestyle regimens, poorer glycemic control, and increased complications. The
mixed success of existing treatments for depression in diabetes patients suggests
a need for supplementary approaches to this common problem. This article reviews
recent evidence for the benefits of self-compassion in chronically ill patients,
suggesting its utility as a clinical tool for improving self-care, depression,
and glycemic control in diabetes. Possible physical and psychological pathways by
which self-compassion may promote better outcomes in diabetes patients are
considered, with particular attention given to reductions in negative
self-judgment and improved motivation to undertake self-care.
DOI: 10.2337/diaspect.28.4.252
PMCID: PMC4647176
PMID: 26600726
1071. Respir Med. 2017 Aug;129:39-45. doi: 10.1016/j.rmed.2017.05.013. Epub 2017

May
26.
Patient-perceived acceptability and behaviour change benefits of inhaler

reminders and adherence feedback: A qualitative study.
Foster JM(1), Reddel HK(2), Usherwood T(3), Sawyer SM(4), Smith L(5).
Author information:
(1)Woolcock Institute of Medical Research, University of Sydney, Sydney,
Australia. Electronic address: j.m.foster@woolcock.org.au.
(2)Woolcock Institute of Medical Research, University of Sydney, Sydney,
Australia. Electronic address: helen.reddel@sydney.edu.au.
(3)Department of General Practice, Sydney Medical School - Westmead, University
of Sydney, Sydney, Australia; George Institute for Global Health, Sydney,
Australia. Electronic address: tim.usherwood@sydney.edu.au.
(4)Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne,
Australia; Department of Paediatrics, The University of Melbourne, Melbourne,
Australia; Murdoch Childrens Research Institute, Melbourne, Australia. Electronic
address: susan.sawyer@rch.org.au.
(5)Faculty of Pharmacy, University of Sydney, Sydney, Australia. Electronic
address: lorraine.smith@sydney.edu.au.
INTRODUCTION: Little is known about patients' perceptions of electronic inhaler

reminders, which have emerged in recent years as adherence promotion aids. This
study explored asthma patients' attitudes toward the acceptability and utility of
inhaler reminders.
METHODS: Participants from a 6-month cluster randomized controlled trial who
received reminders for missed doses via SmartTrack adherence monitors (Adherium
Ltd) were interviewed to explore their perceptions; interviews were
audio-recorded, transcribed and analysed thematically.
RESULTS: 18 participants (50% male, mean age 39 years [range 17-68]) were
interviewed. Three themes were identified. Acceptability and Feasibility:
Interviewees found the monitor easy to use. For some, concerns about the monitor
itself affected adherence, e.g. leaving it at home to avoid breakage. Positive
features included that reminders played only for missed doses, and the choice of
reminder tunes. Utility and Behavioural Impact: Interviewees described reminders
as an effective "training" tool for adherence, encouraging habit-formation,
behaviour change and attitude change. Reminders were considered less acceptable
or useful by participants who preferred taking medication only when symptomatic
or who doubted the necessity or safety of their medication. Sustainability: Some
interviewees reported sustained behaviour change, supported by reminders, through
the establishment of routine or via experiential learning that good adherence
improved their asthma. Other interviewees wanted ongoing support (i.e. reminders
or substitute adherence cues) after study end.
CONCLUSION: Patients with asthma found 6-months' use of reminders and adherence
feedback acceptable and useful for improving their adherence attitudes, adherence
behaviours and confidence in asthma self-management. Some patients may benefit
from ongoing adherence support.
DOI: 10.1016/j.rmed.2017.05.013
1072. Cien Saude Colet. 2018 Mar;23(3):953-961. doi: 10.1590/1413-

81232018233.03722016.
Factors associated with elderly diabetic adherence to treatment in primary health

care.

publisher]
Borba AKOT(1), Marques APO(1), Ramos VP(1), Leal MCC(1), Arruda IKG(1), Ramos
RSPDS(1).
Author information:
(1)Programa de Pós-Graduação em Enfermagem, Centro de Ciências da Saúde,
Universidade Federal de Pernambuco. Campus Universitário, Cidade Universitária.
50670-901 Recife PE Brasil. anninhatito@gmail.com.
This study aimed to investigate factors associated with the treatment adherence
of 150 elderly diabetics assisted in gerontogeriatric outpatient service in
northeastern Brazil. Full adherence to therapy was self-reported by 27.3% of the
elderly. In the bivariate analysis, adherence was associated with self-perceived
health, beliefs in the use of medication, understanding explanations about
diabetes and professional responsible for treatment guidance. After analysis
adjustment, only beliefs in medicine were significant when comparing
non-adherence with full adherence (OR = 9.65; CI95% 1.6; 56.6) and non-adherence
with partial adherence (OR = 18.15; CI95% 3.5;95.4). It can be concluded that
full adherence to diabetes treatment is low and is associated with beliefs in
medications for disease control. It is necessary to develop additional studies to
better define the role of health beliefs and practices of care among elderly
assisted in primary health care.
Publisher: Este estudo investiga os fatores associados à adesão terapêutica em

150 idosos diabéticos assistidos em serviço gerontogeriátrico de natureza
ambulatorial no Nordeste do Brasil. Dentre os idosos, 27,3% autorreferiram adesão
integral à terapêutica. Na análise bivariada a adesão esteve associada com a
autopercepção da saúde, crenças no uso dos remédios, entendimento das explicações
sobre o diabetes e profissional responsável pelas orientações sobre o tratamento.
Após análise ajustada, apenas as crenças no medicamento foram significativas ao
comparar a não adesão com a adesão integral (OR = 9,65; IC95% 1,6;56,6) e a não
adesão com a adesão parcial (OR = 18,15; IC95% 3,5;95,4). Conclui-se que a adesão
integral ao tratamento para o diabetes é baixa e está associada às crenças nas
medicações utilizadas para o controle da doença. Faz-se necessário o
desenvolvimento de estudos adicionais para melhor definir o papel das crenças em
saúde e as práticas de cuidados entre idosos assistidos na atenção básica de
saúde.
DOI: 10.1590/1413-81232018233.03722016
1073. ScientificWorldJournal. 2017;2017:4530183. doi: 10.1155/2017/4530183. Epub

2017
Mar 14.
Assessment of Medication Use among University Students in Ethiopia.
Asmelashe Gelayee D(1), Binega G(2).
Author information:
(1)Department of Pharmacology, College of Medicine and Health Sciences,
(2)Department of Clinical Pharmacy, College of Medicine and Health Sciences,
Background. The extent, nature, and determinants of medication use of individuals

can be known from drug utilization studies. Objectives. This study intended to
determine medication consumption, sharing, storage, and disposal practices of
university students in Northwest Ethiopia. Methods. A descriptive cross-sectional
study was conducted on 404 university students selected through stratified random
sampling technique. Data were collected using self-administered questionnaire and
analyzed with SPSS version 20 statistical software. Pearson's Chi-square test of
independence was conducted with P < 0.05 taken as statistically significant.
Results. At 95.3% response rate, the prevalences of medication consumption and
sharing were 35.3% (N = 136) and 38.2% (N = 147), respectively. One hundred (26%)
respondents admitted that they often keep leftover medications for future use
while the rest (N = 285, 74%) discard them primarily into toilets (N = 126,
44.2%). Evidence of association existed between medication taking and year of
study (P = 0.048), medication sharing and sex (P = 0.003), and medication sharing
and year of study (P = 0.015). Conclusion. There is a high prevalence of
medication consumption, medication sharing, and inappropriate disposal practices
which are influenced by sex and educational status of the university students.
Thus medication use related educational interventions need to be given to
students in general.
DOI: 10.1155/2017/4530183
PMCID: PMC5368397
1074. Niger J Clin Pract. 2015 May-Jun;18(3):371-6. doi: 10.4103/1119-3077.151753.
Medication compliance behavior in psychiatric out-patients with psychoactive

substance use comorbidity in a Nigerian tertiary hospital.
Okpataku CI(1), Kwanashie HO, Ejiofor JI, Olisah VO.
Author information:
(1)Department of Psychiatry, Ahmadu Bello University Teaching Hospital, Zaria,
Nigeria.
BACKGROUND: Psychotropic medication adherence is a major challenge in psychiatric

patients with comorbidity.
OBJECTIVE: The objective was to determine medication adherence behavior among
psychiatric out-patients with psychoactive substance use comorbidity in a
Nigerian Tertiary Hospital.
SETTINGS AND DESIGN: A cross-sectional study of a tertiary hospital in Northern
Nigeria.
METHODS: Adult patients who have been attending the out-patient clinic for at
least 1 year were included. From the routine clinic, each consecutive fourth
patient completed a socio-demographic and drug use questionnaire, a
self-administered medication adherence scale, and a semi-structured proforma
which sought reasons for poor adherence, information on supervision and who keeps
patient medications at home; until a calculated sample of 208 was attained.
STATISTICAL ANALYSIS: Done by means of descriptive statistics using the
Statistical Package for Social Sciences version 16. The level of significance was
set at P < 0.05.
RESULTS: Totally, 208 patients participated in the study. 61 (29.3%) of them were
substance users, out of which 59% never reported missing their medications. No
statistically significant relationship was found between substance use and
medication adherence. A significant proportion of substance users were compliant
with medication use when the drugs were in their possession. For substance users
and nonusers, the major reason for poor drug adherence was the unavailability of
the medications, while nonsubstance users were more likely to complain about
being tired of the medications. No report of side effects in supervised patients.
CONCLUSION: The use of psychoactive substances in patients with other mental
disorders influences their medication adherence behavior.
DOI: 10.4103/1119-3077.151753
1075. Pain. 2015 Jun;156(6):1092-100. doi: 10.1097/j.pain.0000000000000154.

Self-reports of medication side effects and pain-related activity interference in
patients with chronic pain: a longitudinal cohort study.
Martel MO(1), Finan PH, Dolman AJ, Subramanian S, Edwards RR, Wasan AD, Jamison
RN.
Author information:
(1)aDepartment of Anesthesiology, Harvard Medical School, Brigham and Women's
Hospital Pain Management Center, Chestnut Hill, MA, USA bDepartment of Psychiatry
and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore,
MD, USA cDepartment of Social and Behavioral Sciences, Harvard School of Public
Health, Boston, MA, USA dUPMC Pain Medicine, Departments of Anesthesiology and
Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
The primary purpose of this study was to examine the association between
self-reports of medication side effects and pain-related activity interference in
patients with chronic pain. The potential moderators of the association between
reports of side effects and pain-related activity interference were also
examined. A total of 111 patients with chronic musculoskeletal pain were asked to
provide, once a month for a period of 6 months, self-reports of medication use
and the presence of any perceived side effects (eg, nausea, dizziness, headaches)
associated with their medications. At each of these time points, patients were
also asked to provide self-reports of pain intensity, negative affect, and
pain-related activity interference. Multilevel modeling analyses revealed that
month-to-month increases in perceived medication side effects were associated
with heightened pain-related activity interference (P < 0.05). Importantly,
multilevel models revealed that perceived medication side effects were associated
with heightened pain-related activity interference even after controlling for the
influence of patient demographics, pain intensity, and negative affect. This
study provides preliminary evidence that reports of medication side effects are
associated with heightened pain-related activity interference in patients with
chronic pain beyond the influence of other pain-relevant variables. The
implications of our findings for clinical practice and the management of patients
with chronic pain conditions are discussed.
DOI: 10.1097/j.pain.0000000000000154
PMCID: PMC4431924
1076. Eur J Pain. 2018 Jan;22(1):28-38. doi: 10.1002/ejp.1068. Epub 2017 Aug 14.
Efficacy and safety of a fixed-dose combination of ibuprofen and caffeine in the

management of moderate to severe dental pain after third molar extraction.
Weiser T(1), Richter E(2), Hegewisch A(3), Muse DD(4), Lange R(5).
Author information:
(1)Medical Affairs Consumer Health Care, Medical and Regulatory Affairs Germany,
Boehringer Ingelheim Pharma GmbH & Co. KG, Germany.
(2)Corporate Division Medicine, Global Department Biostatistics and Data
Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Germany.
(3)Marketing Self-Medication, Global Department Consumer Health Care Division
Medical and Regulatory Affairs, Boehringer Ingelheim, Promeco S.A. de C.V,
Germany.
(4)Jean Brown Research, Salt Lake City, USA.
(5)Consumer Health Care Development, Medical and Regulatory Affairs, Boehringer
Ingelheim Pharma GmbH & Co. KG, Germany.
BACKGROUND: Ibuprofen is an effective analgesic treatment with a ceiling effect
at doses above 400 mg. This study compared the combination of ibuprofen 400 mg
and caffeine 100 mg with ibuprofen 400 mg monotherapy, caffeine and placebo in
the analgesic treatment of moderate to severe acute dental pain following third
molar extraction.
METHODS: Phase III, active-/placebo-controlled, double-blind, single-centre,
two-stage, parallel-group study in adult patients with at least moderate baseline
pain intensity. Primary endpoint was defined as the time-weighted sum of pain
relief and pain intensity difference over 8 h (SPRID0-8 h), secondary endpoints
included duration of pain relief, time to meaningful pain relief and more.
RESULTS: N = 748 patients were enrolled and N = 562 treated. Mean baseline pain
intensity was 7.7 on a 0-10 numerical rating scale. Analysis of SPRID0-8 h
demonstrated superior analgesic effects for a single dose of ibuprofen/caffeine
versus ibuprofen, caffeine and placebo over 8 h, rescue medication in this stage
was requested by more patients on ibuprofen (32.5%) than on ibuprofen/caffeine
(16.0%). Median time to meaningful pain relief was shorter for ibuprofen/caffeine
(1.13 h) compared with ibuprofen (1.78 h; p = 0.0001). More patients on
ibuprofen/caffeine than on ibuprofen reported meaningful pain relief. Adverse
events were infrequent and mostly mild or moderate across treatment groups.
Tolerability was rated as 'very good' or 'excellent' by most patients in both
treatment groups.
CONCLUSION: This study demonstrated clinically relevant superiority of
ibuprofen/caffeine over monotherapy with ibuprofen in patients with acute dental
pain. All treatments were well tolerated.
SIGNIFICANCE: This trial showed superior efficacy of 400/100 mg
ibuprofen/caffeine, compared to 400 mg ibuprofen alone, for treating acute pain,
reflecting that caffeine is an effective analgesic adjuvant. Data on efficacy of
400 mg ibuprofen combined with caffeine for the treatment of acute pain were not
available yet.
© 2017 The Authors. European Journal of Pain published by John Wiley & Sons Ltd
on behalf of European Pain Federation - EFIC®.
DOI: 10.1002/ejp.1068
PMCID: PMC5763370
1077. J Basic Clin Pharm. 2016 Sep;7(4):105-109. doi: 10.4103/0976-0105.189430.
Evaluation of self-reported medication adherence and its associated factors among

epilepsy patients in Hospital Kuala Lumpur.
Molugulu N(1), Gubbiyappa KS(2), Vasudeva Murthy CR(3), Lumae L(4), Mruthyunjaya
AT(5).
Author information:
(1)Department of Pharmaceutical Technology, School of Pharmacy, Bukit Jalil,
Kuala Lumpur 57000, Malaysia.
(2)Department of Life Sciences, School of Pharmacy, International Medical
University, Bukit Jalil, Kuala Lumpur 57000, Malaysia.
(3)Department of Pathology, School of Medicine, International Medical University,
Bukit Jalil, Kuala Lumpur 57000, Malaysia.
(4)Department of Pharmaceutics, Faculty of Pharmacy, Asia Metropolitan
University, 43200 Cheras, Selangor, Malaysia.
(5)Department of Pharmacy Practice, School of Pharmacy, International Medical
University, Bukit Jalil, Kuala Lumpur 57000, Malaysia.
INTRODUCTION: Reports on medication adherence and its associated factors in
patients with epilepsy in South East Asian countries are lacking. The primary
purpose of this study was to assess the degree of medication adherence and its
relationship with patient's satisfaction, psychosocial factors, quality of life
and mental health in a sample of Malaysian epilepsy patients.
METHODOLOGY: It is a cross-sectional study and was carried out in the outpatient
Neurology Department of Hospital Kuala Lumpur, Malaysia (n=272). Data was
collected by administering the structured questionnaire.
RESULTS AND DISCUSSION: Results showed that 49.3% of the epilepsy patients were
non-adherent to their prescribed regimen. Univariate analysis showed significant
associations between medication adherence and the following factors: race,
seizure frequency, overall patient satisfaction, medication taste and smell,
medication cost and physical appearance, medication effectiveness, complexity of
medication regimen, patient barrier, patient understanding, patient role
functioning, patient positivity, vitality and general interest. Multiple
regression analysis indicated that factors that are influencing medication
adherence are seizure frequency (P = 0.048), overall patient satisfaction (P =
0.043) and patient understanding about their illness (P = 0.001). The model
chosen for testing the relationship between medication adherence and its
associated factors give an R2 value of 25.2% with an adjusted R2 of 21.4%. The F
value was also significant (P = 0.000). Based on the research findings, the
researchers recommends that clinicians need to play a vital role in educating the
patients on their disease conditions. By educating the patients on nature of
epilepsy, different modalities of treatment and benefits of adherence to
treatment will help in the better adherence and management.
DOI: 10.4103/0976-0105.189430
PMCID: PMC5153886
PMID: 27999469
PORTALS: design of an innovative approach to anticoagulation management through

eHealth.
Talboom-Kamp EP(1)(2), Verdijk NA(3)(4), Talboom IJ(5), Harmans LM(4), Numans

ME(3), Chavannes NH(3).
Author information:
(1)Public Health and Primary Care Department, Leiden Universitair Medisch Centrum
(LUMC), P.O. Box 9600, Leiden, 2300 RC, The Netherlands. e.talboom@saltro.nl.
(2)Saltro Diagnostic Centre, P.O. Box 9300, Utrecht, 3506 GH, The Netherlands.
e.talboom@saltro.nl.
(3)Public Health and Primary Care Department, Leiden Universitair Medisch Centrum
(LUMC), P.O. Box 9600, Leiden, 2300 RC, The Netherlands.
(4)Saltro Diagnostic Centre, P.O. Box 9300, Utrecht, 3506 GH, The Netherlands.
(5)Foundation Zorgdraad, Wijnand van Arnhemweg 54, Oosterbeek, 6862XN, The
Netherlands.
BACKGROUND: For the monitoring of International Normalized Ratio (INR) values,

venous thromboembolism (VTE) and atrial fibrillation (AF) patients can visit
anticoagulation clinics, laboratories, or physicians for venous puncture.
Point-of-care testing (POCT) made it possible for patients to monitor INR
themselves (self-monitoring) and even self-adjust their medication dosage
(self-dosage). Both skills are accepted as forms of self-management. eHealth
applications can improve this self-management, resulting in better clinical
outcomes.
METHODS: Our study, called PORTALS, aims at identifying the optimal
implementation strategy of training to improve self-management and explore
factors that enhance good self-management skills. In addition, the relationship
between the implementation strategy of training, clinical outcomes, and
individual characteristics will be investigated. Of the 247 recruited
participants, 110 chose to continue with regular care. 137 patients have been
randomly divided in subgroups and compared using a parallel cohort design: one
group will be trained and educated by e-learning, and the other group will
receive face-to-face group training.
DISCUSSION: More insight in factors that enhance good self-management will help
to improve clinical outcomes and patient satisfaction on anticoagulation therapy.
Our study will provide practical insights and knowledge of eHealth in daily
practice and of the importance of education on the adoption of self-management.
We expect the self-management program including training to help patients to
better manage their own INR values and medication use, thereby increasing health
status and diminishing thromboembolic events and hospitalisation.
TRIAL REGISTRATION: The Netherlands National Trial Register, number NTR3947 .
DOI: 10.1186/s12913-017-2142-2
PMCID: PMC5356357
1079. Breast Cancer (Auckl). 2017 Mar 2;11:1178223417694520. doi:

10.1177/1178223417694520. eCollection 2017.
Predicting Adherence to Aromatase Inhibitor Therapy among Breast Cancer

Survivors: An Application of the Protection Motivation Theory.
Karmakar M(1), Pinto SL(2), Jordan TR(1), Mohamed I(3), Holiday-Goodman M(2).
Author information:
(1)School of Population Health, University of Toledo, Toledo, Ohio, USA.
(2)Department of Pharmacy Practice, University of Toledo, Toledo, Ohio, USA.
(3)Department of Medicine, University of Toledo, Toledo, Ohio, USA.
The purpose of this observational study was to determine if the Protection

Motivation Theory could predict and explain adherence to aromatase inhibitor (AI)
therapy among breast cancer survivors. Purposive sampling was used to identify
288 survivors who had been prescribed AI therapy. A valid and reliable survey was
mailed to survivors. A total of 145 survivors completed the survey. The Morisky
scale was used to measure adherence to AI. The survivors reported a mean score of
6.84 (±0.66) on the scale. Nearly 4 in 10 survivors (38%) were non-adherent.
Adherence differed by age, marital status, insurance status, income, and presence
of co-morbid conditions. Self-efficacy (r=0.485), protection motivation
(r=0.310), and Response Efficacy (r=0.206) were positively and significantly
correlated with adherence. Response Cost (r=-0.235) was negatively correlated
with adherence. The coping appraisal constructs were statistically significant
predictors medication adherence (β=0.437) with self-efficacy being the strongest
significant predictor of adherence (β = 0.429).
DOI: 10.1177/1178223417694520
PMCID: PMC5391055
PMID: 28469437
Conflict of interest statement: DECLARATION OF CONFLICTING INTERESTS: The

1080. Trials. 2019 Jun 18;20(1):364. doi: 10.1186/s13063-019-3435-z.
Holistic care program for elderly patients to integrate spiritual needs, social
activity, and self-care into disease management in primary care (HoPES3): study
protocol for a cluster-randomized trial.
Straßner C(1), Frick E(2), Stotz-Ingenlath G(2), Buhlinger-Göpfarth N(3),

Szecsenyi J(3), Krisam J(4), Schalhorn F(5), Valentini J(5), Stolz R(5), Joos
S(5).
Author information:
Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
cornelia.strassner@med.uni-heidelberg.de.
(2)Department of Psychosomatic Medicine and Psychotherapy, Research Center
Spiritual Care, Technical University of Munich, Langerstr. 3, 81675, München,
Germany.
Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
(4)Department for Medical Biometry, Institute for Medical Biometry and
Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120,
(5)Institute of General Practice and Interprofessional Care, University Hospital
Tübingen, Osianderstr. 5, 72076, Tübingen, Germany.
BACKGROUND: Strategies to improve the care of elderly, multimorbid patients

frequently focus on implementing evidence-based knowledge by structured
assessments and standardization of care. In Germany, disease management programs
(DMPs), for example, are run by general practitioners (GPs) for this purpose.
While the importance of such measures is undeniable, there is a risk of ignoring
other dimensions of care which are essential, especially for elderly patients:
their spiritual needs and personal resources, loneliness and social integration,
and self-care (i.e., the ability of patients to do something on their own except
taking medications to increase their well-being). The aim of this study is to
explore whether combining DMPs with interventions to address these dimensions is
feasible and has any impact on relevant outcomes in elderly patients with
polypharmacy.
METHODS: An explorative, cluster-randomized controlled trial with general
practices as the unit of randomization will be conducted and accompanied by a
process evaluation. Patients aged 70 years or older with at least three chronic
conditions receiving at least three medications participating in at least one DMP
will be included. The control group will receive DMP as usual. In the
intervention group, GPs will conduct a spiritual needs assessment during the
routinely planned DMP appointments and explore whether the patient has a need for
more social contact or self-care. To enable GPs to react to such needs, several
aids will be provided by the study: a) training of GPs in spiritual needs
assessment and training of medical assistants in patient counseling regarding
self-care and social activity; b) access to a summary of regional social offers
for seniors; and c) information leaflets on nonpharmacological interventions
(e.g., home remedies) to be applied by patients themselves to reduce frequent
symptoms in old age. The primary outcome is health-related self-efficacy (using
the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES-6G)). Secondary
outcomes are general self-efficacy (using the General Self-Efficacy Scale
(GSES)), physical and mental health (using the Short-Form Health Survey (SF-12)),
patient activation (using the Patient Activation Measure (PAM)), medication
adherence (using the Medication Adherence Report Scale (MARS)), beliefs in
medicine (using the Beliefs About Medicines Questionnaire (BMQ)), satisfaction
with GP care (using selected items of the European Project on Patient Evaluation
of General Practice (EUROPEP)), social contacts (using the 6-item Lubben Social
Network Scale (LSNS-6)), and loneliness (using the 11-item De-Jong-Gierveld
Loneliness Scale (DJGS-11)). Interviews will be conducted to assess the
mechanisms, feasibility, and acceptability of the interventions.
DISCUSSION: If the interventions prove to be effective and feasible, large-scale
implementation should be sought and evaluated by a confirmatory design.
TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00015696 .
Registered on 22 January 2019.
DOI: 10.1186/s13063-019-3435-z
PMCID: PMC6582494
PMID: 31215468
1081. J Res Pharm Pract. 2016 Jul-Sep;5(3):149-54. doi: 10.4103/2279-042X.185706.
Prescription to over-the-counter switches in the United States.
Chang J(1), Lizer A(2), Patel I(3), Bhatia D(4), Tan X(5), Balkrishnan R(6).
Author information:
(1)Humana - Comprehensive Health Insights, Louisville, USA.
(2)Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, USA.
(3)Department of Biopharmaceutical Sciences, Shenandoah University, Winchester,
USA.
(4)Department of Pharmacogenomics, Shenandoah University, Ashburn, USA.
(5)Department of Pharmaceutical Systems and Policy, West Virginia University,
Morgantown, USA.
(6)Department of Public Health Sciences, University of Virginia, Charlottsville,
USA.
As the role of the pharmacist becomes more patient and counseling-centered, the
healthcare market is changing to keep pace with more modern needs, such as
self-treatment. Self-treatment provides patients the ability to diagnose their
own condition and pick an appropriate medication from the pharmacy to treat their
symptoms. This process allows a certain freedom for consumers to actively engage
in their own health. In order for patients to self-treat, access to
over-the-counter (OTC) medication is of prime importance. Many medications that
are available as OTC today were previously labeled as prescription medications.
As more safety studies and trials are conducted for different drugs, they can be
deemed appropriate for use without a prescription. This review study discusses
the process of switching of prescription medications to OTC medications in the
United States and the implications of switching on patients, practitioners, drug
makers, and insurers.
DOI: 10.4103/2279-042X.185706
PMCID: PMC4966231
PMID: 27512703
1082. J Assoc Nurses AIDS Care. 2014 Nov-Dec;25(6):646-51. doi:

10.1016/j.jana.2014.06.002. Epub 2014 Jul 16.
Real-time medication adherence monitoring intervention: test of concept in people

living with HIV infection.
Pellowski JA, Kalichman SC, White D, Amaral CM, Hoyt G, Kalichman MO.
DOI: 10.1016/j.jana.2014.06.002
PMCID: PMC4194222
1083. Niger J Clin Pract. 2019 May;22(5):692-700. doi: 10.4103/njcp.njcp_569_18.
Knowledge and practice assessment, and self reported barriers to guideline based
asthma management among doctors in Nigeria.
Ozoh OB(1), Ndukwu CI(2), Desalu OO(3), Adeyeye OO(4), Adeniyi B(5).
Author information:
(1)Department of Medicine, College of Medicine, University of Lagos, Lagos State,
Nigeria.
(2)Department of Paediatrics, Faculty of Medicine, Nnamdi Azikiwe University,
Awka, Nigeria.
(3)Department of Medicine, College of Medicine, University of Ilorin, Kwara
State, Nigeria.
(4)Department of Medicine, Lagos State University College of Medicine, Lagos
State, Nigeria.
(5)Department of Medicine, Federal Medical Center, Owo, Osun State, Nigeria.
Background and Objective: Doctors' knowledge contributes to practice and quality

of care rendered to patients. To assess the knowledge and practice assessment and
self reported barriers to guideline-based management among doctors.
Subjects and Methods: This was a cross-sectional study among doctors from various
part of the country attending a continuing medical education (CME) program in
Lagos, Nigeria. We used a self-administered, pretested, semistructured, validated
questionnaire based on the Global Initiative for Asthma (GINA) guideline.
Results: Of the 98 participants, 41 (42%) and 18 (18.4%) had good level of asthma
knowledge and practice, respectively. There was no relationship between level of
knowledge and practice and the level of knowledge was not associated with the
practice (X2 = 6.56, P = 0.16). The most reported barriers to good
guideline-based practice were the unavailability of diagnostic and treatment
facilities (44.3%), poor medication adherence (25.7%), and high cost of asthma
medications (18.6%).
Conclusion: The level of asthma knowledge and practice, respectively, among
doctors in Nigeria is low and there is no relationship between level of knowledge
and practice. Unavailability of diagnostic and treatment facilities, poor
medication adherence, and high cost of medications are important barriers to good
practice. There is a need to improve asthma education among doctors in Nigeria.
Addressing barriers to good practice is essential for the translation of
knowledge into practice.
DOI: 10.4103/njcp.njcp_569_18
1084. Rev Bras Enferm. 2019 Jan-Feb;72(1):102-110. doi: 10.1590/0034-7167-2016-

0500.
Living under treatment for Systemic Hypertension and Diabetes Mellitus: Feelings
and behaviors.

Pereira NPA(1), Lanza FM(2), Viegas SMDF(2).
Author information:
(1)Prefeitura de Matozinhos. Matozinhos, Minas Gerais, Brazil.
(2)Universidade Federal de São João Del-Rei. Divinópolis, Minas Gerais, Brazil.
OBJECTIVE: To understand the feelings and behaviors of people being treated for
Systemic Hypertension (SH) and Diabetes Mellitus (DM).
METHOD: A qualitative study based on Grounded Theory and Symbolic Interactionism,
with 27 participants in treatment for SH and DM followed up by the Family Health
Strategy team. Open, axial and selective coding was performed, giving rise to
three theoretical categories and the central category.
RESULTS: The daily life is explicit in the (lack of)care of the self with the
chronic disease and feelings of sadness and anxiety are expressed as reasons for
the lack of control of the disease. It points out that people take care of
themselves because of fear of complications, reinforced the need for guidance on
the use of medication and the empowerment of the chronic patient for self-care
and care for the other.
FINAL CONSIDERATIONS: Knowing behaviors and feelings of people with SH and/or DM
allows a professional performance beyond the chronic condition.
DOI: 10.1590/0034-7167-2016-0500

eCollection 2015.
Development and evaluation of the Measure of Drug Self-Management.
Bailey SC(1), Annis IE(1), Reuland DS(2), Locklear AD(1), Sleath BL(1), Wolf
MS(3).
Author information:
(1)Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy,
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
(2)Department of Medicine, Division of General Internal Medicine and Clinical
Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
BACKGROUND: Current adherence scales often fail to assess the full spectrum of
behaviors associated with safe and appropriate drug use and may be unsuitable for
patients with limited health literacy. We sought to develop and evaluate a
comprehensive yet brief Measure of Drug Self-Management (MeDS) for use in
research and clinical settings among diverse patient groups.
METHODS: Expert opinion, literature reviews, and interviews with patients and
providers were utilized to create and revise potential items. Item performance
testing was then conducted among 193 adult English-speaking patients with
hypertension and diabetes. Factor analysis was used to inform item selection.
Reliability was assessed via calculations of internal consistency. To assess
construct and predictive validity, MeDS scores were compared with scores from the
8-item Morisky Medication Adherence Scale and relevant clinical measures (HbA1c,
blood pressure, and low-density lipoprotein cholesterol).
RESULTS: The MeDS demonstrated adequate internal consistency with a Cronbach's α
of 0.72. The MeDS was significantly correlated with the Morisky Medication
Adherence Scale (r= -0.62; P<0.001). The MeDS was also associated with clinical
measures, with statistically significant correlations found between MeDS scores
and low-density lipoprotein cholesterol (r= -0.27, P≤0.001) and diastolic blood
pressure (r= -0.18, P=0.01).
CONCLUSION: The MeDS seems to be a valid and reliable tool that can be used to
assess medication self-management skills among diverse patients, including those
with limited literacy skills. Future studies are needed to test the tool in
actual use and explore clinical applications.
DOI: 10.2147/PPA.S85411
PMCID: PMC4527367
PMID: 26257515
1086. BMJ Open. 2016 Mar 22;6(3):e009161. doi: 10.1136/bmjopen-2015-009161.
Cohort profile of the UK Biobank: diagnosis and characteristics of

cerebrovascular disease.
Hewitt J(1), Walters M(2), Padmanabhan S(2), Dawson J(2).
Author information:
(1)Department of Geriatric Medicine, Division of Population Medicine, Cardiff
University, Cardiff, UK Institute of Cardiovascular and Medical Sciences, College
of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
(2)Institute of Cardiovascular and Medical Sciences, College of Medical,
Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
PURPOSE: The UK Biobank is a large-scale biomedical resource, containing

sociodemographic and medical information, including data on a previous diagnosis
of stroke or transient ischaemic attack (TIA). We described these participants
and their medication usage.
PARTICIPANTS: We identified participants who either self-reported or were
identified from a nurse-led interview, having suffered a stroke or a TIA and
compared them against participants without stroke ort TIA. We assessed their risk
factor burden (sex, age, deprivation, waist to hip ratio (WHR), hypertension,
smoking, alcohol intake, diabetes, physical exercise and oral contraception use
(oral contraceptive pill, OCP)) and medication usage.
FINDINGS TO DATE: We studied 502,650 people (54.41% women), 6669 (1.23%)
participants self-reported a stroke. The nurse-led interview identified 7669
(1.53%) people with stroke and 1781 (0.35%) with TIA. Hypertension, smoking,
higher WHR, lower alcohol consumption and diabetes were all more common in people
with cerebrovascular disease (p<0.0001 for each). Women with cerebrovascular
disease were less likely to have taken the OCP (p=0.0002). People with
cerebrovascular disease did more exercise (p=0.03). Antithrombotic medication was
taken by 81% of people with stroke (both self-report and nurse-led responders)
and 89% with TIA. For self-reported stroke, 63% were taking antithrombotic and
cholesterol medications, 54% taking antithrombotic and antihypertensive
medications and 46% taking all 3. For the nurse-led interview and TIA, these
figures were 65%, 54% and 46%, and 70%, 53% and 45%, respectively.
FUTURE PLANS: The UK Biobank provides a large, generalisable and contemporary
data source in a young population. The characterisation of the UK Biobank cohort
with cerebrovascular disease will form the basis for ongoing research using this
data source.
DOI: 10.1136/bmjopen-2015-009161
PMCID: PMC4809076
1087. Psychiatr Serv. 2016 Jul 1;67(7):803-6. doi: 10.1176/appi.ps.201400568. Epub
2016
Feb 14.
Predictors of Pharmacy-Based Measurement and Self-Report of Antidepressant

Adherence: Are Individuals Overestimating Adherence?
Leggett A(1), Ganoczy D(1), Zivin K(1), Valenstein M(1).
Author information:
(1)Dr. Leggett, Dr. Zivin, and Dr. Valenstein are with the Department of
Psychiatry, University of Michigan Medical School, Ann Arbor (e-mail:
leggetta@med.umich.edu ). Dr. Zivin and Dr. Valenstein are also with the Center
for Clinical Management Research, U.S. Department of Veterans Affairs, Ann Arbor,
Michigan, where Ms. Ganoczy is affiliated.
OBJECTIVE: This study considered various factors as predictors of antidepressant

adherence over time as assessed by self-report and medication possession ratios
(MPRs) derived from administrative pharmacy data.
METHODS: Adherence was assessed at six and 12 months among 443 veterans in
ongoing treatment for depression in a trial of peer support. Logistic regression
models were utilized to consider predictors of adequate adherence.
RESULTS: At six and 12 months, respectively, 36% and 35% of patients had poor
adherence on the basis of MPRs and 24% and 18% had poor adherence on the basis of
self-report. MPRs indicating poor adherence were more likely among men, members
of racial groups other than white, and patients with Hispanic ethnicity. Poor
self-reported adherence was associated with increased depressive symptoms and
unemployment.
CONCLUSIONS: These adherence measures may be complementary. Strategies to improve
adherence might target specific demographic groups, unemployed persons, and
persons with higher levels of depressive symptoms.
DOI: 10.1176/appi.ps.201400568
PMCID: PMC5796766
1088. J Am Soc Hypertens. 2017 Sep;11(9):581-588.e5. doi:

10.1016/j.jash.2017.06.011.
Epub 2017 Jul 6.
Adherence to antihypertensive medications and associations with blood pressure

among African Americans with hypertension in the Jackson Heart Study.
Butler MJ(1), Tanner RM(2), Muntner P(2), Shimbo D(3), Bress AP(4), Shallcross
AJ(5), Sims M(6), Ogedegbe G(5), Spruill TM(5).
Author information:
(1)Department of Population Health, NYU School of Medicine, New York, NY, USA.
Electronic address: mark.butler@nyumc.org.
AL, USA.
(3)Department of Medicine, Columbia University Medical Center, New York, NY, USA.
(4)Department of Population Health Sciences, University of Utah, Salt Lake City,
UT, USA.
(5)Department of Population Health, NYU School of Medicine, New York, NY, USA.
(6)Department of Medicine, University of Mississippi Medical Center, Jackson, MS,
USA.
The purpose of this study was to test the association between a self-report
measure of 24-hour adherence to antihypertensive medication and blood pressure
(BP) among African Americans. The primary analysis included 3558 Jackson Heart
Study participants taking antihypertensive medication who had adherence data for
at least one study examination. Nonadherence was defined by self-report of not
taking one or more prescribed antihypertensive medications, identified during
pill bottle review, in the past 24 hours. Nonadherence and clinic BP were
assessed at Exam 1 (2000-2004), Exam 2 (2005-2008), and Exam 3 (2009-2013).
Associations of nonadherence with clinic BP and uncontrolled BP (systolic
BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg) were evaluated using unadjusted and
adjusted linear and Poisson repeated measures regression models. The prevalence
of nonadherence to antihypertensive medications was 25.4% at Exam 1, 28.7% at
Exam 2, and 28.5% at Exam 3. Nonadherence was associated with higher systolic BP
(3.38 mm Hg) and diastolic BP (1.47 mm Hg) in fully adjusted repeated measures
analysis. Nonadherence was also associated with uncontrolled BP (prevalence
ratio = 1.26; 95% confidence interval = 1.16-1.37). This new self-report measure
may be useful for identifying nonadherence to antihypertensive medication in
future epidemiologic studies.
Copyright © 2017 American Society of Hypertension. Published by Elsevier Inc. All

rights reserved.
DOI: 10.1016/j.jash.2017.06.011
PMCID: PMC5603252
1089. J Gen Fam Med. 2018 Nov 20;20(1):19-24. doi: 10.1002/jgf2.219. eCollection
2019
Jan.
The association between physician's affiliation and patients' adherence to their

antihypertensive medication and pharmaceutical knowledge.
Matsumura S(1)(2), Watanabe K(3), Fukuhara S(4).
Author information:
(1)Matsumura Clinic Tokyo Japan.
(2)Department of Clinical Epidemiology National Hospital Organization Tokyo
Medical Center Tokyo Japan.
(3)Center for Education & Research on Clinical Pharmacy Showa Pharmaceutical
University Tokyo Japan.
(4)Department of Healthcare Epidemiology , Graduate School of Medicine and Public
Health Kyoto University Kyoto Japan.
Background: The aim of this study was to examine whether or not the type of
physician is associated with the knowledge of and adherence to hypertensive
medication among patients.
Methods: The study was a self-administered questionnaire survey among patients
who submitted their prescriptions for antihypertensive drugs to 13 pharmacies in
Japan in 2006. We compared patients' knowledge of their medications and the
self-reported adherence according to the type of physician.
Results: A total of 736 patients were surveyed, and 687 (362 from clinics and 325
from hospitals) were analyzed. In total, 51.8% of the patients correctly named
their antihypertensive medicine, with no significant differences observed between
clinics and hospitals (51.4% in clinics vs 52.3% in hospitals; P = 0.81, adjusted
odds ratio (OR) to the hospital: 0.736, 95% confidence interval [CI]: 0.50-1.08).
Significant differences were not observed in the knowledge of the frequency with
which hypertensive medication was supposed to be taken (47.2% in clinics vs 46.5%
in hospitals; P = 0.84, adjusted OR: 0.80, 95% CI: 0.55-1.16), nor observed in
the knowledge of the side effects of the medication (53.2% in clinics vs 51.0% in
hospitals; P = 0.57, adjusted OR: 1.14, 95% CI: 0.78-1.68). No significant
difference was observed in self-reported adherence (75.1% in clinics vs 77.7% in
hospitals; P = 0.42, adjusted OR: 0.73, 95% CI: 0.46-1.16).
Conclusions: About 75% answered that they were taking their medication as
instructed. No significant differences were observed in responses based on the
physician's affiliation. Further studies are needed to achieve better patient's
adherence and pharmaceutical knowledge.
DOI: 10.1002/jgf2.219
PMCID: PMC6321828
PMID: 30631655
An Improved Comprehensive Medication Review Process to Assess Healthcare Outcomes

in a Rural Independent Community Pharmacy.
Twigg G(1), David T(2), Taylor J(3).
Author information:
(1)Apple Discount Drugs, Salisbury, MD 21804, USA. geoff@appledrugs.com.
(2)School of Pharmacy, University of Maryland Eastern Shore, Princess Anne, MD
21853, USA. tdavid@umes.edu.
(3)School of Pharmacy, University of Maryland Eastern Shore, Princess Anne, MD
21853, USA. jtaylor4@umes.edu.
For years many pharmacists have been performing 'brown bag' medication reviews
for patients. While most pharmacists and student pharmacists are familiar with
this process, it is important to determine the value patients receive from this
service. Over the course of this study the authors attempted to modernize the
medication reconciliation process and collect data on patient prescription drug
and over-the-counter drug use, along with quantifying the types of interventions
the pharmacy's clinical staff performed for patients during this process. The
pharmacy partnered with a Quality Improvement Organization to trial their Blue
Bag Intervention (BBI) program. The BBI program offered several additional
services to the traditional brown bag review. The BBI was instituted as a
follow-up tool in the pharmacy's diabetes self-management education/training
clinic to aid in patient follow-up and help the clinical staff identify
medication-related events such as medication adherence issues and drug-drug
interactions. The clinical staff identified approximately 2.2 events per patient
with over 50% being issues that affected patient safety.
DOI: 10.3390/pharmacy7020066
PMCID: PMC6631051
PMID: 31212922
1091. Reprod Health. 2017 Sep 6;14(1):110. doi: 10.1186/s12978-017-0374-6.
Relationship between self-efficacy and patient knowledge on adherence to oral

contraceptives using the Morisky Medication Adherence Scale (MMAS-8).
Tomaszewski D(1), Aronson BD(2), Kading M(3), Morisky D(4).

Author information:
(1)Chapman University School of Pharmacy, 9401 Jeronimo Rd, Irvine, California,
92618, USA.
(2)Ohio Northern University Raabe College of Pharmacy, 525 S Main St, Ada, OH,
45810, USA. b-aronson.1@onu.edu.
(3)College of Pharmacy, University of Minnesota, 232 Life Sciences, 1110 Kirby
Dr, Duluth, MN, 55812, USA.
(4)UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, 16-035
Center for Health Sciences, Los Angeles, CA, 90095-1772, USA.
BACKGROUND: Preconception care, including family planning, is a vital component

of healthcare for women of reproductive age. An average female spends the
majority of her reproductive life trying to prevent a pregnancy. In order to
prevent unintended pregnancy, women often rely on the use of hormonal
contraceptives. In the United States, the majority of hormonal contraceptive
users are prescribed oral contraceptive pills (OCPs). Reduced adherence to OCPs
decreases their ability to prevent pregnancy. The study aimed to measure OCP
adherence among female college students, and explore the relationship between OCP
adherence, knowledge, and self-efficacy.
METHODS: This cross-sectional study recruited a random sample of female college
students to participate in an online survey. OCP adherence was based on the
8-item Morisky Medication Adherence Scale (MMAS-8). Secondary reporting of
medication adherence included participant reports of the number of missed OCP
doses in the previous month and typical month of use.
RESULTS: Of the 5000 invited, 1559 (31.3%) completed the survey. Of those
responding, 670 (41.3%) reported use of OCPs. A total of 293 (44.3%) OCP users
met criteria for low adherence, 241 (36.4%) met criteria for medium adherence,
and 128 (19.3%) met criteria for high adherence. Those with high adherence had
higher self-efficacy (P < 0.001) and perceived knowledge (p < 0.001). After
controlling for other factors, self-efficacy (b = .37) and perceived knowledge
(b = .09) remained associated with OCP adherence.
CONCLUSION: Less than 20% of respondents met the criteria for high adherence to
OCPs. Self-efficacy and knowledge were associated with higher OCP adherence.
Targeted interventions from healthcare providers, health educators, and other
adherence related media to increase the knowledge and self-efficacy of patients
using OCPs may improve adherence rates. Additional research is needed to evaluate
the impact of innovative interventions focused on social and behavioral patient
factors, like knowledge and self-efficacy, on adherence to OCPs.
DOI: 10.1186/s12978-017-0374-6
PMCID: PMC5585984

Oct
26.
HBA1C Control Predictive Validity of Four Self-Reported Measures of Antidiabetes

Zongo A(1), Guenette L(1), Moisan J(1), Gregoire JP(1).
Author information:
(1)Laval University Faculty of Pharmacy, Québec, QC, Canada.
DOI: 10.1016/j.jval.2014.08.079
PMID: 27202609
1093. Rev Bras Enferm. 2018 Nov-Dec;71(6):3006-3012. doi: 10.1590/0034-7167-2018-
0087.
Association between follow-up in health services and antihypertensive medication

adherence.
Albuquerque NLS(1), Oliveira ASS(1), Silva JMD(1), Araújo TL(1).
Author information:
(1)Universidade Federal do Ceará. Fortaleza, Ceará, Brazil.
OBJECTIVE: To analyze the association between the characteristics of follow-up in

health services and adherence to antihypertensive medication in patients with
cardiovascular disease.
METHOD: Analytical study carried out with 270 patients suffering from
hypertension and hospitalized due to cardiovascular complications. Data
collection occurred between November 2015 and April 2016, involving
sociodemographic variables, presence of self-reported diabetes, accessibility and
use of health services, blood pressure levels and medication adherence (analyzed
through the Morisky-Green Test).
RESULTS: The rate of adherence to antihypertensive therapy was 63.0%. Enrollment
in the Hiperdia program had no statistical significance to medication adherence.
People who attended at least between 4 and 6 nursing consultations throughout the
data collection period (p = 0.02) had better adherence.
CONCLUSION: The study's findings provide support for the reorientation of health
services and their public policies towards improving adherence to
antihypertensive therapeutics.
DOI: 10.1590/0034-7167-2018-0087
Drug-Associated Risk Tool: development and validation of a self-assessment

questionnaire to screen for hospitalised patients at risk for drug-related
problems.
Kaufmann CP(#)(1), Stämpfli D(#)(1), Mory N(1), Hersberger KE(1), Lampert

ML(1)(2).
Author information:
(2)Institute of Hospital Pharmacy, Solothurner Spitäler, Olten, Switzerland.
INTRODUCTION: Identifying patients with a high risk for drug-related problems

(DRPs) might optimise the allocation of targeted pharmaceutical care during the
hospital stay and on discharge.
OBJECTIVE: To develop a self-assessment screening tool to identify patients at
risk for DRPs and validate the tool regarding feasibility, acceptability and the
reliability of the patients' answers.
DESIGN: Prospective validation study.
SETTING: Two mid-sized hospitals (300-400 beds).
PARTICIPANTS: 195 patients, exclusion criteria: under 18 years old, patients with
a health status not allowing a meaningful communication (eg, delirium, acute
psychosis, advanced dementia, aphasia, clouded consciousness state), palliative
or terminally ill patients.
METHODS: Twenty-seven risk factors for the development of DRPs, identified in a
previous study, provided the basis of the self-assessment questionnaire, the
Drug-Associated Risk Tool (DART). Consenting patients filled in DART, and we
compared their answers with objective patient data from medical records and
laboratory data.
RESULTS: One hundred and sixty-four patients filled in DART V.1.0 in an average
time of 7 min. After a first validation, we identified statements with a low
sensitivity and revised the wording of the questions related to heart
insufficiency, renal impairment or liver impairment. The revised DART (V.2.0) was
validated in 31 patients presenting heart insufficiency, renal impairment or
liver impairment as comorbidity and reached an average specificity of 88% (range
27-100) and an average sensitivity of 67% (range 21-100).
CONCLUSIONS: DART showed a satisfying feasibility and reliability. The
specificity of the statements was mostly high. The sensitivity varied and was
higher in statements concerning diseases that require regular disease control and
attention to self-care and drug management. Asking patients about their
conditions, medications and related problems can facilitate getting a first,
broad picture of the risk for DRPs and possible pharmaceutical needs.
DOI: 10.1136/bmjopen-2017-016610
PMCID: PMC5855403
1095. Diabetes Educ. 2014 Nov-Dec;40(6):806-19. doi: 10.1177/0145721714551992. Epub

2014 Oct 2.
How do mobile phone diabetes programs drive behavior change? Evidence from a
mixed methods observational cohort study.
Nundy S(1)(2), Mishra A(1), Hogan P(1), Lee SM(3), Solomon MC(4), Peek
ME(3)(5)(6).
Author information:
(1)Department of Medicine, University of Chicago Medical Center, Chicago,
Illinois (Dr Nundy, Ms Mishra, Mr Hogan, Dr Peek)
(2)Chicago Center for Diabetes Translation Research, Chicago, Illinois (Dr Nundy,
Dr Peek)
(3)Department of Health Studies, University of Chicago, Chicago, Illinois (Dr
Lee)
(4)Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
(Ms Solomon)
(5)Center for Health and Social Sciences, University of Chicago, Chicago,
Illinois (Dr Peek)
(6)Center for the Study of Race, Politics and Culture, University of Chicago,
Chicago, Illinois (Dr Peek)
PURPOSE: The purpose of this study was to investigate the behavioral effects of a
theory-driven, mobile phone-based intervention that combines automated text
messaging and remote nursing, using an automated, interactive text messaging
system.
METHODS: This was a mixed methods observational cohort study. Study participants
were members of the University of Chicago Health Plan (UCHP) who largely reside
in a working-class, urban African American community. Surveys were conducted at
baseline, 3 months (mid-intervention), and 6 months (postintervention) to test
the hypothesis that the intervention would be associated with improvements in
self-efficacy, social support, health beliefs, and self-care. In addition,
in-depth individual interviews were conducted with 14 participants and then
analyzed using the constant comparative method to identify new behavioral
constructs affected by the intervention.
RESULTS: The intervention was associated with improvements in 5 of 6 domains of
self-care (medication taking, glucose monitoring, foot care, exercise, and
healthy eating) and improvements in 1 or more measures of self-efficacy, social
support, and health beliefs (perceived control). Qualitatively, participants
reported that knowledge, attitudes, and ownership were also affected by the
program. Together these findings were used to construct a new behavioral model.
CONCLUSIONS: This study's findings challenge the prevailing assumption that
mobile phones largely affect behavior change through reminders and support the
idea that behaviorally driven mobile health interventions can address multiple
behavioral pathways associated with sustained behavior change.
© 2014 The Author(s).
DOI: 10.1177/0145721714551992
PMCID: PMC4492449
1096. MedEdPORTAL. 2016 Dec 23;12:10519. doi: 10.15766/mep_2374-8265.10519.
Medication History Lab and Assessment using the Medication Mysteries Infinite
Case Tool.
Sando KR(1), Doty R(1), Elliott J(2), Stanton ML(3).
Author information:
(1)Clinical Assistant Professor, Department of Pharmacotherapy and Translational
Research, University of Florida College of Pharmacy.
(2)Assistant Professor, Department of Pharmacy Practice, Philadelphia College of
Osteopathic Medicine.
(3)Laboratory Facilitator, Department of Pharmacotherapy and Translational
Research, University of Florida College of Pharmacy.
Introduction: Teaching medication history taking or medication reconciliation to

students requires practice for students to achieve competency. Practice makes
students more confident with the process, but multiple practice opportunities
require multiple cases, and creating these new cases can be a tedious and
time-consuming process.
Methods: The Medication Mysteries Infinite Case Tool was designed to produce
random patient cases using game-like features to allow students to practice
medication history taking and medication reconciliation without the need to use
and train standardized patients. The tool was created using a random draw
card-based system to determine patient personality attributes, drugs they are
taking, and confusions they have about their drug-taking behavior. This tool is
used in a lab dedicated for the purpose of practicing medication history taking
with students being assessed via simulation with standardized patients. This tool
is currently used at the University of Florida College of Pharmacy as part of a
training program for first-year pharmacy students.
Results: Since 2011, seven classes of first- and second-year pharmacy students
have participated in this lab. Each year's class contained an average of 280
students divided into lab groups of 18-24 students. In our initial offering of
the lab and assessment, 200 students on three campuses completed the individual
assessments following the laboratory session. Fifty-eight percent achieved
excellence, and 39% achieved competence on the individual assessment. Only 3%
were assessed as being deficient on their performance and were required to repeat
the assessment. Overall, 86.8% agreed or strongly agreed that the MMICT was an
excellent way to experience how to reconcile medication.
Discussion: Students enjoy the practice and become proficient with the skills
they learn through this process as evidenced by increased self-efficacy and
achieved competence on a standardized assessment. The tool and the research
associated with the outcome were awarded with the 2012 American Association of
Colleges of Pharmacy Innovations in Teaching Award.
DOI: 10.15766/mep_2374-8265.10519
PMCID: PMC6440429
PMID: 30984861
Conflict of interest statement: None to report.
1097. Qual Manag Health Care. 2016 Jan-Mar;25(1):13-21. doi:

10.1097/QMH.0000000000000079.
Relationship Between Patients' Perceptions of Care Quality and Health Care Errors
in 11 Countries: A Secondary Data Analysis.
Hincapie AL(1), Slack M, Malone DC, MacKinnon NJ, Warholak TL.
Author information:
(1)James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati,
Ohio (Drs Hincapie and MacKinnon); and College of Pharmacy, University of
Arizona, Tucson (Drs Slack, Malone, and Warholak).
Patients may be the most reliable reporters of some aspects of the health care
process; their perspectives should be considered when pursuing changes to improve
patient safety. The authors evaluated the association between patients' perceived
health care quality and self-reported medical, medication, and laboratory errors
in a multinational sample. The analysis was conducted using the 2010 Commonwealth
Fund International Health Policy Survey, a multinational consumer survey
conducted in 11 countries. Quality of care was measured by a multifaceted
construct developed using Rasch techniques. After adjusting for potentially
important confounding variables, an increase in respondents' perceptions of care
coordination decreased the odds of self-reporting medical errors, medication
errors, and laboratory errors (P < .001). As health care stakeholders continue to
search for initiatives that improve care experiences and outcomes, this study's
results emphasize the importance of guaranteeing integrated care.
DOI: 10.1097/QMH.0000000000000079
PMCID: PMC4721215
1098. Iran Red Crescent Med J. 2016 Apr 30;18(5):e25183. doi: 10.5812/ircmj.25183.
eCollection 2016 May.
The Effectiveness of Mobile Phone Text Messaging in Improving Medication

Adherence for Patients with Chronic Diseases: A Systematic Review.
Ershad Sarabi R(1), Sadoughi F(1), Jamshidi Orak R(1), Bahaadinbeigy K(2).
Author information:
(1)Health Information Management Department, School of Management and Medical
Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran.
(2)Medical Informatics Research Center, Institute of Futures Studies in Health,
Kerman University of Medical Sciences, Kerman, IR Iran.
CONTEXT: Medication non-adherence is a commonly observed problem in the

self-administration of treatment, regardless of the disease type. Text messaging
reminders, as electronic reminders, provide an opportunity to improve medication
adherence. In this study, we aimed to provide evidence addressing the question of
whether text message reminders were effective in improving patients' adherence to
medication.
EVIDENCE ACQUISITION: We carried out a systematic literature search, using the
five electronic bibliographic databases: PubMed, Embase, PsycINFO, CINAHL, and
the Cochrane central register of controlled trials. Studies were included on the
basis of whether they examined the benefits and effects of short-message service
(SMS) interventions on medication adherence.
RESULTS: The results of this systematic review indicated that text messaging
interventions have improved patients' medication adherence rate (85%, 29.34).
Included in the review, those who had problems with adherence, or those whom text
messaging was most helpful had HIV, asthma, diabetes, schizophrenia and heart
disease (73.5%). The period of intervention varied from 1 week to 14 months. The
most common study design was randomized controlled trials (RCTs) (66%) carried
out in the developed countries.
CONCLUSIONS: This study demonstrated the potential of mobile phone text messaging
for medication non-adherence problem solving.
DOI: 10.5812/ircmj.25183
PMCID: PMC4939231
PMID: 27437126
1099. Front Pharmacol. 2019 Mar 1;10:168. doi: 10.3389/fphar.2019.00168.

eCollection
2019.
Self-Reported Medication Adherence Measured With Morisky Medication Adherence

Scales and Its Determinants in Hypertensive Patients Aged ≥60 Years: A Systematic
Review and Meta-Analysis.
Uchmanowicz B(1), Jankowska EA(2), Uchmanowicz I(1), Morisky DE(3).
Author information:
(1)Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical
(2)Cardiology Department, Centre for Heart Diseases, Military Hospital, Wroclaw,
Poland.
Health, Los Angeles, CA, United States.
Background: The aim of this systematic review and meta-analysis was to estimate
medication adherence in hypertensive patients aged ≥60 years and to explore
potential determinants of adherence with antihypertensive treatment in this age
group. Methods: A systematic search of the PubMed, Scopus, and Google Scholar
using the Cochrane guidelines was performed. The analysis included articles
published between 1 January 2000 and 30 June 2018. The patients were considered
adherent if they scored ≥6 pts. on the Morisky Medication Adherence Scale
(MMAS-8) or ≥3 pts. on the Morisky Green Levine Medication Adherence Scale (MGL).
If available, also odds ratios (OR) with 95% confidence intervals (95% CI) for
determinants of medication adherence were recorded. Results: Thirteen studies
including a total of 5,247 patients were available for the meta-analysis. The
pooled percentage of adherence was 68.86% (95% CI: 57.80-79.92%). Subgroup
analysis did not demonstrate a significant difference in the adherence measured
with the MMAS-8 and the MGL (68.31 vs. 70.39%, P = 0.773). The adherence of
patients from Western countries (Europe, United States) turned out to be
significantly higher than in other patients (83.87 vs. 54.30%, P = 0.004). The
significant determinants of better adherence identified in more than one study
were older age, retirement/unemployment, duration of hypertension >10 years, and
a lower number of prescribed drugs. Conclusion: Medication adherence in the
oldest old hypertensive patients seems to be higher than in younger persons.
Adherence in older persons was associated with age, socioeconomic status, and
therapy-related factors.
DOI: 10.3389/fphar.2019.00168
PMCID: PMC6425867
PMID: 30930769
1100. Pan Afr Med J. 2017 Jun 2;27:80. doi: 10.11604/pamj.2017.27.80.8544.

eCollection
2017.
HIV-infected adolescents have low adherence to antiretroviral therapy: a

cross-sectional study in Addis Ababa, Ethiopia.
Firdu N(1), Enquselassie F(1), Jerene D(1)(2).
Author information:
(1)Addis Ababa University, School of Public Health, Department of Preventive
Medicine, Addis Ababa, Ethiopia.
(2)Management Sciences for Health (MSH), Addis Ababa, Ethiopia.
INTRODUCTION: For antiretroviral therapy (ART) to work effectively, adherence is

very crucial. However, most studies done on ART adherence are either on children
or on adults. There is limited information on the level of adherence among
adolescents.
METHODS: Using a cross-sectional study design, we interviewed 273 HIV-infected
adolescents receiving ART from three hospitals in Addis Ababa. We used a
structured questionnaire to measure adherence levels using patient self-reports.
Bivariate and multivariate methods were used for analysis.
RESULTS: We interviewed 273 adolescents aged 13 to 19 years, and 144 (52.7%) of
the participants were girls. Their mean age was 15.4 years (SD± 1.75). The
self-reported adherence rate of the respondents was 79.1% (216/273). On bivariate
analysis, variables like WHO clinical stage, being on Cotrimoxazole Prophylactic
Therapy (CPT), marital and living status of the parent, whether parent was on ART
or not and having special instructions for ART medications were associated with
optimum adherence. However of those, only WHO stage IV (adjusted OR, 12.874 95%
CI, 2.079-79.706), being on CPT (adjusted OR, 0.339 95% CI, 0.124-0.97) and
adolescents with widowed parent (adjusted OR, 0.087 with 95% CI, 0.021-0.359)
were found to be significantly associated with optimum ART adherence.
CONCLUSION: The level of self-reported ART adherence among HIV-infected
adolescents at the three hospitals was below the recommended threshold. Though
earlier presentation of adolescents to care should be encouraged, more targeted
adherence support should be planned for those who present at an early stage of
their illness.
DOI: 10.11604/pamj.2017.27.80.8544
PMCID: PMC5554655
1101. J Basic Clin Pharm. 2016 Jun;7(3):87-92. doi: 10.4103/0976-0105.183264.
Knowledge of healthcare professionals about medication errors in hospitals.
Abdel-Latif MM(1).
Author information:
(1)Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah
University, Al-Madinah Al-Munawwarah, Saudi Arabia, Egypt; Department of Clinical
Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt.
CONTEXT: Medication errors are the most common types of medical errors in
hospitals and leading cause of morbidity and mortality among patients.
AIMS: The aim of the present study was to assess the knowledge of healthcare
professionals about medication errors in hospitals.
SETTINGS AND DESIGN: A self-administered questionnaire was distributed to
randomly selected healthcare professionals in eight hospitals in Madinah, Saudi
Arabia.
SUBJECTS AND METHODS: An 18-item survey was designed and comprised questions on
demographic data, knowledge of medication errors, availability of reporting
systems in hospitals, attitudes toward error reporting, causes of medication
errors.
STATISTICAL ANALYSIS USED: Data were analyzed with Statistical Package for the
Social Sciences software Version 17.
RESULTS: A total of 323 of healthcare professionals completed the questionnaire
with 64.6% response rate of 138 (42.72%) physicians, 34 (10.53%) pharmacists, and
151 (46.75%) nurses. A majority of the participants had a good knowledge about
medication errors concept and their dangers on patients. Only 68.7% of them were
aware of reporting systems in hospitals. Healthcare professionals revealed that
there was no clear mechanism available for reporting of errors in most hospitals.
Prescribing (46.5%) and administration (29%) errors were the main causes of
errors. The most frequently encountered medication errors were
anti-hypertensives, antidiabetics, antibiotics, digoxin, and insulin.
CONCLUSIONS: This study revealed differences in the awareness among healthcare
professionals toward medication errors in hospitals. The poor knowledge about
medication errors emphasized the urgent necessity to adopt appropriate measures
to raise awareness about medication errors in Saudi hospitals.
DOI: 10.4103/0976-0105.183264
PMCID: PMC4910473
PMID: 27330261
1102. Psychopharmacology (Berl). 2016 May;233(10):1845-66. doi:

10.1007/s00213-016-4244-7. Epub 2016 Mar 30.
Preclinical studies on the reinforcing effects of cannabinoids. A tribute to the

scientific research of Dr. Steve Goldberg.
Tanda G(1).
Author information:
(1)Medication Development Program, Molecular Targets and Medication Discovery
Branch, Intramural Research Program, National Institute on Drug Abuse, National
Institutes of Health, Department of Health and Human Services, 333 Cassell Drive,
Triad Bldg., NIDA suite 3301, Baltimore, MD, 21224, USA. gtanda@mail.nih.gov.
RATIONALE: The reinforcing effects of most abused drugs have been consistently
demonstrated and studied in animal models, although those of marijuana were not,
until the demonstration 15 years ago that delta-9-tetrahydrocannabinol (THC)
could serve as a reinforcer in self-administration (SA) procedures in squirrel
monkeys. Until then, those effects were inferred using indirect assessments.
OBJECTIVES: The aim of this manuscript is to review the primary preclinical
procedures used to indirectly and directly infer reinforcing effects of
cannabinoid drugs.
METHODS: Results will be reviewed from studies of cannabinoid discrimination,
intracranial self-stimulation (ICSS), conditioned place preference (CPP), as well
as change in levels of dopamine assessed in brain areas related to reinforcement,
and finally from self-administration procedures. For each procedure, an
evaluation will be made of the predictive validity in detecting the potential
abuse liability of cannabinoids based on seminal papers, with the addition of
selected reports from more recent years especially those from Dr. Goldberg's
research group.
RESULTS AND CONCLUSIONS: ICSS and CPP do not provide consistent results for the
assessment of potential for abuse of cannabinoids. However, drug discrimination
and neurochemistry procedures appear to detect potential for abuse of
cannabinoids, as well as several novel "designer cannabinoid drugs." Though after
15 years transfer of the self-administration model of marijuana abuse from
squirrel monkeys to other species remains somewhat problematic, studies with the
former species have substantially advanced the field, and several reports have
been published with consistent self-administration of cannabinoid agonists in
rodents.
DOI: 10.1007/s00213-016-4244-7
PMCID: PMC5073892
Conflict of interest statement: The author declares no conflict of interests.
1103. Ann Behav Med. 2015 Feb;49(1):29-39. doi: 10.1007/s12160-014-9641-8.
Predictors of adherence to glaucoma treatment in a multisite study.
Cook PF(1), Schmiege SJ, Mansberger SL, Kammer J, Fitzgerald T, Kahook MY.
Author information:
(1)University of Colorado College of Nursing, University of Colorado, Campus Box
C288-04, Aurora, CO, 80045, USA, paul.cook@ucdenver.edu.
Comment in
Ann Behav Med. 2015 Feb;49(1):5-6.
BACKGROUND: Poor adherence hinders glaucoma treatment. Studies have identified

demographic and clinical predictors of adherence but fewer psychological
variables.
PURPOSE: We examined predictors from four health behavior theories and past
research.
METHODS: In the baseline phase of a three-site adherence study, before any
intervention, 201 participants used electronic Medication Event Monitoring System
(MEMS) bottles to monitor eyedrop use for 2 months, and completed questionnaires
including self-reported adherence.
RESULTS: MEMS showed 79% adherence and self-report 94% (0.5-1.5 missed weekly
doses), but they correlated only r(s) = 0.31. Self-efficacy, motivation, dose
frequency, and nonminority race/ethnicity predicted 35% of variance in MEMS. Cues
to action, self-efficacy, and intention predicted 20% of variance in
self-reported adherence.
CONCLUSIONS: Self-efficacy, motivation, intention, cues to action, dose
frequency, and race/ethnicity each independently predicted adherence. Predictors
from all theories were supported in bivariate analyses, but additional study is
needed. Researchers and clinicians should consider psychological predictors of
adherence. (ClinicalTrials.gov ID# NCT01409421.).
DOI: 10.1007/s12160-014-9641-8
PMCID: PMC4336606
1104. Biol Blood Marrow Transplant. 2018 Feb;24(2):381-385. doi:

10.1016/j.bbmt.2017.10.033. Epub 2017 Nov 2.
Poor Adherence Is Associated with More Infections after Pediatric Hematopoietic

Stem Cell Transplant.
Pai ALH(1), Rausch J(2), Drake S(3), Morrison CF(3), Lee JL(4), Nelson A(5),
Tackett A(4), Berger S(5), Szulczewski L(6), Mara C(7), Davies S(8).
Author information:
(1)Patient and Family Wellness Center, Cancer and Blood Diseases Institute,
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Center for the
Promotion of Adherence and Self-Management, Division of Behavioral Medicine and
Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati,
Ohio; Department of Pediatrics, University of Cincinnati School of Medicine,
Cincinnati, Ohio. Electronic address: ahna.pai@cchmc.org.
(2)Center for Biobehavioral Health, Nationwide Children's Hospital, Cincinnati,
Ohio.
Ohio.
Medical Center, Cincinnati, Ohio.
(5)Division of Bone Marrow Transplantation and Immune Deficiency, Cancer and
Blood Diseases Institute, Cincinnati Children's Hospital Medical Center,
Cincinnati, Ohio.
Ohio; Department of Pediatrics, University of Cincinnati School of Medicine,
Cincinnati, Ohio.
(7)Department of Pediatrics, University of Cincinnati School of Medicine,
Cincinnati, Ohio.
(8)Department of Pediatrics, University of Cincinnati School of Medicine,
Cincinnati, Ohio; Division of Bone Marrow Transplantation and Immune Deficiency,
Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical
Center, Cincinnati, Ohio.
We prospectively examined rates of outpatient oral medication adherence in

children after hematopoietic stem cell transplant (post-HSCT). For 6 months after
first discharge post-HSCT, 50 patients (aged 0 to 16 years) and their primary
caregivers agreed to store 1 oral medication in an electronic pill bottle that
date and time stamps each bottle opening. Demographics, disease, donor type, and
prescribed post-HSCT medication regimen were collected via chart review. For each
patient percent adherence was calculated by dividing the number of doses taken as
indicated by the electronic pill bottle by the number of doses prescribed for the
same time period. Average percent adherence ranged from 63% at 1 month after
discharge to 57% at 6 months after discharge. For patients who received an
allogeneic transplant, lower adherence was associated (P < .005) with higher
infection rates, after controlling for age and time since transplant. No such
relationship was observed for patients who received an autologous transplant.
This study demonstrates that poor oral medication adherence is prevalent,
persistent, and, for patients receiving an allogeneic transplant, associated with
increased incidence of infections during the outpatient treatment period. This
study highlights the need for further research examining factors that hinder
medication adherence as well as monitoring, promoting, and intervening to
maximize medication adherence throughout the HSCT course.
Copyright © 2017 The American Society for Blood and Marrow Transplantation.
Published by Elsevier Inc. All rights reserved.
DOI: 10.1016/j.bbmt.2017.10.033
1105. J Pharm Bioallied Sci. 2016 Apr-Jun;8(2):124-9. doi: 10.4103/0975-

7406.171696.
Nonadherence and factors affecting adherence of diabetic patients to

anti-diabetic medication in Assela General Hospital, Oromia Region, Ethiopia.
Kassahun A(1), Gashe F(2), Mulisa E(2), Rike WA(2).
Author information:
(1)Pharmaceutical Fund and Supply Agency, Addis Ababa, Ethiopia.
(2)Department of Pharmacy, College of Public Health and Medical Sciences, Jimma
University, Jimma, Ethiopia.
BACKGROUND: Diabetes mellitus is a major global health problem covering

approximately 347 million persons worldwide. Glycemic control has a main role in
its management which mainly depends upon patient adherence to the treatment plan.
Accurate assessment of medication adherence is necessary for effective management
of diabetes.
OBJECTIVE: To assess nonadherence and factors affecting adherence of diabetic
patients to anti-diabetic medication in Assela General Hospital (AGH), Oromia
Region, Ethiopia.
MATERIALS AND METHODS: A descriptive cross-sectional study was conducted on
patients seeking anti-diabetic drug treatment and follow-up at AGH using
structured questionnaire and reviewing the patient record card using check list
from January 24, 2014 to February 7, 2014. Descriptive analysis was used to
describe the percentages and number of distributions of the variables in the
study; and association was identified for categorical data. P ≤ 0.05 was
considered as statistically significant.
RESULT: Of all respondents, 149 (52.3%) and 136 (47.7%) were female and male,
respectively. The majority of the study participants 189 (66.3%) were in the age
group of 30-60 years. Two-hundred nineteen (76.8%) of respondents were married
currently. The majority, 237 (83.2%) of respondents did not have blood glucose
self-monitoring equipment (glucometer). A total of 196 (68.8%) respondents were
adhered to anti-diabetic medication. There was a significant association between
adherence to the medication and side effect, level of education, monthly income
and presence of glucometer at home (P < 0.05).
CONCLUSION: The participants in the area of study were moderately adherent to
their anti-diabetic medications with nonadherence rate of 31.2%. Different
factors of medication nonadherence were identified such as side effect and
complexity of regimen, failure to remember, and sociodemographic factors such as
educational level and monthly income.
DOI: 10.4103/0975-7406.171696
PMCID: PMC4832902
PMID: 27134464
1106. Iran Red Crescent Med J. 2016 May 10;18(6):e35805. doi: 10.5812/ircmj.35805.
Self-Care Behaviors and Related Factors in Hypertensive Patients.
Zinat Motlagh SF(1), Chaman R(2), Sadeghi E(3), Eslami AA(4).
Author information:
(1)Social Determinants of Health Research Center, Yasuj University of Medical
Sciences, Yasuj, IR Iran.
(2)Department of Community Medicine, School of Medicine, Yasuj University of
Medical Sciences, Yasuj, IR Iran.
(3)Department of Biostatistics and Epidemiology, Kermanshah University of Medical
Sciences, Kermanshah, IR Iran.
University of Medical Sciences, Isfahan, IR Iran.
BACKGROUND: An assessment of an individual's hypertension self-care behavior may

provide clinicians and practitioners with important information regarding how to
better control hypertension.
OBJECTIVES: The objective of this study was to investigate the self-care
behaviors of hypertensive patients.
PATIENTS AND METHODS: This cross-sectional study was conducted in 2014 in a
sample of 1836 patients of both genders who had been diagnosed with hypertension
in urban and rural health centers in the Kohgiluyeh Boyerahmad Province in
southern Iran. They were randomly selected and were invited to participate in the
study. Self-care activities were measured using the H-hypertension self-care
activity level effects.
RESULTS: The mean age of the respondents was 63 (range: 30 - 92), and 36.1%
reported adherence to the recommended levels of medication; 24.5% followed the
physical activity level guidelines. Less than half (39.2%) met the criteria for
practices related to weight management, and adherence to low-salt diet
recommendations was also low (12.3%). Overall, 86.7% were nonsmokers, and 100%
abstained from alcohol. The results of a logistic regression indicated that
gender was significantly associated with adherence to physical activity (OR =
0.716) and non-smoking (OR = 1.503) recommendations; that is, women were more
likely to take part in physical activity than men. There was also a significant
association between age and adherence to both a low-salt diet (OR = 1.497) and
medication (OR = 1.435).
CONCLUSIONS: Based on our findings, it is crucial to implement well-designed
educational programs to improve hypertension self-care behaviors.
DOI: 10.5812/ircmj.35805
PMCID: PMC5004506
PMID: 27621938
eCollection 2015.
A systematic review of medication exposure assessment in prospective cohort

studies of community dwelling older australians.
Poole SG(1), Bell JS(2), Jokanovic N(1), Kirkpatrick CM(2), Dooley MJ(1).
Author information:
(1)Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical
Sciences, Monash University, Melbourne, Victoria, Australia; Pharmacy Department,
Alfred Health, Melbourne, Victoria, Australia.
(2)Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical
Sciences, Monash University, Melbourne, Victoria, Australia.
INTRODUCTION: It is not known to what extent medication use has been

comprehensively assessed in prospective cohort studies of older Australians.
Understanding the varying methods to assess medication use is necessary to
establish comparability and to understand the opportunities for
pharmacoepidemiological analysis. The objective of this review was to compare and
contrast how medication-related data have been collected in prospective cohorts
of community-dwelling older Australians.
METHODS: MEDLINE and EMBASE (1990-2014) were systematically searched to identify
prospective cohorts of ≥1000 older participants that commenced recruitment after
1990. The data collection tools used to assess medication use in each cohort were
independently examined by two investigators using a structured approach.
RESULTS: Thirteen eligible cohorts were included. Baseline medication use was
assessed in participant self-completed surveys (n = 3), by an investigator
inspecting medications brought to a clinic interview (n = 7), and by interviewing
participants in their home (n = 3). Five cohorts sought participant consent to
access administrative claims data. Six cohorts used multiple methods to assess
medication use across one or more study waves. All cohorts assessed medication
use at baseline and 12 cohorts in follow-up waves. Twelve cohorts recorded
prescription medications by trade or generic name; 12 cohorts recorded medication
strength; and 9 recorded the daily medication dose in at least one wave of the
cohort. Seven cohorts asked participants about their "current" medication use
without providing a definition of "current"; and nine cohorts asked participants
to report medication use over recall periods ranging from 1-week to 3-months in
at least one wave of the cohort. Sixty-five original publications, that reported
the prevalence or outcomes of medication use, in the 13 cohorts were identified
(median = 3, range 1-21).
CONCLUSION: There has been considerable variability in the assessment of
medication use within and between cohorts. This may limit the comparability of
medication data collected in these cohorts.
PMCID: PMC4409061
1108. J Hum Hypertens. 2016 Jan;30(1):73-8. doi: 10.1038/jhh.2015.26. Epub 2015 Apr
2.
Medication adherence and visit-to-visit variability of systolic blood pressure in

African Americans with chronic kidney disease in the AASK trial.
Hong K(1), Muntner P(2), Kronish I(3), Shilane D(4), Chang TI(5).
Author information:
(1)Stanford University School of Medicine, Stanford, CA, USA.
(2)Departments of Medicine and Epidemiology, University of Alabama at Birmingham,
Birmingham, AL, USA.
(3)Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia
University College of Physician & Surgeons, New York, NY, USA.
(4)Department of Health Research and Policy, Stanford University School of
Medicine, Stanford, CA, USA.
(5)Division of Nephrology, Department of Medicine, Stanford University School of
Medicine, Palo Alto, CA, USA.
Lower adherence to antihypertensive medications may increase visit-to-visit

variability of blood pressure (VVV of BP), a risk factor for cardiovascular
events and death. We used data from the African American Study of Kidney Disease
and Hypertension (AASK) trial to examine whether lower medication adherence is
associated with higher systolic VVV of BP in African Americans with hypertensive
chronic kidney disease (CKD). Determinants of VVV of BP were also explored. AASK
participants (n=988) were categorized by self-report or pill count as having
perfect (100%), moderately high (75-99%), moderately low (50-74%) or low (<50%)
proportion of study visits with high medication adherence over a 1-year follow-up
period. We used multinomial logistic regression to examine determinants of
medication adherence, and multivariable-adjusted linear regression to examine the
association between medication adherence and systolic VVV of BP, defined as the
coefficient of variation or the average real variability (ARV). Participants with
lower self-reported adherence were generally younger and had a higher prevalence
of comorbid conditions. Compared with perfect adherence, moderately high,
moderately low and low adherence was associated with 0.65% (±0.31%), 0.99%
(±0.31%) and 1.29% (±0.32%) higher systolic VVV of BP (defined as the coefficient
of variation) in fully adjusted models. Results were qualitatively similar when
using ARV or when using pill counts as the measure of adherence. Lower medication
adherence is associated with higher systolic VVV of BP in African Americans with
hypertensive CKD; efforts to improve medication adherence in this population may
reduce systolic VVV of BP.
DOI: 10.1038/jhh.2015.26
PMCID: PMC4592365
1109. United European Gastroenterol J. 2019 Mar;7(2):307-315. doi:

10.1177/2050640618821804. Epub 2018 Dec 22.
Prevalence and impact of self-reported irritable bowel symptoms in the general

population.
Van den Houte K(1), Carbone F(1), Pannemans J(1), Corsetti M(1), Fischler B(1),
Piessevaux H(1), Tack J(1).
Author information:
(1)Department of Chronic Diseases, Metabolism and Ageing, University of Leuven,
Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven,
Belgium.
Background and aims: The symptom-based diagnostic criteria for irritable bowel
syndrome (IBS) have recently been revised in the Rome IV consensus. On the other
hand, with rising public awareness of IBS, self-diagnosis and self-management is
also increasing. We compared the prevalence and impact of Rome IV-based IBS vs
self-diagnosed IBS in the general population.
Methods: An internet panel filled out an online survey on bowel symptoms and
their impact on health care utilization and daily activities.
Results: A representative internet panel of 1012 individuals completed the online
survey. Bowel symptoms were present in 68.6% of the population. Of these, 21%
consulted a physician for these symptoms in the last year and 42% earlier. Rome
IV IBS criteria were fulfilled by 5.5%, and these were younger and more likely to
be female. In this subset, 37% had consulted a physician for IBS symptoms in the
preceding year and 29% had done so earlier. A colonoscopy had been performed in
22%. Based on a brief description, 17.6% of the population self-identified as
suffering from IBS (p < 0.001 compared to Rome IV IBS prevalence), and these were
more likely to be female. Concordance with the Rome IV criteria was only 25%, but
except for a lower reporting of pain, the symptom pattern, severity, impact on
daily life, inability to work and health care utilization were similar to the
Rome IV group. A total of 134 days of absence from work were attributed to bowel
symptoms in those self-reporting with IBS.
Conclusion: In the general population, bowel symptoms are highly prevalent, and
the self-reported "IBS" is three times more prevalent than according to Rome IV
criteria. Self-reported IBS is associated with a similar impact on health care
utilization and quality of life but a higher impact on absence from work.
DOI: 10.1177/2050640618821804
PMCID: PMC6498809
PMID: 31080615
1110. Trials. 2018 Jan 25;19(1):70. doi: 10.1186/s13063-018-2468-z.
Text4Heart II - improving medication adherence in people with heart disease: a

study protocol for a randomized controlled trial.
Maddison R(1), Stewart R(2), Doughty R(3), Scott T(4), Kerr A(5), Benatar J(2),
Whittaker R(6), Rawstorn JC(7), Rolleston A(8), Jiang Y(6), Estabrooks P(9),
Sullivan RK(10), Bartley H(6), Pfaeffli Dale L(11).
Author information:
(1)Institute for Physical Activity and Nutrition, Deakin University, Geelong,
VIC, Australia. ralph.maddison@deakin.edu.au.
(2)Department of Cardiology, Auckland District Health Board, Auckland, New
Zealand.
(3)Heart Health Research Group, Department of Medicine, University of Auckland,
(4)Department of Cardiology, Waitemata District Health Board, Auckland, New
Zealand.
(5)Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand.
(6)National Institute for Health Innovation, School of Population Health,
University of Auckland, Auckland, New Zealand.
(7)Institute for Physical Activity and Nutrition, Deakin University, Geelong,
VIC, Australia.
(8)The Centre for Health, Tauranga, New Zealand.
(9)Department of Health Promotion, Social and Behavioral Health, University of
Nebraska Medical Centre, Omaha, NE, USA.
(10)Department of Exercise Sciences, Faculty of Science, University of Auckland,
(11)School of Kinesiology, University of British Columbia, Vancouver, BC, Canada.
BACKGROUND: Cardiac rehabilitation (CR) is an essential component of contemporary

management for patients with coronary heart disease, including following an acute
coronary syndrome (ACS). CR typically involves education and support to assist
people following an ACS to make lifestyle changes and prevent subsequent events.
Despite its benefits, uptake and participation in tradition CR programs is low.
The use of mobile technologies (mHealth) offers the potential to improve reach,
access, and delivery of CR support. We aim to determine the effectiveness and
cost-effectiveness of a text-messaging intervention (Text4Heart II) to improve
adherence to medication and lifestyle change in addition to usual care in people
following an ACS. A second aim is to use the RE-AIM framework to inform the
potential implementation of Text4Heart II within health services in New Zealand.
METHODS: Text4Heart II is a two-arm, parallel, superiority randomized controlled
trial conducted in two large metropolitan hospitals in Auckland, New Zealand.
Three hundred and thirty participants will be randomized to either a 24-week
theory- and evidence-based personalized text message program to support
self-management in addition to usual CR, or usual CR alone (control). Outcomes
are assessed at 6 and 12 months. The primary outcome is the proportion of
participants adhering to medication at 6 months as measured by dispensed records.
Secondary outcomes include medication adherence at 12 months, the proportion of
participants adhering to self-reported healthy behaviors (physical activity,
fruit and vegetable consumption, moderating alcohol intake and smoking status)
measured using a composite health behavior score, self-reported medication
adherence, cardiovascular risk factors (lipids, blood pressure), readmissions and
related hospital events at 6 and 12 months. A cost-effectiveness analysis will
also be conducted. Using the RE-AIM framework, we will determine uptake and
sustainability of the intervention.
DISCUSSION: The Text4Heart II trial will determine the effectiveness of a
text-messaging intervention to improve adherence to medication and lifestyle
behaviors at both 6 and 12 months. Using the RE-AIM framework this trial will
provide much needed data and insight into the potential implementation of
Text4Heart II. This trial addresses many limitations/criticisms of previous
mHealth trials; it builds on our Text4Heart pilot trial, it is adequately
powered, has sufficient duration to elicit behavior change, and the follow-up
assessments (6 and 12 months) are long enough to determine the sustained effect
of the intervention.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ID:
ACTRN12616000422426 . Registered retrospectively on 1 April 2016.
DOI: 10.1186/s13063-018-2468-z
PMCID: PMC5785898
1111. Ophthalmology. 2015 Jul;122(7):1308-16. doi: 10.1016/j.ophtha.2015.03.026.

Epub
2015 Apr 24.
The Most Common Barriers to Glaucoma Medication Adherence: A Cross-Sectional

Survey.
Newman-Casey PA(1), Robin AL(2), Blachley T(3), Farris K(4), Heisler M(5),
Resnicow K(6), Lee PP(3).
Author information:
(1)Department of Ophthalmology & Visual Sciences, University of Michigan Medical
School, Ann Arbor, Michigan. Electronic address: panewman@med.umich.edu.
School, Ann Arbor, Michigan; Department of Ophthalmology & International Health,
Johns Hopkins University, Baltimore, Maryland.
School, Ann Arbor, Michigan.
(4)School of Pharmacy, University of Michigan, Ann Arbor, Michigan.
(5)School of Public Health, University of Michigan, Ann Arbor, Michigan;
Department of Internal Medicine, University of Michigan Medical School, Ann
Arbor, Michigan.
(6)School of Public Health, University of Michigan, Ann Arbor, Michigan.
Comment in
Ophthalmology. 2015 Jul;122(7):1280-2.
PURPOSE: To evaluate the frequency of 11 commonly cited barriers to optimal

glaucoma medication adherence among glaucoma patients and to identify barriers
contributing to poor adherence.
DESIGN: Prospective, cross-sectional survey.
PARTICIPANTS: One hundred ninety adults with glaucoma taking 1 or more glaucoma
medication who received care in glaucoma clinics in Ann Arbor, Michigan, and
Baltimore, Maryland.
METHODS: Participants completed a survey on demographic and disease
characteristics, barriers to optimal glaucoma medication adherence, interest in
an eye drop aid, and self-reported adherence (measured by the Morisky Adherence
Scale). Descriptive statistics and logistic regression analyses were performed.
MAIN OUTCOME MEASURES: Frequency and number of barriers to adherence among both
adherent and nonadherent patients. Odds ratios (ORs) with 95% confidence
intervals (CIs) identifying barriers associated with poor adherence.
RESULTS: Twenty-seven percent of the sample reported poor adherence. Sixty-one
percent of all participants cited multiple barriers and 10% cited a single
barrier as impediments to optimal adherence. Twenty-nine percent of subjects
cited no barriers, although only 13% of patients who cited no barriers were
nonadherent. Among nonadherent patients, 31% or more cited each of the 11
barriers as important. Logistic regression analysis, adjusted for age, revealed
that the following barriers were associated with higher odds of nonadherence:
decreased self-efficacy (OR, 4.7; 95% CI, 2.2-9.7; P ≤ 0.0001), difficulty
instilling drops (OR, 2.3; 95% CI, 1.1-4.9; P = 0.03), forgetfulness (OR, 5.6;
95% CI, 2.6-12.1; P ≤ 0.0001), and difficulties with the medication schedule (OR,
2.9; 95% CI, 1.4-6.0; P = 0.006). For each additional barrier cited as important,
there was a 10% increased odds of being nonadherent (OR, 1.1; 95% CI, 1.0-1.2; P
= 0.01).
CONCLUSIONS: Each of the 11 barriers was important to at least 30% of surveyed
patients with poor adherence, with most identifying multiple barriers to
adherence. Low self-efficacy, forgetfulness, and difficulty with drop
administration and the medication schedule were barriers associated with poor
adherence. Interventions to improve medication adherence must address each
patient's unique set of barriers.
Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc.

DOI: 10.1016/j.ophtha.2015.03.026
PMCID: PMC4485580

eCollection 2015.
Self-reported adherence to oral cancer therapy: relationships with symptom

distress, depression, and personal characteristics.
Berry DL(1), Blonquist TM(2), Hong F(3), Halpenny B(4), Partridge AH(5).
Author information:
(1)Phyllis F Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA ;
Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston,
MA, USA ; Department of Medicine, Harvard Medical School, Boston, MA, USA.
(2)Department of Biostatistics and Computational Biology, Dana-Farber Cancer
Institute, Boston, MA, USA.
(3)Department of Biostatistics and Computational Biology, Dana-Farber Cancer
Institute, Boston, MA, USA ; Department of Biostatistics, Harvard School of
Public Health, Boston, MA, USA.
(4)Phyllis F Cantor Center, Dana-Farber Cancer Institute, Boston, MA, USA.
(5)Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute,
Boston, MA, USA ; Department of Medicine, Harvard Medical School, Boston, MA,
USA.
BACKGROUND: Therapeutic cancer chemotherapy is most successful when complete

dosing is achieved. Because many newer therapeutic agents are oral and
self-administered by the patient, adherence is a concern. The purpose of our
analysis was to explore relationships between adherence, patient characteristics,
and barriers to adherence.
METHODS: This secondary analysis utilized self-reported data from a randomized
trial of self-care management conducted at two cancer centers in the US. Symptom
distress was measured using the 15-item Symptom Distress Scale (SDS-15) and
depression with the Patient Health Questionnaire-9 (PHQ-9). Adherence to oral
medication was self-reported using the 8-item Morisky Medication Adherence Scale
(MMAS-8). Measures were collected via Web-based, study-specific software ~8 weeks
after treatment start date. Odds of low/medium adherence (score <8) were explored
using univariate logistic regression. Given the number of factors and possible
relationships among factors, a classification tree was built in lieu of a
multivariable logistic regression model.
RESULTS: Of the eligible participants enrolled, 77 were on oral therapy and 70
had an MMAS score. Forty-nine (70%) reported a high adherence score (=8). Higher
odds of low/medium adherence were associated with greater symptom distress
(P=0.09), more depression (P=0.05), chemotherapy vs hormonal oral medication
(P=0.03), being female (P=0.02), and being randomized to the control group in the
parent trial (P=0.09). Conversely, high adherence was associated with working
(P=0.08), being married/partnered (P=0.004), and being older (P=0.02). Factors
identified as significantly related to low/medium adherence from the univariate
logistic regression analyses were supported by the classification tree results.
CONCLUSION: Nonadherence to therapeutic oral medications in patients with cancer
was associated with being unmarried/unpartnered, symptom distress, younger age,
not working, and female sex. These findings may help to identify patients at risk
for nonadherence and for whom supportive interventions to enhance adherence may
be needed.
DOI: 10.2147/PPA.S91534
PMCID: PMC4639537
PMID: 26604712
1113. J Am Med Inform Assoc. 2016 Jan;23(1):144-58. doi: 10.1093/jamia/ocv160. Epub

2016 Jan 7.
Interactive tools for inpatient medication tracking: a multi-phase study with

cardiothoracic surgery patients.
Wilcox L(1), Woollen J(2), Prey J(2), Restaino S(3), Bakken S(2), Feiner S(4),
Sackeim A(3), Vawdrey DK(5).
Author information:
(1)School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA,
USA Department of Computer Science, Columbia University, New York, NY, USA
wilcox@cc.gatech.edu.
(2)Department of Biomedical Informatics, Columbia University, New York, NY, USA.
(3)College of Physicians and Surgeons, Columbia University Medical Center, New
York, NY, USA.
(4)Department of Computer Science, Columbia University, New York, NY, USA.
(5)Department of Biomedical Informatics, Columbia University, New York, NY, USA
New York-Presbyterian Hospital, New York, NY, USA.
OBJECTIVE: Prior studies of computing applications that support patients'

medication knowledge and self-management offer valuable insights into effective
application design, but do not address inpatient settings. This study is the
first to explore the design and usefulness of patient-facing tools supporting
inpatient medication management and tracking.
MATERIALS AND METHODS: We designed myNYP Inpatient, a custom personal health
record application, through an iterative, user-centered approach.
Medication-tracking tools in myNYP Inpatient include interactive views of home
and hospital medication data and features for commenting on these data. In a
two-phase pilot study, patients used the tools during cardiothoracic
postoperative care at Columbia University Medical Center. In Phase One, we
provided 20 patients with the application for 24-48 h and conducted a closing
interview after this period. In Phase Two, we conducted semi-structured
interviews with 12 patients and 5 clinical pharmacists who evaluated refinements
to the tools based on the feedback received during Phase One.
RESULTS: Patients reported that the medication-tracking tools were useful. During
Phase One, 14 of the 20 participants used the tools actively, to review
medication lists and log comments and questions about their medications.
Patients' interview responses and audit logs revealed that they made frequent use
of the hospital medications feature and found electronic reporting of questions
and comments useful. We also uncovered important considerations for subsequent
design of such tools. In Phase Two, the patients and pharmacists participating in
the study confirmed the usability and usefulness of the refined tools.
CONCLUSIONS: Inpatient medication-tracking tools, when designed to meet patients'
needs, can play an important role in fostering patient participation in their own
care and patient-provider communication during a hospital stay.
© The Author 2016. Published by Oxford University Press on behalf of the American
Medical Informatics Association. All rights reserved. For Permissions, please
email: journals.permissions@oup.com.
DOI: 10.1093/jamia/ocv160
PMCID: PMC5009934
1114. BMC Cardiovasc Disord. 2019 Feb 11;19(1):38. doi: 10.1186/s12872-019-1019-1.
Risk factors for medication non-adherence among atrial fibrillation patients.
Reading SR(1), Black MH(1), Singer DE(2), Go AS(3)(4), Fang MC(5), Udaltsova
N(3), Harrison TN(1), Wei RX(1), Liu IA(1), Reynolds K(6); ATRIA-CVRN
Investigators.
Author information:
(1)Department of Research and Evaluation, Kaiser Permanente Southern California,
100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA.
(2)Department of General Internal Medicine, Massachusetts General Hospital,
Boston, MA, USA.
(3)Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
(4)Departments of Epidemiology, Biostatistics and Medicine, University of
California San Francisco, San Francisco, CA, USA.
(5)Division of Hospital Medicine, University of California San Francisco, San
Francisco, CA, USA.
(6)Department of Research and Evaluation, Kaiser Permanente Southern California,
100 S. Los Robles Ave., 2nd floor, Pasadena, CA, 91101, USA.
kristi.reynolds@kp.org.
BACKGROUND: Atrial fibrillation (AF) patients are routinely prescribed

medications to prevent and treat complications, including those from common
co-occurring comorbidities. However, adherence to such medications may be
suboptimal. Therefore, we sought to identify risk factors for general medication
non-adherence in a population of patients with atrial fibrillation.
METHODS: Data were collected from a large, ethnically-diverse cohort of Kaiser
Permanente Northern and Southern California adult members with incident diagnosed
AF between January 1, 2006 and June 30, 2009. Self-reported questionnaires were
completed between May 1, 2010 and September 30, 2010, assessing patient
socio-demographics, health behaviors, health status, medical history and
medication adherence. Medication adherence was assessed using a previously
validated 3-item questionnaire. Medication non-adherence was defined as either
taking medication(s) as the doctor prescribed 75% of the time or less, or
forgetting or choosing to skip one or more medication(s) once per week or more.
Electronic health records were used to obtain additional data on medical history.
Multivariable logistic regression analyses examined the associations between
patient characteristics and self-reported general medication adherence among
patients with complete questionnaire data.
RESULTS: Among 12,159 patients with complete questionnaire data, 6.3% (n = 771)
reported medication non-adherence. Minority race/ethnicity versus non-Hispanic
white, not married/with partner versus married/with partner, physical inactivity
versus physically active, alcohol use versus no alcohol use, any days of
self-reported poor physical health, mental health and/or sleep quality in the
past 30 days versus 0 days, memory decline versus no memory decline, inadequate
versus adequate health literacy, low-dose aspirin use versus no low-dose aspirin
use, and diabetes mellitus were associated with higher adjusted odds of
non-adherence, whereas, ages 65-84 years versus < 65 years of age, a Charlson
Comorbidity Index score ≥ 3 versus 0, and hypertension were associated with lower
adjusted odds of non-adherence.
CONCLUSIONS: Several potentially preventable and/or modifiable risk factors
related to medication non-adherence and a few non-modifiable risk factors were
identified. These risk factors should be considered when assessing medication
adherence among patients diagnosed with AF.
DOI: 10.1186/s12872-019-1019-1
PMCID: PMC6371431
PMID: 30744554
1115. Pediatr Infect Dis J. 2017 Aug;36(8):751-757. doi:

10.1097/INF.0000000000001573.
Roles of Medication Responsibility, Executive and Adaptive Functioning in

Adherence for Children and Adolescents With Perinatally Acquired HIV.
Garvie PA(1), Brummel SS, Allison SM, Malee KM, Mellins CA, Wilkins ML, Harris
LL, Patton ED, Chernoff MC, Rutstein RM, Paul ME, Nichols SL; Pediatric HIV/AIDS
Cohort Study.
Author information:
(1)From the *Research Department, Children's Diagnostic & Treatment Center, Fort
Lauderdale, Florida; †Center for Biostatistics in AIDS Research, Harvard T.H.
Chan School of Public Health, Boston, Massachusetts; ‡Division of AIDS Research,
National Institute of Mental Health, Bethesda, Maryland; §Department of
Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of
Medicine, Chicago, Illinois; ¶Department of Psychiatry and Sociomedical Sciences,
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric
Institute and Columbia University, New York, New York; ‖Department of Infectious
Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee; **Department
of Pediatrics, Baylor College of Medicine, Houston, Texas; ††Private Practice,
Fort Lauderdale, Florida; ‡‡Division of General Pediatrics, Children's Hospital
of Philadelphia, Philadelphia, Pennsylvania; §§Department of Pediatrics, Texas
Children's Hospital, Houston, Texas; and ¶¶Department of Neurosciences,
University of California, La Jolla, San Diego, California.
BACKGROUND: Medication adherence is a critical but challenging developmental task

for children and adolescents with perinatally acquired HIV (PHIV). Understanding
how medication responsibility, executive functions (EFs) and adaptive functioning
(AF) influence adherence may help prepare adolescents for transition to
adulthood.
METHODS: Participants included PHIV children and adolescents 7-16 years of age
enrolled in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol, who
were prescribed antiretroviral medications. Measures included caregiver report
and child self-report measures of adherence, medication responsibility and EF,
caregiver report of child AF, examiner-administered tests of EF and processing
speed and demographic and health characteristics.
RESULTS: Two hundred fifty-six participants with PHIV (mean age: 12 years old)
were 51% female, 80% black and 79% non-Hispanic. Per 7-day recall, 72% were
adherent (no missed doses). Children/adolescents self-reported that 22% had sole
and 55% had shared medication responsibility. Adjusted logistic models revealed
significantly higher odds of adherence with sole caregiver responsibility for
medication [odds ratio (OR): 4.10, confidence interval (CI): 1.43-11.8, P =
0.009], child nadir CD4% <15% (OR: 2.26, CI: 1.15-4.43, P = 0.018), better
self-reported behavioral regulation (OR: 0.65, CI: 0.44-0.96, P = 0.029) and
slower processing speed (OR: 0.54, CI: 0.38-0.77, P < 0.001), adjusting for
demographic variables (age, race and caregiver education).
CONCLUSIONS: Among children and adolescents with PHIV, continued caregiver
medication management, especially during adolescence, is essential. Although
global EF and AF were not significantly associated with adherence, behavioral
regulation was. Given that EF and AF develop throughout adolescence, their
relationships to adherence should be evaluated longitudinally, especially as
youth transition to adulthood and caregiver responsibility diminishes.
DOI: 10.1097/INF.0000000000001573
PMCID: PMC5512435
1116. AIDS Patient Care STDS. 2017 Feb;31(2):78-86. doi: 10.1089/apc.2016.0196.

Epub
2017 Jan 16.
Preintervention Profiles of Information, Motivational, and Behavioral

Self-Efficacy for Methamphetamine Use and HIV Medication Adherence Among Gay and
Bisexual Men.
Starks TJ(1)(2)(3), Millar BM(2)(3), Lassiter JM(3)(4), Parsons JT(1)(2)(3).
Author information:
(1)1 Department of Psychology, Hunter College of the City University of New York
(CUNY) , New York, New York.
(2)2 Health Psychology and Clinical Science Doctoral Program, Graduate Center,
City University of New York (CUNY) , New York, New York.
(3)3 Center for HIV/AIDS Educational Studies and Training (CHEST) , New York, New
York.
(4)4 Department of Psychology, Muhlenberg College , Allentown, Pennsylvania.
Although rates of crystal methamphetamine use in the United States have fallen
from their peak in the mid-2000s, use remains a major public health concern,
which disproportionately affects gay and bisexual men (GBM). It poses a
particular challenge for HIV-positive men, for whom it has been linked to
medication adherence problems as well as compromised immune function. Although
the information, motivation, and behavioral skills (IMB) model has been widely
used to conceptualize health behavior, little is known about GBM's initial levels
of information, motivation, and behavioral self-efficacy to improve HIV
medication adherence and to reduce crystal methamphetamine use at the outset of
treatment. The present study identified profiles of IMB factors related to HIV
medication adherence and crystal methamphetamine use in a sample of 210
HIV-positive GBM who consented to participate in an intervention study. Results
indicated three distinct patterns of IMB factors. The largest group was ready to
change both adherence and methamphetamine use (n = 104). This group also had
depression scores that were significantly lower than other groups. A second group
appeared ready to change medication adherence, but was ambivalent about changing
methamphetamine use (n = 60). This group reported significantly more symptoms of
methamphetamine dependence than the other groups. A third group was characterized
by global IMB barriers to change (n = 46). Results are discussed in the context
of tailoring psychoeducation, motivational interviewing, and cognitive behavioral
interventions to match these preintervention patterns of IMB factors.
DOI: 10.1089/apc.2016.0196
PMCID: PMC5312573
1117. J Pediatr Psychol. 2017 Oct 1;42(9):1006-1015. doi: 10.1093/jpepsy/jsx064.
Use of Unannounced Telephone Pill Counts to Measure Medication Adherence Among

Adolescents and Young Adults Living With Perinatal HIV Infection.
Raymond JF(1)(2), Bucek A(1)(2), Dolezal C(1)(2), Warne P(1)(2), Benson S(1)(2),
Abrams EJ(3), Elkington KS(1)(2), Kalichman S(4), Kalichman M(4), Mellins
CA(1)(2).
Author information:
(1)HIV Center for Clinical and Behavioral Studies, New York State Psychiatric
Institute.
(2)Columbia University.
(3)ICAP, Columbia University Mailman School of Public Health.
(4)University of Connecticut.
Objective: To examine unannounced telephone pill counts as a measure of adherence

to antiretroviral therapy among adolescents and young adults living with
perinatal HIV infection.
Methods: Participants were recruited from an ongoing longitudinal study to
complete four monthly, unannounced telephone pill counts. Detailed notes
concerning participants' medication habits surrounding adherence were recorded.
Results: Two-thirds of 102 eligible participants aged 18-27 years participated;
57% were female, 69% were Black. Blacks and participants with viral loads >40
and >1,000 copies/ml were less likely to participate. Average adherence across
calls was 77%. Those who completed all calls averaged significantly higher
adherence scores than those who did not. Calls revealed adherence barriers at
individual (e.g., medication disorganization), social (e.g., limited support),
and system (e.g., pharmacy problems) levels.
Conclusions: Despite challenges, this procedure can be implemented with this
population and can help identify adherence barriers important for interventions
that address medication-taking behaviors.
journals.permissions@oup.com
DOI: 10.1093/jpepsy/jsx064
PMCID: PMC5896628
1118. Neuropsychiatr Dis Treat. 2015 Feb 26;11:517-31. doi: 10.2147/NDT.S75975.

eCollection 2015.
Toward an online cognitive and emotional battery to predict treatment remission

in depression.
Gordon E(1), Rush AJ(2), Palmer DM(3), Braund TA(4), Rekshan W(1).
Author information:
(1)Brain Resource, San Francisco, CA, USA.
(2)Duke-NUS, Singapore.
(3)Brain Resource, Sydney, NSW, Australia ; Brain Dynamics Center, Sydney Medical
School - Westmead and Westmead Millennium Institute, The University of Sydney,
(4)Brain Resource, Sydney, NSW, Australia.
PURPOSE: To evaluate the performance of a cognitive and emotional test battery in

a representative sample of depressed outpatients to inform likelihood of
remission over 8 weeks of treatment with each of three common antidepressant
medications.
PATIENTS AND METHODS: Outpatients 18-65 years old with nonpsychotic major
depressive disorder (17 sites) were randomized to escitalopram, sertraline or
venlafaxine-XR (extended release). Participants scored ≥12 on the baseline
16-item Quick Inventory of Depressive Symptomatology - Self-Report and completed
8 weeks of treatment. The baseline test battery measured cognitive and emotional
status. Exploratory multivariate logistic regression models predicting remission
(16-item Quick Inventory of Depressive Symptomatology - Self-Report score ≤5 at 8
weeks) were developed independently for each medication in subgroups stratified
by age, sex, or cognitive and emotional test performance. The model with the
highest cross-validated accuracy determined the participant proportion in each
arm for whom remission could be predicted with an accuracy ≥10% above chance. The
proportion for whom a prediction could be made with very high certainty (positive
predictive value and negative predictive value exceeding 80%) was calculated by
incrementally increasing test battery thresholds to predict
remission/non-remission.
RESULTS: The test battery, individually developed for each medication, improved
identification of remitting and non-remitting participants by ≥10% beyond chance
for 243 of 467 participants. The overall remission rates were escitalopram:
40.8%, sertraline: 30.3%, and venlafaxine-XR: 31.1%. Within this subset for whom
prediction exceeded chance, test battery thresholds established a negative
predictive value of ≥80%, which identified 40.9% of participants not remitting on
escitalopram, 77.1% of participants not remitting on sertraline, and 38.7% of
participants not remitting on venlafaxine-XR (all including 20% false negatives).
CONCLUSION: The test battery identified about 50% of each medication group as
being ≥10% more or less likely to remit than by chance, and identified about 38%
of individuals who did not remit with ≥80% certainty. Clinicians might choose to
avoid this specific medication in these particular patients.
DOI: 10.2147/NDT.S75975
PMCID: PMC4348126
PMID: 25750532
1119. J Clin Nurs. 2018 Oct;27(19-20):3758-3767. doi: 10.1111/jocn.14559. Epub 2018

Jul
23.
Fatalism, faith and fear: A case study of self-care practice among adults with
Type 2 diabetes in urban Malaysia.
Saidi S(1), Milnes LJ(2), Griffiths J(3).
Author information:
(1)Kulliyyah of Nursing, International Islamic University Malaysia, Kuantan
Pahang, Malaysia.
(2)School of Healthcare, University of Leeds, Leeds, UK.
(3)Division of Nursing, Midwifery and Social Work, School of Health Sciences,
University of Manchester, Manchester, UK.
AIMS AND OBJECTIVES: To explore self-care and self-care support in patients with
Type 2 diabetes in urban Malaysia.
BACKGROUND: The prevalence of Type 2 diabetes in Malaysia and associated
long-term and life-changing complications is increasing. With effective self-care
and self-care support, severe complications of the condition can be avoided or
reduced. Prior to this study, no evidence existed about Malaysian patients'
management of the condition or support for self-care from the healthcare system.
DESIGN: A single embedded qualitative case study.
METHODS: Semistructured interviews with 18 patients with Type 2 diabetes aged
28-69 years, healthcare professionals (n = 19), observations (n = 13) of clinic
appointments from two urban settings in Malaysia and a documentary analysis.
Recordings were transcribed verbatim, field notes were made during observations
and the data analysed and synthesised within and across case using Framework
analysis.
FINDINGS: Three main themes explained self-care and self-care support in
Malaysia: fatalism, faith and fear. Patients were fatalistic about developing
diabetes-they perceived it as inevitable because it is so common in Malaysia.
However, faith in God, coupled with fear of the consequences of diabetes,
motivated them to engage in self-care practices. The fear was largely induced by
diabetes healthcare professionals working in overcrowded clinics, and stretched
thinly across the service, who used a direct and uncompromising approach to
instil the importance of self-care to avoid severe long-term complications.
CONCLUSION: This study provided important insight on how people in Malaysia
developed diabetes, their responses to the disease and the approach of healthcare
professionals in supporting them to engage with self-care.
RELEVANCE TO CLINICAL PRACTICE: Any future development of self-care programmes in
Malaysia needs to recognise the factors that motivate patients to self-care and
include components that build self-efficacy.
DOI: 10.1111/jocn.14559
1120. Gerontol Geriatr Med. 2019 Jun 27;5:2333721419855662. doi:
10.1177/2333721419855662. eCollection 2019 Jan-Dec.
Feasibility of a Texting Intervention to Improve Medication Adherence Among Older

HIV+ African Americans: A Mixed-Method Pilot Study.
Pagan-Ortiz ME(1), Goulet P(2), Kogelman L(3), Levkoff SE(1)(4), Weitzman PF(1).
Author information:
(1)Environment and Health Group, Cambridge, MA, USA.
(2)Boston Medical Center, MA, USA.
(3)Tufts Medical Center, Boston, MA, USA.
(4)University of South Carolina, Columbia, USA.
Antiretroviral therapy (ART) is the primary treatment for HIV, and adherence to
it is crucial to addressing health disparities. Approximately half of individuals
in the United States living with HIV are African Americans, and those over 45
years of age are more likely to die early from HIV/AIDS than their White
counterparts. This mixed-method pilot study evaluated the feasibility of a
text-based mobile phone intervention designed to improve ART adherence among
older African Americans with HIV. Feasibility was assessed via implementation,
participant adherence, acceptability, and satisfaction, as well as short-term
impact on medication adherence, adherence-related self-efficacy, and positive
affect. The intervention utilized pill reminder, motivational, and health
educational texts. Participants (N = 21) ranged in age from 50 to 68 years.
Outcomes were evaluated via quantitative results from self-report measures and
qualitative data from four focus groups. Attrition to the study was 100%. After 8
weeks, participants reported statistically significant improvements in medication
adherence, but not in self-efficacy or affect scores. Qualitative findings
highlight the psychologically supportive potential of the intervention,
challenges to adherence, as well as suggestions for improvement. The study
demonstrates that a text messaging intervention may be feasible for older African
Americans with HIV, and helpful in supporting ART adherence.
DOI: 10.1177/2333721419855662
PMCID: PMC6598320
PMID: 31276016

1121. Bipolar Disord. 2015 Sep;17(6):653-61. doi: 10.1111/bdi.12326.
Symptom severity, self-reported adherence, and electronic pill monitoring in

poorly adherent patients with bipolar disorder.
Sajatovic M(1)(2)(3), Levin JB(1)(2), Sams J(1)(2), Cassidy KA(1), Akagi K(1),
Aebi ME(2), Ramirez LF(1), Safren SA(4), Tatsuoka C(2)(3).
Author information:
(1)Department of Psychiatry, Case Western Reserve University School of Medicine,
Cleveland, OH, USA.
(2)University Hospitals Case Medical Center, Neurological and Behavioral Outcomes
Center, Cleveland, OH, USA.
(3)Department of Neurology, Case Western Reserve University School of Medicine,
Cleveland, OH, USA.
(4)Department of Psychiatry, Harvard Medical School/Massachusetts General
Hospital, Boston, MA, USA.
OBJECTIVES: This analysis of screening and baseline data from an ongoing trial
examined self-report versus automated adherence monitoring and assessed the
relationship between bipolar disorder (BD) symptoms and adherence in 104 poorly
adherent individuals.
METHODS: Adherence was measured with the Tablets Routine Questionnaire (TRQ) and
the Medication Event Monitoring System (MEMS). Symptoms were measured with the
Montgomery-Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale
(YMRS), and the Brief Psychiatric Rating Scale (BPRS).
RESULTS: The mean age of the sample was 46.3 years [standard deviation (SD) =
9.41 years], with 72% (n = 75) women and 71% (n = 74) African American subjects.
Adherence improved from screening to baseline, with a mean missed drug proportion
measured by TRQ of 61.43% (SD = 26.48%) versus a baseline mean of 46.61% (SD =
30.55%). The mean proportion of missed medication using MEMS at baseline was
66.43% (SD = 30.40%). The correlation between TRQ and MEMS was 0.47. The
correlation between a single index drug and all BD medications was 0.95. Symptoms
were generally positively correlated with TRQ (worse adherence = more severe
symptoms), but in most instances was only at a trend level (p > 0.05), with the
exception of the correlations between baseline TRQ and MADRS and BPRS, which were
positive (r = 0.20 and r = 0.21, respectively) and significant (p ≤ 0.05).
CONCLUSIONS: In patients with BD, monitoring increased adherence by 15%. MEMS
identified 20% more non-adherence than self-report. Using a standard procedure to
identify a single index drug for adherence monitoring may be one way to assess
global adherence in patients with BD receiving polypharmacy treatment. Greater BD
symptom severity may be a clinical indicator to assess for adherence problems.
DOI: 10.1111/bdi.12326
PMCID: PMC4632982
1122. Int J Clin Pharm. 2019 Aug;41(4):1031-1046. doi: 10.1007/s11096-019-00845-z.

Epub
2019 May 15.
Implementation fidelity of an intervention programme to enhance adherence to

antihypertensive medication in Dutch community pharmacies.
van der Laan DM(1), Langendoen-Gort M(2), Nijpels G(2), Boons CCLM(3), Elders
PJM(2), Hugtenburg JG(3).
Author information:
Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan
1117, Amsterdam, The Netherlands. d.vanderlaan1@vumc.nl.
(2)Department of General Practice and Elderly Care Medicine, Amsterdam Public
Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De
Boelelaan 1117, Amsterdam, The Netherlands.
Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan
1117, Amsterdam, The Netherlands.
Background Insight into the delivery of interventions is necessary to gain a

better understanding of what caused an intervention to succeed or fail. The
Cardiovascular medication non-Adherence Tailored Intervention (CATI) study failed
to show effectiveness of a patient-tailored, pharmacist-led intervention
programme on self-reported adherence to antihypertensive medication. Objective To
evaluate the implementation fidelity of the CATI intervention programme. Setting
Twenty Dutch community pharmacies. Method The process of a randomised controlled
trial was evaluated. Both quantitative and qualitative data were collected and
analysed according to Carrolls' Conceptual Framework for Implementation Fidelity.
Implementation fidelity is defined as the degree to which the intervention was
implemented as intended. Main outcome measure Four key intervention components of
the intervention programme (i.e., first consultation: barrier identification,
information and advice, written summary, and follow-up consultation). Results For
most participants the key intervention components were implemented as intended.
The training of pharmacists, intensive monitoring during the study and structured
and easy-to-use intervention materials facilitated the implementation of the
intervention. The method to select participants for the intervention programme
was considered insufficient and pharmacists questioned the eligibility of some
participants because of a low degree of intake non-adherence. Conclusion
Implementation fidelity was moderate to high for all key intervention components.
Therefore, the absence of effectiveness of the CATI intervention programme on
self-reported medication adherence cannot be explained by poor implementation of
the intervention. However, the limited genuine eligibility of some participants
resulted in a limited potential for improvement in medication adherence.
DOI: 10.1007/s11096-019-00845-z
PMCID: PMC6677874
PMID: 31093942
1123. Patient Prefer Adherence. 2017 Feb 10;11:221-228. doi: 10.2147/PPA.S120003.

eCollection 2017.
Acceptability and efficacy of interactive short message service intervention in

improving HIV medication adherence in Chinese antiretroviral treatment-naïve
individuals.
Ruan Y(1), Xiao X(2), Chen J(2), Li X(2), Williams AB(3), Wang H(2).
Author information:
(1)Nursing Department, Second Xiangya Hospital.
(2)Xiangya School of Nursing, Central South University, Changsha, Hunan, People's
Republic of China.
(3)School of Nursing, Yale University, West Haven, CT, USA.
AIM: The aim of this study was to examine the acceptability and efficacy of
interactive short message service (SMS) in improving medication adherence in
antiretroviral treatment (ART)-naïve individuals living with HIV/AIDS in
Hengyang, Hunan, China.
BACKGROUND: SMS via mobile phone has emerged as a potential tool for improving
ART adherence. However, most studies used SMS only as a medication reminder, with
few studies exploring the effect of comprehensive, interactive SMS.
PATIENTS AND METHODS: In a randomized controlled trial, 100 HIV-positive patients
on ART for <3 months were randomized into control or intervention arm.
Participants in the control group received routine standard instruction for ART
medication in the HIV clinics, while the intervention group received 6 months of
an SMS intervention in addition to the standard care. A total of 124 text
messages within 6 modules were edited, preinstalled, and sent to participants
according to personalized schedules. Knowledge (of HIV and HIV medications),
self-reported antiretroviral adherence (Visual Analog Scale [VAS] and Community
Programs for Clinical Research on AIDS [CPCRA] Antiretroviral Medication
Self-Report), and CD4 count were assessed at baseline and immediate
post-intervention. Intervention participants were interviewed after completion of
the study about their satisfaction with and acceptability of the SMS
intervention.
RESULTS: Baseline assessments were comparable between arms. Repeated-measures
analysis showed that both HIV-related and ART medication knowledge of the
intervention group showed better improvement over time than those of the control
group after the intervention (P<0.0001). For the adherence measures, compared
with the control group, participants in the intervention group had significantly
higher VAS mean score (Z=2.735, P=0.006) and lower suboptimal adherence rate
(Z=2.208, P=0.027) at the end of the study. The intervention had no effect on CD4
cell count. Almost all (96%) intervention participants reported satisfaction or
high satisfaction with the SMS intervention, with 74% desiring to continue to
receive the SMS intervention. The preferred frequency of messages was 1-2
messages per week.
CONCLUSION: An interactive SMS intervention with comprehensive content shows
promising efficacy in promoting medication adherence in ART-naïve individuals.
Future work might further refine its ability to optimally tailor the intervention
for individual preferences.
DOI: 10.2147/PPA.S120003
PMCID: PMC5312688
PMID: 28228652

1124. Int J Clin Pharm. 2016 Apr;38(2):289-95. doi: 10.1007/s11096-015-0236-7. Epub

2016 Jan 6.
Medicines reconciliation in comparison with NICE guidelines across secondary care

mental health organisations.
Kothari M(1), Maidment I(2), Lyon R(3), Haygarth L(4).
Author information:
(1)Aston University, Aston Triangle, Birmingham, B4 7ET, UK. medha288@gmail.com.
(2)Aston University, Aston Triangle, Birmingham, B4 7ET, UK.
(3)Sussex Partnership NHS Foundation Trust, Brighton, West Sussex, BN13 3EP, UK.
(4)University of Huddersfield, Huddersfield, West Yorkshire, HD1 3DH, UK.
BACKGROUND: Medicines reconciliation-identifying and maintaining an accurate list

of a patient's current medications-should be undertaken at all transitions of
care and available to all patients.
OBJECTIVE: A self-completion web survey was conducted for chief pharmacists (or
equivalent) to evaluate medicines reconciliation levels in secondary care mental
health organisations.
SETTING: The survey was sent to secondary care mental health organisations in
England, Scotland, Northern Ireland and Wales.
METHOD: The survey was launched via Bristol Online Surveys. Quantitative data was
analysed using descriptive statistics and qualitative data was collected through
respondents free-text answers to specific questions.
MAIN OUTCOMES MEASURE: Investigate how medicines reconciliation is delivered,
incorporate a clear description of the role of pharmacy staff and identify areas
of concern.
RESULTS: Forty-two (52 % response rate) surveys were completed. Thirty-seven
(88.1 %) organisations have a formal policy for medicines reconciliation with
defined steps. Results show that the pharmacy team (pharmacists and pharmacy
technicians) are the main professionals involved in medicines reconciliation with
a high rate of doctors also involved. Training procedures frequently include an
induction by pharmacy for doctors whilst the pharmacy team are generally trained
by another member of pharmacy. Mental health organisations estimate that nearly
80 % of medicines reconciliation is carried out within 24 h of admission. A full
medicines reconciliation is not carried out on patient transfer between mental
health wards; instead quicker and less exhaustive variations are implemented.
71.4 % of organisations estimate that pharmacy staff conduct daily medicine
reconciliations for acute admission wards (Monday to Friday). However, only 38 %
of organisations self-report to pharmacy reconciling patients' medication for
other teams that admit from primary care.
CONCLUSION: Most mental health organisations appear to be complying with NICE
guidance on medicines reconciliation for their acute admission wards. However,
medicines reconciliation is conducted less frequently on other units that admit
from primary care and rarely completed on transfer when it significantly differs
to that on admission. Formal training and competency assessments on medicines
reconciliation should be considered as current training varies and adherence to
best practice is questionable.
DOI: 10.1007/s11096-015-0236-7
PMCID: PMC4828472
Structural and functional support among US older adults with asthma:

cross-Sectional associations with medication adherence.
O'Conor R(1), Hebert-Beirne J(2), Kwasny M(3), Eldeirawi K(4), Hasnain-Wynia

R(5), Wisnivesky J(6), Wolf M(7), Federman A(6).
Author information:
(1)General Internal Medicine and Geriatrics, Northwestern University, Chicago,
Illinois, USA r-oconor@northwestern.edu.
(2)School of Public Health, University of Illinois at Chicago, Chicago, Illinois,
USA.
(3)Department of Preventive Medicine, Northwestern University, Chicago, Illinois,
USA.
(4)College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA.
(5)Denver Health and Hospital Authority, Denver, Colorado, USA.
(6)Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
(7)Department of General Internal Medicine, Northwestern University, Chicago,
Illinois, USA.
OBJECTIVES: Disadvantaged older adults may benefit from social support in

adhering to their medications, but the multidimensional nature of social
relationships makes it difficult to identify the most relevant domain. We
examined associations of structural and functional support with medication
adherence among a cohort of older adults with asthma.
DESIGN: Cross-sectional analysis of the Asthma Beliefs and Literacy in the
Elderly cohort study.
SETTING: Outpatient clinics in New York, New York, and Chicago, Illinois, USA.
PARTICIPANTS: English-speaking and Spanish-speaking older adults (≥60 years) with
asthma.
OUTCOME MEASURES: Medication adherence was measured using dose counts from
inhaler and self-report.
RESULTS: Among 383 participants, the mean age was 67 years, 38% identified as
Hispanic, 33% identified as black, 52% reported monthly incomes ≤US$1350 and 64%
demonstrated poor adherence to their asthma controller medication. Structural and
functional support were weakly correlated (r=-0.15, p=0.005). In adjusted
analyses, structural support was not associated with medication adherence.
Participants who received infrequent functional support in managing their
medications had lower odds of poor adherence according to dose counts (OR 0.51,
95% CI 0.26 to 0.98), but not when assessed via self-report (OR 0.81, 95% CI 0.44
to 1.48).
CONCLUSION: The receipt of frequent functional support in managing medications
was associated with poor adherence to asthma controller medications. Further
research is needed to better understand the manner and context which functional
support operates in relation to medication adherence among older adults.

DOI: 10.1136/bmjopen-2018-027430
PMID: 31462464
Conflict of interest statement: Competing interests: MW has unrestricted research

grants from Merck, Sharpe, Dohme and Eli Lily; has consulted for Luto UK and
Pfizer and received honoraria from MedLearning Group, New York University. JW has
received consulting honorarium from Quintiles, AstraZenaca, Sanofi and Merck, and
research grants from Sanofi and Quorum.
1126. J Am Board Fam Med. 2015 Jan-Feb;28(1):38-45. doi:

10.3122/jabfm.2015.01.140123.
The impact of health coaching on medication adherence in patients with poorly

controlled diabetes, hypertension, and/or hyperlipidemia: a randomized controlled
trial.
Thom DH(1), Willard-Grace R(2), Hessler D(2), DeVore D(2), Prado C(2),
Bodenheimer T(2), Chen E(2).
Author information:
(1)From the Department of Family and Community Medicine, University of
California, San Francisco, School of Medicine; San Francisco (DHT, RW-G, DH, DD,
CP, TB, EC); and the Silver Avenue Health Center, San Francisco, CA (EC).
dthom@fcm.ucsdf.edu.
(2)From the Department of Family and Community Medicine, University of
California, San Francisco, School of Medicine; San Francisco (DHT, RW-G, DH, DD,
CP, TB, EC); and the Silver Avenue Health Center, San Francisco, CA (EC).
BACKGROUND: Lack of concordance between medications listed in the medical record

and taken by the patient contributes to poor outcomes. We sought to determine
whether patients who received health coaching by medical assistants improved
their medication concordance and adherence.
METHODS: This was a nonblinded, randomized, controlled, pragmatic intervention
trial. English- or Spanish-speaking patients, age 18 to 75 years, with poorly
controlled type 2 diabetes, hypertension, and/or hyperlipidemia were enrolled
from 2 urban safety net clinics and randomized to receive 12 months of health
coaching versus usual care.
RESULTS: Outcomes included concordance between medications documented in the
medical record and those reported by the patient and adherence based on the
patient-reported number of days (of the last 7) on which patient took all
prescribed medications. The proportion of medications completely concordant
increased in the coached group versus the usual care group (difference in change,
10%; P = .05). The proportion of medications listed in the chart but not taken
significantly decreased in the coached group compared with the usual care group
(difference in change, 17%; P = .013). The mean number of adherent days increased
in the coached but not in the usual care group (difference in change, 1.08; P <
.001).
CONCLUSIONS: Health coaching by medical assistants significantly increases
medication concordance and adherence.
DOI: 10.3122/jabfm.2015.01.140123
1127. Diabetes Res Clin Pract. 2015 Nov;110(2):193-201. doi:

10.1016/j.diabres.2015.09.007. Epub 2015 Sep 18.
Social determinants of health in adults with type 2 diabetes--Contribution of

mutable and immutable factors.
Walker RJ(1), Smalls BL(2), Egede LE(3).
Author information:
HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Center for Health
Disparities Research, Medical University of South Carolina, Charleston, SC, USA.
(2)Center for Surgery and Public Health, Brigham and Women's Hospital, Boston,
MA, USA.
Disparities Research, Medical University of South Carolina, Charleston, SC, USA;
Division of General Internal Medicine and Geriatrics, Department of Medicine,
Medical University of South Carolina, Charleston, SC, USA. Electronic address:
egedel@musc.edu.
AIMS: Socioeconomic, psychosocial, and neighborhood factors influence clinical

outcomes and self-care behaviors in diabetes; however, few studies simultaneously
assessed the impact of multiple social determinant of health factors on glycemic
control. We used an explanatory model to examine the differential contribution of
social determinants and clinical factors on glycemic control. Secondarily, we
examined the contribution of mutable and immutable factors to identify meaningful
future interventions.
METHODS: Six hundred and fifteen adults with type 2 diabetes in the southeastern
United States were recruited. A hierarchical model was run with HbA1c as the
dependent variable and independent variables entered in blocks: demographics
(block 1), socioeconomic (block 2), psychosocial (block 3), built environment
(block 4), clinical (block 5), and knowledge/self-care (block 6).
RESULTS: Significant associations for HbA1c included self-efficacy (β=-0.10,
p<0.001), social support (β=0.01, p<0.05), comorbidity (β=-0.09, p<0.05), insulin
use (β=0.95, p<0.001), medication adherence (β=-0.11, p<0.05), and being a former
smoker (β=0.34, p<0.05); accounting for 24.4% of the variance.
CONCLUSIONS: Important factors that drive glycemic control are mutable, and
amenable to health interventions. Greater attention should be given to
interventions that increase self-efficacy and social support, reduce the burden
of comorbidities, and enhance medication adherence and smoking cessation.
DOI: 10.1016/j.diabres.2015.09.007
PMCID: PMC4681588
1128. Shanghai Arch Psychiatry. 2014 Dec;26(6):347-56. doi:
10.11919/j.issn.1002-0829.214101.
Sexual dysfunction in outpatients with schizophrenia in Turkey: a cross-sectional

study.
Hocaoglu C(1), Celik FH(1), Kandemir G(1), Guveli H(2), Bahceci B(1).
Author information:
(1)Department of Psychiatry,Recep Tayyip Erdogan University, Rize, Turkey.
(2)Istanbul University Oncology Enstitude, Department of Psychiatry, Istanbul,
Turkey.
BACKGROUND: Sexual dysfunction is one of several factors related to medication

compliance in patients taking antipsychotic medication but the magnitude of this
problem is unknown.
AIM: Compare the self-reported sexual functioning of clinically stable patients
with schizophrenia taking antipsychotic medication to that of healthy controls
using the Turkish version of the 5-item Arizona Sexual Experience Scale (ASEX).
This scale, which has previously been validated in Turkey, assesses 5 components
of sexual function: sex drive, sexual arousal, vaginal lubrication/penile
erection, ability to achieve orgasm, and satisfaction with orgasm.
METHODS: The Scale for the Assessment of Positive Symptoms, the Scale for
Assessment of Negative Symptoms, and ASEX were administered to 101 clinically
stable outpatients with schizophrenia (38 females and 63 males). The ASEX was
also administered to 89 control subjects (41 females and 48 males) without a
history of mental illness. Respondents were classified as having sexual
dysfunction if ASEX total score (range 5-30) >18, if any ASEX item score (range
1-6) ≥ 5, or if 3 or more ASEX items ≥4.
RESULTS: Male patients with schizophrenia have significantly more self-reported
sexual dysfunction than healthy controls (46% vs. 8%). The prevalence of sexual
dysfunction is higher in female patients than in male patients (68% vs. 46%), but
it was also very high in healthy female controls (68%), so the sexual dysfunction
of female patients cannot be attributed to their illness or to the medications
they are taking. Within the patient group, there was no significant relationship
between the severity of positive or negative symptoms and the severity of sexual
dysfunction, and the severity of sexual function was not different between
patients taking first-generation or second-generation antipsychotic medications.
CONCLUSIONS: The very different findings by gender in Turkey highlights the
importance of assessing location-specific and gender-specific sexual norms when
trying to assess the role of mental illness and medications on sexual
functioning. Prospective studies are needed to distinguish the relative
importance of cultural norms, the schizophrenic illness, and the use of
antipsychotic medication in the etiology and course of sexual dysfunction among
individuals with schizophrenia.
Publisher:
性功能障碍是影响患者对抗精神病药物服药依从性的因素之一，但尚不清楚这个问题的严重程度。比较服用抗精
神病药物且临床症状稳定的精神分裂症患者和健康对照者自我报告的性功
能状况。评估工具采用土耳其语版的 5 个条目的亚利桑那性体验量表（Arizona Sexual Experience Scale
，ASEX）。该量表的效度已在土耳其得到验证。量表评估性欲、性唤起、阴道润滑/阴茎勃起、达到高潮的能力
以及对高潮的满意度等 5 个方面的性功能。采用阳性症状量表、阴性
症状量表和 ASEX 分别对 101 例临床症状稳定的门诊精神分裂症患者（女性 38 例、男性 63 例）进行评估。对 89
例无精神疾病史的对照者（女性 41 名、男性 48 名）也进行了
ASEX 量表评估。如果 ASEX 总分（范围 5-30）>18，或者任一条目得分（范围 1-6）≥5，或者至少有 3 个条目
得分都大于 4，则被视为存在性功能障碍。自我报告有性
功能障碍的男性精神分裂症患者多于健康对照者（46％对 8％）。虽然女性患者性功能障碍的患病率显著高于男
性患者（68％对 46％），但是对照组中健康女性的性功能障碍患病
率也非常高（68％），因而女性患者的性功能障碍不能归咎于她们的疾病或是正在服用的药物。患者组中，阳性
症状和阴性症状的严重程度与性功能障碍无相关性，服用第一代抗精神
病药的患者与服用第二代抗精神病药的患者之间的性功能障碍严重程度无明显差异。在土耳其，不同性别的精神
分裂症患者性功能状况的研究结果不同，这凸显了在评估精神障碍和药物
对性功能的影响时制定特定区域、特定性别的性行为社会规范的重要性。今后需要采用前瞻性研究来区分文化规
范、精神疾病以及使用的抗精神病药物在精神分裂症患者性功能障碍的病
因和病程中的相对作用。
DOI: 10.11919/j.issn.1002-0829.214101
PMCID: PMC4311108
PMID: 25642109
1129. J Transcult Nurs. 2016 Jan;27(1):57-64. doi: 10.1177/1043659614526456. Epub

2014
May 20.
Acculturation, Medication Adherence, Lifestyle Behaviors, and Blood Pressure

Control Among Arab Americans.
Tailakh AK(1), Evangelista LS(2), Morisky DE(3), Mentes JC(3), Pike NA(3),
Phillips LR(3).
Author information:
(1)California State University, Los Angeles, CA, USA
ayman.tailakh@calstatela.edu.
(2)University of California, Irvine, CA, USA.
(3)University of California, Los Angeles, CA, USA.
PURPOSE: The aim of this study was to examine the relationship between
acculturation, medication adherence, lifestyle behaviors (e.g., physical
activity, nutrition, weight control), and blood pressure control among
hypertensive Arab Americans.
DESIGN: The study utilized a cross-sectional descriptive design. A convenience
sample of 126 participants completed questionnaires and had measures of blood
pressure, weight, and height. Forty-six participants were hypertensive and were
included in the analysis.
RESULTS: Only 29.2% of participants reported high medication adherence. High
medication adherence was associated with lower diastolic blood pressure, eating a
healthy diet, and following lifestyle modifications. Acculturation was
significantly associated with physical activity and body mass index.
CONCLUSION: Our study found that acculturated participants were more adherent to
medications and physical activity and had better blood pressure control. Further
studies are needed to explore how acculturation improves adherence and what
factors contribute to better adherence in order to design culturally sensitive
interventions.
DOI: 10.1177/1043659614526456
PMCID: PMC4446252
1130. ESC Heart Fail. 2019 Feb;6(1):164-173. doi: 10.1002/ehf2.12380. Epub 2018 Nov
27.
Post-discharge short message service improves short-term clinical outcome and

self-care behaviour in chronic heart failure.
Chen C(1), Li X(2), Sun L(1), Cao S(1), Kang Y(1), Hong L(1), Liang Y(1), You
G(1), Zhang Q(1).
Author information:
(1)Department of Cardiology, West China Hospital, Sichuan University, No. 37 Guo
Xue Xiang, Chengdu, China.
(2)Department of Cardiovascular Surgery, West China Hospital, Sichuan University,
Chengdu, China.
AIMS: In addition to giving optimal medical and device therapy, promoting

self-care of chronic heart failure (CHF) patients also plays an important role in
comprehensive disease management for better outcomes. The study was aimed to
investigate whether short message service (SMS) would help to improve death or
readmission-free survival and self-care behaviour in CHF patients.
METHODS AND RESULTS: This was a randomized controlled trial. Between December
2011 and September 2015, patients admitted with decompensated CHF in a tertiary
referral hospital who fulfilled the inclusion criteria were enrolled and
randomized to receive SMS, structured telephone support (STS), or usual care
after discharge. All patients were followed up to 180 days after discharge by
phone call or clinic visit. Primary endpoint was the 180 day composite event,
defined as all-cause mortality or readmission. Secondary endpoints included
self-care behaviour and quality of life. Seven hundred sixty-seven patients
(61 ± 15 years, 56.5% male) were finally randomized to receive SMS (n = 252), STS
(n = 255), or usual care (n = 260). Baseline characteristics were similar among
the three groups. Five hundred twenty-five (68.4%) patients were in New York
Heart Association Class III or IV, and 472 (61.5%) patients had an ejection
fraction of <50%. During a 180 day follow-up, 76 (9.9%) patients died and 274
(35.7%) patients experienced at least one readmission. In a short-term follow-up
of 30 days, there was no difference in mortality and the composite endpoint among
the three groups (SMS vs. STS vs. usual care: 2.8% vs. 3.1% vs. 3.8% for
mortality, P = 0.786; 12.3% vs. 14.5% vs. 15.4% for the composite endpoint,
P = 0.588). The 180 day composite event rate was significantly lower in the SMS
and STS groups (50.4% vs. 41.3% and 36.5%, both P < 0.05) than in the usual care
group, but no difference was observed between the two phone-based intervention
groups (P = 0.268). Although there was no difference between the two groups,
better self-care behaviour was reported in the SMS and STS groups than in the
control group (medication compliance, 78.9% vs. 81.4% vs. 69.5%, P = 0.011; water
restriction, 70.8% vs. 74.5% vs. 61.5%, P = 0.013). Quality-of-life score was
similar among the three groups at 180 days (P = 0.526).
CONCLUSIONS: In CHF patients, post-discharge SMS, which appeared as efficient as
STS, reduced the 180 day composite event and improved self-care behaviour. SMS
intervention could be integrated into CHF management.
© 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on
behalf of the European Society of Cardiology.
DOI: 10.1002/ehf2.12380
PMCID: PMC6352960
1131. JCO Clin Cancer Inform. 2019 May;3:1-6. doi: 10.1200/CCI.18.00128.
Clinician Report of Oral Oncolytic Symptoms and Adherence Obtained via a

Patient-Reported Outcome Measure (PROM).
Nachar VR(1)(2), Farris K(2)(3), Beekman K(4), Griggs J(1)(3), Hough S(1)(3),
Mackler E(3).
Author information:
(1)University of Michigan, Ann Arbor, MI.
(2)University of Michigan College of Pharmacy, Ann Arbor, MI.
(3)Michigan Oncology Quality Consortium, Ann Arbor, MI.
(4)IHA Hematology Oncology Consultants, Ypsilanti, MI.
PURPOSE: Patient-reported outcome measures (PROMs) for symptom monitoring during

cancer therapy have been shown to have a positive impact on outcomes. These
findings have primarily been shown for patients receiving intravenous
chemotherapy. In addition, there is known discordance between physician reporting
of symptoms and patient self-report. This initiative sought to describe
patient-reported symptom burden and medication adherence and to indicate the
degree of PROM results being discussed with the provider as indicated by
documentation in the medical record for patients taking oral oncolytic therapy.
METHODS: The Michigan Oncology Quality Consortium (MOQC) PROM, which included
symptom ratings, medication adherence, and patient confidence in self-management,
was completed during outpatient visits and compared with corresponding data
documented in the electronic medical record (EMR).
RESULTS: There were 82 completed PROMs. Approximately half included at least one
symptom rated as severe (46%). Sixty-five percent of reported severe symptoms
were documented in the EMR. Patient-reported moderate-to-severe pain was most
likely to be documented in the EMR (100%), whereas patient-reported
moderate-to-severe depression and anxiety were least likely to be documented
(21%). Of the total symptoms documented, grading of symptom severity matched that
of the patients' own report for 11% of severe symptoms. Adherence to oral
oncolytics was excellent for 63% of patients, and patient adherence was
documented in 7% of provider notes.
CONCLUSION: Patients frequently reported moderate-to-severe symptoms, and
approximately 40% of patients reported nonadherence. Clinician report (documented
in the EMR) of the patient symptom burden, symptom severity, and adherence to
oral oncolytic therapy was not consistent with the patients' self-report. Use of
a PROM for patients taking oral oncolytics has the opportunity to improve symptom
management and medication adherence.
DOI: 10.1200/CCI.18.00128
PMID: 31100014
1132. Afr J Prim Health Care Fam Med. 2016 Jul 28;8(1):e1-5. doi:
10.4102/phcfm.v8i1.900.
Assessment of self-reported adherence among patients with type 2 diabetes in

Matlala District Hospital, Limpopo Province.
Adegbola SA, Marincowitz GJ(1), Govender I, Ogunbanjo GA.
Author information:
(1)Department of Family Medicine & Primary Health Care, University of Limpopo.
rhinorth@mweb.co.za.
INTRODUCTION: Complications associated with Diabetes Mellitus are a burden to

health services, especially in resource poor settings. These complications are
associated with substandard care and poor adherence to treatment plans. The aim
of the study was to assess the self-reported adherence to treatment amongst
patients with type 2 diabetes in Matlala District Hospital, Limpopo Province.
METHODS: This cross-sectional study used convenience sampling with a
standardised, validated questionnaire. Data were collected over 4 months, and
Microsoft Excel was used for data capturing.
RESULTS: We found that 137 (70%) of the participants considered themselves
adherent to their diabetes medication. Younger age (p = 0.028), current
employment (p = 0.018) and keeping appointment were factors significantly
associated with adherence. Reasons given for poor adherence were that the clinic
did not have their pills (29%), they had forgotten to take their medication (16%)
and gone travelling without taking enough pills (14%). Reasons given for poor
adherences to a healthy lifestyle were being too old (29%), 22% had no specific
reason, 13% struggled to motivate themselves and 10% simply forgot what to do.
Sixty-eight percent of the adhered participants recommended the use of medication
at meal times, 14% set a reminder, and 8% used the assistance of a treatment
supporter.
CONCLUSIONS AND RECOMMENDATIONS: The study revealed a higher than expected
reported level of adherence to diabetes treatment. Further research is needed to
assess whether self-reported adherence corresponds to the metabolic control of
the patients and to improve services.
DOI: 10.4102/phcfm.v8i1.900
PMCID: PMC4992187
1133. AIDS Patient Care STDS. 2014 Nov;28(11):579-86. doi: 10.1089/apc.2014.0156.

Epub
2014 Oct 7.
Effect of a smartphone application incorporating personalized health-related

imagery on adherence to antiretroviral therapy: a randomized clinical trial.
Perera AI(1), Thomas MG, Moore JO, Faasse K, Petrie KJ.
Author information:
(1)1 Department of Psychological Medicine, University of Auckland , New Zealand .
Erratum in
AIDS Patient Care STDS. 2015 Jan;29(1):52.
Poor adherence to combination antiretroviral therapy (ART) is a major global

challenge. In this study we examined the efficacy of a smartphone application
incorporating personalized health-related visual imagery that provided real-time
information about the level of medication and the patient's level of
immunoprotection, in order to improve adherence to ART. We randomized 28 people
on ART to either a standard or augmented version of the smartphone application.
The augmented version contained components that illustrated participants' current
estimated plasma concentrations of antiretroviral drugs and the immune protection
provided by ART. Adherence to ART was assessed at baseline and at 3 months using
self-reported adherence, pharmacy dispensing records, and HIV viral load.
Information was also collected on illness and medication beliefs and use of the
application. Participants who received the augmented application showed a
significantly higher level of self-reported adherence to ART at 3 months (p=0.03)
and decreased viral load (p=0.023) as compared to individuals using the standard
version. Greater usage of the extra components of the augmented application was
associated with greater perceived understanding of HIV infection and increased
perceived necessity for ART. Smartphone applications that incorporate
personalized health-related visual imagery may have potential to improve
adherence to ART.
DOI: 10.1089/apc.2014.0156
PMCID: PMC4216527
eCollection 2015.
Factors associated with medication information in diabetes care: differences in

perceptions between patients and health care professionals.
Längst G(1), Seidling HM(2), Stützle M(2), Ose D(1), Baudendistel I(1), Szecsenyi
J(1), Wensing M(3), Mahler C(1).
Author information:
Hospital of Heidelberg, Heidelberg, Germany.
(2)Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg,
Germany ; Department of Clinical Pharmacology and Pharmacoepidemiology,
University of Heidelberg, Heidelberg, Germany.
Hospital of Heidelberg, Heidelberg, Germany ; Radboud University Nijmegen Medical
Centre, Scientific Institute for Quality of Healthcare, Nijmegen, the
Netherlands.
PURPOSE: This qualitative study in patients with type 2 diabetes and health care
professionals (HCPs) aimed to investigate which factors they perceive to enhance
or impede medication information provision in primary care. Similarities and
differences in perspectives were explored.
METHODS: Eight semistructured focus groups were conducted, four with type 2
diabetes patients (n=25) and four with both general practitioners (n=13) and
health care assistants (n=10). Sessions were audio and video recorded,
transcribed verbatim, and subjected to computer-aided qualitative content
analysis.
RESULTS: Diabetes patients and HCPs broadly highlighted similar factors as
enablers for satisfactory medication information delivery. Perceptions
substantially differed regarding impeding factors. Both patients and HCPs
perceived it to be essential to deliver tailored information, to have a trustful
and continuous patient-provider relationship, to regularly reconcile medications,
and to provide tools for medication management. However, substantial differences
in perceptions related to impeding factors included the causes of inadequate
information, the detail required for risk-related information, and barriers to
medication reconciliation. Medication self-management was a prevalent topic among
patients, whereas HCPs' focus was on fulfilling therapy and medication management
responsibilities.
CONCLUSION: The findings suggest a noteworthy gap in perceptions between
information provision and patients' needs regarding medication-related
communication. Medication safety and adherence may be improved if HCPs
collaborate more closely with diabetes patients in managing their medication, in
particular by incorporating the patients' perspective. Health care systems need
to be structured in a way that supports this process.
DOI: 10.2147/PPA.S88357
PMCID: PMC4612137
PMID: 26508840

eCollection 2014.
Medication adherence behaviors of Medicare beneficiaries.

Carr-Lopez SM(1), Shek A(1), Lastimosa J(2), Patel RA(1), Woelfel JA(1), Galal
SM(1), Gundersen B(1).
Author information:
(1)Pharmacy Practice Department, University of the Pacific, Stockton, CA, USA.
(2)Thomas J Long School of Pharmacy and Health Sciences, University of the
Pacific, Stockton, CA, USA.
BACKGROUND: Medication adherence is crucial for positive outcomes in the

management of chronic conditions. Comprehensive medication consultation can
improve medication adherence by addressing intentional and unintentional
nonadherence. The Medicare Part D prescription drug benefit has eliminated some
cost barriers. We sought to examine variables that impact self-reported
medication adherence behaviors in an ambulatory Medicare-beneficiary population
and to identify the factors that influence what information is provided during a
pharmacist consultation.
METHODS: Medicare beneficiaries who attended health fairs in northern California
were offered medication therapy management (MTM) services during which
demographic, social, and health information, and responses to survey questions
regarding adherence were collected. Beneficiaries were also asked which critical
elements of a consultation were typically provided by their community pharmacist.
Survey responses were examined as a function of demographic, socioeconomic, and
health-related factors.
RESULTS: Of the 586 beneficiaries who were provided MTM services, 575 (98%)
completed the adherence questions. Of responders, 406 (70%) reported taking
medications "all of the time". Of the remaining 169 (30%), the following reasons
for nonadherence were provided: 123 (73%) forgetfulness; 18 (11%) side effects;
and 17 (10%) the medication was not needed. Lower adherence rates were associated
with difficulty paying for medication, presence of a medication-related problem,
and certain symptomatic chronic conditions. Of the 532 who completed survey
questions regarding the content of a typical pharmacist consultation, the topics
included: 378 (71%) medication name and indication; 361 (68%) administration
instructions; 307 (58%) side effects; 257 (48%) missed-dose instructions; and 245
(46%) interactions. Subsidy recipients and non-English speakers were
significantly less likely to be counseled on drug name, indication, and side
effects. The presence of certain health conditions was also associated with
missing consultation elements.
CONCLUSION: While Medicare beneficiaries are generally adherent to medication
therapy, adherence barriers must be identified and addressed during comprehensive
medication consultation.
DOI: 10.2147/PPA.S64825
PMCID: PMC4172241
PMID: 25258521
1136. J Phys Ther Sci. 2015 Nov;27(11):3493-7. doi: 10.1589/jpts.27.3493. Epub 2015
Nov
30.
Effects of traditional Thai self-massage using a Wilai massage stick(TM) versus

ibuprofen in patients with upper back pain associated with myofascial trigger
points: a randomized controlled trial.
Wamontree P(1), Kanchanakhan N(2), Eungpinichpong W(3), Jeensawek A(4).
Author information:
(1)College of Public Health Sciences, Chulalongkorn University, Thailand ; School
of Health Science, Mae Fah Luang University, Thailand.
(2)College of Public Health Sciences, Chulalongkorn University, Thailand.
(3)Research Center in Back, Neck, and Other Joint Pain, and Human Performance,
Khon Kaen University, Thailand.
(4)Lat Lum Kaew Hospital, Thailand.
[Purpose] The aim of this study was to examine the effects of traditional Thai
self-massage using a Wilai massage stick(TM) versus ibuprofen on reducing upper
back pain associated with myofascial trigger points. [Subjects and Methods] Sixty
patients who were diagnosed as having upper back pain associated with myofascial
trigger points were randomly allocated to either a massage group using a Wilai
massage stick(TM) or a medication group taking ibuprofen for 5 days. Both groups
were advised to perform the same daily stretching exercise program. Pain
intensity, pressure pain threshold, tissue hardness, and cervical range of motion
were assessed at baseline, immediately after the first treatment session, and on
the fifth day after the last treatment session. [Results] The massage group had
significant improvement in all parameters at all assessment time points. Similar
changes were observed in the medication group except for the pressure pain
threshold and tissue hardness. The adjusted post-test mean values for each
assessment time point were significantly better in the massage group than in the
medication group. [Conclusion] Tradition Thai self-massage using a Wilai massage
stick(TM) provides better results than taking ibuprofen for patients who have
upper back pain associated with myofascial trigger points. It could be an
alternative treatment for this patient population.
DOI: 10.1589/jpts.27.3493
PMCID: PMC4681931
PMID: 26696724
1137. J Ayub Med Coll Abbottabad. 2018 Oct-Dec;30(4):552-557.
Medication Adherence In Post Myocardial Infarction Patients.
Hussain S(1), Jamal SZ(1), Qadir F(1).
Author information:
(1)National Institute of Cardiovascular Disease, Karachi, Pakistan.
BACKGROUND: Medication non-adherence after acute myocardial infarction is a

global problem causing increased morbidity and mortality. This multifaceted
problem has not been well studied in our part of the world. Our study aimed to
determine the burden of medication non-adherence in post myocardial infarction
patients.
METHODS: This cross-sectional study was conducted at National Institute of
Cardiovascular disease, Karachi, from December 2016 to June 2017. A total of 350
patients were included at the time of discharge after their first myocardial
infarction (MI) of which follow up was completed for 315 patients. Baseline
characteristics and discharged drug data were collected for each individual.
Patients were called at 7th day, 1 and 3months post discharge and were assessed
for the medication adherence using Morisky medication adherence scale. They were
stratified accordingly into self-reported high, moderate and low groups. Chi-
square test was used to determine significant relationship between variables. The
level of significance was set at level of p-value ≤0.05.
RESULTS: Among 315 patients, only 45% patients were adherent to prescribed drugs
at 7th day follow up and the adherence further reduces to 19% at 3rd post MI
month (p-value <0.001). High income, male gender, and presence of partner
persistently showed significantly higher medication adherence. Factors like
younger age, addiction and advance education showed higher adherence only in
early follow up periods. However, presence of comorbidities, intervention and
specific diagnosis had no significant impact. The most common stated reasons for
non-adherence were forgetfulness and poor understanding of drugs.
CONCLUSIONS: Adherence to prescribed medication in post myocardial infarction
patients was found to be strikingly suboptimal, contributed by multiple factors.
Modification of these factors would likely improve patient adherence to
medication and eventually long-term outcome.
1138. Health Policy Technol. 2015 Dec 1;4(4):387-398.
Medication-related cognitive artifacts used by older adults with heart failure.
Mickelson RS(1), Willis M(2), Holden RJ(3).
Author information:
(1)Vanderbilt School of Nursing, Vanderbilt University, Nashville, TN, USA; The
Center for Research and Innovation in Systems Safety (CRISS), Vanderbilt
University Medical Center, Nashville, TN, USA.
(2)School of Information Studies, Syracuse University, Syracuse, NY, USA.
(3)Department of BioHealth Informatics, Indiana University School of Informatics
and Computing, Indianapolis, IN, USA.
OBJECTIVE: To use a human factors perspective to examine how older adult patients
with heart failure use cognitive artifacts for medication management.
METHODS: We performed a secondary analysis of data collected from 30 patients and
14 informal caregivers enrolled in a larger study of heart failure self-care.
Data included photographs, observation notes, interviews, video recordings,
medical record data, and surveys. These data were analyzed using an iterative
content analysis.
RESULTS: Findings revealed that medication management was complex, inseparable
from other patient activities, distributed across people, time, and place, and
complicated by knowledge gaps. We identified fifteen types of cognitive artifacts
including medical devices, pillboxes, medication lists, and electronic personal
health records used for: 1) measurement/evaluation; 2) tracking/communication; 3)
organization/administration; and 4) information/sensemaking. These artifacts were
characterized by fit and misfit with the patient's sociotechnical system and
demonstrated both advantages and disadvantages. We found that patients often
modified or "finished the design" of existing artifacts and relied on
"assemblages" of artifacts, routines, and actors to accomplish their self-care
goals.
CONCLUSIONS: Cognitive artifacts are useful but sometimes are poorly designed or
are not used optimally. If appropriately designed for usability and acceptance,
paper-based and computer-based information technologies can improve medication
management for individuals living with chronic illness. These technologies can be
designed for use by patients, caregivers, and clinicians; should support
collaboration and communication between these individuals; can be coupled with
home-based and wearable sensor technology; and must fit their users' needs,
limitations, abilities, tasks, routines, and contexts of use.
DOI: 10.1016/j.hlpt.2015.08.009
PMCID: PMC4741110
PMID: 26855882
1139. Patient Relat Outcome Meas. 2017 Nov 9;8:143-156. doi: 10.2147/PROM.S140851.
eCollection 2017.
Validating the Patient Experience with Treatment and Self-Management (PETS), a
patient-reported measure of treatment burden, in people with diabetes.
Rogers EA(1)(2), Yost KJ(3), Rosedahl JK(3), Linzer M(4), Boehm DH(5), Thakur
A(5), Poplau S(5), Anderson RT(6), Eton DT(3).
Author information:
(1)Department of Medicine, University of Minnesota Medical School, Minneapolis,
MN, USA.
(2)Department of Pediatrics, University of Minnesota Medical School, Minneapolis,
MN, USA.
(3)Department of Health Services Research, Mayo Clinic, Rochester, MN, USA.
(4)Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
(5)Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
(6)University of Virginia School of Medicine, Charlottesville, VA, USA.
Aims: To validate a comprehensive general measure of treatment burden, the

Patient Experience with Treatment and Self-Management (PETS), in people with
diabetes.
Methods: We conducted a secondary analysis of a cross-sectional survey study with
120 people diagnosed with type 1 or type 2 diabetes and at least one additional
chronic illness. Surveys included established patient-reported outcome measures
and a 48-item version of the PETS, a new measure comprised of multi-item scales
assessing the burden of chronic illness treatment and self-care as it relates to
nine domains: medical information, medications, medical appointments, monitoring
health, interpersonal challenges, health care expenses, difficulty with health
care services, role activity limitations, and physical/mental exhaustion from
self-management. Internal reliability of PETS scales was determined using
Cronbach's alpha. Construct validity was determined through correlation of PETS
scores with established measures (measures of chronic condition distress,
medication satisfaction, self-efficacy, and global well-being), and known-groups
validity through comparisons of PETS scores across clinically distinct groups. In
an exploratory test of predictive validity, step-wise regressions were used to
determine which PETS scales were most associated with outcomes of chronic
condition distress, overall physical and mental health, and medication adherence.
Results: Respondents were 37-88 years old, 59% female, 29% non-white, and 67%
college-educated. PETS scales showed good reliability (Cronbach's alphas ≥0.74).
Higher PETS scale scores (greater treatment burden) were correlated with more
chronic condition distress, less medication convenience, lower self-efficacy, and
worse general physical and mental health. Participants less (versus more)
adherent to medications and those with more (versus fewer) health care financial
difficulties had higher mean PETS scores. Medication burden was the scale that
was most consistently associated with well-being and patient-reported adherence.
Conclusion: The PETS is a reliable and valid measure for assessing perceived
treatment burden in people coping with diabetes.
DOI: 10.2147/PROM.S140851
PMCID: PMC5687778
PMID: 29184456

Pictograms for Safer Medication Management by Health Care Workers.

Vaillancourt R(1), Pouliot A(2), Streitenberger K(3), Hyland S(4), Thabet P(5).
Author information:
(1), PharmD, is with the Children's Hospital of Eastern Ontario, Ottawa, Ontario.
(2), PhD, is with the Children's Hospital of Eastern Ontario, Ottawa, Ontario.
(3), RN, is with the Institute for Safe Medication Practices Canada (ISMP
Canada), Toronto, Ontario.
(4), BScPhm, MHSc, is with the Institute for Safe Medication Practices Canada
(ISMP Canada), Toronto, Ontario.
(5), BSc, is with the Children's Hospital of Eastern Ontario, Ottawa, Ontario.
BACKGROUND: Inherent risks are associated with the preparation and administration
of medications. As such, a key aspect of medication safety is to ensure safe
medication management practices.
OBJECTIVE: To identify key medication safety issues and high-alert drug classes
that might benefit from implementation of pictograms, for use by health care
providers, to enhance medication administration safety. This study was the first
step in the development of such pictograms.
METHODS: Self-identified medication management experts participated in a modified
Delphi process to achieve consensus on situations where safety pictograms are
required for labelling to optimize safe medication management. The study was
divided into 3 phases: issue generation, issue reduction, and issue selection.
Issues achieving at least 80% consensus and deemed most essential were selected
for future studies. Retained issues were subjected to semiotic analysis, and
preliminary pictograms were developed.
RESULTS: Of the 87 health care professionals (pharmacists, pharmacy technicians,
nurses, and physicians) invited to participate in the Delphi process, 30
participated in all 3 phases. A total of 55 situations that could potentially
benefit from safety pictograms were generated initially. Through the Delphi
process, these were narrowed down to 10 situations where medication safety might
be increased with the use of safety pictograms. For most of the retained issues,
between 3 and 6 pictograms were designed, based on the results of the semiotic
analysis.
CONCLUSIONS: The pharmacists, pharmacy technicians, nurses, and physicians
participating in this study reached consensus and identified 10 medication
administration safety issues that might benefit from the development and
implementation of safety pictograms. Pictograms were developed for a total of 9
issues. In follow-up studies, these pictograms will be validated for
comprehension and evaluated for effectiveness.
Publisher: Il y a des risques inhérents associés à la préparation et à

l’administration de médicaments. Pour cette raison, l’un des principaux aspects
de la sécurité des médicaments est d’assurer des pratiques de gestion des
médicaments sécuritaires.Déterminer les principales questions de sécurité des
médicaments et les classes de médicaments de niveau d’alerte élevé pour
lesquelles l’ajout de pictogrammes, destinés aux fournisseurs de soins de santé,
permettrait de rendre l’administration de médicaments plus sécuritaire. La
présente étude représentait la première étape dans l’élaboration de ces
pictogrammes.Des professionnels qui se définissaient comme experts en gestion de
médicaments ont participé à un processus Delphi modifié dans le but d’arriver à
un consensus à propos des situations où des pictogrammes de sécurité doivent être
ajoutés à l’étiquette afin d’optimiser la gestion sécuritaire des médicaments.
L’étude a été divisée en trois phases : génération de questions de sécurité,
élimination de questions de sécurité et sélection de questions de sécurité. Les
questions qui atteignaient un consensus d’au moins 80 % et qui étaient
considérées comme les plus essentielles ont été retenues pour des études
ultérieures. Les questions de sécurité retenues ont été soumises à une analyse
sémiotique, puis des ébauches de pictogrammes ont été créées.Parmi les 87
professionnels de la santé (notamment des pharmaciens, des techniciens en
pharmacie, du personnel infirmier et des médecins) invités à participer au
processus Delphi, 30 ont pris part aux trois étapes. Au total, 55 situations pour
lesquelles il pourrait être avantageux d’utiliser des pictogrammes de sécurité
ont été générées au départ. Grâce au processus Delphi, ce nombre a été réduit à
10 situations pour lesquelles la sécurité des médicaments pourrait être accrue à
l’aide de pictogrammes de sécurité. Pour la plupart des questions retenues, entre
trois et six pictogrammes ont été conçus à l’aide des résultats de l’analyse
sémiotique.Les pharmaciens, les techniciens en pharmacie, le personnel infirmier
et les médecins qui ont participé à l’étude ont atteint un consensus sur dix
questions au sujet de l’administration sécuritaire des médicaments pour
lesquelles l’élaboration et la mise en place de pictogrammes de sécurité
pourraient être avantageuses. Ensuite, des pictogrammes ont été conçus pour neuf
questions au total. Dans les études ultérieures, il faudra évaluer l’efficacité
des pictogrammes et s’assurer qu’ils sont interprétés correctement.
DOI: 10.4212/cjhp.v69i4.1575
PMCID: PMC5008424
PMID: 27621488
1141. BMJ Open. 2017 Oct 8;7(10):e017540. doi: 10.1136/bmjopen-2017-017540.
MEDication reminder APPs to improve medication adherence in Coronary Heart

Disease (MedApp-CHD) Study: a randomised controlled trial protocol.
Santo K(1)(2), Chow CK(1)(2)(3), Thiagalingam A(2)(3)(4), Rogers K(5), Chalmers

J(2)(6), Redfern J(1)(2).
Author information:
(1)Cardiovascular Division, The George Institute for Global Health, Sydney,
Australia.
(2)Sydney Medical School, University of Sydney, Sydney, Australia.
(3)Department of Cardiology, Westmead Hospital, Sydney, Australia.
(4)Cardio-respiratory Division, Westmead Institute for Medical Research, Sydney,
Australia.
(5)Statistics Division, The George Institute for Global Health, Sydney,
Australia.
(6)Professorial Unit, The George Institute for Global Health, Sydney, Australia.
INTRODUCTION: The growing number of smartphone health applications available in

the app stores makes these apps a promising tool to help reduce the global
problem of non-adherence to long-term medications. However, to date, there is
limited evidence that available medication reminder apps are effective. This
study aims to determine the impact of medication reminder apps on adherence to
cardiovascular medication when compared with usual care for people with coronary
heart disease (CHD) and to determine whether an advanced app compared with a
basic app is associated with higher adherence.
METHODS AND ANALYSIS: Randomised controlled trial with follow-up at 3 months to
evaluate the feasibility and effectiveness of medication reminder apps on
medication adherence compared with usual care. An estimated sample size of 156
patients with CHD will be randomised to one of three groups (usual care group,
basic medication reminder app group and advanced medication reminder app group).
The usual care group will receive standard care for CHD with no access to a
medication reminder app. The basic medication reminder app group will have access
to a medication reminder app with a basic feature of providing simple daily
reminders with no interactivity. The advanced medication reminder app group will
have access to a medication reminder app with additional interactive and
customisable features. The primary outcome is medication adherence measured by
the eight-item Morisky Medication Adherence Scale at 3 months. Secondary outcomes
include clinical measurements of blood pressure and cholesterol levels, and
medication knowledge. A process evaluation will also be performed to assess the
feasibility of the intervention by evaluating the acceptability, utility and
engagement with the apps.
ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Western
Sydney Local Health Network Human Research Ethics Committee
(AU/RED/HREC/1/WMEAD/3). Study findings will be disseminated via usual scientific
forums.
DOI: 10.1136/bmjopen-2017-017540
PMCID: PMC5640083
1142. Rev Lat Am Enfermagem. 2016 Jun 7;24. pii: S0104-11692016000100334. doi:
10.1590/1518-8345.0745.2705.
Satisfaction with medication in coronary disease treatment: psychometrics of the

Treatment Satisfaction Questionnaire for Medication.
[Article in English, Portuguese, Spanish; Abstract available in Portuguese and

Spanish from the publisher]
Liberato AC(1), Rodrigues RC(2), São-João TM(3), Alexandre NM(2), Gallani MC(4).
Author information:
(1)Doctoral student, University of Washington, Seattle, USA., University of
Washington, University of Washington, Seattle , USA.
(2)Associate Professor, Faculdade de Enfermagem, Universidade Estadual de
Campinas, Campinas, SP, Brazil., Universidade Estadual de Campinas, Faculdade de
Enfermagem, Universidade Estadual de Campinas, Campinas SP , Brazil.
(3)Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas,
Campinas, SP, Brazil., Universidade Estadual de Campinas, Faculdade de
Enfermagem, Universidade Estadual de Campinas, Campinas SP , Brazil.
(4)Full Professor, Faculty of Nursing, Laval University, Quebec, Canada., Faculty
of Nursing, Laval University, Quebec , Canada.
OBJECTIVE: to psychometrically test the Brazilian version of the Treatment

Satisfaction Questionnaire for Medication - TSQM (version 1.4), regarding ceiling
and floor effect, practicability, acceptability, reliability and validity.
METHODS: participants with coronary heart disease (n=190) were recruited from an
outpatient cardiology clinic at a university hospital in Southeastern Brazil and
interviewed to evaluate their satisfaction with medication using the TSQM
(version 1.4) and adherence using the Morisky Self-Reported Measure of Medication
Adherence Scale and proportion of adherence. The Ceiling and Floor effect were
analyzed considering the 15% worst and best possible TSQM scores; Practicability
was assessed by time spent during TSQM interviews; Acceptability by proportion of
unanswered items and participants who answered all items; Reliability through the
Cronbach's alpha coefficient and Validity through the convergent construct
validity between the TSQM and the adherence measures.
RESULTS: TSQM was easily applied. Ceiling effect was found in the side effects
domain and floor effect in the side effects and global satisfaction domains.
Evidence of reliability was close to satisfied in all domains. The convergent
construct validity was partially supported.
CONCLUSIONS: the Brazilian TSQM presents evidence of acceptability and
practicability, although its validity was weakly supported and adequate internal
consistency was observed for one domain.
Publisher: realizar o teste psicométrico da versão brasileira do Treatment

Satisfaction Questionnaire for Medication - TSQM (versão 1.4) [Questionário
Satisfação com Tratamento Medicamentoso] com relação aos efeitos de teto e chão,
praticidade, aceitabilidade, confiabilidade e validade.os participantes com
doença cardíaca coronária (n=190) foram recrutados num ambulatório de cardiologia
de um hospital universitário no sudeste do Brasil e entrevistados para avaliar
satisfação em relação ao tratamento medicamentoso através da TSQM (versão 1.4) e
adesão através da Morisky Self-Reported Measure of Medication Adherence Scale
[Medida de Auto-Relato de Adesão ao Tratamento Medicamentoso] e proporção de
aderência. Os efeitos Teto e Chão foram analisados considerando os 15% piores e
15% melhores escores possíveis obtidos no TSQM; Praticidade foi avaliada pelo
tempo gasto na aplicação do TSQM durante a entrevista; Aceitabilidade foi
verificada pela proporção de itens não respondidos e participantes que
responderam todos os itens; Confiabilidade foi verificada com o coeficiente alfa
de Cronbach e Validade através da validade de construto convergente entre o TSQM
e as medidas de adesão.o TSQM foi facilmente aplicado. O efeito teto foi
encontrado no domínio efeitos colaterais e o efeito chão foi encontrado nos
domínios efeitos colaterais e satisfação global. Evidência de confiabilidade foi
próxima de satisfatória em todos os domínios. A validade de construto convergente
foi parcialmente apoiada.a versão brasileira do TSQM apresenta evidência de
aceitabilidade e praticidade embora sua validade tenha sido pouco apoiada e
consistência interna adequada foi observada em um domínio.Publisher: testar las
propiedades psicométricas de la versión brasileña del Treatment Satisfaction
Questionnaire for Medication - TSQM (versión 1.4), considerando los efectos techo
y suelo, factibilidad, aceptabilidad, confiabilidad y validez.participantes con
enfermedad coronaria (n=190) fueron reclutados de una clínica ambulatoria de
cardiología en un hospital universitario en el sudeste de Brasil y entrevistados
para evaluar su satisfacción con la medicación con el TSQM (versión 1.4) y su
adhesión con la Morisky Self-Reported Measure of Medication Adherence Scale y
proporción de adhesión. Los efectos techo y suelo fueron analizados considerando
los 15% peores y mejores puntuaciones en el TSQM; la factibilidad fue evaluada
por el tiempo gasto durante las entrevistas de TSQM; la aceptabilidad por la
proporción de ítems no respondidos y participantes que contestaron a todos los
ítems; la confiabilidad con el coeficiente alfa de Cronbach y la validez de
constructo convergente entre el TSQM y las medidas de adhesión.el TSQM fue
aplicado con facilidad. El efecto de techo fue encontrado en el dominio de los
efectos secundarios y el efecto suelo en los dominios de efectos secundarios y
satisfacción global. Las evidencias de confiabilidad fueron aproximadamente
satisfechas en todos los dominios. La validez de constructo convergente fue
parcialmente apoyada.la versión brasileña del TSQM presenta evidencias de
aceptabilidad y factibilidad, a pesar del soporte débil a su validez y de la
observación de consistencia interna adecuada para un dominio.
DOI: 10.1590/1518-8345.0745.2705
PMCID: PMC4915802
1143. Am J Manag Care. 2015 Jun 1;21(6):e372-8.
Stimulating comprehensive medication reviews among Medicare Part D beneficiaries.
Doucette WR(1), Pendergast JF, Zhang Y, Brown G, Chrischilles EA, Farris KB,
Frank J.
Author information:
(1)University of Iowa College of Pharmacy, 115 S Grand Ave, 518 PHAR, Iowa City,
IA 52242-1112. E-mail: william-doucette@uiowa.edu.
OBJECTIVES: To assess the impact of a patient engagement intervention utilizing

the Medication User Self-Evaluation (MUSE) tool on the completion percentage of
comprehensive medication reviews (CMRs) among Medicare Part D beneficiaries.
STUDY DESIGN: A case-control study.
METHODS: Beneficiaries from 2 Medicare Part D plans were randomly assigned to 3
study arms (1 control arm plus 2 intervention arms for 2011 and 2012,
respectively). Each beneficiary who participated in the MUSE intervention met 3
inclusion criteria and was matched with a single control group beneficiary based
on: gender; age (within 5-year interval); plan type (ie, Medicare Prescription
Drug Plan, Medicare Advantage Prescription Drug Plan); number of unique
prescriptions; pharmacy medication therapy management (MTM) training status; and
time period (2011, 2012). The outcome of interest was whether or not the
beneficiary received a CMR in the 6 months following the index date. Generalized
estimating equation (GEE) models were used to compare CMR percentages over time
and between MUSE intervention groups. This study used MTM service claims data.
RESULTS: The final sample of 1015 beneficiaries received MUSE intervention, of
which 1007 were successfully matched to a control beneficiary. The estimated odds
of having a CMR among those who received the MUSE intervention were 2 times that
of their counterparts (P = .0048) across both study years.
CONCLUSIONS: Given the strong evidence found for a positive association between
participation in a CMR and the MUSE intervention, Part D plans could use the MUSE
to engage targeted beneficiaries in using pharmacist-provided MTM services.
Anticoagulation adherence and its associated factors in patients with atrial

fibrillation: a cross-sectional study.
Chen PT(1), Wang TJ(2), Hsieh MH(3), Liu JC(4), Liu CY(5), Wang KY(6), Laio
WC(7).
Author information:
(1)Nursing, Cardinal Tien Junior College of Healthcare and Management, Taipei,
Taiwan.
(2)Nursing, National Taipei University of Nursing and Health Sciences, Taipei,
Taiwan tsaejyy@ntunhs.edu.tw.
(3)Cardiology, Taipei Medical University, Taipei, Taiwan.
(4)Internal Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei
City, Taiwan.
(5)Speech Language Pathology and Audiology, National Taipei University of Nursing
and Health Sciences, Taipei, Taiwan.
(6)Nursing, National Defense Medical Center, Taipei, Taiwan.
(7)Nursing, China Medical University, Taichung, Taiwan.
OBJECTIVE: To investigate anticoagulant adherence and its associated factors,

including demographics, clinical variables, atrial fibrillation (AF) severity,
knowledge, satisfaction with services, perceived barriers, perceived benefits,
symptom severity and self-efficacy in patients with AF.
DESIGN: This is a cross-sectional study.
PARTICIPANTS AND SETTING: A convenient sample of patients with AF were recruited
from cardiology clinics of two teaching hospitals in Taiwan.
MEASURES: Data were collected using the study questionnaires, including the
AF-related symptom subscale of the AF Severity Scale, the Knowledge of Warfarin
Anticoagulation Treatment Scale, the Satisfaction Scale about Service and
Warfarin Treatment, the perceived benefits subscale of the Beliefs about
Anticoagulation Survey, the Concerns about Anticoagulation Therapy Scale, The
Self-efficacy for Appropriate Medication Use Scale and the short-form Adherence
to Refills and Medications Scale.
RESULTS: A total of 151 patients with AF participated in the study; 53 treated
with warfarin and 98 treated with novel oral anticoagulants (NOACs). The
difference in adherence to warfarin (mean=8.6; SD=1.6) and NOACs (mean=8.9;
SD=2.0) was statistically insignificant. Multiple linear regression analysis
showed that perceived barriers (β=0.18, p=0.017) and self-efficacy (β=-0.48,
p<0.001) were significant predictors of anticoagulation adherence. For every
1-unit increase in the perceived barriers, there will be a 0.18-unit increase in
the adherence to anticoagulation therapy. For every 1-unit increase in the
self-efficacy, there will be a 0.48-unit decrease in the adherence to
anticoagulation therapy. Perceived barriers and self-efficacy collectively
explained 34.0% of the variance in adherence to anticoagulation therapy
(F(2,149)=38.11, p<0.001).
CONCLUSION: We found no better adherence to NOACs compared with warfarin.
Patients with greater self-efficacy and perceived fewer barriers showed better
adherence to anticoagulation therapy.

DOI: 10.1136/bmjopen-2019-029974
PMID: 31481562
1145. BMC Health Serv Res. 2014 Nov 26;14:586. doi: 10.1186/s12913-014-0586-1.
Mobile phone intervention for increasing adherence to treatment for type 2

diabetes in an urban area of Bangladesh: protocol for a randomized controlled
trial.
Islam SM(1)(2), Lechner A(3), Ferrari U(4), Froeschl G(5), Alam DS(6), Holle
R(7), Seissler J(8), Niessen LW(9).
Author information:
(1)Center for Control of Chronic Diseases, International Center for Diarrhoeal
Diseases Research, Bangladesh (ICDDR,B), 68, Shaheed Tajuddin Ahmed Sarani,
Mohakhali, Dhaka, 1212, Bangladesh. shariful.islam@icddrb.org.
(2)Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU),
Leopoldstrasse 7, 80802, Munich, Germany. shariful.islam@icddrb.org.
(3)Diabetes Center, Diabetes Research Group, Medizinische Klinik und Poliklinik
IV, Ludwig-Maximilians-Universität, Ziemssenstr. 1, 80336, Munich, Germany.
andreas.lechner@med.uni-muenchen.de.
uta.ferrari@med.uni-muenchen.de.
(5)Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU),
Leopoldstrasse 7, 80802, Munich, Germany. Froeschl@lrz.uni-muenchen.de.
(6)Center for Control of Chronic Diseases, International Center for Diarrhoeal
Diseases Research, Bangladesh (ICDDR,B), 68, Shaheed Tajuddin Ahmed Sarani,
Mohakhali, Dhaka, 1212, Bangladesh. dsalam@icddrb.org.
(7)Economic Evaluations, Helmholtz Zentrum München (GmbH), German Research Center
for Environmental Health, Munich, Germany. holle@helmholtz-muenchen.de.
jochen.seissler@med.uni-muenchen.de.
(9)Centre for Applied Health Research and Delivery, Liverpool School of Tropical
Medicine, Pembroke Place, Liverpool, L3 5QA, UK. Louis.Niessen@liverpool.ac.uk.
BACKGROUND: Mobile phone technologies including SMS (short message service) have
been used to improve the delivery of health services in many countries. However,
data on the effects of mobile health technology on patient outcomes in
resource-limited settings are limited. The aim of this study therefore is to
measure the impact of a mobile phone SMS service on treatment success of newly
diagnosed type 2 diabetes in an urban area of Bangladesh.
METHODS/DESIGN: This is a single-centred randomized controlled intervention trial
(prospective) comparing standard-of-care with standard-of-care plus a mobile
phone-based SMS intervention for 6 months. A total of 216 participants with newly
diagnosed type 2 diabetes will be recruited. Data will be collected at the
outpatient department of Bangladesh Institute of Health Science (BIHS) hospital
at baseline and after 6 months. The primary outcome measure will be change in
HbA1c between baseline and 6 months. The secondary outcome measures are
self-reported medication adherence, clinic attendance, self-reported adoption of
healthy behaviours, diabetes knowledge, quality of life and cost effectiveness of
the SMS intervention. The inclusion criteria will be as follows: diagnosed as
patients with type 2 diabetes by the BIHS physician, using oral medication
therapy, living in Dhaka city, registered with the BIHS hospital, using a mobile
phone, willing to return for follow up after 6 months and providing written
informed consent. Participants will be allocated to control and intervention arms
after recruitment using a randomization software. Data will be collected on
socio-demographic and economic information, mobile phone use and habits,
knowledge of prevention, management and complications of diabetes, self-perceived
quality of life assessment, self-reported diseases, medical history, family
history of diseases, medication history, medication adherence, health seeking
behaviour, tobacco use, physical activity, diet, mental health status, life
events and disability, anthropometric measurements of weight, height, blood
pressure and blood tests for HbA1c.
DISCUSSION: Mobile phone SMS services have the potential to communicate with
diabetes patients and to build awareness about the disease, improve
self-management and avoid complications also in resource-limited setting. If this
intervention proves to be efficient and cost-effective in the current trial,
large-scale implementation could be undertaken.
TRIAL REGISTRATION: DRKS00005188 .
DOI: 10.1186/s12913-014-0586-1
PMCID: PMC4247872
Summative service and stakeholder evaluation of an NHS-funded community Pharmacy

Emergency Repeat Medication Supply Service (PERMSS).
Nazar H(1), Nazar Z(2), Simpson J(3), Yeung A(4), Whittlesea C(1).
Author information:
(1)School of Medicine, Pharmacy and Health, Durham University, Stockton-On-Tees,
UK.
(2)School of Pharmacy and Biomedical Sciences, University of Portsmouth,
Portsmouth, UK.
(3)Clinical Strategy, NHS England North-Cumbria and the North East, Durham, UK.
(4)Senior Specialist Pharmacist Advisor, Northumberland, Tyne and Wear Local
Pharmacy Network, Northumberland, UK.
Erratum in
BMJ Open. 2016 May 20;6(5):e009736corr1.
OBJECTIVES: Service and stakeholder evaluation of an NHS-funded service providing

out-ofhours (OOH) emergency repeat medications to patients self-presenting at
community pharmacies.
SETTING: Community pharmacies across the North East of England accredited to
provide this service.
PARTICIPANTS: Patients self-presenting to community pharmacies during OOH periods
with emergency repeat medication supply requests.
INTERVENTION: Community pharmacists assessed each request for clinical
appropriateness and when suitable provide an emergency repeat medication supply,
with additional pharmaceutical advice and services if required.
PRIMARY OUTCOMES: Number of emergency repeat medication supplies, time of
request, reason for access, medication(s), pharmaceutical advice and services
provided. Secondary outcomes were community pharmacist and patient satisfaction.
RESULTS: A total of 2485 patients were managed across 227 community pharmacies
(15 December 2014 to 7 April 2015). Most patients presented on Saturdays, with
increased activity over national holidays. Older age was associated with
increased service use. Of the 3226 medications provided, 439 were classified as
high risk. Patients found this service easy to access and were willing to access
the community pharmacy in the future for medication-related issues. In the
absence of this service, 50% of patients would have missed their medication(s)
until they saw their doctor and a further 46% would have accessed an alternative
service. The cost of National Health Service (NHS) service(s) for patients who
would have accessed an alternative OOH service was estimated as 37 times that of
the community pharmacy service provided. Community pharmacists were happy to
provide this service despite increased consultation times and workload.
CONCLUSIONS: Community pharmacists were able to manage patients' OOH requests for
emergency repeat medication and patients were happy with the service provided.
Since the service cost was favourable when compared with alternative OOH
services, it would be a viable option to reduce the workload on the wider NHS.
DOI: 10.1136/bmjopen-2015-009736
PMCID: PMC4735177

eCollection 2018.
Patient satisfaction, health care resource utilization, and acute headache

medication use with galcanezumab: results from a 12-month open-label study in
patients with migraine.
Ford JH(1), Foster SA(1), Stauffer VL(1), Ruff DD(1), Aurora SK(1), Versijpt
J(2).
Author information:
(1)Eli Lilly and Company, Indianapolis, IN 46225, USA, ford_janet@lilly.com.
(2)Department of Neurology - Headache and Facial Pain Clinic, Vrije Universiteit
Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels,
Belgium.
Background: Effects of galcanezumab, a monoclonal antibody against calcitonin

gene-related peptide, on patient satisfaction, health care resource utilization
(HCRU), and acute medication use were evaluated in a long-term, open-label study
in patients with migraine.
Methods: Patients with episodic (78.9%) or chronic migraine (21.1%) were
evaluated in the CGAJ study, an open-label study with 12-month treatment period.
Galcanezumab 120 mg (with a loading dose of 240 mg) or 240 mg was administered
subcutaneously once a month during treatment period. A self-rated scale, Patient
Satisfaction with Medication Questionnaire-Modified (PSMQ-M), was used to measure
satisfaction levels. Participants reported HCRU for the previous 6 months at
baseline and that which occurred since the patient's last study visit during
treatment period. Acute headache medication use for migraine or headache for the
past month was self-reported by participants at baseline and at each monthly
visit during treatment period.
Results: At Months 1, 6, and 12, at least 69% of patients treated with
galcanezumab responded positively for overall satisfaction, preference over prior
treatments, and less impact from side effects. There were within-group reductions
from baseline in migraine-specific HCRU (per 100 person-years) with galcanezumab
for health care professional visits (173.4 to 59.6), emergency room visits (20.2
to 4.7), and hospital admissions (3.7 to 0.4) during treatment period.
Statistically significant reductions in HCRU were observed for some events. There
were significant within-group reductions from baseline in mean number of
days/month with acute headache medication use for migraine or headache at each
monthly visit during treatment period (overall change: -5.1 for galcanezumab 120
mg/240 mg; p<0.001).
Conclusion: Results from this long-term, open-label study suggest that treatment
with galcanezumab is likely to lead to high patient satisfaction with treatment
as well as meaningful reductions in migraine-specific HCRU and acute headache
medication use in people with migraine.
DOI: 10.2147/PPA.S182563
PMCID: PMC6239121
PMID: 30519007
Conflict of interest statement: Disclosure JHF, SAF, VLS, DDR, and SKA are
full-time employees of Eli Lilly and Company and/or one of its subsidiaries and
may hold company stocks. JV received personal fees and nonfinancial support from
Teva, personal fees from Novartis, and grants and nonfinancial support from
Allergan. The authors report no other conflicts of interest in this work.
1148. Int J Geriatr Psychiatry. 2018 Feb;33(2):e307-e313. doi: 10.1002/gps.4795.

Epub
2017 Sep 29.
Association between anxious symptoms and sleeping medication use among US older
adults.
Harris D(1), McNicoll L(2), Epstein-Lubow G(1)(2)(3), Thomas KS(1)(4).
Author information:
(1)Center for Gerontology and Healthcare Research, School of Public Health, Brown
University, Providence, RI, USA.
(2)Alpert School of Medicine, Brown University, Providence, RI, USA.
(3)Butler Hospital, Providence, RI, USA.
(4)U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA.
OBJECTIVE: To investigate the relationship between anxiety symptoms and sleeping
medication use among a nationally representative sample of US older adults.
DESIGN: Cross-sectional design using data from the 2011 National Health and Aging
Trends Study to examine the relationship between anxiety symptoms as rated by the
Generalized Anxiety Disorder-2 and self-reported sleeping medication use. Survey
weights were applied to account for complex survey design. Logistic regression
was used to measure the association between anxiety symptoms and sleeping
medication use after adjusting for sociodemographic factors, physical health, and
other sleep-related issues.
RESULTS: In 2011, 13.1% of respondents experienced high anxiety symptoms and
29.0% reported taking a sleeping medication at least once a week during the last
30 days. Results estimate that approximately 4 million US older adults have
clinically significant anxiety symptoms and approximately 10 million US older
adults used a sleeping medication in the last 30 days. Adjusted results revealed
that high anxiety symptoms are significantly associated with sleeping medication
use compared to low anxiety symptoms (AOR = 1.57; 95% CI, 1.29-1.91). Depression
symptoms were also associated with sleeping medication (AOR = 1.29; 95% CI,
1.08-1.55).
CONCLUSIONS: Results demonstrated that anxiety symptoms are significantly
associated with sleeping medication use among US older adults. We also found that
depressive symptoms, chronic conditions, and worse self-rated health are
associated with sleeping medication use. As sleeping medications are associated
with adverse health events, these results have clinical implications for treating
anxiety symptoms among older patients.
DOI: 10.1002/gps.4795
PMCID: PMC5773373

eCollection 2018.
Effect of different methods for estimating persistence and adherence to new

glucose-lowering drugs: results of an observational, inception cohort study in
Portugal.
Torre C(1)(2), Guerreiro J(1), Longo P(1), Raposo JF(3)(4), Leufkens H(5),
Martins AP(2)(6).
Author information:
(1)Centre for Health Evaluation & Research (CEFAR), National Association of
Pharmacies, Lisboa, Portugal, carla.torre@campus.ul.pt.
(2)Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy,
University of Lisbon, Lisboa, Portugal, carla.torre@campus.ul.pt.
(3)Nova Medical School, New University of Lisbon, Lisboa, Portugal.
(4)Portuguese Diabetes Association (APDP), Lisboa, Portugal.
for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
(6)Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal.
Purpose: Several methods have been developed for assessing medication-taking

behavior; understanding the determinants and variability in estimates obtained is
crucial in interpreting results. We estimated persistence and adherence levels to
new glucose-lowering drugs (GLDs) in type 2 diabetes mellitus (T2DM) patients
using different methods: through the collection of pharmacy records and combining
pharmacy records with self-reported data.
Methods: We conducted a prospective observational cohort study of T2DM patients
initiating a new GLD. Data were collected at baseline through interviews
(demographic and clinical data). Follow-up data included pharmacy records (refill
dates and medication possession) and telephone questionnaires (self-declared
monitored GLD refill in another pharmacy, reasons for drug withdrawal). The
cohort was divided into incident and prevalent new users. Persistence and
adherence (proportion of days covered) were estimated for patients using pharmacy
records exclusively (Method 1) and ≥1 self-declared statement of being persistent
(Method 2). Log-rank tests were used to compare Kaplan-Meier curves of time to
nonpersistence.
Results: A total of 1,328 patients were recruited. When considering Method 1,
38.7% (95% confidence interval [95% CI]: 36.0-41.5) of patients were persistent,
whereas combining with self-reported information, this estimate increased to
65.6% (95% CI: 62.9-68.2). Using Method 1, the risk of persistence failure was
associated with using an oral GLD, living alone and living in a suburban/urban
setting. Three hundred and twenty-seven (24.8%) patients stopped to use the
inception GLD.
Conclusion: Regardless of the method used, results indicated low levels of
persistence and adherence to a new GLD; however, when combining self-reported
information, higher estimates were obtained. Considering pharmacy records
exclusively, prevalent new users, who were more complex patients in terms of T2DM
disease but more likely to be pharmacy-loyal patients, were significantly more
adherent than the incident new users. Barriers and reasons leading to GLD
withdrawal, namely adverse drug event management, should be addressed, since they
represent half of the reasons for treatment switching or discontinuation.
DOI: 10.2147/PPA.S170134
PMCID: PMC6103301
PMID: 30147305
Conflict of interest statement: Disclosure CT was working at CEFAR/National

Association of Pharmacies (ANF) when the study was performed and is currently
employed by the Portuguese Pharmaceutical Society and has no conflict of interest
to declare. JFR has received honoraria for consultancy or giving lectures from
Merck Sharp & Dohme, Lilly and Novo Nordisk over the last year. All costs
associated with the development and implementation of this study were fully
supported by the Portuguese ANF. ANF had no role in study protocol, data analysis
or interpretation of this study. The authors report no other conflicts of
1150. Asian Pac J Allergy Immunol. 2015 Mar;33(1):14-20. doi:

10.12932/AP0473.33.1.2015.
Survey of asthma management in Thailand - the asthma insight and management

study.
Boonsawat W(1), Thompson PJ, Zaeoui U, Samosorn C, Acar G, Faruqi R, Poonnoi P.
Author information:
(1)Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen,
40002, Thailand.
BACKGROUND: Previous Thai surveys of asthma care have shown suboptimal management
and poor control. Since then several editions of the Thailand National Asthma
Guidelines have been distributed to help improve asthma control. A new survey was
undertaken to see if any improvement in care had occurred. It examined patients'
insights, attitudes and perceptions about their asthma and its treatment.
METHODS: Asthma patients (>12 years) were randomly selected and participated in
face-to-face interviews. Patients answered 53 questions exploring general health,
diagnosis, symptoms, exacerbations, patient burden, disease management, treatment
and attitudes. The Global Initiative for Asthma guidelines were used to assess
asthma control.
RESULTS: Data were obtained from 400 asthma patients from 8,177 screened
households. This showed that 36% had had exacerbations in the previous year, 17%
had been hospitalized and 35% had had an unscheduled emergency visit to hospital
or a doctor's office or clinic. Work or school was missed by 44% due to asthma
while a similar number had had an asthma episode that made them feel their life
was in danger. Only 8% had good asthma control. Patients had low expectations
with respect to asthma treatment and their understanding of how to use therapies
was poor. Forty-four percent of participants reported day-time symptoms and about
one-third (34%) of adults and adolescents in the survey reported night-time
symptoms at least once a week in the previous 4 weeks. Asthma patients in
Thailand rated their average productivity when asthma was at its worst at 48%, on
a scale of 0 to 100%, which equates to a 36% decline in productivity. Rescue
medication during the previous four weeks had been used by 44% of asthma patients
while 54% had used a controller medication. Pill controller medication is the
most used form among those reporting controller medication use (67%), whereas 57%
reported taking an inhaler. Oral steroids had been used in the previous 12 months
by 40% of patients with the average number for 3 day or longer at 24 times, while
the median was about 4 times.
CONCLUSIONS: Asthma had a profound impact on patients' wellbeing, despite the
availability of effective treatments and evidence-based management guidelines. A
large proportion of asthma patients overestimate their asthma control and have
inappropriate concepts about asthma treatment. Gaining better insight into
patient's attitudes about self-care is critical to improve asthma management.
DOI: 10.12932/AP0473.33.1.2015
1151. Trials. 2017 Jul 4;18(1):286. doi: 10.1186/s13063-017-1996-2.
Bracelet- and self-directed observational therapy for control of tuberculosis:

study protocol for a cluster randomized controlled trial.
Huang R(1), Ren G(2), Hu J(3).
Author information:
(1)Department of Occupational and Environmental Health, Xiangya School of Public
Health, Central South University, Changsha, Hunan Province, 410078, China.
(2)Department of Nutrition and Food Hygiene, Xiangya School of Public Health,
Central South University, Changsha, Hunan Province, 410078, China.
renguofeng@csu.edu.cn.
(3)Department of Occupational and Environmental Health, Xiangya School of Public
Health, Central South University, Changsha, Hunan Province, 410078, China.
huja_xy@126.com.
BACKGROUND: Approximately 80% of global tuberculosis (TB) cases occur in

low-resource settings, with little opportunity for TB control. We hypothesized
that the rapid increase in smartphone users and advances in digital technology
would render bracelet-based applications possible; specifically, that bracelet-
and self-directed observational therapy (BSDOT) can be used by patients with TB
to ensure adherence to TB medication regimens and by basic village physicians to
monitor care. This will ultimately allow TB to be controlled in low-resource
environments.
METHODS AND DESIGN: This study will have three phases: development of a bracelet
capable of storing pills and recording adherence to medication regimens; creation
of a BSDOT smartphone application capable of supporting reminders to patients and
health care interactions between patients and village physicians; and performance
of a cluster randomized controlled trial in Hunan Province, China. Patients in
the intervention group will receive free bracelets and smartphones, and their
daily medication intake will be directed by the smartphones; the control group
will receive no intervention. The primary outcome will be the TB treatment result
as defined by the World Health Organization (WHO) as follows: Cured, Treatment
completed, Treatment failed, Died, Lost to follow-up, Not evaluated, or Treatment
success. The secondary outcome will be treatment adherence, defined as the
percentage of patients receiving TB treatment who missed fewer than 5% of doses.
We will also assess self-reported adherence using the Morisky, Green, and Levine
Adherence Scale (MGLS) and evaluate respondents' knowledge about TB and quality
of life. A regression model will be used to explore whether the interventions
improve drug adherence and other outcome measures. DISCUSSION: This will be a
powerful means by which to strengthen TB control and prevent TB, especially
multidrug-resistant epidemics of the disease. In addition, our novel
smartphone-based tool can be readily adopted for use in low-resource remote
environments with limited health care facilities and few economic assets.
ETHICS AND DISSEMINATION: The protocol has been approved by the Ethics Committee
of Xiangya School of Public Health, Central South University (reference number:
XYGW-2016-14).
TRIAL REGISTRATION: Chinese Clinical Trial Registry, ID: ChiCTR-IOR-16008424 .
Registered on 5 June 2016.
DOI: 10.1186/s13063-017-1996-2
PMCID: PMC5496390
1152. Patient Educ Couns. 2015 Jan;98(1):34-40. doi: 10.1016/j.pec.2014.10.002.

Epub
2014 Oct 22.
Understanding the influence of psychological and socioeconomic factors on

diabetes self-care using structured equation modeling.
Walker RJ(1), Gebregziabher M(2), Martin-Harris B(3), Egede LE(4).
Author information:
Department of Health Science and Research, Medical University of South Carolina,
Charleston, SC, USA.
HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Division of Public Health
Sciences, Department of Medicine, Medical University of South Carolina,
Charleston, SC, USA.
(3)Department of Health Science and Research, Medical University of South
Carolina, Charleston, SC, USA; Department of Otolaryngology-Head and Neck
Surgery, Medical University of South Carolina, Charleston, SC, USA.
Division of General Internal Medicine and Geriatrics, Department of Medicine,
Medical University of South Carolina, Charleston, SC, USA. Electronic address:
egedel@musc.edu.
OBJECTIVE: To develop and test latent variables of the social determinants of
health that influence diabetes self-care.
METHODS: 615 adults with type 2 diabetes were recruited from two adult primary
care clinics in the southeastern United States. Confirmatory factor analyses
(CFA) identified the latent factors underlying socioeconomic determinants,
psychosocial determinants, and self-care (diet, exercise, foot care, glucose
testing, and medication adherence). Structured equation modeling (SEM)
investigated the relationship between determinants and self-care.
RESULTS: Latent variables were created for diabetes self-care, psychological
distress, self-efficacy, social support and social status. The initial model
(chi2(254) = 388.04, p < 0.001, RMSEA = 0.03, CFI = 0.98) showed that lower
psychological distress (r = -0.13, p = 0.019), higher social support (r = 0.15, p
= 0.008), and higher self-efficacy (r = 0.47, p < 0.001) were significantly
related to diabetes self-care. Social status was not significantly related to
self-care (r = 0.003, p = 0.952). In the trimmed model (chi2(189) = 211.40, p =
0.126, RMSEA = 0.01, CFI = 0.99) lower psychological distress (r = -0.13, p =
0.016), higher social support (r = 0.15, p = 0.007), and higher self-efficacy (r
= 0.47, p < 0.001) remained significantly related to diabetes self-care.
CONCLUSION: Based on theoretical relationships, three latent factors that measure
social determinants of health (psychological distress, social support and
self-efficacy) are strongly associated with diabetes self-care.
PRACTICE IMPLICATIONS: This suggests that social determinants should be taken
into account when developing patient self-care goals.
DOI: 10.1016/j.pec.2014.10.002
PMCID: PMC4314329
1153. Health Promot Perspect. 2018 Apr 18;8(2):139-146. doi: 10.15171/hpp.2018.18.

eCollection 2018.
The association between self-care and quality of life in hypertensive patients:

findings from the Azar cohort study in the North West of Iran.
Kazemi Shishavan M(1), Asghari Jafarabadi M(2)(3), Aminisani N(3), Shahbazi M(4),
Alizadeh M(5).
Author information:
(1)Department of Community and Family Medicine, Tabriz University of Medical
Sciences, Tabriz, Iran.
(2)Road Traffic Injury Research Center, Tabriz University of Medical Sciences,
Tabriz, Iran.
(3)Department of Statistics and Epidemiology, Tabriz University of Medical
(4)School of Public Health, Professor Jackson State University, Jackson,
Mississippi, USA.
(5)Social Determinants of Health Research Center, Department of Community and
Family Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Background: Hypertension affects the quality of life of patients and their

caregivers. The aim of this study was to assess the knowledge and self-care
behaviors and health-related quality of life (HRQOL) among hypertensive people.
Methods: All people aged 35 years and older with hypertension were invited to
participate in this study. Information on self-care behavior for hypertension
(H-scale), and health-related quality of life (WHOHRQOL-BRFF) were completed by
trained interviewer. Data analysis was done using SPSS 16. Results: The median
age of hypertensive patients was 62.5(25th to 75th percentile: 55 to 72 years),
the correlation between quality of life and overall self-care scores was not
significant(r =-0.048, P =0.520). Physical activity was the only significant
predictor for quality of life,showing that the quality of life of hypertensive
people increased by 3.371 units per day of being physically active in the cohort
study (β =0.223, P<0.01). The only significant predictor of quality of life among
the elderly was medication use (β =-0.572, P<0.001). Quality of life of
participants decreased 3.456 units per day as a result of medication adherence.
Conclusion: No association was observed between self-care and HRQOL total score
in hypertensive patients in the study. Among the self-care domains, only
medication adherence and physical activity had significant association with
social health. There was a reverse association between smoking and HRQOL.
DOI: 10.15171/hpp.2018.18
PMCID: PMC5935818
PMID: 29744310
1154. BMC Pulm Med. 2016 Aug 30;16(1):130. doi: 10.1186/s12890-016-0292-3.
Asthma control and severe exacerbations in patients with moderate or severe

asthma in Jilin Province, China: a multicenter cross-sectional survey.
Yan BD(1), Meng SS(1)(2), Ren J(1), Lv Z(3), Zhang QH(1), Yu JY(1), Gao R(1), Shi
CM(4), Wu CF(5), Liu CL(6), Zhang J(1), Ma ZS(1), Liu J(7).
Author information:
(1)The Department of Respiratory Medicine, The Second Hospital of Jilin
University, Changchun, China.
(2)Department of Critical Care Medicine, Zhongda Hospital, School of Medicine,
Southeast University, Nanjing, China.
(3)The Tumor Centre, The First Hospital of Jilin University, Changchun, China.
(4)The Department of Respiratory Medicine, China-Japan Union Hospital of Jilin
University, Changchun, China.
(5)The Department of Respiratory Medicine, The People's Hospital of Jilin
Province, Changchun, China.
(6)The Department of Respiratory Medicine, The 208th Hospital of the Chinese
People's Liberation Army, Changchun, China.
(7)The Department of Respiratory Medicine, The Second Hospital of Jilin
University, Changchun, China. liujing020901@163.com.
BACKGROUND: No systemic evaluation of asthma control in Jilin Province has been

reported. Asthma control might provide the basis for asthma management in this
region. A multicenter hospital-based cross-sectional study was performed to
investigate the asthma control and related factors for severe asthma
exacerbations in patients with moderate or severe asthma in Jilin Province,
China.
METHODS: The study enrolled 1546 patients in five grade one general hospitals
from January to December 2013. Asthma medication, patient self-management, asthma
control test (ACT) scores and frequency of severe asthma exacerbations during the
follow-up (12 months) were collected via a follow-up questionnaire.
RESULTS: In the study, 889 patients provided a complete follow-up questionnaire.
Severe asthma exacerbations occurred in 54.89 % of patients. ACT score ≤15,
asthma medication ≤ 3 months, severe asthma, income level lower than average Per
Capita Disposable Income (PCDI) and a lower educational level were risk factors
of a severe exacerbation.
CONCLUSIONS: Poor adherence to asthma medication, poor asthma symptom control,
lower income, a low educational level might be possible reasons for the high
incidence of severe asthma exacerbations and poor asthma control in Jilin
Province of China.
DOI: 10.1186/s12890-016-0292-3
PMCID: PMC5006269
1155. Indian J Psychol Med. 2019 Jul-Aug;41(4):357-361. doi:

10.4103/IJPSYM.IJPSYM_455_18.
The Effectiveness of a Brief Psychological Intervention for Patients with

Diabetes-Related Distress.
Raveendranathan D(1), George J(1), Perumal NL(2), Mysore A(1).
Author information:
(1)Department of Psychiatry, St. John's Medical College, Bengaluru, Karnataka,
India.
(2)Department of Endocrinology, St. John's Medical College, Bengaluru, Karnataka,
India.
Background: Diabetes-related distress (DRD) is the negative emotional and

psychological reaction to living with diabetes mellitus (DM). DRD has been
reported to affect glycemic control and self-management practices adversely.
Limited research is available on the effectiveness of psychological interventions
for DRD. We aimed to study the effectiveness of a brief psychological
intervention for patients with DRD.
Methods: The findings of a targeted brief psychological intervention conducted
for patients with DRD, as a part of psycho-endocrinology liaison services in a
general hospital, are reported. Details regarding the assessment and intervention
given were collected from the patients' records. Forty-one patients with DRD
diagnosed using Diabetes Distress Scale (DDS) were given the single session
intervention consisting of brief diabetes education focusing on physical activity
and medication adherence, relaxation techniques, and illness-specific
problem-solving strategies. Effectiveness was assessed using change in Clinical
Global Impression-Severity (CGI-S), patient-rated visual analog scale, brief
physical activity questionnaire, and medication adherence at baseline and 2-month
follow-up.
Results: Analysis using Wilcoxon signed rank test found a significant change in
the follow-up scores on all the assessment scales.
Conclusions: The study highlights the benefits of brief intervention for reducing
DRD, thus reducing the emotional burden of living with DM.
DOI: 10.4103/IJPSYM.IJPSYM_455_18
PMCID: PMC6657474
PMID: 31391669
1156. Int J MS Care. 2018 Nov-Dec;20(6):251-259. doi: 10.7224/1537-2073.2017-031.
Associations Between Treatment Satisfaction, Medication Beliefs, and Adherence to

Disease-Modifying Therapies in Patients with Multiple Sclerosis.
Thach AV, Brown CM, Herrera V, Sasane R, Barner JC, Ford KC, Lawson KA.
Background: Adherence to disease-modifying therapy (DMT) remains problematic for

many patients with multiple sclerosis (MS). An improved understanding of factors
affecting DMT adherence may inform effective interventions. This study examined
associations between treatment satisfaction, medication beliefs, and DMT
adherence.
Methods: A survey was mailed in 2016 to 600 adult patients with
relapsing-remitting MS taking an injectable or oral DMT. Patients were sampled
from the North American Research Committee on Multiple Sclerosis (NARCOMS)
Registry. The survey measured self-reported DMT adherence (doses taken divided by
doses prescribed during previous 2-week period-adherence ≥0.80), DMT satisfaction
using the Treatment Satisfaction Questionnaire for Medication version II,
medication beliefs using the Beliefs About Medicines Questionnaire, and
demographic and clinical covariates. Relationships between variables were
examined using multivariate logistic regression.
Results: Final analyses included 489 usable surveys. Mean ± SD participant age
was 60.5 ± 8.3 years. Most respondents were white (93.8%), female (86.6%), taking
an injectable DMT (66.9%), and adherent to DMT (92.8%). Significant predictors of
DMT adherence were age (odds ratio [OR], 1.086; 95% CI, 1.020-1.158; P = .011),
type of DMT (oral vs. injectable; OR, 23.350; 95% CI, 2.254-241.892; P = .008),
and DMT experience (naive vs. experienced; OR, 2.831; 95% CI, 1.018-7.878; P =
.046).
Conclusions: In patients with MS sampled from a patient registry, treatment
satisfaction and medication beliefs were not significantly associated with DMT
adherence. Based on significant predictors, younger patients, patients taking
injectable DMTs, and patients with previous experience with another DMT(s) are at
higher risk for nonadherence. Future research is warranted to assess
relationships between variables in more diverse MS populations.
DOI: 10.7224/1537-2073.2017-031
PMCID: PMC6295882
PMID: 30568562
1157. Contemp Clin Trials Commun. 2018 Jul 25;11:149-155. doi:

10.1016/j.conctc.2018.07.007. eCollection 2018 Sep.
Design of an experimental protocol to examine medication non-adherence among

young drivers diagnosed with ADHD: A driving simulator study.
Lee YC(1), Ward McIntosh C(2), Winston F(3), Power T(2), Huang P(2), Ontañón
S(4), Gonzalez A(5).
Author information:
(1)George Mason University, USA.
(2)Children's Hospital of Philadelphia, USA.
(3)Children's Hospital of Philadelphia and University of Pennsylvania, USA.
(4)Drexel University, USA.
(5)University of Central Florida, USA.
The diagnosis of ADHD among teens and young adults has been associated with a
higher likelihood of motor vehicle crashes. Some studies suggest a beneficial
effect of ADHD medication but the exact efficacy is still being debated. Further,
medication adherence, which is low in this age group, can further reduce
effectiveness. Our long-term objective is to reduce unsafe driving among drivers
with ADHD by detecting medication non-adherence through driver behavior modeling
and monitoring. As a first step, we developed the described lab study protocol to
obtain reliable driver behavior data that will then be used to design and train
behavior models built through machine learning. This experimental study protocol
was developed to systematically compare driving behaviors under two medication
conditions (before and after intake of medication) among young adults with ADHD
and a control group of non-ADHD. A driving simulator was used to examine driving
behaviors and interactions with traffic. The primary outcome was speed management
for two comparisons (ADHD vs. non-ADHD and before vs. after medication), and
secondary objectives involved understanding differences among the participants
utilizing self-reported surveys about ADHD symptoms, drivers' knowledge, and
perception about safety. The study protocol was designed to maximize participant
safety and efficiency of data collection, as multiple measures were collected
over two 2-h study visits. The sampled ADHD drivers were demographically and
psychosocially similar but clinically different from the non-ADHD group. Overall,
this protocol was effective in participant recruitment and retention, allowed
staggered data collection, and can be incorporated in a subsequent clinical trial
that examines the efficacy of a machine-learning based driver monitoring
intervention.
DOI: 10.1016/j.conctc.2018.07.007
PMCID: PMC6082792
PMID: 30101205
1158. J HIV AIDS Soc Serv. 2016;15(4):404-416. doi: 10.1080/15381501.2016.1228309.

Epub
2016 Sep 23.
Psychosocial Correlates of Medication Adherence among HIV-Positive, Cognitively

Impaired Individuals.
Arentsen TJ(1), Panos S(2)(3), Thames AD(3), Arbid JN(4), Castellon SA(2)(3),
Hinkin CH(2)(3).
Author information:
(1)Memphis Veterans Affairs Medical Center, Memphis, TN.
(2)VA Greater Los Angeles Healthcare System, Los Angeles CA.
(3)University of California, Los Angeles, Psychiatry and Biobehavioral Sciences,
Los Angeles CA.
(4)University of Massachusetts Boston, Boston MA.
Although cognitive impairment has been shown to adversely affect antiviral

medication adherence, a subset of cognitively impaired adults nonetheless are
able to adequately adhere to their medication regimen. However, little is known
about factors that serve as buffers against suboptimal adherence among the
cognitively impaired. This study consisted of 160 HIV-positive, cognitively
impaired adults (Global Deficit Score ≥ 0.50) whose medication adherence was
monitored over 6-months using an electronic monitoring device (MEMS caps).
Logistic regressions were run to determine psychosocial variables associated with
medication adherence. Higher self-efficacy and treatment related support, a
stable medication regimen, stable stress levels, and absence of current stimulant
use were predictive of optimal adherence. A distinct array of psychosocial
factors was found that buffer against the adverse effects of cognitive impairment
on medication adherence. Assessment and interventions targeting these factors may
improve adherence rates among cognitively impaired adults.
DOI: 10.1080/15381501.2016.1228309
PMCID: PMC5509354
PMID: 28713226

eCollection 2019.
The impact of personal and cultural beliefs on medication adherence of patients

with chronic illnesses: a systematic review.
Shahin W(1), Kennedy GA(1), Stupans I(1).
Author information:
(1)School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria
3083, Australia.
Background: Patients' adherence to therapeutic regimes may be influenced by

subjective beliefs about chronic conditions. One of the challenges for health
professionals in enhancing adherence is taking patients' understanding into
account when giving health advice and/or providing medical treatment.
Purpose: This review aimed to evaluate the consequent effects of personal and
cultural beliefs on medication adherence, in patients with chronic conditions
such as hypertension, diabetes mellitus, chronic obstructive pulmonary disease
and asthma.
Method: A systematic review methodology was used. PubMed, CINAHL, EMBASE and
PsychINFO, databases were searched for relevant articles. The main terms analyzed
were illness perceptions, health beliefs, cultural beliefs, chronic conditions
Results: From 2,646 articles, 127 were retained for further assessment, and
finally 25 met the inclusion criteria. A cross-sectional questionnaire survey
research design was conducted in all included articles. Of these most (n=22)
targeted hypertension or diabetes mellitus. A number of personal and cultural
based factors were identified as being associated with adherence to medication
regimes - 40% of articles (n=10) examined perception of illness, 20% (n=5) health
literacy, 16% (n=4) cultural beliefs, 12% (n=3) self-efficacy, 16% (n=4)
spiritual and religious beliefs, as well as 20% (n=5) illness knowledge.
Statistically significant associations between medication adherence and these
personal and cultural factors were found in 80% (n=20) of the included studies.
However, the direction of associations varied between studies depending on the
factor that was examined.
Conclusion: This review has evaluated the impact of personal and cultural factors
on medication adherence and highlighted the gaps in literature regarding
adherence. Further research is required to fully identify the associations
between religious beliefs, control beliefs and illness knowledge and medication
adherence.
DOI: 10.2147/PPA.S212046
PMCID: PMC6611718
PMID: 31303749

this work.
1160. Am J Drug Alcohol Abuse. 2016 Jul;42(4):422-30. doi:

10.3109/00952990.2016.1154966. Epub 2016 May 16.
Concurrent alcohol and medication poisoning hospital admissions among older rural
and urban residents.
Zanjani F(1), Smith R(2), Slavova S(3), Charnigo R(3), Schoenberg N(4), Martin
C(5), Clayton R(6).
Author information:
(1)a Behavioral and Community Health, School of Public Health , University of
Maryland , College Park , MD , USA.
(2)b Epidemiology , University of Kentucky , Lexington , KY , USA.
(3)c Biostatistics , University of Kentucky , Lexington , KY , USA.
(4)d Behavioral Science , University of Kentucky , Lexington , KY , USA.
(5)e Psychiatry , University of Kentucky , Lexington , KY , USA.
(6)f Health Behavior , University of Kentucky , Lexington , KY , USA.
BACKGROUND: Alcohol and medication interactions are projected to increase due to

the growth of older adults that are unsafely consuming alcohol and medications.
Plus, aging adults who reside in rural areas are at the highest risk of
experiencing medication interactions.
OBJECTIVE: Estimate concurrent alcohol and medication (alcohol/medication)
hospitalizations in adults 50+ years, comparing age groups and rural/urban
regions.
METHODS: Kentucky nonfederal, acute care inpatient hospital discharge electronic
records for individuals aged 50+ years from 2001 to 2012 were examined. Rate
differences were estimated across age and regional strata. Differences in the
underlying principal diagnosis, intent, and medications were also examined.
RESULTS: There were 2168 concurrent alcohol/medication hospitalizations among 50+
year olds identified. There was a 187% increase in alcohol/medication
hospitalizations from 2001 (n = 104) to 2012 (n = 299). The per capita
alcohol/medication hospitalization rate increased from 8.91 (per 100,000) in 2001
to 19.98 (per 100,000) in 2012, a 124% increase. The characteristics of the
hospitalizations included 75% principal diagnosis as medication poisoning,
self-harm as the primary intent (55%) in 50-64-year olds, and unintentional
intent (41%) in 65+ adults. Benzodiazepines were most often involved in the
poisonings (36.5%).
CONCLUSIONS: Concurrent alcohol/medication hospitalizations in Kentucky are
increasing among aging adults. Greater increases in rural areas and the 65+ aged
adults were seen, although there were also higher alcohol/medication
hospitalizations in urban and 50-64 aged adults. These findings indicate the need
for public-health prevention and clinical intervention to better educate and
manage alcohol consuming older adults on safe medication and alcohol practices.
DOI: 10.3109/00952990.2016.1154966
PMCID: PMC4998842
Conflict of interest statement: Declaration of interest: The authors report no

declarations of interest.
1161. Ther Adv Drug Saf. 2016 Aug;7(4):159-64. doi: 10.1177/2042098616651198. Epub
2016
May 20.
Making rational choices about how best to support consumers' use of medicines: a
perspective review.
Ryan R(1), Hill S(2).
Author information:
(1)Centre for Health Communication and Participation, School of Psychology and
Public Health, College of Science, Health and Engineering, La Trobe University,
Victoria 3086, Australia.
(2)Centre for Health Communication and Participation, School of Psychology and
Public Health, College of Science, Health and Engineering, La Trobe University,
Inappropriate medicine use and polypharmacy create significant challenges for

consumers and the health systems they live in, worldwide. In this review, we
describe the evidence underpinning interventions directed primarily at healthcare
consumers, including information provision, pharmacist-delivered interventions
and practical supports, such as reminders to improve outcomes related to
medicines. We identify a relatively small number of strategies that seem
effective or promising: self-monitoring and self-management programmes,
simplified dosing regimens and pharmacist-delivered interventions such as
medication review. These interventions could be applied in practice to address
some of the problems associated with inappropriate use of medicines,
multimorbidity and polypharmacy. The evidence also indicates that success with
many strategies is not consistent, suggesting that understanding the individual's
context and their preferences will also be important for improving medicines'
use. In addition, some strategies in current use are ineffective. Taken together,
we argue that the evidence should inform deliberate, rational decisions between
strategies to support consumers in using medicines safely and effectively. Future
medicine-use research should likewise build rationally and constructively on what
is known about promising interventions, avoiding duplication of past research,
and working to help consumers negotiate the many challenges presented by
polypharmacy.
DOI: 10.1177/2042098616651198
PMCID: PMC4959633
PMID: 27493719

eCollection 2018.
Factors affecting medication adherence in community-managed patients with

hypertension based on the principal component analysis: evidence from Xinjiang,
China.
Zhang Y(#)(1), Li X(#)(1), Mao L(1), Zhang M(1), Li K(1), Zheng Y(1), Cui W(1),
Yin H(1), He Y(1), Jing M(1).
Author information:
(1)Department of Public Health, Shihezi University School of Medicine, Shihezi,
Xinjiang, China.
Purpose: The analysis of factors affecting the nonadherence to antihypertensive

medications is important in the control of blood pressure among patients with
hypertension. The purpose of this study was to assess the relationship between
factors and medication adherence in Xinjiang community-managed patients with
hypertension based on the principal component analysis.
Patients and methods: A total of 1,916 community-managed patients with
hypertension, selected randomly through a multi-stage sampling, participated in
the survey. Self-designed questionnaires were used to classify the participants
as either adherent or nonadherent to their medication regimen. A principal
component analysis was used in order to eliminate the correlation between
factors. Factors related to nonadherence were analyzed by using a χ2-test and a
binary logistic regression model.
Results: This study extracted nine common factors, with a cumulative variance
contribution rate of 63.6%. Further analysis revealed that the following
variables were significantly related to nonadherence: severity of disease,
community management, diabetes, and taking traditional medications.
Conclusion: Community management plays an important role in improving the
patients' medication-taking behavior. Regular medication regimen instruction and
better community management services through community-level have the potential
to reduce nonadherence. Mild hypertensive patients should be monitored by
community health care providers.
DOI: 10.2147/PPA.S158662
PMCID: PMC5955046
PMID: 29785095


eCollection 2014.
A qualitative study on hypertensive care behavior in primary health care settings

in Malaysia.
Shima R(1), Farizah MH(2), Majid HA(2).
Author information:
(1)Department of Social and Preventive Medicine, University of Malaya, Kuala
Lumpur, Malaysia ; Ministry of Health Malaysia, Putrajaya, Malaysia.
(2)Department of Social and Preventive Medicine, University of Malaya, Kuala
Lumpur, Malaysia ; Centre for Population Health, Faculty of Medicine, University
of Malaya, Kuala Lumpur, Malaysia.
PURPOSE: The aim of this study was to explore patients' experiences with their
illnesses and the reasons which influenced them in not following hypertensive
care recommendations (antihypertensive medication intake, physical activity, and
diet changes) in primary health clinic settings.
PATIENTS AND METHODS: A qualitative methodology was applied. The data were
gathered from in-depth interviews with 25 hypertensive patients attending
follow-up in nine government primary health clinics in two districts (Hulu Langat
and Klang) in the state of Selangor, Malaysia. The transcribed data were analyzed
using thematic analysis.
RESULTS: There was evidence of lack of patient self-empowerment and community
support in Malaysian society. Most of the participants did not take their
antihypertensive medication or change their physical activity and diet after
diagnosis. There was an agreement between the patients and the health care
professionals before starting the treatment recommendation, but there lacked
further counseling and monitoring. Most of the reasons given for not taking
antihypertensive medication, not doing physical activity and not following diet
recommendations were due to side effects or fear of the side effects of
antihypertensive medication, patients' attitudes, lack of information from health
care professionals and insufficient social support from their surrounding
environment. We also observed the differences on these reasons for nonadherence
among the three ethnic groups.
CONCLUSION: Health care professionals should move toward supporting adherence in
the management of hypertensive patients by maintaining a dialogue. Patients need
to be given time to enable them to overcome their inhibition of asking questions
and to accept the recommendations. A self-management approach must be responsive
to the needs of individuals, ethnicities, and communities.
DOI: 10.2147/PPA.S69680
PMCID: PMC4240212
PMID: 25484577
1164. Behav Neurol. 2019 Apr 23;2019:2806341. doi: 10.1155/2019/2806341.

eCollection
2019.
Medication Belief and Adherence among Patients with Epilepsy.
Niriayo YL(1), Mamo A(1), Gidey K(1), Demoz GT(2).
Author information:
(1)Department of Clinical Pharmacy, School of Pharmacy, College of Health
Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
(2)Clinical Pharmacy and Pharmacy Practice Unit, Departments of Pharmacy, College
of Health Sciences, Aksum University, Aksum, Tigray, Ethiopia.
Background: Medication adherence and belief are crucial to achieving the desired
goal of therapy in epileptic patients. However, there is a lack of study
regarding medication adherence and belief in our setting. Therefore, the purpose
of this study was to investigate medication adherence and belief and associated
factors among ambulatory patients with epilepsy.
Method: A cross-sectional study was conducted on randomly selected epileptic
patients at the neurologic clinic of Ayder Comprehensive Specialized Hospital,
Ethiopia. Medication adherence and belief were assessed using self-reported
questionnaires which were developed based on the review of different literatures.
Data were analyzed using binary logistic regression analysis.
Result: We included a total of 292 patients. Almost two-thirds (65.4%) of the
patients were nonadherent to their medications. The most common cause of
nonadherence was forgetfulness (48.7%) followed by inability to get medicine
(28.8) and safety concern (23.5%). The majority (78.4%) of the patients had high
medication necessity belief while 44.1% had high concern belief about the
potential adverse effect of their medications. Overall, 39.4% of the patients had
a negative belief toward their medications. Comorbidity (AOR: 3.51, 95% CI:
1.20-10.31), seizure encounter within the last 3 months (AOR: 5.45, 95% CI:
2.48-12.00), low medication necessity belief (AOR: 3.38, 95% CI: 1.14-10.00),
high medication concern belief (AOR: 4.23, 95% CI: 2.07-8.63), and negative
medication belief (AOR: 4.17, 95% CI: 1.74-10.02) were predictors of medication
nonadherence.
Conclusion: Majority of the epileptic patients were nonadherent to their
medications, and more than one-third of the patients had a negative medication
belief. Low medication necessity belief, high medication concern belief, negative
medication belief, comorbidity, and seizure encounter were predictors of
medication nonadherence. Therefore, healthcare providers should design
educational programs to enhance the patients' believe about their medication in
order to improve medication adherence and overall treatment outcome.
DOI: 10.1155/2019/2806341
PMCID: PMC6507244
PMID: 31178940
1165. Int J Ther Massage Bodywork. 2016 Sep 9;9(3):27-30. eCollection 2016 Sep.
Case Study: The Use of Massage Therapy to Relieve Chronic Low-Back Pain.
Allen L.
OBJECTIVES: To study the effects of massage on chronic low-back pain in a patient

with four different diagnoses: osteoarthritis, scoliosis, spinal stenosis, and
degenerative disc disease. The patient's goal was to cut down on the amount of
pain medication he takes.
METHODS: A 63-year-old man with chronic back pain received four massages across a
twenty-day period. Progress was recorded using the Oswestry Low Back Pain Scale,
as he self-reported on levels of pain and interference with his activities of
daily living.
RESULTS: Improvement was noted in 9 out of 10 measurements of self-reported pain
and activities of daily living, with the only exception being his ability to lift
heavy objects, which remained unchanged. The most dramatic differences were
improvements in his ability to walk, and in the changing degrees of pain. The
client also self-reported being able to decrease his pain medication and the
ability to ride his bicycle for the first time in years.
CONCLUSIONS: Massage therapy is a promising treatment for chronic low-back pain
for patients who may have multiple pathologies, any one of which could be
responsible for the condition. Further study is encouraged to determine the
efficacy of massage therapy as a readily accessible, lower-cost alternative to
more invasive therapies and as an adjunct to regular medical care, when
appropriate.
PMCID: PMC5017818
PMID: 27648110
1166. Mater Sociomed. 2015 Dec;27(6):442-6. doi: 10.5455/msm.2015.27.442-446.
INTRAVENOUS MEDICATION ADMINISTRATION ERRORS AND THEIR CAUSES IN CARDIAC CRITICAL

CARE UNITS IN IRAN.
Bagheri-Nesami M(1), Esmaeili R(1), Tajari M(2).
Author information:
(1)School of Nursing and Midwifery. Department of Medical-Surgical Nursing,
Mazandaran Pediatric Infectious Disease Research Center (MPIDRC), Mazandaran
University of Medical Sciences, Sari, Iran.
(2)Nasibeh School of Nursing and Midwifery, Mazandaran University of Medical
Sciences. Sari, Iran.
BACKGROUND AND OBJECTIVES: The dangerous events caused by medication errors are
one of the main challenges faced in critical care units. The present study was
conducted to determine the frequency of intravenous medication administration
errors and their causes in cardiac critical care units in Iran.
MATERIALS AND METHODS: The present descriptive study was conducted in the
critical care units (CCUs and cardiac surgery intensive care units) of 12
teaching hospitals. Of the total of 240 nurses working in these departments, 190
participated in the present study. The data collection tools used in this study
included the "nurses' demographic data questionnaire", the "patients' medical and
demographic data questionnaire" and the "nurses' self-reporting questionnaire
about the frequency of intravenous medication administration errors and their
causes". The data obtained were analyzed in SPSS-20 using descriptive statistics
such as the absolute and relative frequency.
FINDINGS: During the 2 months in which this study was being conducted, 2542
patients were admitted to these departments and 20240 doses of intravenous
medications were administered to these patients. The nurses reported 262
intravenous medication administration errors. The most common intravenous
medication error pertained to administering the wrong medication (n=71 and
27.1%). As for the causes of intravenous medication administration errors, 51.5%
of the errors were associated with work conditions, 24% with packaging, 13.4%
with communication, 9.9% with transcription and 1.2% with pharmacies.
DISCUSSION AND CONCLUSION: According to the results, strategies are recommended
to be adopted for reducing or limiting medication errors, such as building a
stronger pharmacology knowledge base in nurses and nursing students, improving
work conditions and improving communication between the nurses and physicians.
DOI: 10.5455/msm.2015.27.442-446
PMCID: PMC4733547
PMID: 26889108
1167. Niger J Clin Pract. 2016 Jul-Aug;19(4):460-4. doi: 10.4103/1119-3077.180060.
Are blood pressure values compatible with medication adherence in hypertensive

patients?
Uludag A(1), Sahin EM(1), Agaoglu H(1), Gungor S(1), Ertekin YH(1), Tekin M(1).
Author information:
(1)Department of Family Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart
University, Çanakkale, Turkey.
BACKGROUND AND AIM: In the management of hypertension (HT), maintaining the

medication adherence with treatment is as important as starting treatment.
Studies have shown that the majority of patients taking medication do not reach
their target values. This study aimed to investigate the relationship between the
patient medication adherence and blood pressure (BP) values and reflection to
general well-being.
MATERIAL AND METHODS: The study included 259 primary HT patients. The patients
with BP measurements completed the Medication Adherence Self-Efficacy Scale-Short
Form 13 and the World Health Organization-5 (WHO-5) well-being index. A Holter
device was attached, and 24 h BP monitoring was completed.
RESULTS: The mean points for medication adherence scale was 29.2 ± 10.3 (1-40)
and mean WHO-5 points was 13.7 ± 4.6 (4-25) for patients. Clinical mean systolic
BP was 140.0 ± 12.6 and diastolic 84.8 ± 9.0 mm Hg, while 24 h mean BP was
systolic 119.5 ± 10.6 and diastolic 73.3 ± 8.1 mm Hg. While there was negative
correlation between medication adherence scale scores and clinical systolic BP (r
= -0.171; P = 0.006), there was no correlation with other BP readings. There was
no correlation with the WHO-5 score and clinical readings, though there was a
positive correlation between ambulatory mean systolic and diastolic BP (r =
0.141; P = 0.023 and r = 0.123; P = 0.049, respectively). There was positive
correlation between the patient's medication adherence scores and the WHO-5
scores (r = 0.141; P = 0.023).
CONCLUSION: When clinicians assess medication adherence of patients, they should
benefit from objective BP measurements and scales. Subjective and objective
findings are important while making clinical decision.
DOI: 10.4103/1119-3077.180060
1168. J Aging Res. 2015;2015:682503. doi: 10.1155/2015/682503. Epub 2015 Aug 5.
Self-Assessment of Adherence to Medication: A Case Study in Campania Region

Community-Dwelling Population.
Menditto E(1), Guerriero F(1), Orlando V(1), Crola C(2), Di Somma C(3), Illario
M(2), Morisky DE(4), Colao A(5).
Author information:
(1)Center of Pharmacoeconomics (CIRFF), Federico II University, 80131 Naples,
Italy.
(2)Research and Development Board, Federico II University Hospital, 80131 Naples,
Italy ; Translational Medical Sciences (DISMET), Federico II University, 80131
Naples, Italy.
(3)IRCCS SDN, 80131 Naples, Italy.
Health, Los Angeles, CA 90095-1772, USA.
(5)Department of Clinical Medicine and Surgery, Federico II University, 80131
Naples, Italy.
Objectives. The aim of the study was to assess self-reported medication adherence
measure in patients selected during a health education and health promotion
focused event held in the Campania region. The study also assessed
sociodemographic determinants of adherence. Methods. An interviewer assisted
survey was conducted to assess adherence using the Italian version of the 8-item
Morisky Medication Adherence Scale (MMAS-8). Participants older than 18 years
were interviewed by pharmacists while waiting for free-medical checkup. Results.
A total of 312 participants were interviewed during the Health Campus event. A
total of 187 (59.9%) had low adherence to medications. Pearson's bivariate
correlation showed positive association between the MMAS-8 score and gender,
educational level and smoking (P < 0.05). A multivariable analysis showed that
the level of education and smoking were independent predictors of adherence.
Individuals with an average level of education (odds ratio (OR), 2.21, 95%
confidence interval (CI), 1.08-4.52) and nonsmoker (odds ratio (OR) 1.87, 95%
confidence interval (CI), 1.04-3.35) were found to be more adherent to medication
than those with a lower level of education and smoking. Conclusion. The analysis
showed very low prescription adherence levels in the interviewed population. The
level of education was a relevant predictor associated with that result.
DOI: 10.1155/2015/682503
PMCID: PMC4541012
PMID: 26346487
1169. Int J Health Policy Manag. 2015 May 13;4(7):417-30. doi:

10.15171/ijhpm.2015.95.
Discussing the Effects of Poor Health Literacy on Patients Facing HIV: A

Narrative Literature Review.
Palumbo R(1).
Author information:
(1)Department of Management and Information Technology, University of Salerno,
Salerno, Italy.
BACKGROUND: Scholars describe poor health literacy as a "silent epidemic," which

is challenging the functioning of healthcare systems all over the world. Health
literacy is mainly meant as an individual trait which concerns the ability to
obtain, process, and understand basic health information in order to effectively
navigate the health system. Low health literate patients perceive poor
self-efficacy dealing with their health conditions, are not willing to be
involved in the provision of care, show larger risks of hospitalization and
mortality, and are not aware about the determinants of well-being. Hence, limited
health literacy has been associated with inadequate management of long-term
conditions; nonetheless, several authors argue that health literacy has been an
overlooked factor dealing with HIV.
METHODS: This study is aimed at discussing the effects of poor health literacy on
people living with HIV, drawing from the findings of a narrative literature
review which involved 41 papers retrieved from the databases "Scopus-Elsevier"
and "PubMed."
RESULTS: The scientific literature is not consistent dealing with the
relationship between health literacy and HIV treatment. For example, health
literate patients seem to better understand their health conditions; on the other
hand, people living with poor health literacy are likely to report higher
compliance with providers' prescriptions, blindly trusting healthcare
professionals.
CONCLUSION: Poor health literacy is a social barrier to access healthcare
services and to appropriate health treatment among patients living with HIV.
Tailored interventions should be aimed at enhancing the health skills of patients
affected by HIV infection to improve their ability to navigate the health system.
© 2015 by Kerman University of Medical Sciences.
DOI: 10.15171/ijhpm.2015.95
PMCID: PMC4493582
1170. Oman Med J. 2019 Jul;34(4):327-335. doi: 10.5001/omj.2019.64.
Hydroxyurea: Pattern of Use, Patient Adherence, and Safety Profile in Patients

with Sickle Cell Disease in Oman.
Jose J(1), Elsadek RA(2), Jimmy B(1), George P(2).
Author information:
(1)School of Pharmacy, University of Nizwa, Nizwa, Oman.
(2)Department of General Medicine, Nizwa Hospital, Nizwa, Oman.
Objectives: Many barriers contribute to the underutilization of hydroxyurea (HU)

in the treatment of sickle cell disease (SCD), and adherence to its use is often
reported to be suboptimal. It is important to have information on the safety of
HU in patients with SCD. Our study assessed the pattern of use, patients'
adherence to medication, discontinuation of use, and safety of HU in patients
with SCD.
Methods: This cross-sectional study was conducted in the department of medicine
of a referral hospital in Oman over five months and included a review of patient
files and patient interview. Approval was obtained from the Regional Research and
Ethics Committee of the A'Dakhiliyah Governorate and the hospital administration.
The parameters were compared between groups using the chi-square test.
Results: Of 298 patients studied, 128 (43.0%) had used HU at some points. The
difference in the prevalence of HU use was statistically significant based only
on age (p = 0.014), with younger patients more likely to be currently using HU or
used HU in the past. The majority of patients were adherent (82.5%) based on
self-reported adherence. The prevalence of discontinuation (temporary or
permanent) of HU use was high (57.0%), and suspected adverse drug reaction (ADR)
was the most common reason. Among those who had never used HU, 33.7% of patients
had an indication for the initiation of HU. A quarter of patients who used HU
developed a suspected ADR, with blood abnormalities being the commonest. The
duration of HU use influenced ADR prevalence (p = 0.015).
Conclusions: Among the current users of HU, the majority of the patients were
adherent based on self-reported medication adherence. The prevalence of
discontinuation of HU use and instances of non-initiation of HU among those
indicated were high. A larger study, ideally of a prospective nature, in various
governorates of Oman, would provide a wider picture at the national level.
DOI: 10.5001/omj.2019.64
PMCID: PMC6642718
PMID: 31360322
1171. Int J Clin Health Psychol. 2015 May-Aug;15(2):121-129. doi:
10.1016/j.ijchp.2014.11.003. Epub 2014 Dec 25.
Psychometric properties of the eight-item Morisky Medication Adherence Scale

(MMAS-8) in a psychiatric outpatient setting.
De Las Cuevas C(1), Peñate W(1).
Author information:
(1)Universidad de La Laguna, Spain.
The eight-item Morisky Medication Adherence Scale (MMAS-8) is a structured

self-report measure of medication-taking behavior that has been widely used in
various cultures. In Spain, no studies to date have analyzed the psychometric
properties of the scale in psychiatric care. The purpose of the present
instrumental study was to determine the psychometric properties of the Spanish
version of the MMAS-8 in a sample of 967 consecutive psychiatric outpatients. The
scale showed adequate construct validity and results pointed to a one-factor
solution in which all the items contributed to the final index of adherence. The
MMAS-8 exhibited significant correlation coefficients with the 10-item Drug
Attitude Inventory, Form C of the Multidimensional Health Locus of Control scale,
and the Hong Psychological Reactance Scale. Moreover, the MMAS-8 was able to
differentiate between various mental disorder diagnosis groups. The findings of
this study suggest that the Spanish version of the MMAS-8 is a reliable and valid
measure of medication adherence that can be used in a psychiatric outpatient
setting.
Publisher: La Escala de Adherencia a la Medicación de Morisky-8 ítems (MMAS-8) es

una medida auto-informada estructurada de la conducta de toma de la medicación
ampliamente utilizada en diferentes culturas. No existen estudios en España que
analicen sus propiedades psicométricas en población psiquiátrica. El objetivo de
este estudio es determinar las propiedades psicométricas de la versión española
de la MMAS-8 en una muestra de 967 pacientes psiquiátricos en régimen
ambulatorio. Los resultados mostraron una adecuada validez de constructo, con una
clara tendencia a una solución monofactorial, donde todos los ítems colaboraron
en el índice final de adherencia. MMAS-8 alcanzó correlaciones significativas con
el Inventario de Actitudes hacia la Medicación-10 ítems, con la forma C de la
Escala Multidimensional de Locus de Control sobre la Salud y la Escala de
Reactancia Psicológica. También la MMAS-8 permitió diferenciar el nivel de
adherencia entre diferentes trastornos psicopatológicos. Los hallazgos de este
estudio indican que la MMAS-8 es una medida fiable y válida para evaluar la
adherencia a la medicación y que puede ser utilizada con muestras de pacientes
psiquiátricos.
DOI: 10.1016/j.ijchp.2014.11.003
PMCID: PMC6224788
PMID: 30487829
1172. J Pediatr Psychol. 2018 Mar 1;43(2):122-132. doi: 10.1093/jpepsy/jsx090.
The Stability and Influence of Barriers to Medication Adherence on Seizure

Outcomes and Adherence in Children With Epilepsy Over 2 Years.
Ramsey RR(1), Zhang N(2), Modi AC(1).
Author information:
(1)Division of Behavioral Medicine and Clinical Psychology.
(2)Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital
Medical Center.
Objective: To determine the stability and influence of adherence barriers on

medication adherence and seizure control in pediatric epilepsy.
Methods: Caregivers of 118 children aged 2-12 years old with epilepsy completed
the Pediatric Epilepsy Medication Self-Management Questionnaire at nine time
points over 2 years post diagnosis. Electronically monitored antiepileptic drug
adherence and seizure outcome data were collected.
Results: Hierarchical linear modeling results for overall barriers remained
stable over 2 years. Specific item-level barriers were also generally stable over
time, with the exception of running out of medication becoming more of a barrier
over time. No specific barriers were related to seizure control; however,
difficulties swallowing medication, forgetting, and medication refusal were
related to electronically monitored adherence over time.
Conclusions: Assessing for specific adherence barriers over time may lead to
identification of interventions that result in improved adherence and care.
DOI: 10.1093/jpepsy/jsx090
PMCID: PMC5896586
PMID: 29049791
1173. Br J Ophthalmol. 2017 Jun;101(6):801-807. doi: 10.1136/bjophthalmol-2016-

308505.
Epub 2017 Mar 7.
Treatment patterns and medication adherence of patients with glaucoma in South

Korea.
Kim CY(1), Park KH(2), Ahn J(3), Ahn MD(4), Cha SC(5), Kim HS(6), Kim JM(7), Kim
MJ(8), Kim TW(9), Kim YY(10), Lee JW(11), Park SW(12), Sohn YH(13), Sung KR(14),
Yoo C(15), Cha J(16), Kim YJ(16).
Author information:
(1)Institute of Vision Research, Department of Ophthalmology, Yonsei University
College of Medicine, Seoul, Republic of Korea.
(2)Department of Ophthalmology, Seoul National University Hospital, Seoul,
Republic of Korea.
(3)Ajou University School of Medicine, Suwon, Republic of Korea.
(4)Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic
of Korea.
(5)Department of Ophthalmology, Yeungnam University College of Medicine, Daegu,
Republic of Korea.
(6)Sungmo Eye Hospital, Busan, Republic of Korea.
(7)Department of Ophthalmology, Sungkyunkwan University School of Medicine,
Kangbuk Samsung Hospital, Seoul, Republic of Korea.
(8)Kong Eye Clinic, Seoul, Republic of Korea.
(9)Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.
(10)Korea University Guro Hospital, Seoul, Republic of Korea.
(11)Pusan National University Hospital, Busan, Republic of Korea.
(12)Chonnam National University Medical School & Hospital, Gwangju, Republic of
Korea.
(13)Kim's Eye Hospital, Seoul, Republic of Korea.
(14)Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic
of Korea.
(15)Korea University Anam Hospital, Seoul, Republic of Korea.
(16)Pfizer Pharmaceutical Korea Limited, Seoul, Republic of Korea.
BACKGROUND/AIMS: This study aimed to investigate treatment patterns and

medication adherence of glaucoma. It also identified key factors associated with
non-adherence.
METHODS: It was a cross-sectional, observational study. Patients who use
eye-drops for ≤2 years were recruited at 15 eye clinics from March to November
2013. Data were collected through self-administered questionnaires and medical
chart review. Medication adherence was evaluated using patients' self-report on
pill count and defined as patients' administering drug for ≥80% of prescribed
days. Medication adherence rate was calculated by dividing actual number of
administration from total prescribed number of administration for 7 days.
Patients whose self-reported prescription was different from total daily doses of
physicians' prescription were considered as non-adherent.
RESULTS: A total of 1050 patients included, and medication adherence rate was
evaluated in 1046 patients whose verification of adherence was available. Of the
total, 27.4% were non-adherent, and the medication adherence rates of the total,
the adherent, and the non-adherent were 90.6±17.8%, 96.8±5.5% and 56.6±24.7%,
respectively. The most commonly used medication was prostaglandin (PGA) alone and
the second was combination of two-class (β-blocker and carbonic anhydrase
inhibitor (CAI)) and three-class combination of PGA, β-blocker and CAI followed.
In multivariate analysis, the risk of non-adherence was 1.466 times greater in
males than in females (95% CI 1.106 to 1.943) and 1.328-fold greater as the daily
number of administration was increased (95% CI 1.186 to 1.487).
CONCLUSION: Approximately, one-third of the patients were non-adherent, and males
and increased daily number of administration were associated with non-adherence.
It highlights that more systematic treatment strategies should be considered for
better medication adherence, leading to effective glaucoma management.
http://www.bmj.com/company/products-services/rights-and-licensing/.
DOI: 10.1136/bjophthalmol-2016-308505
PMCID: PMC5583683
Conflict of interest statement: Competing interests: None.
1174. J Am Geriatr Soc. 2014 Dec;62(12):2369-76. doi: 10.1111/jgs.13162. Epub 2014

Dec
8.
Cost analysis of a home-based nurse care coordination program.
Marek KD(1), Stetzer F, Adams SJ, Bub LD, Schlidt A, Colorafi KJ.
Author information:
(1)College of Nursing and Health Innovation, Arizona State University, Phoenix,
Arizona.
Comment in
J Am Geriatr Soc. 2014 Dec;62(12):2433-5.
OBJECTIVES: To determine whether a home-based care coordination program focused

on medication self-management would affect the cost of care to the Medicare
program and whether the addition of technology, a medication-dispensing machine,
would further reduce cost.
DESIGN: Randomized, controlled, three-arm longitudinal study.
SETTING: Participant homes in a large Midwestern urban area.
PARTICIPANTS: Older adults identified as having difficulty managing their
medications at discharge from Medicare Home Health Care (N = 414).
INTERVENTION: A team consisting of advanced practice nurses (APNs) and registered
nurses (RNs) coordinated care for two groups: home-based nurse care coordination
(NCC) plus a pill organizer group and NCC plus a medication-dispensing machine
group.
MEASUREMENTS: To measure cost, participant claims data from 2005 to 2011 were
retrieved from Medicare Part A and B Standard Analytical Files.
RESULTS: Ordinary least squares regression with covariate adjustment was used to
estimate monthly dollar savings. Total Medicare costs were $447 per month lower
in the NCC plus pill organizer group (P = .11) than in a control group that
received usual care. For participants in the study at least 3 months, total
Medicare costs were $491 lower per month in the NCC plus pill organizer group (P
= .06) than in the control group. The cost of the NCC plus pill organizer
intervention was $151 per month, yielding a net savings of $296 per month or
$3,552 per year. The cost of the NCC plus medication-dispensing machine
intervention was $251 per month, and total Medicare costs were $409 higher per
month than in the NCC plus pill organizer group.
CONCLUSION: Nurse care coordination plus a pill organizer is a cost-effective
intervention for frail elderly Medicare beneficiaries. The addition of the
medication machine did not enhance the cost effectiveness of the intervention.
© 2014 The Authors.The Journal of the American Geriatrics Society published by

Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.
DOI: 10.1111/jgs.13162
PMCID: PMC4383646
1175. J Manag Care Spec Pharm. 2015 May;21(5):391-9.
Understanding reasons for nonadherence to medications in a medicare part d

beneficiary sample.
Hincapie AL(1), Taylor AM, Boesen KP, Warholak T.
Author information:
(1)Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave.,
Cincinnati, OH, 45267. Ana.Hincapie@uc.edu.
BACKGROUND: Poor medication adherence is a predictor of poor health outcomes,

especially in populations with chronic diseases. Although several self-reported
measures of medication adherence exist, the scope of each is limited.
OBJECTIVE: To identify barriers to medication adherence in order to facilitate
effective delivery of telephone-based medication therapy management (MTM)
services to beneficiaries of contracted Medicare Part D plans.
METHODS: This study used a cross-sectional telephone-based questionnaire designed
to elicit reasons for low medication adherence. Patients were eligible to
participate if they were identified as nonadherent for an antilipidemic,
antihypertensive, or antidiabetic agent. Nonadherence was defined as less than
80% of proportion of days covered (PDC). The questionnaire included 17 items
pertaining to medication use and 3 demographic items. Data were collected between
September 2012 and February 2013. Data analyses included descriptive statistics
and Rasch analyses.
RESULTS: A total of 124 patients participated in the telephone survey. Of those
completing the survey, the majority were patients (97.6%); only 3 surveys (2.4%)
were completed by caregivers. The sample population had a mean age of 69.8 years
(SD = 9.9), and more than half of participants (60.4%) were female. Nineteen
percent of respondents received their medications by mail. Medication
nonadherence generated alerts mostly associated with antilipidemic agents
(n = 50, 40.3%), followed by antihypertensive drugs (n = 36, 29.0%), and
antidiabetic medications (n = 23, 18.5%). The response categories for medication
belief items were collapsed from 4 to 3 categories to achieve acceptable Rasch
model fit (to fit the model and approximate interval level data). Ten percent of
participants reported having medications prescribed either that they did not get
or that they obtained but did not use. Almost 30% of patients reported having
medications prescribed that they started using but stopped. However, only 4% of
patients reporting adherence issues were related to the alert triggering for
chronic medications; 96% of reports were linked to unrelated medications that did
not generate an alert. The most common reason cited for medication nonadherence
was experiencing side effects.
CONCLUSIONS: Most participants reported positive beliefs about medications and
did not report adherence issues related to those triggering alerts. MTM programs
offer potential solutions to a number of barriers to medication adherence and a
unique opportunity to raise awareness about the importance of medication
adherence among members.
DOI: 10.18553/jmcp.2015.21.5.391
1176. Eur J Hosp Pharm. 2016 May;23(3):171-176. doi: 10.1136/ejhpharm-2015-000767.

Epub
2015 Dec 1.
Impact of clinical pharmacist intervention on length of stay in an acute

admission unit: a cluster randomised study.
Lind KB(1), Soerensen CA(2), Salamon SA(3), Jensen TM(1), Kirkegaard H(4), Lisby
M(4).
Author information:
(1)Emergency Department, Randers Regional Hospital, Randers, Denmark.
(2)Randers Department, Hospital Pharmacy Central Denmark Region, Randers,
Denmark.
(3)Department of Emergency Medicine, Aalborg University Hospital, Aalborg,
Denmark.
(4)Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus,
Denmark.
Objectives: Physicians in acute admission units (AAUs) are obliged to obtain

medication history and perform medication reconciliation, which is time consuming
and often incomplete. Studies show that clinical pharmacists (CPs) can obtain
accurate medication histories, but so far no studies have investigated the effect
of this on time measures. Therefore, the objective of the present study was to
investigate the effect of a CP intervention on length of stay (LOS) in an AAU.
Methods: The study was designed as a prospective, cluster randomised study.
Weekdays were randomised to control or intervention. CP intervention consisted of
obtaining medication history and performing medication reconciliation and review.
The primary outcome was LOS in the AAU. Secondary outcomes were other
time-related measures-for example, physicians' self-reported time spent on
medication topics. Finally, the number of documented medications per patient was
established.
Results: 232 and 216 patients, respectively, were included on control (n=63) and
intervention (n=63) days. The mean LOS was 342 (95% CI 323 to 362) min in the
intervention group and 339 (95% CI 322 to 357) min in the control group, which
was not statistically significantly different. Physicians spent on average 4.3
(95% CI 3.7 to 5.0) min in the intervention group and 7.5 (95% CI 6.6 to 8.5) min
in the control group, corresponding to an overall reduction of 43.0% (95% CI
30.9% to 53.0%, p<0.001). The number of documented medications per patient was
10.0 (intervention group) and 8.8 (control group).
Conclusions: This study indicates that LOS in the AAU was not affected by CP
intervention; however, physicians reported a significant reduction in time spent
on medication topics.
Trial registration number: Clinical Trial Gov: 1-16-02-379-13.
DOI: 10.1136/ejhpharm-2015-000767
PMCID: PMC6451522
PMID: 31156841
1177. Epilepsy Behav. 2017 Apr;69:7-11. doi: 10.1016/j.yebeh.2016.11.022. Epub 2017

Feb
20.
Understanding the self-management skills of persons with epilepsy.
Bautista RED(1).
Author information:
(1)Comprehensive Epilepsy Program, Department of Neurology, University of Florida
Health Sciences Center/Jacksonville, United States. Electronic address:
ramon.bautista@jax.ufl.edu.
PURPOSE: To determine whether the self-management skills of persons with epilepsy

(PWE) vary across the different domains of the Epilepsy Self-Management Scale
(ESMS).
METHODS: 172 PWE completed a survey questionnaire as well as the ESMS.
RESULTS: Using ANOVA with pairwise comparison, the mean item scores of the
medication, seizure, and safety management subscales of the ESMS were
significantly higher than the lifestyle and information management subscales
(p<0.01). The mean item score for the lifestyle management subscale was
significantly higher than the information management subscale (p<0.01).
CONCLUSION: PWE in our population performed differently across the various
domains of the ESMS and did worse on the lifestyle and information management
subscales. We discuss the implications of this on patient counseling and
education.
DOI: 10.1016/j.yebeh.2016.11.022

2018
Jan 31.
A focus group study of patient's perspective and experiences of type 2 diabetes

and its management in Jordan.
Jarab AS(1), Mukattash TL(1), Al-Azayzih A(1), Khdour M(2).
Author information:
(1)Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of
Science and Technology, Irbid 22110, Jordan.
(2)Faculty of Pharmacy, Al-Quds University, Palestinian Territories, Israel.
Background: Diabetes is increasingly becoming a major health problem in Jordan

and glycemic goals are often not achieved.
Objective: To explore the patients' perspectives regarding type 2 diabetes and
its management in order to "fine-tune" future pharmaceutical care intervention
programs.
Method: Focus groups method was used to explore views from individuals with type
2 diabetes attending outpatient diabetes clinic at the Royal Medical Services
Hospital. All interviews were recorded, transcribed and analyzed using a thematic
analysis approach.
Results: A total of 6 focus groups, with 6 participants in each one, were
conducted. Participants in the present study demonstrated a great information
needs about diabetes and the prescribed treatment. Medication regimen
characteristics including rout of administration, number of prescribed
medications and dosage frequency in addition to perceived side effects
represented the major barriers to medication adherence. In addition to
demonstrating negative beliefs about the illness and the prescribed medications,
participants showed negative attitudes and low self-efficacy to adhere to
necessary self-care activities including diet, physical activity and
self-monitoring of blood glucose.
Conclusion: Future pharmaceutical care interventions designed to improve
patients' adherence and health outcomes in patients with type 2 diabetes should
consider improving patients' understanding of type 2 diabetes and its management,
simplifying dosage regimen, improving patient's beliefs and attitudes toward type
2 diabetes, prescribed medications and different self-care activities in addition
to improving patient's self efficacy to perform different treatment
recommendations.
DOI: 10.1016/j.jsps.2018.01.013
PMCID: PMC5856954
PMID: 29556120
1179. J Clin Med Res. 2015 Oct;7(10):791-4. doi: 10.14740/jocmr2284w. Epub 2015 Aug
23.
Maternal Uncontrolled Anxiety Disorders Are Associated With the Increased Risk of
Hypertensive Disorders in Japanese Pregnant Women.
Suzuki S(1), Shinmura H(1), Kato M(1).
Author information:
(1)Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika
Maternity Hospital, Tokyo, Japan.
BACKGROUND: We examined the risk of hypertensive disorders in relation to

maternal depressive and anxiety disorders which were diagnosed before or during
early pregnancy in Japanese women.
METHODS: We reviewed the obstetric records of all Japanese singleton deliveries
at ≥ 22 weeks' gestation managed at the Japanese Red Cross Katsushika Maternity
Hospital between 2009 and 2014. Potential risk factors for hypertensive disorders
with maternal depressive and anxiety disorders were selected as follows: maternal
age, parity, medications, self-interruption of medications and economic problems.
RESULTS: The incidence of hypertensive disorders did not increase in the pregnant
women with depressive disorders compared with that in the normal control pregnant
women (P = 0.96). However, the incidence of hypertensive disorders in the women
with anxiety disorders was higher than that in the control women (odds ratio
(OR): 2.61, 95% confidence interval (CI): 1.4 - 5.0, P < 0.01). In the women with
anxiety disorders, 19% performed self-interruption of medications during
pregnancy, and it was associated with the increased risk of hypertensive
disorders (vs. no medication group, OR: 7.50, 95% CI: 1.5 - 38, P = 0.03; vs.
medication group, OR: 16.0, 95% CI: 2.4 - 110, P < 0.01).
CONCLUSIONS: Maternal uncontrolled anxiety disorders due to self-interruption of
medications seemed to be associated with the increased risk of hypertensive
disorders in Japanese pregnant women.
DOI: 10.14740/jocmr2284w
PMCID: PMC4554219
PMID: 26346308
1180. JMIR Res Protoc. 2019 Jun 21;8(6):e13351. doi: 10.2196/13351.
"Smartphone Medication Adherence Saves Kidneys" for Kidney Transplantation

Recipients: Protocol for a Randomized Controlled Trial.
McGillicuddy J(1), Chandler J(2), Sox L(2), Mueller M(2), Nemeth L(2), Baliga
P(1), Treiber F(2).
Author information:
(1)College of Medicine, Medical University of South Carolina, Charleston, SC,
United States.
(2)College of Nursing, Medical University of South Carolina, Charleston, SC,
United States.
BACKGROUND: Kidney transplant recipients' poor medication adherence and poor

control of comorbidities, particularly hypertension, are risk factors for graft
rejection, graft loss, and death. Few randomized controlled trials (RCTs) have
been successful in improving sustained medication adherence and blood pressure
control among kidney transplantation recipients. We provide rationale for an RCT
evaluating a mobile health medical self-management system for kidney
transplantation recipients called Smartphone Medication Adherence Saves Kidneys
(SMASK).
OBJECTIVE: Our objective is to determine whether SMASK is efficacious in
improving medication adherence and sustaining blood pressure control among kidney
transplantation recipients with uncontrolled hypertension and poor medication
adherence compared to an enhanced standard care.
METHODS: This two-arm, 6-month, phase II single-site efficacy RCT will involve 80
kidney transplantation recipients. Participants will be randomly assigned to the
SMASK intervention arm or control arm. SMASK includes multilevel components:
automated reminders from an electronic medication tray; tailored text messages
and motivational feedback, guided by the self-determination theory; and automated
summary reports for providers. Evaluations will be conducted preintervention, at
3 and 6 months, and posttrial at 12 months. Specific aims are to test the
hypotheses that compared to standard care, the SMASK cohort will demonstrate
significantly improved changes at 3, 6, and 12 months in the primary outcome
variables medication adherence (proportion with electronic monitor-derived score
>0.90) and blood pressure control (proportion meeting and sustaining adherence to
the Kidney Disease Improving Global Outcomes [KDIGO] guidelines for blood
pressure control); the secondary outcome variables provider adherence to KDIGO
guidelines, measured by timing of medication changes and changes in
self-determination theory constructs; and the exploratory outcome variables
estimated glomerular filtration rate, variability in calcineurin inhibitor trough
levels, and proportion of patients meeting and sustaining the 24-hour ambulatory
blood pressure below 130/80 mm Hg. After the 6-month evaluation, interviews with
a random sample of SMASK subjects (n=20) and health care providers (n=3-5) will
assess user reactions including acceptability, usability, and aids/barriers to
sustainability. Data from the RCT and interviews will be triangulated to further
refine and optimize SMASK and prepare for a multisite effectiveness RCT.
RESULTS: The SMASK project received funding from National Institute of Diabetes
and Digestive and Kidney Diseases in June 2016, obtained institutional review
board approval in April 2016, and began data collection in July 2016. As of July
2018, we completed enrollment with a total of 80 participants.
CONCLUSIONS: This study will provide data regarding the efficacy of SMASK to
improve medication adherence and blood pressure control in a cohort of
hypertensive kidney transplant recipients. An efficacious SMASK intervention will
pave the way for a larger, multicenter, effectiveness RCT powered sufficiently to
evaluate clinical events in a real-world setting and with the potential to
demonstrate improved outcomes at lower cost than standard care.
©John McGillicuddy, Jessica Chandler, Luke Sox, Martina Mueller, Lynne Nemeth,
Prabhakar Baliga, Frank Treiber. Originally published in JMIR Research Protocols
DOI: 10.2196/13351
PMCID: PMC6611329
PMID: 31228175
1181. JMIR Mhealth Uhealth. 2018 Jul 3;6(7):e154. doi: 10.2196/mhealth.9987.
A Novel mHealth Approach for a Patient-Centered Medication and Health Management

System in Taiwan: Pilot Study.
Hsieh WT(#)(1), Su YC(#)(2)(3), Han HL(1), Huang MY(1)(4)(5).
Author information:
(1)Biomedical Research and Innovation Incubation Center, MacKay Memorial
Hospital, Taipei, Taiwan.
(2)Department of Emergency, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical
Foundation, Chiayi, Taiwan.
(3)School of Medicine, Tzu Chi University, Hualien, Taiwan.
(4)Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
(5)Department of Emergency, MacKay Memorial Hospital, Taipei, Taiwan.
BACKGROUND: Mobile health (mHealth) apps have recently demonstrated the potential
to engage and empower people to improve their own health. Although the
availability of health-related apps is increasing, their adoption rate in Taiwan
is exceptionally low mainly due to the preponderance of Western culture-based app
designs that are challenging for non-English-speaking individuals. To our
knowledge, no mHealth app is available in Taiwan that is culturally tailored for
Chinese-speaking users and that applies a patient-centered approach to
self-manage medication and health.
OBJECTIVE: The purpose of this study was to design and deploy a culturally
tailored mHealth system that could be easily integrated into current clinical
practice and to evaluate how this mHealth system could support the continuity of
patient care in Taiwan.
METHODS: An mHealth information system and a mobile app were designed. To promote
the best patient experience, a Quick Response (QR) code system was developed to
enable efficient registration of personal medication information through the
mobile app. The app also supported notifications for drug utilization, refills,
and symptom checks. Patients were encouraged to record medication use, symptoms,
and self-assessments in the app during their treatment period. Evaluation of the
novel mHealth system was conducted from August 1, 2016 to December 31, 2016 at
MacKay Memorial Hospital, Taipei, Taiwan. Population data and app usage
statistics were analyzed.
RESULTS: During the 5-month implementation period, a total of 25,909 users
downloaded the app with an overall 7-day retention rate of 15.4% (SD 3.9). Young
male adults (range 25-44 years) were the predominant user population. Patients'
feedback on app usability and design, QR code system as drug input method,
medication reminders, and linking family or friends into care networks was
generally positive. Physicians showed great interest in utilizing
patient-generated data in their care process, and the positive medication
adherence rate was the most highly valued component of this system.
CONCLUSIONS: This pilot study demonstrated the value of a novel mHealth approach
for individualized medication and health management in Taiwan. The mHealth system
shows the potential to optimize personalized care into existing clinical services
and may help hospitals and health authorities perform continuous quality
improvement and policy development.
©Wen-Ting Hsieh, Yung-Cheng Su, Hsin-Lien Han, Ming-Yuan Huang. Originally

PMCID: PMC6053609
PMID: 29970356
1182. SAGE Open Med. 2019 Jul 23;7:2050312119865647. doi: 10.1177/2050312119865647.

eCollection 2019.
The association between health literacy levels and patient-reported outcomes in

Japanese type 2 diabetic patients.
Ueno H(1), Ishikawa H(1)(2), Suzuki R(3)(4), Izumida Y(3), Ohashi Y(5), Yamauchi
T(3), Kadowaki T(3)(6)(7), Kiuchi T(1).
Author information:
(1)Department of Health Communication, School of Public Health, Graduate School
of Medicine, The University of Tokyo, Tokyo, Japan.
(2)Graduate School of Public Health, Teikyo University, Tokyo, Japan.
(3)Department of Diabetes and Metabolic Diseases, Graduate School of Medicine,
The University of Tokyo, Tokyo, Japan.
(4)Division of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen
Diseases Tokyo Medical University, Tokyo, Japan.
(5)Nursing Department, The University of Tokyo Hospital, Tokyo, Japan.
(6)Department of Prevention of Diabetes and Life-style Related Diseases, Graduate
School of Medicine, The University of Tokyo, Tokyo, Japan.
(7)Department of Metabolism and Nutrition, Mizonokuchi Hospital, Teikyo
University, Kawasaki, Kanagawa, Japan.
Objectives: The aim of this study is to empirically examine a full pathway model
of health literacy, and health and well-being outcomes among patients with type 2
diabetes.
Methods: A three-wave longitudinal survey was administered to 148 patients with
diabetes. Covariance structure analysis was conducted to create a path diagram,
with health literacy and burden of medical expenses included as independent
variables and with psychosocial factors, behaviors, and health and well-being
outcomes included as dependent variables.
Results: The model fit indices showed a comparative fit index of 0.985 at
baseline, 0.959 after 3 months, and 0.948 after 6 months, with a root mean square
error of approximation of 0.040 at baseline, 0.079 after 3 months, and 0.085
after 6 months. There were 14 significant paths across the three time points
between health literacy and understanding of diabetes care, self-efficacy,
communication with doctors, and medication adherence.
Conclusion: The model fitness index showed an adequate result. Health literacy
was significantly positively associated with understanding of diabetes care,
self-efficacy, communication with doctors, and medication adherence. Health
literacy had a direct positive influence on medication adherence and possibly an
indirect positive influence on exercise/diet via self-efficacy. The results were
generally consistent across the three time points, suggesting good reliability of
the models. Improving health literacy may lead to better self-management of
diabetes and favorable health outcomes.
DOI: 10.1177/2050312119865647
PMCID: PMC6651654
PMID: 31384463


eCollection 2018.
Disruption in time projection and non-adherence to long-term therapies.
Reach G(1)(2), Boubaya M(3), Brami Y(1), Lévy V(3)(4).
Author information:
(1)Department for Endocrinology, Diabetes and Metabolic Diseases, Avicenne
Hospital, APHP, Bobigny, France, gerard.reach@aphp.fr.
(2)EA 3412, Health Education and Practices Laboratory (LEPS), Paris 13
University, Sorbonne Paris Cité, Bobigny, France, gerard.reach@aphp.fr.
(3)Clinical Research Unit and Clinical Research Center, Avicenne Hospital, APHP,
Bobigny, France.
(4)INSERM UMR 1153 (Centre of Research in Epidemiology and Statistics, Sorbonne
Paris Cité), ECSTRRA team (Epidemiology and Clinical Statistics for Tumor,
Respiratory, and Ressuscitation Assessments), Hôpital Saint Louis, Paris, France.
Objective: Patients' non-adherence to medical prescriptions is a crucial issue in

contemporary medicine because it can jeopardize care efficacy. Non-adherence is
especially frequent in patients with chronic diseases. In this article, we
propose that a particular condition, which we call disruption in time projection,
is a cause of non-adherence to medication therapies in chronic diseases.
Methods: A questionnaire was administered to 120 hospitalized people with type 2
diabetes addressing three psychological constructs defining time projection:
patience/impatience in a fictive monetary scenario (preferring to receive €1,500
in 1 year or €500 today), magnitude of temporal horizon (greater or lesser
ability to imagine future events) and perception of the degree of physical
similarity of current self to self at 1 year, 5 years and 10 years from the
present. In addition, the questionnaire evaluated adherence to medication, social
deprivation and depression.
Results: In the multivariate analyses, two factors were associated with adherence
to medication: patience (P<0.001) and long temporal horizon (P=0.006). Two
factors were associated with HbA1c ≥8% (64 mmol/mol): non-adherence to medication
(P=0.003) and short temporal horizon (P=0.011). Three factors were associated
with long temporal horizon: adherence to medication (P<0.001), patience (P<0.001)
and the existence of grandchildren (P=0.002). Social deprivation (P<0.001),
non-adherence (P<0.001), female gender (P=0.002) and short temporal horizon
(P=0.050) were associated with impatience. Finally, an association of adherence
to expected similarity in the future to current self, impatience, short temporal
horizon, social deprivation and depression was also shown in a multiple
correspondence analysis.
Conclusion: What we termed a disruption in time projection may be a unique
determinant for non-adherence to long-term therapy and, therefore, may influence
the outcome of chronic diseases. We hypothesize that this is involved in both
intentional and unintentional non-adherence and that it represents the loss of a
protective mechanism. If this novel concept is to be confirmed in other settings
and generalized to other chronic diseases, the recognition of its role in disease
prognosis may help orient the teaching and practice of medicine.
DOI: 10.2147/PPA.S180280
PMCID: PMC6234996
PMID: 30519002

1184. J Behav Med. 2016 Aug;39(4):633-41. doi: 10.1007/s10865-016-9741-y. Epub 2016

Apr
9.
Measuring insulin adherence among adults with type 2 diabetes.
Osborn CY(1), Gonzalez JS(2)(3).
Author information:
(1)Department of Medicine, Department of Biomedical Informatics, Center for
Health and Health Education, Vanderbilt University Medical Center, 2525 West End
Ave. Suite 370, Nashville, TN, 37203, USA. chandra.osborn@vanderbilt.edu.
(2)Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA.
(3)Diabetes Research Center, Albert Einstein College of Medicine, New York, NY,
USA.
Erratum in
J Behav Med. 2016 Aug;39(4):733.
Non-adherence to insulin is common and associated with suboptimal health. We

adapted the Morisky Medication Adherence Scale to specify insulin adherence
(MIAS) and compared it to the Adherence to Refills and Medication Scale for
Diabetes (ARMS-D) and the Summary of Diabetes Self-Care Activities medications
subscale (SDSCA-MS) and an insulin-specific (SDSCA-IS) version. A sample of 144
insulin-treated adults (58 % African American/Black, 34 % Caucasian/White, 8 %
Other/Mixed race; 6.9 % Hispanic) completed these measures along with a HbA1C
test. The internal consistency and factor structure of the MIAS were adequate;
59 % of participants forgot to take insulin and 46 % reported non-adherence. The
MIAS was associated with the ARMS-D, SDSCA-MS, and SDSCA-IS (p < 0.001), and
higher MIAS scores were marginally associated with better self-rated health
(p = 0.057), but significantly associated with fewer emergency room visits
(p = 0.001), and better HbA1C (p = 0.001). The MIAS is a valid and reliable
insulin adherence assessment tool for practice and research applications.
DOI: 10.1007/s10865-016-9741-y
PMCID: PMC4945416
1185. BMC Health Serv Res. 2017 Aug 9;17(1):547. doi: 10.1186/s12913-017-2462-2.
The impact of a hospital electronic prescribing and medication administration

system on medication administration safety: an observational study.
Jheeta S(1), Franklin BD(2)(3).
Author information:
(1)Centre for Medication Safety and Service Quality, Imperial College Healthcare
NHS Trust, London, UK. seetal.jheeta@nhs.net.
(2)Centre for Medication Safety and Service Quality, Imperial College Healthcare
NHS Trust, London, UK.
(3)Research Department of Practice and Policy, UCL School of Pharmacy, London,
UK.
BACKGROUND: The aim of the study was to explore the impact of the implementation
of an electronic prescribing and medication administration system (ePA) on the
safety of medication administration in an inpatient hospital setting. Objectives
were to compare the prevalence and types of: 1) medication administration errors,
and 2) documentation discrepancies, between a paper and an ePA system.
Additionally, we wanted to describe any observed changes to medication
administration practices.
METHODS: The study was based on an elderly medicine ward in an English hospital.
From December 2014 to June 2015, nurses' medication administration rounds were
observed every 5 days before and after ePA implementation using an interrupted
time-series approach. Medication administration error and documentation
discrepancy rates pre- versus post-ePA were analysed descriptively and
chi-squared tests used to test for any difference; segmented regression analysis
was used to determine changes in longitudinal trend.
RESULTS: Observations were made at 15 pre- and 15 post-ePA implementation
time-points. Pre-ePA on paper, there were 18 medication administration errors in
428 opportunities for error (4.2%; 95% confidence interval 2.3-6.1%), and with
ePA there were 18 in 528 (3.4%; 95% confidence interval 1.9-5.0%; p = 0.64).
Regarding documentation, pre-ePA on paper there were 5 discrepancies in 460
observed documentations (1.1%; 95% confidence interval 0.1-2.0%); with ePA there
were 18 in 557 (3.2%; 95% confidence interval 1.8-4.7%; p = 0.04). The most
common electronic documentation discrepancy was documentation that a dose had
been administered when it had not. Segmented regression analysis was unable to
detect any significant longitudinal changes. Changes to working practices
post-ePA were observed, such as nurses demonstrating less-consistent
self-checking when preparing and administering medications.
CONCLUSIONS: Findings suggest no change in medication error rate, although ePA
encourages certain types of errors and mitigates others. There was a
statistically significant increase in documentation discrepancies which is likely
to be due to adoption of new working practices with ePA.
DOI: 10.1186/s12913-017-2462-2
PMCID: PMC5549345
1186. Contemp Clin Trials. 2015 Jul;43:105-13. doi: 10.1016/j.cct.2015.05.013. Epub

2015 May 21.
The Telehealth Enhancement of Adherence to Medication (TEAM) in pediatric IBD

trial: Design and methodology.
Hommel KA(1), Gray WN(2), Hente E(3), Loreaux K(3), Ittenbach RF(4), Maddux M(5),
Baldassano R(6), Sylvester F(7), Crandall W(8), Doarn C(9), Heyman MB(10), Keljo
D(11), Denson LA(4).
Author information:
(1)Cincinnati Children's Hospital Medical Center, United States; University of
Cincinnati College of Medicine, United States. Electronic address:
kevin.hommel@cchmc.org.
(2)Auburn University, United States.
(3)Cincinnati Children's Hospital Medical Center, United States.
(4)Cincinnati Children's Hospital Medical Center, United States; University of
Cincinnati College of Medicine, United States.
(5)Children's Mercy Hospitals and Clinics, United States; University of Missouri
Kansas City School of Medicine, United States.
(6)Children's Hospital of Philadelphia, United States; University of Pennsylvania
(7)University of North Carolina, United States.
(8)Nationwide Children's Hospital, United States; Ohio State University College
of Medicine, United States.
(9)University of Cincinnati, United States.
(10)UCSF Benioff Children's Hospital, United States; University of California,
San Francisco, United States.
(11)Children's Hospital of Pittsburgh, United States; University of Pittsburgh
Medication nonadherence is a significant health care issue requiring regular

behavioral treatment. Lack of sufficient health care resources and patient/family
time commitment for weekly treatment are primary barriers to receiving
appropriate self-management support. We describe the methodology of the
Telehealth Enhancement of Adherence to Medication (TEAM) trial for medication
nonadherence in pediatric inflammatory bowel disease (IBD). For this trial,
participants 11-18 years of age will be recruited from seven pediatric hospitals
and will complete an initial 4-week run in to assess adherence to a daily
medication. Those who take less than 90% of their prescribed medication will be
randomized. A total of 194 patients with IBD will be randomized to either a
telehealth behavioral treatment (TBT) arm or education only (EO) arm. All
treatments will be delivered via telehealth video conferencing. The patients will
be assessed at baseline, post-treatment, 3, 6, and 12 months. We anticipate that
participants in the TBT arm will demonstrate a statistically significant
improvement at post-treatment and 3-, 6-, and 12-month follow-up compared to
participants in the EO arm for both medication adherence and secondary outcomes
(i.e., disease severity, patient quality of life, and health care utilization).
If efficacious, the TEAM intervention could be disseminated broadly and reduce
health care access barriers so that the patients could receive much needed
self-management intervention.
DOI: 10.1016/j.cct.2015.05.013
PMCID: PMC4522393
1187. Int J Behav Med. 2019 Apr;26(2):230-235. doi: 10.1007/s12529-018-09766-z.
Coding Client Language in Motivational Interviewing for HIV Medication Adherence

Using Self-Determination Theory.
Hogan A(1), Catley D(2)(3), Goggin K(4)(5), Evangeli M(6).
Author information:
(1)Department of Psychology, Royal Holloway, University of London, Egham, Surrey,
TW20 0EX, UK.
(2)Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy
Kansas City, Kansas City, USA.
(3)Department of Pediatrics, University of Missouri - Kansas City, Kansas City,
USA.
(4)Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas
City, USA.
(5)Schools of Medicine and Pharmacy, University of Missouri - Kansas City, Kansas
City, USA.
(6)Department of Psychology, Royal Holloway, University of London, Egham, Surrey,
TW20 0EX, UK. michael.evangeli@rhul.ac.uk.
BACKGROUND: Both motivational interviewing (MI) and self-determination theory

(SDT) emphasise the importance of an individual's autonomy. SDT proposes that
motivation is on a continuum with autonomous motivation (AM) at the
self-determined end of the spectrum. Whether client speech reflects AM is not
coded in MI process studies, however, as it is subsumed under the broader
category of change talk (CT). We aimed to code naturalistic speech within MI
sessions for HIV medication (antiretroviral) adherence according to whether
expressed motivation was autonomous or controlled. We then assessed relationships
between adherence and both autonomous/controlled motivational speech (AM/CM) and
CT.
METHODS: We developed a new coding tool (the SDT coding system: SDTCS) to measure
naturally occurring AM speech and CM speech expressed during an MI session
targeting antiretroviral (ART) adherence with 62 adults living with HIV (16
female; mean age 40 years). We coded the same sessions using the motivational
interviewing skills code (MISC) 2.5 and then examined relationships with on-time
ART adherence.
RESULTS: The SDTCS was developed using a combined inductive and deductive
approach. Adequate reliability estimates were achieved and the measure possessed
good content validity. Naturally occurring AM speech had a stronger relationship
to ART adherence in the week after the MI session than CM speech. There was also
some evidence that the relationship between AM speech and adherence was stronger
than between CT and adherence.
CONCLUSION: Future refinement and extension of the SDTCS could allow for a more
nuanced understanding of client motivational speech that is currently provided by
existing coding tools.
DOI: 10.1007/s12529-018-09766-z
PMCID: PMC6440936
1188. Epilepsy Behav. 2017 Apr;69:44-52. doi: 10.1016/j.yebeh.2017.01.032. Epub

2017
Feb 20.
Patient emotions and perceptions of antiepileptic drug changes and titration

during treatment for epilepsy.
Fishman J(1), Cohen G(2), Josephson C(3), Collier AM(4), Bharatham S(5), Zhang
Y(6), Wild I(7).
Author information:
(1)UCB Pharma, 1950 Lake Park Drive SE, Smyrna, GA 30080, USA. Electronic
address: jesse.fishman@ucb.com.
address: gregory.cohen@ucb.com.
(3)Department of Clinical Neurosciences, University of Calgary, Cummings School
of Medicine, Foothills Medical Center, 1403 29th St NW, Calgary, Alberta T2N 2T9,
Canada. Electronic address: cbjoseph@ucalgary.ca.
(4)St Mary's Hospital, 750 Wellington Ave, Grand Junction, CO 81501, USA.
Electronic address: marietxmd@gmail.com.
address: srikanth.bharatham@ucb.com.
address: ying.zhang5@ucb.com.
address: imane.wild@ucb.com.
OBJECTIVE: To investigate the impact of antiepileptic drug (AED) change and dose
titration on the emotional well-being of patients with epilepsy.
METHODS: Members of an online epilepsy community were invited to voluntarily
participate in an online survey. The cross-sectional anonymous survey consisted
of 31 multiple choice questions balanced in terms of variety and
positivity/negativity of emotions concerning participants' most recent AED
change. To substantiate survey results, spontaneous comments from
epilepsy-related online forums and social media websites that mentioned
participants' experiences with AED medication changes (termed passive listening
statements) were analyzed and categorized by theme.
RESULTS: All 345 survey participants (270 [78.3%] female; 172 [49.9%] were
26-45years old) self-reported an epilepsy/seizure diagnosis and were currently
taking seizure medication; 263 (76.2%) were taking ≥2 AEDs and 301 (87.2%) had ≥1
seizure in the previous 18months. All participants reported a medication change
within the previous 12months (dose increased [153 participants (44.3%)],
medication added [105 (30.4%)], dose decreased [49 (14.2%)], medication removed
[38 (11.0%)]). Improving seizure control (247 [71.6%]) and adverse events (109
[31.6%]) were the most common reasons for medication change. Primary emotions
most associated (≥10% of participants) with an AED regimen change were (before
medication change; during/after medication change) hopefulness (50 [14.5%]; 43
[12.5%]), uncertainty (50 [14.5%]; 69 [20.0%]), and anxiety (35 [10.1%]; 45
[13.0%]), and were largely due to concerns whether the change would work (212/345
[61.4%]; 180/345 [52.2%]). In the text analysis segment aimed at validating the
survey, 230 participants' passive listening statements about medication titration
were analyzed; additional seizure activity during dose titration (93 [40.4%]),
adverse events during titration (71 [30.9%]), higher medication dosages (33
[14.3%]), and drug costs (25 [10.9%]) were the most commonly noted concerns.
CONCLUSION: Although the emotional well-being of patients with epilepsy is
complex, our study results suggest that participants report their emotional
well-being as negatively affected by changes in AED regimen, with most patients
reporting uncertainty regarding the outcome of such a change. Future research is
warranted to explore approaches to alleviate patient concerns associated with AED
medication changes.
Copyright © 2017 Ellen Carey, UCB Brussels, Belgium. Published by Elsevier Inc.
DOI: 10.1016/j.yebeh.2017.01.032
1189. Arthritis Care Res (Hoboken). 2017 Nov;69(11):1724-1732. doi:

10.1002/acr.23202.
Epub 2017 Sep 26.
Gout Self-Management in African American Veterans: A Qualitative Exploration of

Challenges and Solutions From Patients' Perspectives.
Singh JA(1), Herbey I(2), Bharat A(2), Dinnella JE(3), Pullman-Mooar S(3), Eisen
S(4), Ivankova N(2).
Author information:
(1)VA Medical Center and University of Alabama at Birmingham, and Mayo Clinic
College of Medicine, Rochester, Minnesota.
(2)University of Alabama at Birmingham.
(3)Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia,
Pennsylvania.
(4)Washington University School of Medicine and St. Louis VA Medical Center, St.
Louis, Missouri.
OBJECTIVE: To explore gout self-management and associated challenges and

solutions in African Americans.
METHODS: We conducted semistructured interviews with 35 African American veterans
with gout, who received health care at Birmingham or Philadelphia Veterans
Affairs (VA) medical centers, had filled urate-lowering therapy (ULT; most
commonly allopurinol) for at least 6 months, and had a ULT medication possession
ratio ≥80%. The interview protocol was constructed to explore key concepts
related to gout self-management, including initial diagnosis of gout, beginning
medical care for gout, the course of the gout, ULT medication adherence, dietary
strategies, comorbidity and side effects, and social support.
RESULTS: Thirty-five African American male veterans with gout who had ≥80% ULT
adherence (most commonly, allopurinol) were interviewed at Birmingham (n = 18) or
Philadelphia (n = 17) VA medical centers. Mean age was 65 years, mean body mass
index was 31.9 kg/m2 , 97% had hypertension, 23% had coronary artery disease, and
31% had renal failure. The main themes motivating African American veterans to
better gout self-management were fear of pain, adherence to medications,
self-discipline, lifestyle changes, information gathering, and developing a
positive outlook. Birmingham participants more frequently revealed skipping gout
medications. More Philadelphia participants discussed lifestyle/diet changes to
prevent gout flares, indicated limiting social activities that involved drinking,
and sought more information about gout self-management from health care providers
and internet sources.
CONCLUSION: Identified themes, including cultural differences by site, led to the
development of a patient-centered intervention to improve gout self-management in
African American men with gout.
DOI: 10.1002/acr.23202
1190. J Family Med Prim Care. 2018 May-Jun;7(3):645-646. doi:

10.4103/jfmpc.jfmpc_345_17.
Appropriately reporting results using the medication subscale of the summary of

diabetes self-care activities measure: A comment on Dasappa et al. (2017).
Basu S(1).
Author information:
(1)Department of Community Medicine, Maulana Azad Medical College, New Delhi,
India.
PMCID: PMC6069655
PMID: 30112326
1191. Prev Chronic Dis. 2018 Oct 18;15:E127. doi: 10.5888/pcd15.180218.
Self-Efficacy and Adherence Behaviors in Rheumatoid Arthritis Patients.
Oshotse C(1)(2), Zullig LL(1)(3), Bosworth HB(1)(3)(4), Tu P(5), Lin C(5).
Author information:
(1)Department of Population Health Sciences, Duke University, Durham, North
Carolina.
(2)411 West Chapel Hill St, Ste 600, Durham, NC 27701. Email:
Christiana.oshotse@duke.edu.
(3)Center for Health Services Research in Primary Care, Durham Veterans Affairs
Health Care System, Durham, North Carolina.
(4)Departments of Psychiatry and School of Nursing, Duke University, Durham,
North Carolina.
(5)Duke University Policy and Organizational Management Program, Durham, North
Carolina.
INTRODUCTION: Rheumatoid arthritis (RA) is a common disease that requires patient

self-management with chronic medications. Adherence rates for RA medications are
suboptimal. This study explores medication adherence and self-efficacy behaviors
among RA patients.
METHODS: We conducted a qualitative study comprising focus groups and individual
interviews. Nineteen participants were recruited and screened to participate in
three 90-minute focus groups (n = 13) and six 60-minute individual interviews. We
created and maintained a codebook to analyze data. Interviews were analyzed by
using NViVo qualitative analysis software.
RESULTS: Key points in participant interviews were 1) self-efficacy as influenced
by the ability to establish routines, and having an understanding relationship
with their healthcare provider; 2) self-efficacy to adjust medications depended
on having permission from providers to adjust medications, perceptions of the
effectiveness of medications, and confidence in self-knowledge to make
appropriate adjustments; and 3) changes in self-efficacy over time were
influenced by initial denial and later acceptance of the diagnosis. Participant
interviews revealed that medication adherence is a spectrum that ranges from
adherent to nonadherent.
CONCLUSION: Participants' experience with RA medications revealed varied
underlying reasons for adherence behaviors. Recognizing adherence as a dynamic
behavior has important implications for how adherence interventions are designed.
For example, participants reported adjusting medications in response to the
unpredictable nature of RA. Interventions could collect information about RA
symptoms and be tailored to provide adherence support at times when patients need
it most. The importance of self-efficacy in influencing participants' adherence
behaviors is an area for continuing research among patients and providers.
DOI: 10.5888/pcd15.180218
PMCID: PMC6198676
1192. Medicine (Baltimore). 2019 Feb;98(6):e14291. doi:
10.1097/MD.0000000000014291.
Effect of an interactive voice response system on self-management in kidney

transplant recipients: Protocol for a randomized controlled trial.
Ganjali R(1), Taherzadeh Z(2)(3), Ghorban Sabbagh M(4)(5), Nazemiyan F(4)(5),

Mamdouhi F(4)(5), Tabesh H(1), Badiee Aval S(6), Golmakani R(7), Mostafavi SM(1),
Eslami S(1)(8)(9).
Author information:
(1)Department of Medical Informatics, Faculty of Medicine.
(2)Neurogenic Inflammation Research Center.
(3)Targeted Drug Delivery Research Center.
(4)Kidney Transplantation Complications Research Center.
(5)Department of Nephrology, Faculty of Medicine.
(6)Complementary Medicine Research Center, Faculty of Traditional Medicine.
(7)Department of Emergency Medicine, Doctor Shariati Hospital.
(8)Pharmaceutical Research Center, Mashhad University of Medical Sciences,
Mashhad, Iran.
(9)Department of Medical Informatics, University of Amsterdam, Amsterdam, The
Netherlands.
INTRODUCTION: Adherence to a complex and ongoing set of therapeutic

recommendations significantly determines short and long-term outcomes after
kidney transplantation (KT). Interactive voice response system (IVRS) is a novel
phone-based platform which is potentially useful to deliver health behavior
interventions.
OBJECTIVE: The aims of the study is to describe the development of a
theory-driven and educational IVRS investigate the effect of an IVRS on the
self-management outcomes in KT recipients as compared with the control group.
METHODS: This study has been designed as a randomized, 2 parallel groups
controlled trial. The KT recipients' older than18 years of age with access to a
cellphone will be included. A total of 120 patients will be randomly assigned to
the control and intervention groups. The participants in the intervention group
will receive completely automatic calls in 3 categories: educational, medication
adherence, and reminders by the IVRS, whereas those in the control group will
receive usual care. The follow up will be performed within 6 months. The primary
outcome will be the medication adherence while patients' transplant knowledge,
health-related quality of life, and rehospitalization rates will be considered as
secondary outcomes.
RESULTS: Thus far, recruitment of participants has not been completed and results
will be published in 2019.
DISCUSSION: The IVRS is potentially useful to help KT recipients improve the
self-management outcomes. The hypothesis is using an IVRS intervention makes a
significant difference between basel assessment of adherence to immunosuppressive
medications scale, 12-item short form survey, second version, kidney transplant
understanding tool baseline scores, and those obtained at the end of study.
TRIAL REGISTRATION NUMBER: This trial is registered with the Iran Trial Registrar
under registration number IRCT20180124038492N1 and registration date 30 January
2018. https://irct.ir/trial/29215.
DOI: 10.1097/MD.0000000000014291
PMCID: PMC6380874
1193. Front Hum Neurosci. 2014 Nov 26;8:943. doi: 10.3389/fnhum.2014.00943.

eCollection
2014.
Slow cortical potential neurofeedback and self-management training in outpatient

care for children with ADHD: study protocol and first preliminary results of a
randomized controlled trial.
Christiansen H(1), Reh V(2), Schmidt MH(2), Rief W(2).
Author information:
(1)Department of Psychology, Child and Adolescent Psychology, Philipps-University
Marburg Marburg, Germany.
(2)Department of Psychology, Clinical Psychology, Philipps-University Marburg
Marburg, Germany.
BACKGROUND: Treatment for children with attention deficit/hyperactivity disorder

(ADHD) today is predominantly pharmacological. While it is the most common
treatment, it might not always be the most appropriate one. Moreover, long term
effects remain unclear. Behavior therapy (BT) and non-pharmacological treatments
such as neurofeedback (NF) are promising alternatives, though there are no
routine outpatient care/effectiveness studies yet that have included children
with medication or changes in medication.
METHODS/DESIGN: This paper presents the protocol of a randomized controlled trial
to compare the effectiveness of a Slow Cortical Potential (SCP) NF protocol with
self-management (SM) in a high frequent outpatient care setting. Both groups
(NF/SM) receive a total of 30 high frequent therapy sessions. Additionally, 6
sessions are reserved for comorbid problems. The primary outcome measure is the
reduction of ADHD core symptoms according to parent and teacher ratings.
PRELIMINARY RESULTS: Untill now 58 children were included in the study (48
males), with a mean age of 8.42 (1.34) years, and a mean IQ of 110 (13.37).
Conners-3 parent and teacher ratings were used to estimate core symptom change.
Since the study is still ongoing, and children are in different study stages,
pre-post and follow-up results are not yet available for all children included.
Preliminary results suggest overall good pre-post effects, though. For parent and
teacher ratings an ANOVA with repeated measures yielded overall satisfying
pre-post effects (η (2) 0.175-0.513). Differences between groups (NF vs. SM)
could not yet be established (p = 0.81).
DISCUSSION: This is the first randomized controlled trial to test the
effectiveness of a NF protocol in a high frequent outpatient care setting that
does not exclude children on or with changes in medication. First preliminary
results show positive effects. The rationale for the trial, the design, and the
strengths and limitations of the study are discussed.
TRIAL REGISTRATION: This trial is registered in www.clinicaltrials.gov as
NCT01879644.
DOI: 10.3389/fnhum.2014.00943
PMCID: PMC4244863
PMID: 25505396
1194. Rural Remote Health. 2019 May;19(2):5270. doi: 10.22605/RRH5270. Epub 2019
May
22.
A nurse-led structured education program improves self-management skills and

reduces hospital readmissions in patients with chronic heart failure: a
randomized and controlled trial in China.
Cui X(1), Zhou X(2), Ma LL(3), Sun TW(4), Bishop L(5), Gardiner FW(6), Wang L(7).
Author information:
(1)Department of Cardiology, Liaocheng People's Hospital, Liaocheng, Shandong,
252000, China cuixiaoning06@163.com.
252000, China lwayne450@gmail.com.
252000, China maldongchang@126.com.
(4)Department of General ICU, the First Affiliated Hospital of Zhengzhou
University, Henan Key Laboratory of Critical Care Medicine, Zhengzhou 450052,
Henan, China suntongwen@163.com.
(5)Royal Flying Doctor Service; and The Australian National University, Canberra,
ACT 2600, Australia lara.bishop@rfds.org.au.
(6)Royal Flying Doctor Service; and The Australian National University, Canberra,
ACT 2600, Australia gus_gardiner@hotmail.com.
252000, China; and School of Biomedical Sciences, Charles Sturt University, Wagga
Wagga, NSW 2650, Australia lwang@csu.edu.au.
INTRODUCTION: Patient self-management skills are an important part of heart

failure (HF) management. However, there is a lack of knowledge about the
effectiveness of nurse-led education on patient self-management and the
associated clinical outcomes of rural Chinese patients with chronic heart failure
(CHF). As such, this study was designed to evaluate the impact of a nurse-led
education program on patient self-management and hospital readmissions in rural
Chinese patients with CHF.
METHODS: Ninety-six patients in the eastern Chinese province of Shandong with CHF
were randomly divided into intervention and control groups. A structured
education program was delivered to the intervention group during hospitalization
and after discharge. Control group patients were managed as per clinical
guidelines without structured education. Medication adherence, dietary
modifications, social support, and symptom control were assessed 12 months after
the educational intervention.
RESULTS: The mean score of medication adherence, dietary modifications, social
support and symptom control in the intervention group was higher than in the
control group at the end of the study (p<0.01). The readmission rates for HF in
the intervention and control group were 10.4% and 27.1%, respectively (p=0.036).
CONCLUSIONS: This study has demonstrated that a structured education program was
associated with a significant improvement in medication adherence, dietary
modifications, social support, and symptom control in rural CHF patients.
Furthermore, this program was associated with a significant reduction in hospital
readmission. This study indicates that implementation of a nurse-led education
program improves self-management and clinical outcomes of rural CHF patients, who
may not have regular access to cardiac management services as per metropolitan
populations.
DOI: 10.22605/RRH5270
PMID: 31113205
1195. Osteoporos Sarcopenia. 2017 Dec;3(4):174-184. doi:

10.1016/j.afos.2017.10.002.
Epub 2017 Nov 3.
Understanding the factors associated with initiation and adherence of

osteoporosis medication in Japan: An analysis of patient perceptions.
Orimo H(1), Sato M(2), Kimura S(2), Wada K(3), Chen X(3), Yoshida S(3), Crawford
B(3).
Author information:
(1)Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo,
Japan.
(2)Eli Lilly Japan K.K., Kobe, Japan.
(3)QuintilesIMS, Tokyo, Japan.
Objectives: This study aimed to identify factors associated with initiation and
adherence of osteoporosis medication from a patient perspective.
Methods: A web-based survey was developed based on health behavior theories.
Descriptive analyses were conducted for all survey items. Analyses in a
structural equation modeling framework were conducted to identify factors
associated with treatment initiation and adherence.
Results: Five hundred forty-five women completed the questionnaire. A majority
were currently receiving medications for osteoporosis (n = 376, 69.0%) and 25.0%
of these patients (n = 94) were considered adherent to their treatment. Knowledge
was strongly associated with osteoporosis treatment initiation (standard error
[SE], 0.58). Greater knowledge of disease was associated with increased
likelihood of initiating medication. Medication complexity (SE, 0.49) and
perceived susceptibility to fracture and loss of independence (SE, -0.37) were
also associated with initiation. Perceived barriers (SE, -0.85) such as
inconvenience, lack of efficacy and financial burden were observed to be the
greatest obstacle to adherence. The greater the perceived barriers, the less
likely patients were to adhere to medication. Patients' perception of
self-efficacy (SE, 0.37) also affected adherence. The greater the patient
perception of ability to independently manage their medication, the more likely
they were to adhere to the medication.
Conclusions: Different factors were found to be associated with initiation and
adherence of osteoporosis medication. Patient knowledge of their disease and the
perception of barriers were found to be the most influential. Empowering patients
with the knowledge to better understand their disease and decreasing the
perception of barriers through education initiatives may be effective in
improving patient outcomes.
DOI: 10.1016/j.afos.2017.10.002
PMCID: PMC6372844
PMID: 30775527
1196. Clin Appl Thromb Hemost. 2018 Apr;24(3):525-531. doi:

10.1177/1076029617693940.
Epub 2017 Feb 19.
Drug Adherence in Patients With Nonvalvular Atrial Fibrillation Taking

Non-Vitamin K Antagonist Oral Anticoagulants in Turkey: NOAC-TR.
Emren SV(1), Şenöz O(2), Bilgin M(3), Beton O(4), Aslan A(5), Taşkin U(6),
Açiksari G(7), Asarcikli LD(3), Çakir H(8), Bekar L(9), Bolat İ(10), Yayla Ç(11),
Çelebi B(12), Dalgiç O(13), Çelik O(14), Şafak Ö(15), Akyel S(16), Güngör H(17),
Düzel B(18), Zoghi M(19).
Author information:
(1)1 Department of Cardiology, Afyonkarahisar State Hospital, Afyonkarahisar,
Turkey.
(2)2 Department of Cardiology, Artvin State Hospital, Artvin, Turkey.
(3)3 Department of Cardiology, Ankara Dışkapı Research and Education Hospital,
Ankara, Turkey.
(4)4 Department of Cardiology, Sivas Cumhuriyet University, Sivas, Turkey.
(5)5 Department of Cardiology, Dokuz Eylül University, Izmir, Turkey.
(6)6 Department of Cardiology, Akşehir State Hospital, Konya, Turkey.
(7)7 Department of Cardiology, Istanbul İstinye State Hospital, Istanbul, Turkey.
(8)8 Department of Cardiology, Darıca Farabi State Hospital, Kocaeli, Turkey.
(9)9 Department of Cardiology, Hitit University, Çorum, Turkey.
(10)10 Department of Cardiology, Fethiye State Hospital, Muğla, Turkey.
(11)11 Department of Cardiology, Ankara Yüksek İhtisas Research and Education
Hospital, Ankara, Turkey.
(12)12 Department of Cardiology, Silifke State Hospital, Mersin, Turkey.
(13)13 Department of Cardiology, Karşıyaka State Hospital, İzmir, Turkey.
(14)14 Department of Cardiology, School of Medicine, Hitit University, Çorum,
Turkey.
(15)15 Department of Cardiology, Burdur State Hospital, Burdur, Turkey.
(16)16 Department of Cardiology, Münif İslamoğlu State Hospital, Kastamonu,
Turkey.
(17)17 Department of Cardiology, Aydın University School of Medicine, Aydın,
Turkey.
(18)18 Department of Cardiology, Mersin State Hospital, Mersin, Turkey.
(19)19 Department of Cardiology, Ege University, Izmir, Turkey.
Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important

factor for ensuring efficacy and safety in nonvalvular atrial fibrillation
(NVAF). There are controversial results regarding NOAC adherence in real-world
data and there are no data about NOAC adherence in Turkish population. This study
investigated the NOAC adherence based on self-report, factors affecting
nonadherence, and the relation of the adherence level with efficacy and safety
outcomes. This multicenter cross-sectional study included 2738 patients (59%
female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more
than 3 months with >30 days of supply between September 1, 2015, and February 28,
2016. To measure the adherence level, an 8-item Morisky Medication Adherence
Scale was used. The mean age of the patients was 70 ± 10 years. Of the 2738
patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A
total of 630 (23%) patients had high medication adherence, 712 (26%) moderate
adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6%
vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%,
P = .004) bleeding rates. The adherence to NOAC was found to be quite low in
Turkey. Nonadherence is associated with bleeding and thromboembolic
cardiovascular events. Age, taking NOAC twice a day, and the additional
noncardiac diseases, depression, and dementia were the independent factors
affecting poor medication adherence.
DOI: 10.1177/1076029617693940
PMCID: PMC6714660
1197. Nicotine Tob Res. 2015 Jun;17(6):710-8. doi: 10.1093/ntr/ntu216. Epub 2014
Oct
21.
Efficacy of a tobacco quitline among adult survivors of childhood cancer.
Klesges RC(1), Krukowski RA(2), Klosky JL(3), Liu W(4), Srivastava DK(4), Boyett
JM(4), Lanctot JQ(5), Hudson MM(6), Folsom C(5), Robison LL(5).
Author information:
(1)Department of Epidemiology and Cancer Control, St. Jude Children's Research
Hospital, Memphis, TN; Department of Preventive Medicine, University of Tennessee
Health Science Center, Memphis, TN; rklesges@uthsc.edu.
(2)Department of Preventive Medicine, University of Tennessee Health Science
Center, Memphis, TN;
(3)Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN;
(4)Department of Biostatistics, St. Jude Children's Research Hospital, Memphis,
TN;
(5)Department of Epidemiology and Cancer Control, St. Jude Children's Research
Hospital, Memphis, TN;
(6)Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN.
INTRODUCTION: The purpose of this investigation was to determine the efficacy of

two evidence-based tobacco quitlines in adult survivors of childhood cancer who
regularly smoke cigarettes.
METHODS: A total of 519 adult survivors of childhood cancer were randomized to
either Proactive + 4 weeks of medication (Counselor-initiated intervention, n =
260) or a Reactive + 2 weeks of medication (Participant-initiated intervention, n
= 259) condition. Both conditions received telephone counseling to quit smoking
as well as nicotine replacement therapy. The primary outcome was biochemically
verified (i.e. cotinine) point prevalence smoking cessation at 12 months
follow-up.
RESULTS: Participants randomized to the Proactive + 4 weeks of medication
condition self-reported a higher rate of cessation than those survivors in the
Reactive + 2 weeks of medication condition at 8 weeks (33.2% vs. 17.0%, p <
.001), but cessation rates were not significantly different at 12 months (23.0%
vs. 18.7%, p = .29). However, 80% of participants claiming abstinence failed
biochemical verification, indicating marked falsification of self-reported
smoking status. Adjusted cessation rates were less than 2% in both intervention
conditions.
CONCLUSIONS: Our results indicate that neither a Proactive + 4 weeks of
medication or Reactive + 2 weeks of medication quitline significantly impacted
long-term smoking cessation rates. Our results further indicate that self-reports
of smoking status are unreliable in survivors of childhood cancer, a population
in considerable need of tobacco abstinence. Rates of smoking cessation may be
markedly overestimated in studies of childhood cancer survivors that rely on
self-reports of tobacco abstinence, and future studies need to include
biochemical verification of tobacco status in this population.
DOI: 10.1093/ntr/ntu216
PMCID: PMC4838048
1198. Pediatr Pulmonol. 2018 Apr;53(4):431-436. doi: 10.1002/ppul.23950. Epub 2018

Feb
19.
Impact of home spirometry on medication adherence among adolescents with cystic

fibrosis.
Shakkottai A(1), Kaciroti N(2), Kasmikha L(1), Nasr SZ(1).
Author information:
(1)Pediatric Pulmonology, Michigan Medicine, Ann Arbor, Michigan.
(2)Department of Biostatistics, University of Michigan School of Public Health,
Ann Arbor, Michigan.
OBJECTIVE: Medication adherence among adolescents with cystic fibrosis (CF) is

often suboptimal and this has significant impact on their health and quality of
life. The purpose of the study was to evaluate the impact of frequent home
pulmonary function (PFT) monitoring on medication adherence among adolescents
with CF.
HYPOTHESIS: We hypothesized that weekly home PFT monitoring will improve
adherence while not significantly adding to the treatment burden.
METHODS: Individuals aged 12-21 years with CF were provided a spirometer to
measure PFTs weekly for 1 year. Results were reviewed weekly via telephone. PFT
data were downloaded from the device during quarterly clinic visits. Adherence
was calculated from prescription refill data and compared to the previous year.
Perceptions of treatment burden were assessed using the CF questionnaire-revised
(CFQ-R) quality of life measure. Health outcome measures including nutritional
status and PFTs from clinic were collected for the study period and the year
prior.
RESULTS: Thirty-nine subjects participated in the study. Mean age was
15.89 ± 2.18 years and 54% were female. Mean adherence to weekly spirometry
monitoring was 59.47 ± 24.60%. Values generated on the device showed good
correlation with those obtained in clinic. Mean medication possession ratio (MPR)
was 60% in the previous year and 65% during the study (P = 0.04). Mean treatment
burden scaled score on the CFQ-R was 68 at enrollment and 66 at study completion
(P = 0.14).
CONCLUSIONS: Frequent home PFT monitoring is feasible in CF adolescents and could
successfully improve medication adherence without significantly impacting
treatment burden.
DOI: 10.1002/ppul.23950

eCollection 2018.
Access and adherence to medications for the primary and secondary prevention of
atherosclerotic cardiovascular disease in Singapore: a qualitative study.
Koh JJK(1), Cheng RX(2), Yap Y(2), Haldane V(1), Tan YG(2), Teo KWQ(2),
Srivastava A(1), Ong PS(2), Perel P(3), Legido-Quigley H(1)(3).
Author information:
(1)Saw Swee Hock School of Public Health, National University of Singapore,
Singapore, helena.legido-quigley@lshtm.ac.uk.
(2)Department of Pharmacy, National University of Singapore, Singapore.
(3)London School of Hygiene and Tropical Medicine, London, UK,
helena.legido-quigley@lshtm.ac.uk.
Background: Atherosclerotic cardiovascular disease (ASCVD) is a growing public

health threat globally, and many individuals remain undiagnosed, untreated, and
their condition remains uncontrolled. The key to effective ASCVD management is
adherence to pharmacotherapy, and non-adherence has been associated with an
increased risk of cardiovascular events and complications such as stroke, further
impacting a patient's ability to be adherent. Our qualitative study aimed to
explore factors influencing medication adherence in the primary and secondary
prevention of ASCVD in Singapore. We propose a synthesized framework, which
expands on current understandings of the factors of medication adherence, as a
frame of analysis in this study.
Methods: We conducted in-depth, semi-structured interviews with 20 patients over
the age of 40 with ASCVD and/or its risk factors in Singapore. QSR Nvivo 11 was
used to conduct thematic analysis using an inductive approach.
Results: Using a synthesized framework, we reported that complex medication
regimens, the lack of support received during regimen changes, and the perceived
seriousness of a condition could impact a patient's medication adherence. Key
findings suggest that the relationship between health care professionals and
patients impacted patient acceptability of the medication regimen and
consequently medication adherence. Different patient beliefs regarding diagnosis,
medication, and adherence had some bearing on the ability to perceive the need to
adhere to their medication. Patients also reported that they could afford
medication, sometimes with the help of family members. Patients also largely
reported not needing help managing their medication, considering it an individual
responsibility.
Conclusion: We identified key factors which future interventions looking to
improve medication adherence ought to consider. These include changing patient
perceptions of health systems, diagnosis, medication, and adherence;
patient-centeredness in developing interventions that facilitate adherence
through building self-efficacy and stronger support networks via patient
empowerment and engagement; decreasing patient co-payments on medication; and
cultivating a trusting patient-provider relationship.
DOI: 10.2147/PPA.S176256
PMCID: PMC6255116
PMID: 30538432

1200. Ther Adv Endocrinol Metab. 2018 Jun 12;9(8):231-240. doi:

10.1177/2042018818781669. eCollection 2018.
Diabetes education and medication adjustment in Ramadan (DEAR) program prepares

for self-management during fasting with tele-health support from pre-Ramadan to
post-Ramadan.
Zainudin SB(1), Abu Bakar KNB(2), Abdullah SB(3), Hussain AB(3).
Author information:
(1)Department of General Medicine Sengkang General Hospital 110 Sengkang East Way
Singapore 544886, Singapore.
(2)National University of Singapore, Singapore.
(3)Singapore General Hospital, Singapore.
Background: We evaluated the outcome for fasting Muslims with diabetes prepared
with pre-Ramadan optimization through education and medication adjustment,
tele-support and intervention up to post-Ramadan.
Methods: Muslims with diabetes planning to fast were recruited into a focused
diabetes program for Ramadan fasting.It consisted of (a) a pre-Ramadan assessment
and test fasting to optimize glycemic control, (b) education on diabetes
management during fasting, (c) tele-monitoring from pre-Ramadan and (d) a
post-Ramadan review. Their metabolic profiles and diaries for meals, activities
and glucose monitoring were evaluated.
Results: Twenty-nine participants were enrolled, with mean age 58.4 ± 9.2 years,
75.9% female, 79.3% Malays and 93.1% type 2 diabetes. A total of 92% needed
medication adjustment and 93% fasted for at least 14 days. Glycated hemoglobin
(HbA1c) and weight decreased from 8.8 ± 1.8% (72.7 mmol/mol) pre-Ramadan to 8.5 ±
1.7% (69.4 mmol/mol) post-Ramadan and 76.6 ± 20.3 kg pre-Ramadan to 75.9 ± 21.3
kg post-Ramadan, respectively. There were decreased complications of hypoglycemia
from 13.8% to 10.3% and several-fold improvement in hyperglycemia from 31.0% to
3.5% during Ramadan fasting when compared with pre-Ramadan.
Conclusions: Muslims with diabetes were able to self-manage when fasting using
tele-monitoring support and intervention, with decreased complications during
Ramadan compared with pre-Ramadan.
DOI: 10.1177/2042018818781669
PMCID: PMC6116763
PMID: 30181849

1201. Can J Kidney Health Dis. 2019 Aug 17;6:2054358119867993. doi:

10.1177/2054358119867993. eCollection 2019.
Impact of Once- Versus Twice-Daily Tacrolimus Dosing on Medication Adherence in

Stable Renal Transplant Recipients: A Canadian Single-Center Randomized
Controlled Trial.
Paterson TSE(1), Demian M(1), Shapiro RJ(2), Loken Thornton W(1).
Author information:
(1)Department of Psychology, Simon Fraser University, Burnaby, BC, Canada.
(2)Faculty of Medicine, The University of British Columbia, Vancouver, Canada.
Background: Prevalence of immunosuppressant nonadherence in renal transplant

recipients is high despite negative clinical outcomes associated with
nonadherence. Simplification of dosing has been demonstrated to improve adherence
in renal transplant recipients as measured through electronic monitoring and
self-report.
Objective: The purpose of this study was to replicate and extend previous
findings by measuring adherence with multiple methods in a Canadian sample.
Design: The study design was a randomized controlled medication dosing trial in
adult renal transplant patients. The trial length was 4 months.
Setting: This study was conducted within the Solid Organ Transplant (SOT) Clinic
at Vancouver General Hospital (VGH; Vancouver, Canada).
Patients: A total of 46 adult renal recipients (at least 1 year post-transplant)
were recruited through the SOT clinic. With 8 withdrawals, 38 individuals
completed all phases of the study.
Measurements: Medication adherence was measured for a period of 4 months using
multiple methods, including electronic monitoring (MEMS [Medication Event
Monitoring System]), pharmacy refill data (medication possession ratio [MPR]),
and by self-report using the Adherence subscale of the Transplant Effects
Questionnaire (TEQ).
Methods: Participants were randomized to twice-daily (n = 19) or once-daily
tacrolimus dosing (n = 19) and followed over a 4-month period via monthly clinic
study visits. Comparisons between the treatment groups were performed using the
Mann-Whitney U and chi-square tests, for continuous and categorical variables,
respectively.
Results: As outlined in Table 3, the once-daily dosing group showed significantly
better MEMS Dose Adherence (P = .001), whereas MEMS Timing Adherence showed a
tendency toward better adherence for this group, but was not significant (P =
.052). MEMS Days Adherent (P = .418), MPR% (P = .123), and self-reported
adherence (P = .284) did not differ between the once- and twice-daily dosing
groups when measured as continuous variables. The MPR% was significantly better
for the once-daily dosing group when measured dichotomously but not continuously
(P = .044). Notably, most of those exposed to once-daily dosing (63.2%) preferred
this to the twice-daily regimen.
Limitations: Limitations included small sample size and short follow-up period,
precluding the examination of clinical outcome differences.
Conclusions: Results for dose adherence replicate the finding that dose
simplification increases adherence to immunosuppressants as measured through
electronic monitoring. Such an advantage for the once-daily dosing group was not
seen across the 2 other electronic monitoring measurement variables (days and
timing adherence). This study extends previous research by examining adherence in
once versus twice-daily dosing via prescription refill data in a Canadian sample.
Given the gravity of potential health outcomes associated with nonadherence,
although results indicate inconsistencies in significance testing across
measurement methods, the medium to large effect sizes seen in the data favoring
better adherence with once-daily dosing provide an indication of the potential
clinical significance of these findings.
Trial registration: This study was registered with ClinicalTrials.gov
(NCT01334333) on April 11, 2011.
Publisher: Bien que la non-observance du traitement immunosuppresseur soit

associée à de mauvais résultats cliniques, sa prévalence demeure élevée chez les
receveurs d’une greffe rénale. Il a été démontré qu’une posologie simplifiée
améliorait l’observance thérapeutique mesurée par suivi électronique et
auto-évaluation dans cette population.Cette étude visait à reproduire et à
élargir les résultats d’études précédentes en mesurant par différentes méthodes
l’observance thérapeutique dans un échantillon de patients canadiens.Un essai
contrôlé à répartition aléatoire d’une durée de quatre mois examinant la
posologie médicamenteuse d’adultes greffés rénaux.L’étude s’est tenue au sein de
la Solid Organ Transplant Clinic (clinique SOT) du Vancouver General Hospital
(VGH; Vancouver, Canada).Quarante-six greffés rénaux adultes ont été recrutés (au
moins un an post-transplantation) par l’entremise de la clinique SOT. En raison
de huit retraits, l’étude porte sur trente-huit individus ayant complété toutes
les phases de l’étude.L’observance thérapeutique a été mesurée sur une période de
quatre mois, selon différentes méthodes, notamment le suivi électronique (MEMS),
le renouvellement des ordonnances (rapport de possession de médicaments—RPM) et
l’auto-évaluation avec la sous-échelle d’observance du Transplant Effects
Questionnaire (TEQ).Les participants ont été répartis aléatoirement pour recevoir
du tacrolimus deux fois par jour (n = 19) ou une fois par jour (n = 19) et ont
été suivis pendant quatre mois au moyen de visites mensuelles à la clinique. Les
comparaisons entre les groupes de traitement ont été effectuées par tests U de
Mann-Whitney (variables continues) et tests de chi-deux (variables
nominales).Comme indiqué dans le tableau 3, lorsque l’observance est mesurée par
MEMS, le groupe ayant reçu une dose quotidienne unique a montré une observance
nettement supérieure au niveau de la dose (P = 0.001), de même qu’une tendance
vers une meilleure observance du traitement au niveau du moment, quoique cette
dernière ne soit pas significative (P = 0.052). Le nombre de jours d’observance
mesuré par MEMS (P = 0.418), le pourcentage RPM (P = 0.123) et l’observance
auto-déclarée (P = 0.284) n’ont pas différé entre les groupes lorsque mesurés
comme variables continues. Le pourcentage RPM était significativement plus élevé
pour le groupe traité une fois par jour, lorsque mesuré de façon dichotomique,
mais non continue (P = 0.044). La majorité des patients traités par une dose
unique quotidienne (63.2%) ont préféré ce schéma posologique à une prise deux
fois par jour.La petite taille de l’échantillon et la courte période de suivi
empêchent l’examen des différences observées dans les résultats cliniques.Les
résultats sur l’observance de la dose reproduisent la conclusion selon laquelle
un dosage simplifié augmenterait l’observance du traitement immunosuppresseur,
lorsque mesurée par MEMS. Un tel avantage pour le groupe recevant une dose
quotidienne unique n’a pas été observé pour les deux autres variables de mesure
par MEMS (observance en jours et du moment de la prise du médicament). La
présente étude élargit les recherches antérieures en examinant l’observance de la
posologie (une ou deux fois par jour) avec les données de renouvellement des
ordonnances dans un échantillon canadien. Compte tenu de la gravité des effets
potentiels de la non-observance thérapeutique sur la santé, et bien que les
résultats indiquent des incohérences entre les méthodes de mesure dans la
vérification des hypothèses, l’ampleur moyenne à grande de l’effet observé dans
les données favorisant une meilleure observance à une dose unique quotidienne
souligne l’importance clinique potentielle de ces résultats.
DOI: 10.1177/2054358119867993
PMCID: PMC6699008
PMID: 31452902

1202. AIDS Behav. 2018 Mar;22(3):909-917. doi: 10.1007/s10461-017-2004-2.
Association of Adolescent- and Caregiver-Reported Antiretroviral Therapy

Adherence with HIV Viral Load Among Perinatally-infected South African
Adolescents.
Brittain K(1)(2), Asafu-Agyei NA(3)(4), Hoare J(5), Bekker LG(6), Rabie H(7),
Nuttall J(3), Roux P(3), Stein DJ(5), Zar HJ(3)(4), Myer L(8)(9).
Author information:
(1)Division of Epidemiology & Biostatistics, School of Public Health & Family
Medicine, University of Cape Town, Cape Town, South Africa.
kirsty.brittain@uct.ac.za.
(2)Centre for Infectious Disease Epidemiology & Research, School of Public Health
& Family Medicine, University of Cape Town, Cape Town, South Africa.
kirsty.brittain@uct.ac.za.
(3)Department of Paediatrics & Child Health, University of Cape Town, Cape Town,
South Africa.
(4)Medical Research Council Unit on Child & Adolescent Health, Cape Town, South
Africa.
(5)Department of Psychiatry & Mental Health, University of Cape Town, Cape Town,
South Africa.
(6)Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular
(7)Department of Paediatrics & Child Health, Tygerberg Academic Hospital &
Stellenbosch University, Cape Town, South Africa.
(8)Division of Epidemiology & Biostatistics, School of Public Health & Family
(9)Centre for Infectious Disease Epidemiology & Research, School of Public Health
& Family Medicine, University of Cape Town, Cape Town, South Africa.
Accurate measurement of antiretroviral therapy (ART) adherence remains

challenging and there are few data assessing the validity of self-reported
adherence among perinatally HIV-infected adolescents. We examined adolescent and
caregiver reports of adolescent adherence among perinatally-infected adolescents
aged 9-14 years in Cape Town, South Africa, and explored factors that may modify
associations between reported adherence and elevated viral load (VL). Among 474
adolescents (median age 12.0 years; median duration of ART use 7.5 years),
elevated VL and caregiver- and adolescent-report of missed ART doses were common.
Elevated VL was particularly prevalent among older, male adolescents.
Low-moderate concordance was observed between caregiver and adolescent report.
Among adolescents aged ≥ 12 years, caregiver- and adolescent-reported adherence
was associated with elevated VL across most items assessed, but few significant
associations were observed among adolescents < 12 years of age. Refined adherence
measures and tools to identify adolescents who require adherence interventions
are needed in this context.
DOI: 10.1007/s10461-017-2004-2
PMCID: PMC6620475
1203. Scand J Prim Health Care. 2014 Dec;32(4):180-6. doi:

10.3109/02813432.2014.972062. Epub 2014 Oct 27.
Effects of a pharmacist-led structured medication review in primary care on

drug-related problems and hospital admission rates: a randomized controlled
trial.
Lenander C(1), Elfsson B, Danielsson B, Midlöv P, Hasselström J.
Author information:
(1)Department of Clinical Sciences in Malmö, Lund University , Malmö , Sweden.
OBJECTIVE: To determine whether a pharmacist-led medications review in primary

care reduces the number of drugs and the number of drug-related problems.
DESIGN: Prospective randomized controlled trial.
SETTING: Liljeholmen Primary Care Centre, Stockholm, Sweden.
SUBJECTS: 209 patients aged ≥ 65 years with five or more different medications.
Intervention. Patients answered a questionnaire regarding medications. The
pharmacist reviewed all medications (prescription, non-prescription, and herbal)
regarding recommendations and renal impairment, giving advice to patients and
GPs. Each patient met the pharmacist before seeing their GP. Control patients
received their usual care.
MAIN OUTCOME MEASURES: Drug-related problems and number of drugs. Secondary
outcomes included health care utilization and self-rated health during 12 months
of follow-up.
RESULTS: No significant difference was seen when comparing change in drug-related
problems between the groups. However, a significant decrease in drug-related
problems was observed in the intervention group (from 1.73 per patient at
baseline to 1.31 at follow-up, p < 0.05). The change in number of drugs was more
pronounced in the intervention group (p < 0.046). Intervention group patients
were not admitted to hospital on fewer occasions or for fewer days, and there was
no significant difference between the two groups regarding utilization of primary
care during follow-up. Self-rated health remained unchanged in the intervention
group, whereas a drop (p < 0.02) was reported in the control group. This resulted
in a significant difference in change in self-rated health between the groups (p
< 0.047).
CONCLUSIONS: The addition of a skilled pharmacist to the primary care team may
contribute to reductions in numbers of drugs and maintenance of self-rated health
in elderly patients with polypharmacy.
DOI: 10.3109/02813432.2014.972062
PMCID: PMC4278387
Barriers and facilitators to medication adherence: a qualitative study with

general practitioners.
Kvarnström K(1), Airaksinen M(1), Liira H(2)(3).
Author information:
(1)Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty
of Pharmacy, University of Helsinki, Finland.
(2)General Practice, School of Medicine, University of Western Australia,
Crawley, Western Australia, Australia.
(3)Department of General Practice and Primary Health Care, Helsinki University
Central Hospital, University of Helsinki, Finland.
BACKGROUND: General practitioners (GPs) manage the drug therapies of people with
chronic diseases, and poor adherence to medication remains a major challenge.
OBJECTIVE: This qualitative study examined GPs' insights into non-adherence and
ways of overcoming this problem.
METHODS: We ran four focus groups comprising 16 GPs at the Kirkkonummi Health
Centre (Southern Finland). Interviews were audiotaped, transcribed verbatim and
analysed by inductive content analysis.
MAIN RESULTS: The two main themes in the discussions with the GPs were
non-adherence in the care of chronic disease and increased need for medicine
information. The medication management challenges identified were related to:
patient-specific factors, the healthcare system, characteristics of drug
therapies and the function and role of healthcare professionals as a team. To
improve the situation, the GPs offered a number of solutions: improved
coordination of care, better patient education and IT systems as well as enhanced
interprofessional involvement in the follow-up of patients.
DISCUSSION AND CONCLUSIONS: With an ageing population, the GPs were increasingly
confronted with non-adherence in the care of chronic diseases. They had mostly a
positive attitude towards organising care in a more interprofessional manner. To
support medication adherence and self-management, the GPs appreciated
pharmacists' assistance especially with patients with polypharmacy and chronic
diseases.
DOI: 10.1136/bmjopen-2016-015332
PMCID: PMC5786122
1205. Ann Ig. 2016 Mar-Apr;28(2):113-21. doi: 10.7416/ai.2016.2090.
Validation of a questionnaire for ICU nurses to assess knowledge, attitudes and

behaviours towards medication errors.
Di Muzio M(1), Tartaglini D(2), De Vito C(3), La Torre G(3).
Author information:
(1)PhD Student, Department of Biomedicine and Prevention, University of Rome Tor
Vergata, Italy - Department of Public Health and Infectious Diseases, Sapienza
University of Rome, Italy.
(2)University Campus Bio-Medico, Rome, Italy.
(3)Department of Public Health and Infectious Diseases, Sapienza University of
Rome, Italy.
AIM: Medication errors are dangerous for the patients in an intensive care unit
(ICU). Little is known about knowledge, attitudes and professional behaviour of
nurses towards prevention of errors and clinical risk management can reduce
errors during the preparation and administration phases of intravenous drugs. In
this study we have evaluated the reliability and validity of the questionnaire to
examine knowledge, attitudes and professional behaviour of ICU nurses.
METHODS: Reliability analysis was tested and content validity evaluated using
Cronbach's alpha to check internal consistency with the intention to obtain no
misunderstanding with the results. The questionnaire composed of seven sections
for a total of 36 items, was administrated among ICU nurses working in a
university hospital in Rome, Italy. Data were collected in October 2015.
Statistical analysis was performed with the statistical software for Windows
SPSS, version 22.0.
RESULTS: The questionnaire was administered to 30 ICU nurses' in anonymous,
voluntary and self-administered form with close-ended type of questions, except
for the socio-demographic characteristics. The highest value of Cronbach's alpha
resulted on 19 items (alpha= 0,776) meaning that the questionnaire has a
satisfactory internal validity. The study highlights that nurses (80%) are aware
that appropriate knowledge on the calculation of medication's dose is essential
to reduce medication errors during the phase of drugs'preparation.
CONCLUSION: This study demonstrated that a short version of the questionnaire has
very good reliability properties in the study and this needs to be taken into
account for future studies.
DOI: 10.7416/ai.2016.2090
1206. J Diabetes Investig. 2017 Mar;8(2):195-200. doi: 10.1111/jdi.12571. Epub 2016

Sep
19.
Effect of a newly-devised nutritional guide based on self-efficacy for patients

with type 2 diabetes in Japan over 2 years: 1-year intervention and 1-year
follow-up studies.
Yamamoto T(1), Moyama S(1), Yano H(2).
Author information:
(1)Department of Clinical Nutrition, Hikone Municipal Hospital, Hikone, Shiga,
Japan.
(2)Department of Diabetes and Metabolism, Hikone Municipal Hospital, Hikone,
Shiga, Japan.
AIMS/INTRODUCTION: We devised a new system called "Educational Guidance"

(E-Guide) for nutritional education based on self-efficacy. The present study
aimed to examine the effects of E-Guide use on glycemic control among patients
MATERIALS AND METHODS: We carried out an interventional and observational study
that included 74 patients with type 2 diabetes. The extent of glycemic control in
the 39 patients who received guidance through the E-Guide (E-Guide group) was
compared with that of 35 patients who received conventional nutritional guidance
(control group). We carried out a 1-year follow-up survey (subanalysis) based on
the electronic health records of 18 patients from the E-guide group and 19
patients from the control group. These patients continued treatment at Hikone
Municipal Hospital, Hikone, Shiga, Japan. Changes in glycated hemoglobin levels,
body mass index and medication dose were examined from time of enrollment to the
end of the 1-year intervention, and during the 1-year follow-up.
RESULTS: Decreases in glycated hemoglobin levels were more pronounced in the
E-Guide group than in the control group during the intervention period
(P < 0.05). The levels further decreased during the follow-up period (P < 0.01).
In the E-Guide group, body mass index decreased significantly throughout the
follow-up period (P < 0.001). Additionally, increased medication doses were
significantly less common in the E-Guide group than in the control group
(P < 0.01).
CONCLUSIONS: Intervention based on our "E-Guide" is more useful and powerful than
the conventional methods for glycemic control and self-care behavior among
patients with type 2 diabetes in Japan.
© 2016 The Authors. Journal of Diabetes Investigation published by Asian

Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia,
Ltd.
DOI: 10.1111/jdi.12571
PMCID: PMC5334309
1207. Asia Pac J Oncol Nurs. 2017 Oct-Dec;4(4):275-282. doi:

10.4103/apjon.apjon_7_17.
Medication Burden of Treatment Using Oral Cancer Medications.
Given BA(1), Given CW(2), Sikorskii A(3), Vachon E(1), Banik A(4).
Author information:
(1)College of Nursing, Michigan State University, East Lansing, MI, USA.
(2)Department of Family Medicine, College of Human Medicine, Michigan State
University, East Lansing, MI, USA.
(3)College of Nursing, University of Arizona, Tucson, AZ, USA.
(4)Department of Statistics and Probability, College of Natural Science, Michigan
State University, East Lansing, MI, USA.
OBJECTIVE: With the changes in healthcare, patients with cancer now have to
assume greater responsibility for their own care. Oral cancer medications with
complex regimens are now a part of cancer treatment. Patients have to manage
these along with the management of medications for their other chronic illnesses.
This results in medication burden as patients assume the self-management.
METHODS: This paper describes the treatment burdens that patients endured in a
randomized, clinical trial examining adherence for patients on oral cancer
medications. There were four categories of oral agents reported. Most of the
diagnoses of the patients were solid tumors with breast, colorectal, renal, and
gastrointestinal.
RESULTS: Patients had 1-4 pills/day for oral cancer medications as well as a
number for comorbidity conditions (>3), for which they also took medications
(10-11). In addition, patients had 3.7-5.9 symptoms and side effects. Patients on
all categories except those on sex hormones had 49%-57% drug interruptions
necessitating further medication burden.
CONCLUSIONS: This study points out that patients taking oral agents have multiple
medications for cancer and other comorbid conditions. The number of pills, times
per day, and interruptions adds to the medication burden that patients'
experience. Further study is needed to determine strategies to assist the
patients on oral cancer medications to reduce their medication burden.
DOI: 10.4103/apjon.apjon_7_17
PMCID: PMC5559936
PMID: 28966954
1208. J Investig Allergol Clin Immunol. 2019 Feb 11:0. doi: 10.18176/jiaci.0387.
[Epub
ahead of print]
Clinical factors associated with the overuse of asthma rescue medication.
Urrutia I(1), Delgado J(2), Domínguez-Ortega J(3), Mascarós E(4), Pérez M(5),
Resler G(5), Plaza V(6); on behalf on the MISTRAL Investigators Group.
Author information:
(1)Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay,
Spain.
(2)Allergy Department, Hospital Virgen Macarena, Sevilla, Spain.
(3)Department of Allergy, Healthcare Research Institute IdiPAZ, CIBER de
Enfermedades Respiratorias, CIBERES, Hospital Universitario La Paz, Madrid,
Spain.
(4)Medicina de Familia y Comunitaria, Centro de Salud Fuente de San Luis,
Valencia, Spain, Spain.
(5)Medical Department AstraZeneca. Barcelona. Spain.
(6)Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau,
Institut dÍnvestigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain.
BACKGROUND AND OBJECTIVE: Our aim was to evaluate the relationship between asthma
clinical factors and use of relief medication.
METHODS: This was an observational cross-sectional study conducted in Spain. The
study recruited patients ≥ 12 years of age diagnosed with persistent asthma
according to the GINA criteria and receiving maintenance treatment for at least
12 months. Use of relief medication was dichotomized: low use of rescue
medication (LURM) (≤ twice/week) or high use of rescue medication (HURM) (≥ three
times/week). A variety of clinical variables and patient reported outcomes (PROs)
such as the Asthma Control Questionnaire-5 (ACQ-5) and Test of Adherence to
Inhalers (TAI) were recorded.
RESULTS: A total of 406 patients were recruited, mean (SD) age 44.3(17.9) years
and 64% women. In 76.1% rescue medication was used ≤ twice/week. Bivariate
analysis showed HURM was related to smoking habit, unscheduled emergency room
visits, hospital admissions, increased inhaled corticosteroid doses, therapeutic
upgrading and night awakenings in the last four weeks (p<0.001). The multivariate
analysis showed a higher risk of using relief medication in smokers and former
smokers, when the number of night awakenings increased, in cases of
self-perception of partially controlled or uncontrolled asthma, or when asthma is
uncontrolled according to ACQ-5.
CONCLUSIONS: Our study identifies the potential of using abuse of rescue
medication in the last week as an alarm signal for disease parameters such as
exacerbations, poor asthma control and disease severity.
DOI: 10.18176/jiaci.0387
PMID: 30741637
1209. Curr Med Res Opin. 2015 Jan;31(1):145-60. doi: 10.1185/03007995.2014.978939.

Epub
2014 Nov 4.
Packaging interventions to increase medication adherence: systematic review and

meta-analysis.
Conn VS(1), Ruppar TM, Chan KC, Dunbar-Jacob J, Pepper GA, De Geest S.
Author information:
(1)University of Missouri , Columbia, MO , USA.
OBJECTIVE: Inadequate medication adherence is a widespread problem that
contributes to increased chronic disease complications and health care
expenditures. Packaging interventions using pill boxes and blister packs have
been widely recommended to address the medication adherence issue. This
meta-analysis review determined the overall effect of packaging interventions on
medication adherence and health outcomes. In addition, we tested whether effects
vary depending on intervention, sample, and design characteristics.
RESEARCH DESIGN AND METHODS: Extensive literature search strategies included
examination of 13 computerized databases and 19 research registries, hand
searches of 57 journals, and author and ancestry searches. Eligible studies
included either pill boxes or blister packaging interventions to increase
medication adherence. Primary study characteristics and outcomes were reliably
coded. Random-effects analyses were used to calculate overall effect sizes and
conduct moderator analyses.
RESULTS: Data were synthesized across 22,858 subjects from 52 reports. The
overall mean weighted standardized difference effect size for two-group
comparisons was 0.593 (favoring treatment over control), which is consistent with
the mean of 71% adherence for treatment subjects compared to 63% among control
subjects. We found using moderator analyses that interventions were most
effective when they used blister packs and were delivered in pharmacies, while
interventions were less effective when studies included older subjects and those
with cognitive impairment. Methodological moderator analyses revealed
significantly larger effect sizes in studies reporting continuous data outcomes
instead of dichotomous results and in studies using pharmacy refill medication
adherence measures compared with studies with self-report measures.
CONCLUSIONS: Overall, meta-analysis findings support the use of packaging
interventions to effectively increase medication adherence. Limitations of the
study include the exclusion of packaging interventions other than pill boxes and
blister packs, evidence of publication bias, and primary study sparse reporting
of health outcomes and potentially interesting moderating variables such as the
number of prescribed medications.
DOI: 10.1185/03007995.2014.978939
PMCID: PMC4562676
1210. Bipolar Disord. 2015 Feb;17(1):106-12. doi: 10.1111/bdi.12226. Epub 2014 Jun
26.
Correlates of attitudes towards mood stabilizers in individuals with bipolar

disorder.
Chang CW(1), Sajatovic M, Tatsuoka C.
Author information:
(1)Mandel School of Applied Social Sciences, Case Western Reserve University,
Cleveland, OH, USA.
OBJECTIVES: Attitudes towards medication are believed to be important for

medication adherence and social factors are believed to have effects on
attitudes. Only a limited literature has focused on how attitudes to medication
may correlate with social factors relevant to medication adherence among
individuals with bipolar disorder (BPD). This secondary analysis of baseline data
from a longitudinal study examined the relationships between attitudes towards
mood stabilizers and psychosocial variables.
METHODS: Community mental health clinic patients (n = 122) were assessed on the
outcome variable of medication attitudes as measured by the Attitudes towards
Mood Stabilizers Questionnaire (AMSQ). Independent variables included education
as well as standardized measures of psychiatric symptom severity, alcohol and
drug problem severity, health locus of control (the belief that one's health is
self-determined versus determined by factors outside of one's own control), and
psychosocial support. A hierarchical multiple regression model evaluated the
relationship between AMSQ and these variables.
RESULTS: More positive medication attitudes were seen in individuals with higher
levels of social support and in those who held a stronger belief that their
health outcomes are determined by others, such as family or clinicians.
Education, symptom severity, alcohol problem severity and drug problem severity
were not significant attitudinal correlates.
CONCLUSIONS: Attitudes towards mood stabilizers are correlated with both the
support a person receives from others in their social network and how much a
person believes others can influence his or her health. Clinicians need to be
aware of the importance of the social environment as it relates to medication
attitudes and more research is needed on how treatment attitudes may actually
translate into medication adherence behavior.
DOI: 10.1111/bdi.12226
PMCID: PMC4277504
1211. JMIR Diabetes. 2017 Aug 16;2(2):e20. doi: 10.2196/diabetes.8030.
Digital Health for Medication Adherence in Adult Diabetes or Hypertension: An

Integrative Review.
Conway CM(#)(1)(2), Kelechi TJ(#)(2).
Author information:
(1)School of Nursing, Western Carolina University, Cullowhee, NC, United States.
(2)College of Nursing, Medical University of South Carolina, Charleston, SC,
United States.
BACKGROUND: Optimal management of chronic diseases, such as type 2 diabetes and

hypertension, often include prescription medications. Medication adherence (MA)
is one component of self-management. Optimization through digital health-eHealth
and mHealth-could enhance patient awareness and/or communication between the
patient and provider.
OBJECTIVE: Medication adherence is a major issue that affects 50%-60% of
chronically ill adults. Digital health refers to eHealth and mHealth,
collectively, and as these technologies become more accessible, remote health
delivery is increasingly available as an adjunct to improve medication adherence;
communicate with patients and providers; and provide education to patients,
families, and communities. The objective of this integrative review was to
examine the types of digital health technologies that targeted medication
adherence in the adult population with diabetes or hypertension.
METHODS: An integrative review was conducted using databases within EBSCOhost,
PubMed, and Scopus. Eligible studies available as of September 2016 had to be
written in English, had to contain digital health interventions to improve
medication adherence to prescription medications in adults 18 years or older, and
had to focus on diabetes or hypertension.
RESULTS: Of the 337 located studies, 13 (3.9%) used a digital health intervention
for medication adherence to prescribed medications for diabetes or hypertension
and were assessed according to the Chronic Care Model.
CONCLUSIONS: The 13 studies included in this review found no conclusive evidence
of improved medication adherence using digital health interventions such as
interactive voice response (IVR), short message service (SMS) text messaging,
telemonitoring, and interactive software technology. Among the 13 studies were
digital health interventions that foster medication adherence via one-way
communication to the patient or two-way communication between the patient and
health care provider for adjunct medication adherence strategies. More research
is needed to determine which digital health interventions are most beneficial for
individuals with diabetes or hypertension.
©Cheryl Moseley Conway, Teresa J Kelechi. Originally published in JMIR Diabetes

(http://diabetes.jmir.org), 16.08.2017.
DOI: 10.2196/diabetes.8030
PMCID: PMC6238839
PMID: 30291093
1212. Rev Lat Am Enfermagem. 2019 Mar 18;27:e3112. doi: 10.1590/1518-

8345.2746.3112.
Aspects that influence the self-care of patients living with human

immunodeficiency virus.
Alencar RA(1), Parenti ABH(1), Lopes CC(1), Ramos FT(1), Ciosak SI(2).
Author information:
(1)Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu,
SP, Brazil.
(2)Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil.
OBJECTIVE: to analyze aspects related to the increase or decrease of self-care in

patients living with human immunodeficiency virus treated in a specialized
outpatient service.
METHOD: analytical cross-sectional study with 135 patients aged 18 and over, of
both sexes, who are followed up on the service. The independent variables and
outcomes were collected from the nursing consultation instrument, whose
theoretical reference is the Orem's Theory. The data were analyzed by parametric
approach. Relationships or differences were considered significant if p <0.05.
The analysis was done with SPSS v21.0 software.
RESULTS: most participants were male (56.3%), with a mean age of 42.1 years.
Patients who needed to conceal the diagnosis had less self-care (β = -0.72
(-1.38, -0.06), p <0.031). The chance of performing self-care decreased with
increasing age (OR = 0.93 (0.89, 0.97), p <0.003). On the other hand, patients
with a permanent partner had a higher chance of performing self-care (OR = 3.46
(1.27, 9.46), p <0.015).
CONCLUSION: aspects related to the increase or decrease of self-care in patients
living with human immunodeficiency virus were evidenced. However, further studies
are necessary to emphasize the analytical character of the self-care of these
patients.
DOI: 10.1590/1518-8345.2746.3112
PMCID: PMC6432987
1213. Front Pharmacol. 2014 Oct 1;5:220. doi: 10.3389/fphar.2014.00220. eCollection

2014.
Multidrug punch cards in primary care: a mixed methods study on patients'

preferences and impact on adherence.
Boeni F(1), Hersberger KE(1), Arnet I(1).
Author information:
University of Basel Basel, Switzerland.
BACKGROUND: Multidrug punch cards are frame cards with 28 plastic cavities filled
with a patient's oral solid medication. They are used in primary care to
facilitate medication management and to enhance adherence. Main criticism
concerned handling difficulties and fading knowledge about medication of patients
using them. This study aimed at exploring daily use, preferences, and adherence
of primary care patients using multidrug punch cards.
METHODS: Community pharmacies in Switzerland recruited primary care patients
using multidrug punch cards. A mixed methods approach was applied with
quantitative interviews performed by telephone and qualitative interviews
face-to-face.
RESULTS: Of 149 eligible patients from 21 community pharmacies, 22 participated
2011 in the quantitative and 11 participated 2013/14 in the qualitative
interview. Patients were very satisfied with the multidrug punch cards and stated
increased medication safety. All considered adherence as very important.
Self-reported adherence was 10 (median) on a visual analog scale (0 = no intake,
10 = perfect adherence). The absence of package inserts and predefined handling
difficulties e.g., tablets spiking at removal were not perceived as problems.
CONCLUSIONS: Patients are satisfied with the multidrug punch cards, feel safe,
mostly have no handling problems and adhere to their treatment. Trust in
health-care professionals and patients' experiences emerged as key variables for
initiating multidrug punch card use and for medication adherence. This mixed
methods study invalidates previous concerns about disadvantages of multidrug
punch cards. Health-care professionals should actively recommend them for primary
care patients with polypharmacy and poor adherence.
DOI: 10.3389/fphar.2014.00220
PMCID: PMC4181287
PMID: 25324777
1214. Pain. 2016 Aug;157(8):1791-8. doi: 10.1097/j.pain.0000000000000583.
Patient vs provider reports of aberrant medication-taking behavior among

opioid-treated patients with chronic pain who report misusing opioid medication.
Nikulina V(1), Guarino H, Acosta MC, Marsch LA, Syckes C, Moore SK, Portenoy RK,
Cruciani RA, Turk DC, Rosenblum A.
Author information:
(1)aDepartment of Psychology, Queens College, CUNY, Flushing, NY, USA bNational
Development and Research Institutes, Inc, New York, NY, USA cDartmouth Center for
Technology and Behavioral Health, Lebanon, NH, USA dMJHS Institute for Innovation
in Palliative Care, New York, NY, USA eCapital Health, Pennington, NJ, USA
fUniversity of Washington, Seattle, WA, USA.
During long-term opioid therapy for chronic noncancer pain, monitoring medication
adherence of patients with a history of aberrant opioid medication-taking
behaviors (AMTB) is an essential practice. There is limited research, however,
into the concordance among existing monitoring tools of self-report, physician
report, and biofluid screening. This study examined associations among patient
and provider assessments of AMTB and urine drug screening using data from a
randomized trial of a cognitive-behavioral intervention designed to improve
medication adherence and pain-related outcomes among 110 opioid-treated patients
with chronic pain who screened positive for AMTB and were enrolled in a pain
program. Providers completed the Aberrant Behavior Checklist (ABC) and patients
completed the Current Opioid Misuse Measure (COMM) and the Chemical Coping
Inventory (CCI). In multivariate analyses, ABC scores were compared with COMM and
CCI scores, while controlling for demographics and established risk factors for
AMTB, such as pain severity. Based on clinical cutoffs, 84% of patients reported
clinically significant levels of AMTB and providers rated 36% of patients at
elevated levels. Provider reports of AMTB were not correlated with COMM or CCI
scores. However, the ABC ratings of experienced providers (nurse
practitioners/attending physicians) were higher than those of less experienced
providers (fellows) and were correlated with CCI scores and risk factors for
AMTB. Associations between patient- and provider-reported AMTB and urine drug
screening results were low and largely nonsignificant. In conclusion, concordance
between patient and provider reports of AMTB among patients with chronic pain
prescribed opioid medication varied by provider level of training.
DOI: 10.1097/j.pain.0000000000000583
PMCID: PMC4949142
1215. Liver Transpl. 2015 Jan;21(1):22-8. doi: 10.1002/lt.24023.
Medication misuse, nonadherence, and clinical outcomes among liver transplant

recipients.
Serper M(1), Patzer RE, Reese PP, Przytula K, Koval R, Ladner DP, Levitsky J,
Abecassis MM, Wolf MS.
Author information:
(1)Division of Gastroenterology and Hepatology.
Medication nonadherence after liver transplantation (LT) is associated with

adverse clinical outcomes such as graft rejection and graft loss. Few studies
have examined nonadherence and its impact on clinical outcomes in LT. The study
objectives were (1) to evaluate medication understanding (with treatment
knowledge and demonstrated regimen use scores) and medication adherence or
nonadherence to entire regimens among LT recipients and (2) to examine
associations of these exposures with clinical outcomes. We conducted a 2-site
study of 105 recipients between 2011 and 2012 at 2 transplant centers in Chicago,
IL and Atlanta, GA. Data were collected via detailed, in-person interviews and
medical record reviews. Study participants were middle-aged and predominantly
male; 15% of the sample had limited literacy. On average, patients were taking 11
medications [standard deviation (SD) = 4], and 39% had undergone a medication
change within the last month. The average scores for the entire medication
regimen were 86% (SD = 22%) for treatment knowledge and 78% (SD = 22%) for
demonstrated regimen use. The mean score for self-reported nonadherence to the
entire regimen was 14% (SD = 20%), whereas 32% of the patients were nonadherent
according to tacrolimus levels. In multivariate analyses, lower income, less time
since transplantation, a higher number of medications, and limited literacy were
inversely associated with treatment knowledge scores (all P < 0.05), whereas
limited literacy was associated with nonadherence according to tacrolimus levels
(P < 0.05). In multivariate models, higher scores for treatment knowledge
[incidence rate ratio (IRR) = 0.85, 95% confidence interval (CI) = 0.74-0.97] and
demonstrated regimen use (IRR = 0.87, 95% confidence interval = 0.77-0.98) were
independently associated with 15% and 13% reductions in the number of
posttransplant rehospitalizations, respectively. Inadequate treatment knowledge
and improper regimen use may be significant determinants of unintentional
nonadherence among LT recipients and are associated with adverse clinical
outcomes.
© 2014 American Association for the Study of Liver Diseases.
DOI: 10.1002/lt.24023
PMCID: PMC5831120

eCollection 2018.
Experiences, expectations and challenges of an interactive mobile phone-based

system to support self-management of hypertension: patients' and professionals'
perspectives.
Hallberg I(1)(2)(3), Ranerup A(3)(4), Bengtsson U(1)(3), Kjellgren K(1)(2)(3).
Author information:
(1)Institute of Health and Care Sciences, University of Gothenburg, Gothenburg,
Sweden.
(2)Department of Medical and Health Sciences, Linköping University, Linköping,
Sweden.
(3)Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg,
Sweden.
(4)Department of Applied Information Technology, University of Gothenburg,
Gothenburg, Sweden.
Background: A well-controlled blood pressure (BP) reduces cardiovascular

complications. Patient participation in care using technology may improve the
current situation of only 13.8% of adults diagnosed with hypertension worldwide
having their BP under control.
Objective: The objective of this study was to explore patients' and
professionals' experiences of and expectations for an interactive mobile
phone-based system to support self-management of hypertension.
Methods: The self-management system consists of: 1) a mobile phone platform for
self-reports, motivational messages and reminders; 2) a device for measuring BP
and 3) graphical feedback of self-reports. Patients diagnosed with high BP (n=20)
and their treating professionals (n=7) participated in semi-structured
interviews, after 8 weeks use of the system in clinical practice. Data were
analyzed thematically.
Results: The self-reporting of BP, symptoms, medication use, medication side
effects, lifestyle and well-being was perceived to offer insight into how daily
life activities influenced BP and helped motivate a healthy lifestyle. Taking
increased responsibility as a patient, by understanding factors affecting one's
well-being, was reported as an enabling factor for a more effective care. Based
on the experiences, some challenges were mentioned: for adoption of the system
into clinical practice, professionals' educational role should be extended and
there should be a reorganization of care to fully benefit from technology. The
patients and professionals gave examples of further improvements to the system,
for example, related to the visualization of graphs from self-reports and an
integration of the system into the general technical infrastructure. These
challenges are important on the path to accomplishing adoption.
Conclusion: The potential of a more autonomous, knowledgeable and active patient,
through use of the interactive mobile system would improve outcomes of
hypertension treatment, which has been desired for decades. Documentation and
visualization of patients' self-reports and the possibilities to communicate
these with professionals may be a significant resource for person-centered care.
DOI: 10.2147/PPA.S157658
PMCID: PMC5885974
PMID: 29643739

1217. BMC Pulm Med. 2019 Feb 26;19(1):52. doi: 10.1186/s12890-019-0814-x.
A longitudinal study of cannabis use increasing the use of asthma medication in

young Norwegian adults.
Bramness JG(1)(2), von Soest T(3)(4).
Author information:
(1)Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental
Health Disorders, Innlandet Hospital Trust, P.O. Box 104, 2381 Brumunddal, Hamar,
Norway. j.g.bramness@medisin.uio.no.
(2)Institute of Clinical Medicine, University of Tromsø - The Arctic University
of Norway, Tromsø, Norway. j.g.bramness@medisin.uio.no.
(3)Department of Psychology, University of Oslo, Oslo, Norway.
(4)Norwegian Social Research, OsloMet - Oslo Metropolitan University, Oslo,
Norway.
BACKGROUND: A small number of studies have shown that the use of cannabis
increases the risk of bronchial asthma. There is, however, a paucity of
longitudinal studies which are able to control for known risk factors of
bronchial asthma.
METHODS: Survey data from a population-based longitudinal study encompassing 2602
young adults followed for 13 years were coupled with individual prescription data
on asthma medication (β2-adrenergic receptor agonists and glucocorticoids for
inhalation) from the Norwegian national prescription database, which covers the
entire Norwegian population. Current cannabis use, gender, age, years of
education, body mass index (BMI; kg/m2) and current smoking were measured.
RESULTS: Prescription of asthma medication was associated with female gender,
self-reported earlier asthma and allergies, daily tobacco smoking and current
cannabis use. In a model adjusting for gender, age, years of education, BMI,
earlier self-reported asthma and allergies and current tobacco smoking the odds
ratio for a current cannabis user to fill prescriptions for asthma medication was
1.71 (95% CI: 1.06-2.77; p = 0.028).
CONCLUSIONS: This suggests that cannabis is a risk factor for bronchial asthma or
use of asthma medication even when known risk factors are taken into
consideration. Intake of cannabis through smoking should be avoided in persons at
risk.
DOI: 10.1186/s12890-019-0814-x
PMCID: PMC6390535

eCollection 2014.
Perceived need to take medication is associated with medication non-adherence in
patients with rheumatoid arthritis.
Zwikker HE(1), van Dulmen S(2), den Broeder AA(1), van den Bemt BJ(3), van den
Ende CH(1).
Author information:
(1)Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands ;
Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands.
(2)Department of Primary and Community Care, Radboud University Medical Centre,
Nijmegen, the Netherlands ; NIVEL (Netherlands Institute for Health Services
Research), Utrecht, the Netherlands ; Department of Health Science, Buskerud and
Vestfold University College, Drammen, Norway.
(3)Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands ;
Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands ;
Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the
Netherlands.
BACKGROUND: This is the first cross-sectional study that aims to examine

associations between beliefs about medication and non-adherence in patients with
rheumatoid arthritis (RA) using disease-modifying antirheumatic drugs, taking
potential psychological confounders into account.
METHODS: Eligible patients (diagnosed with RA for ≥1 year or ≥18 years, using
greater than or equal to one disease-modifying antirheumatic drug) were included
by their rheumatologist during regular outpatient visits between September 2009
and September 2010. Included patients received questionnaires. The Beliefs about
Medicines Questionnaire was used to measure the perceived need to take medication
(necessity beliefs), the concerns about taking medication (concern beliefs),
general medication beliefs, and attitudes toward taking medication. Medication
non-adherence (no/yes) was measured using the Compliance Questionnaire
Rheumatology (CQR). Associations between beliefs and non-adherence, and the
influence of demographical, clinical, and psychological factors (symptoms of
anxiety/depression, illness cognitions, self-efficacy) were assessed using
RESULTS: A total of 580 of the 820 eligible patients willing to participate were
included in the analyses (68% female, mean age 63 years, 30% non-adherent to
their medication). Weaker necessity beliefs (OR [odds ratio]: 0.8, 95% CI
[confidence interval]: 0.8-0.9) and an unfavorable balance between necessity and
concern beliefs (OR: 0.9, 95% CI: 0.9-1.0) were associated with CQR
non-adherence. Also, having an indifferent attitude toward medication (no/yes)
was associated with CQR non-adherence (OR: 5.3, 95% CI: 1.1-25.8), but the
prevalence of patients with an indifferent attitude toward medication was low.
The associations were barely confounded by demographical, clinical, and
psychological factors.
CONCLUSION: Increasing necessity beliefs about medication in clinical practice
might be worthwhile in improving medication adherence in RA patients.
DOI: 10.2147/PPA.S66849
PMCID: PMC4270192
PMID: 25525340
1219. Ann Behav Med. 2018 Feb 17;52(3):228-238. doi: 10.1093/abm/kax047.
Daily Communal Coping in Couples With Type 2 Diabetes: Links to Mood and
Self-Care.
Zajdel M(1), Helgeson VS(1), Seltman HJ(1), Korytkowski MT(2), Hausmann LRM(3).
Author information:
(1)Carnegie Mellon University, Pittsburgh, PA.
(2)University of Pittsburgh Medical Center, Pittsburgh, PA.
(3)VA Pittsburgh Healthcare System, Pittsburgh, PA.
Background: Adjusting to the challenges of a chronic illness does not affect

patients alone but also influences social network members-most notably spouses.
One interpersonal framework of coping with a chronic illness is communal coping,
described as when a problem is appraised as joint and the couple collaborates to
manage the problem.
Purpose: We sought to determine whether daily communal coping was linked to daily
mood and self-care behavior and examined one potential mechanism that may explain
these links: perceived emotional responsiveness.
Methods: Patients who had been diagnosed with diabetes less than 5 years ago and
their spouses (n = 123) completed a daily diary questionnaire that assessed
communal coping and mood for 14 consecutive days. The patients also reported
daily self-care behaviors. We used multilevel modeling to examine the links of
communal coping to patient and spouse mood and patient self-care. Because both
patients and spouses reported their mood, the actor-partner interdependence model
(APIM) was employed to examine mood.
Results: Multilevel APIM showed that actor communal coping was associated with
lower depressed mood, higher happy mood, and lower angry mood and partner
communal coping was linked to higher happy mood. Patient communal coping was
related to better dietary and medication adherence, and spouse communal coping
was linked to better medication adherence. Perceived emotional responsiveness
partially mediated the relations of communal coping to mood but not to self-care
behaviors.
Conclusions: Communal coping on a daily basis may help both patients and spouses
adjust psychologically to the illness as well as enhance patient self-care
behaviors.
DOI: 10.1093/abm/kax047
PMID: 29538665
1220. J Cardiol. 2017 Sep;70(3):238-243. doi: 10.1016/j.jjcc.2016.11.009. Epub 2016

Dec
19.
Adherence to medication and characteristics of Japanese patients with

non-valvular atrial fibrillation.
Suzuki T(1), Shiga T(2), Omori H(3), Tatsumi F(4), Nishimura K(5), Hagiwara N(1).
Author information:
(1)Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
(2)Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Electronic address: mshiga@hij.twmu.ac.jp.
(3)Department of Medicine, Tokyo Women's Medical University Medical Center East,
Tokyo, Japan.
(4)Department of Cardiology, Tokyo Women's Medical University Aoyama Hospital,
Tokyo, Japan.
(5)Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
BACKGROUND: Adherence to medication plays an important role in the prevention of

morbidity and mortality in non-valvular atrial fibrillation (NVAF) patients. The
aim of this study is to assess adherence to medication and risk factors for
non-adherence in Japanese NVAF patients who are prescribed anticoagulants.
METHODS: A total of 378 outpatients with NVAF who completed self-reported
questionnaires were analyzed in this prospective study (mean age 69±12 years; 26%
female). Self-reported adherence to cardiovascular drugs including anticoagulants
was measured with a modified Siegal scale. Depression was defined as a Patient
Health Questionnaire-9 score of ≥10. Univariate and multivariate analyses were
performed on several variables to analyze factors affecting non-adherence.
RESULTS: In total, 291 (77%) of our patients received warfarin, and the remainder
received direct oral anticoagulants. Fifty-two (14%) patients were defined as
non-adherent. Univariate analyses showed that age <65 years, ≥2 times daily
dosing of cardiovascular drugs and employment, but not depression, were
significantly associated with non-adherence, 1.87 (95% CI: 1.01-3.42, p=0.04),
2.97 (95% CI: 1.64-5.49, p<0.01), 2.11 (95% CI: 1.16-3.93, p=0.01), and 0.74 (95%
CI: 0.26-2.64), respectively. Multivariate analysis showed that only ≥2 times
daily dosing was a significant independent risk factor (HR 3.06, 95% CI:
1.67-5.69, p<0.01).
CONCLUSIONS: Our study showed that the prevalence of non-adherence to medications
was 14% in NVAF patients. Frequent daily dosing was an independent risk factor
for non-adherence to medication (UMIN-CTR No. UMIN 000023514).
Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All

rights reserved.
DOI: 10.1016/j.jjcc.2016.11.009
1221. Health Serv Res Manag Epidemiol. 2015 Jun 4;2:2333392815589094. doi:
Health Literacy and Medication Adherence Among Patients Treated in a Free Health
Clinic: A Pilot Study.
Sawkin MT(1)(2), Deppe SJ(3), Thelen J(4)(5), Stoner SC(1), Dietz CA(2), Rasu
RS(5).
Author information:
(1)Department of Pharmacy Practice and Administration, University of Missouri -
Kansas City School of Pharmacy, Kansas City, Missouri, USA.
(2)Kansas City CARE Clinic, formerly known as Kansas City Free Health Clinic,
Kansas City, Missouri, USA.
(3)Medical Science Liaison, Medical Affairs - Virology, Janssen Pharmaceutical of
Johnson & Johnson, Kansas City, Missouri, USA.
(4)Department of Psychology, University of Missouri - Kansas City, Kansas City,
Missouri, USA.
(5)Department of Pharmacy Practice, School of Pharmacy, University of Kansas,
Lawrence, Kansas, USA.
BACKGROUND: A patient's health literacy is not routinely assessed during visits

with a health care provider. Since low health literacy is a risk factor for poor
health outcomes, assessing health literacy should be considered as part of the
standard medical workup.
OBJECTIVES: To evaluate the health literacy levels and medication adherence of
patients treated by pharmacists in both the general medicine and the chronic care
clinics at an urban free health clinic.
METHODS: Eligible patients from the free health clinic completed the Rapid
Estimate of Adult Literacy in Medicine (REALM), a health literacy measurement
tool, during their clinic visit in 2011. Medication adherence was self-reported
by the patients.
RESULTS: A total of 100 patients participated (mean age = 48). The majority of
participants were female (56%) and white (55%). Most (64%) of the patients scored
at a high school reading level according to REALM. Only 21% of participants read
at a seventh- to eighth-grade level. Overall medication adherence rate was 73%.
Forgetting to take medication was the most popular reason given for nonadherence.
CONCLUSION: Disease state and adherence were significantly related in patients
with HIV/AIDS and hypertension. Patient's ethnicity was significantly associated
with literacy levels (P < .05). Although patients' literacy levels were not
significantly associated with self-reported adherence in this population,
availability of a patient's baseline health literacy level as a part of the
medical record may help clinicians to individualize their interaction based on
the patient's health literacy level in order to achieve better health outcomes,
including improved medication adherence, especially for underserved populations.
DOI: 10.1177/2333392815589094
PMCID: PMC5266426
PMID: 28462257

1222. Med Princ Pract. 2017;26(1):35-40. doi: 10.1159/000450644. Epub 2016 Sep 7.
Factors Affecting Adherence to Statins in Hypercholesterolemic Kuwaiti Patients:

A Cross-Sectional Study.
Al-Foraih M(1), Somerset S.
Author information:
(1)Public Authority for Applied Education and Training, Safat, Kuwait.
OBJECTIVE: This study examined statin adherence amongst Kuwaiti

hypercholesterolemic patients in order to identify factors associated with poor
adherence and to determine whether or not an association exists between statin
adherence and the risk profile of coronary heart disease (CHD).
SUBJECTS AND METHODS: Two hundred hypercholesterolemic patients (30-69 years of
age) were recruited from Kuwaiti primary healthcare clinics and interviewed about
demographic characteristics, pre-existing self-reported medical conditions and
prescribed medications. The Morisky Medication Adherence Scale was used to assess
statin adherence (a self-reported, medication-adherence questionnaire divided
into 3 levels, with a score of 8 denoting high adherence, 6 to <8 denoting medium
adherence and <6 denoting low adherence). Data regarding anthropometric,
psychological and serum risk factors were collected using 2 additional
questionnaires, laboratory tests and bioelectrical impedance scales. Binary
logistic regression was used to determine predictors of adherence and general
linear modelling was used to test relationships between continuous outcomes and
statin adherence.
RESULTS: Of the 200 participants, 117 (58.5%) reported low adherence, 83 (41.5%)
reported medium adherence and no patients (0%) scored high adherence. Younger
patients (aged 30-50 years) had lower adherence than older patients (>50 years)
[odds ratio (OR) 1.05; 95% confidence interval (CI) 1.01-1.09] for every extra
year; p < 0.01). Those without diabetes, i.e. 113 (56.5%), were less likely to
report medium adherence than those with diabetes (OR 0.42; 95% CI 0.23-0.75; p <
0.01). Low statin adherence was associated with higher levels of plasma
cholesterol (p < 0.001) and low-density lipoprotein (p < 0.01).
CONCLUSION: In this study, there was a high prevalence of low statin adherence,
especially among younger patients with fewer concomitant diseases. The results
indicated an inverse relationship between statin adherence and CHD risk profile.
DOI: 10.1159/000450644
PMCID: PMC5588393
1223. Curr Hypertens Rep. 2015 Dec;17(12):94. doi: 10.1007/s11906-015-0606-5.
Interventions to Improve Medication Adherence in Hypertensive Patients:

Systematic Review and Meta-analysis.
Conn VS(1), Ruppar TM(2), Chase JA(3), Enriquez M(4), Cooper PS(5).
Author information:
(1)School of Nursing, University of Missouri, S317 Sinclair Building, Columbia,
MO, 65211, USA. conn@missouri.edu.
MO, 65211, USA.
MO, 65211, USA.
MO, 65211, USA.
MO, 65211, USA.
This systematic review applied meta-analytic procedures to synthesize medication

adherence interventions that focus on adults with hypertension. Comprehensive
searching located trials with medication adherence behavior outcomes. Study
sample, design, intervention characteristics, and outcomes were coded.
Random-effects models were used in calculating standardized mean difference
effect sizes. Moderator analyses were conducted using meta-analytic analogues of
ANOVA and regression to explore associations between effect sizes and sample,
design, and intervention characteristics. Effect sizes were calculated for 112
eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The
overall standardized mean difference effect size between treatment and control
subjects was 0.300. Exploratory moderator analyses revealed interventions were
most effective among female, older, and moderate- or high-income participants.
The most promising intervention components were those linking adherence behavior
with habits, giving adherence feedback to patients, self-monitoring of blood
pressure, using pill boxes and other special packaging, and motivational
interviewing. The most effective interventions employed multiple components and
were delivered over many days. Future research should strive for minimizing risks
of bias common in this literature, especially avoiding self-report adherence
measures.
DOI: 10.1007/s11906-015-0606-5
PMCID: PMC5662945
Why do some people with type 2 diabetes who are using insulin have poor glycaemic
control? A qualitative study.
Tong WT(1), Vethakkan SR(2), Ng CJ(1).

Author information:
(1)Faculty of Medicine, Department of Primary Care Medicine, University of
Malaya, Kuala Lumpur, Malaysia.
(2)Faculty of Medicine, Department of Medicine, University of Malaya, Kuala
Lumpur, Malaysia.
OBJECTIVE: To explore factors influencing poor glycaemic control in people with

type 2 diabetes using insulin.
RESEARCH DESIGN: A qualitative method comprising in-depth individual interviews.
A semistructured interview guide was used. The interviews were audiorecorded,
transcribed verbatim and analysed using a thematic approach.
PARTICIPANTS: Seventeen people with type 2 diabetes using insulin with glycated
haemoglobin (HbA1c) ≥9% for >1 year.
SETTING: The Primary Care Clinic and Diabetes Clinic in the University of Malaya
Medical Centre (UMMC), Malaysia.
RESULTS: Data analysis uncovered four themes: lifestyle challenges in adhering to
medical recommendations; psychosocial and emotional hurdles; treatment-related
factors; lack of knowledge about and self-efficacy in diabetes self-care.
CONCLUSIONS: Factors that explain the poor glycaemic control in people with type
2 diabetes using insulin were identified. Healthcare providers could use these
findings to address patients' concerns during consultations and help to improve
glycaemic control.
DOI: 10.1136/bmjopen-2014-006407
PMCID: PMC4316456
1225. Eval Health Prof. 2016 Jun;39(2):131-84. doi: 10.1177/0163278715588927. Epub

2015
Jun 30.
Measuring Self-Care in Persons With Type 2 Diabetes: A Systematic Review.
Lu Y(1), Xu J(2), Zhao W(3), Han HR(4).
Author information:
(1)School of Nursing, China Medical University, Shenyang City, Liaoning Province,
(2)Department of Community-Public Health, Johns Hopkins University School of
Nursing, Baltimore, MD, USA.
(3)Endocrinology Department, Peking Union Medical College Hospital, Beijing,
(4)Department of Community-Public Health, Johns Hopkins University School of
Nursing, Baltimore, MD, USA hhan3@jhu.edu.
This systematic review examines the characteristics and psychometric properties

of the instruments used to assess self-care behaviors among persons with type 2
diabetes. Electronic databases were searched for relevant studies published in
English within the past 20 years. Thirty different instruments were identified in
75 articles: 18 original instruments on type 2 diabetes mellitus self-care, 8
translated or revised version, and 4 not specific but relevant to diabetes.
Twenty-one instruments were multidimensional and addressed multiple dimensions of
self-care behavior. Nine were unidimensional: three focusing exclusively on
medication taking, three on diet, one on physical activity, one on
self-monitoring of blood glucose, and one on oral care. Most instruments (22 of
30) were developed during the last decade. Only 10 were repeated more than once.
Nineteen of the 30 instruments reported both reliability and validity information
but with varying degrees of rigor. In conclusion, most instruments used to
measure self-care were relatively new and had been applied to only a limited
number of studies with incomplete psychometric profiles. Rigorous psychometric
testing, operational definition of self-care, and sufficient explanation of
scoring need to be considered for further instrument development.
DOI: 10.1177/0163278715588927
PMCID: PMC4792777
1226. J Ren Nutr. 2015 Sep;25(5):433-9. doi: 10.1053/j.jrn.2015.03.001. Epub 2015

Apr
22.
Self-Motivation Is Associated With Phosphorus Control in End-Stage Renal Disease.
Umeukeje EM(1), Merighi JR(2), Browne T(3), Victoroff JN(4), Umanath K(5), Lewis
JB(1), Ikizler TA(1), Wallston KA(6), Cavanaugh K(7).
Author information:
(1)Division of Nephrology and Hypertension, Vanderbilt University, Nashville,
Tennessee; Vanderbilt Center for Kidney Disease, Nashville, Tennessee.
(2)School of Social Work, University of Minnesota, Saint Paul, Minnesota.
(3)College of Social Work, University of South Carolina, Columbia, South
Carolina.
(4)School of Medicine, University of Washington, Seattle, Washington.
(5)Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit,
Michigan.
(6)Vanderbilt University School of Nursing, Nashville, Tennessee.
(7)Division of Nephrology and Hypertension, Vanderbilt University, Nashville,
Tennessee; Vanderbilt Center for Kidney Disease, Nashville, Tennessee. Electronic
address: kerri.cavanaugh@vanderbilt.edu.
Erratum in
J Ren Nutr. 2019 Aug 13;:.
OBJECTIVE: Hyperphosphatemia is common in end-stage renal disease and associates

with mortality. Phosphate binders reduce serum phosphorus levels; however,
adherence is often poor. This pilot study aims to assess patients'
self-motivation to adhere to phosphate binders, its association with phosphorus
control, and potential differences by race.
DESIGN AND METHODS: Cross sectional design. Subjects were enrolled from one
academic medical center dialysis practice from July to November 2012.
Self-motivation to adhere to phosphate binders was assessed with the autonomous
regulation (AR) scale (range: 1-7) and self-reported medication adherence with
the Morisky Medication Adherence Scale. Linear regression models adjusting for
age, sex, health literacy, and medication adherence were applied to determine
associations with serum phosphorus level, including any evidence of interaction
by race.
RESULTS: Among 100 participants, mean age was 51 years (±15 years), 53% were
male, 72% were non-white, 89% received hemodialysis, and mean serum phosphorus
level was 5.7 ± 1.6 mg/dL. More than half (57%) reported the maximum AR score
(7). Higher AR scores were noted in those reporting better health overall (P =
.001) and those with higher health literacy (P = .01). AR score correlated with
better medication adherence (r = 0.22; P = .02), and medication adherence was
negatively associated with serum phosphorus (r = -0.40; P < .001). In subgroup
analysis among non-whites, higher AR scores correlated with lower serum
phosphorus (high vs lower AR score: 5.55 [1.5] vs 6.96 [2.2]; P = .01).
Associations between AR score (β 95% confidence interval: -0.37 [-0.73 to -0.01];
P = .04), medication adherence (β 95% confidence interval: -0.25 [-0.42 to
-0.07]; P = .01), and serum phosphorus persisted in adjusted analyses.
CONCLUSIONS: Self-motivation was associated with phosphate binder adherence and
phosphorus control, and this differed by race. Additional research is needed to
determine if personalized, culturally sensitive strategies to understand and
overcome motivational barriers may optimize mineral bone health in end-stage
renal disease.
DOI: 10.1053/j.jrn.2015.03.001
PMCID: PMC4546917
1227. Pediatr Blood Cancer. 2017 Dec;64(12). doi: 10.1002/pbc.26689. Epub 2017 Jun
23.
Randomized feasibility trial to improve hydroxyurea adherence in youth ages 10-18

years through community health workers: The HABIT study.
Green NS(1), Manwani D(2), Matos S(3), Hicks A(3), Soto L(4), Castillo Y(4),
Ireland K(2), Stennett Y(4), Findley S(5), Jia H(6), Smaldone A(6).
Author information:
(1)Department of Pediatrics, Columbia University Medical Center, New York, New
York.
(2)Department of Pediatrics, Albert Einstein College of Medicine, New York, New
York.
(3)Community Health Worker Network of New York City, New York, New York.
(4)Community League of the Heights, New York, New York.
(5)Mailman School of Public Health, Columbia University, New York, New York.
(6)Columbia University School of Nursing, New York, New York.
INTRODUCTION: The main therapeutic intervention for sickle cell disease (SCD) is
hydroxyurea (HU). The effect of HU is largely through dose-dependent induction of
fetal hemoglobin (HbF). Poor HU adherence is common among adolescents.
METHODS: Our 6-month, two-site pilot intervention trial, "HABIT," was led by
culturally aligned community health workers (CHWs). CHWs performed support
primarily through home visits, augmented by tailored text message reminders.
Dyads of youth with SCD ages 10-18 years and a parent were enrolled. A customized
HbF biomarker, the percentage decrease from each patients' highest historical
HU-induced HbF, "Personal best," was used to qualify for enrollment and assess HU
adherence. Two primary outcomes were as follows: (1) intervention feasibility and
acceptability and (2) HU adherence measured in three ways: monthly percentage
improvement toward HbF Personal best, proportion of days covered (PDC) by HU, and
self-report.
RESULTS: Twenty-eight dyads were enrolled, of which 89% were retained.
Feasibility and acceptability were excellent. Controlling for group assignment
and month of intervention, the intervention group improved percentage decrease
from Personal best by 2.3% per month during months 0-4 (P = 0.30), with similar
improvement in adherence demonstrated using pharmacy records. Self-reported
adherence did not correlate. Dyads viewed CHWs as supportive for learning about
SCD and HU, living with SCD and making progress in coordinated self-management
responsibility to support a daily HU habit. Most parents and youth appreciated
text message HU reminders.
CONCLUSIONS: The HABIT pilot intervention demonstrated feasibility and
acceptability with promising effect toward improved medication adherence. Testing
in a larger multisite intervention trial is warranted.
DOI: 10.1002/pbc.26689
PMCID: PMC6538388

eCollection 2016.
Mode of administration of dulaglutide: implications for treatment adherence.
Amblee A(1).
Author information:
(1)Department of Internal Medicine, Division of Endocrinology, John Stroger
Hospital of Cook County, Chicago, IL, USA; Rush University Medical Center,
Chicago, IL, USA.
BACKGROUND: Medication complexity/burden can be associated with nonadherence in

patients with type 2 diabetes mellitus (T2DM). Patients' satisfaction with their
treatment is an important consideration for physicians. Strategies like using
longer acting efficacious agents with less frequent dosing may help adherence.
OBJECTIVE: To explore the mode of administration of dulaglutide and its
implications for treatment adherence in T2DM.
METHODS: PubMed search using the term "Dulaglutide" through October 31, 2015 was
conducted. Published articles, press releases, and abstracts presented at
national/international meetings were considered.
RESULTS/CONCLUSION: Dulaglutide is a once-weekly glucagon like peptide-1 analog
with a low intraindividual variability. Phase III trials demonstrated significant
improvements in glycemia and weight, with a low hypoglycemia risk similar to
liraglutide/exenatide, but with substantially fewer injections. A significant
improvement was observed in the total Diabetes Treatment Satisfaction
Questionnaire score, Impact of Weight on Self-Perception, and perceived frequency
of hyperglycemia with dulaglutide when compared with placebo, exenatide,
liraglutide, or metformin. Treatment satisfaction scores showed an improvement
with dulaglutide (34%-39%) when compared with exenatide (31%). A positive
experience with a high initial (97.2%) and final (99.1%) injection success rate
along with a significant reduction in patients' fear of self-injecting, as
measured by the modified self-injecting subscale of the Diabetes Fear of
Injecting and Self-Testing Questionnaire and Medication Delivery Device
Assessment Battery, was found. Its acceptance was high (>96%) among a variety of
patients including patients who fear injections and injection-naïve users.
Dulaglutide is available as a single-dose automatic self-injecting device, which
has a low volume, does not need reconstitution, and avoids patient handling of
the needle. Dose adjustment based on weight, sex, age, race, ethnicity, or
injection-site is not necessary. In chronic diseases like diabetes where patients
need lifelong medications, the efficacy, safety, and convenience of a
once-weekly, easy-to-use, self-injecting device should encourage patient
adherence to dulaglutide therapy.
DOI: 10.2147/PPA.S82866
PMCID: PMC4898439
PMID: 27330280
1229. J Pediatr Health Care. 2017 May - Jun;31(3):362-371. doi:

10.1016/j.pedhc.2016.11.002. Epub 2016 Dec 9.
Asthma Home Management in the Inner-City: What can the Children Teach us?
Bellin MH, Newsome A, Land C, Kub J, Mudd SS, Bollinger ME, Butz AM.
OBJECTIVE: Knowledge of asthma home management from the perspective of poor,

minority children with asthma is limited.
METHOD: Convenience sampling methods were used to recruit families of low-income
children who are frequently in the emergency department for uncontrolled asthma.
Thirteen youths participated in focus groups designed to elicit reflections on
asthma home management. Data were analyzed using grounded theory coding
techniques.
RESULTS: Participants (Mean age = 9.2 years) were African American (100%),
enrolled in Medicaid (92.3%), averaged 1.4 (standard deviation = 0.7) emergency
department visits over the prior 3 months, and resided in homes with at least 1
smoker (61.5%). Two themes reflecting multifaceted challenges to the development
proper of self-management emerged in the analysis.
DISCUSSION: Findings reinforce the need to provide a multipronged approach to
improve asthma control in this high-risk population including ongoing child and
family education and self-management support, environmental control and housing
resources, linkages to smoking cessation programs, and psychosocial support.

DOI: 10.1016/j.pedhc.2016.11.002
PMCID: PMC6407130
1230. Swiss Med Wkly. 2014 Oct 2;144:w14016. doi: 10.4414/smw.2014.14016.

eCollection
2014.
Asking about adherence - from flipping the coin to strong evidence.
Glass T(1), Cavassini M(2).
Author information:
(1)Swiss Tropical and Public Health Institute, Basel, Switzerland; University of
Basel, Switzerland.
(2)Service of Infectious Diseases, Lausanne University Hospital, Switzerland.
In the era of antiretroviral therapy (ART) as prevention for transmission of HIV

as well as treatment for HIV-positive individuals irrespective of CD4 cell
counts, the importance of adherence has grown. Although adherence is not the only
determinant of treatment success, it is one of the only modifiable risk factors.
Treatment failure reduces future treatment options and therefore long-term
clinical success as well as increases the possibility of developing drug
resistant mutations. Drug-resistant strains of HIV can then be transmitted to
uninfected or drug-naïve individuals limiting their future treatment options,
making adherence an important public-health topic, especially in resource-limited
settings. Adherence should be monitored as a part of routine clinical care;
however, no gold standard for assessment of adherence exists. For use in daily
clinical practice, self-report is the most likely candidate for widespread use
due to its many advantages over other measurement methods, such as low cost and
ease of administration. Asking individuals about their adherence behaviour has
been shown to yield valid and predictive data - well beyond the mere flip of a
coin. However, there is still work to be done. This article reviews the
literature and evidence on self-reported adherence, identifies gaps in adherence
research, and makes recommendations for clinicians on how to best utilise
self-reported adherence data to support patients in daily clinical practice.
DOI: 10.4414/smw.2014.14016
The potential impact of intelligent systems for mobile health self-management

support: Monte Carlo simulations of text message support for medication
adherence.
Piette JD(1), Farris KB, Newman S, An L, Sussman J, Singh S.
Author information:
(1)Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann
Arbor, MI, USA, jpiette@umich.edu.
BACKGROUND: Mobile health (mHealth) services cannot easily adapt to users' unique
needs.
PURPOSE: We used simulations of text messaging (SMS) for improving medication
adherence to demonstrate benefits of interventions using reinforcement learning
(RL).
METHODS: We used Monte Carlo simulations to estimate the relative impact of an
intervention using RL to adapt SMS adherence support messages in order to more
effectively address each non-adherent patient's adherence barriers, e.g.,
forgetfulness versus side effect concerns. SMS messages were assumed to improve
adherence only when they matched the barriers for that patient. Baseline
adherence and the impact of matching messages were estimated from literature
review. RL-SMS was compared in common scenarios to simple reminders, random
messages, and standard tailoring.
RESULTS: RL could produce a 5-14% absolute improvement in adherence compared to
current approaches. When adherence barriers are not accurately reported, RL can
recognize which barriers are relevant for which patients. When barriers change,
RL can adjust message targeting. RL can detect when messages are sent too
frequently causing burnout.
CONCLUSIONS: RL systems could make mHealth services more effective.
DOI: 10.1007/s12160-014-9634-7
PMCID: PMC4335096
1232. BMC Infect Dis. 2018 Mar 5;18(1):104. doi: 10.1186/s12879-018-3019-7.
Treatment outcomes and factors affecting unsuccessful outcome among new pulmonary
smear positive and negative tuberculosis patients in Anqing, China: a
retrospective study.
Wen Y(1), Zhang Z(2), Li X(2), Xia D(3), Ma J(3), Dong Y(3), Zhang X(3).
Author information:
(1)School of Laboratory Medicine, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, People's Republic of China. wyf@wnmc.edu.cn.
(2)Tuberculosis Prevention and Control Department, Anqing Center for Disease
Control and Prevention, Anqing City, Anhui Province, 246003, People's Republic of
China.
(3)School of Laboratory Medicine, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, People's Republic of China.
BACKGROUND: Monitoring the treatment outcomes of tuberculosis and determining the

specific factors associated with unsuccessful treatment outcome are essential to
evaluate the effectiveness of tuberculosis control program. This study aimed to
assess treatment outcomes and explore the factors associated with unsuccessful
outcomes among new pulmonary smear positive and negative tuberculosis patients in
Anqing, China.
METHODS: A nine-year retrospective study was conducted using data from Anqing
Center for Diseases Prevention and Control. New pulmonary tuberculosis patients
treated with two six-month regimens were investigated. Non-conditional logistic
regression was performed to calculate odds ratios and 95% confidence intervals
for factors associated with unsuccessful outcomes.
RESULTS: Among 22,998 registered patients (16,939 males, 6059 females), 64.54%
were smear-positive patients. The treatment success rates was 95.02% for
smear-positive patients and 95.00% for smear-negative patients. Characteristics
associated with an higher risk of unsuccessful treatment among smear-positive
patients included aged above 35 years, treatment management model of
self-medication, full-course management and supervision in intensive phase,
unchecked chest X-ray, cavity in chest X-ray, and miliary shadow in chest X-ray,
while normal X-ray was negative factor. Unsuccessful treatment among
smear-negative patients was significantly associated with age over 45 years,
treatment management model of full-course management, unchecked chest X-ray,
presence of miliary shadow in chest X-ray and delay over 51 days.
CONCLUSIONS: Tuberculosis treatment in Anqing area was successful and independent
of treatment regimens. Special efforts are required for patients with
unsuccessful outcomes.
DOI: 10.1186/s12879-018-3019-7
PMCID: PMC5836329
A Systematic Review of Health Literacy Interventions for People Living with HIV.
Perazzo J(1), Reyes D(2), Webel A(3).
Author information:
(1)Frances Payne Bolton School of Nursing, Case Western Reserve University, 2120
Cornell Road, Cleveland, OH, USA. jdp118@case.edu.
(2)School of Nursing, Rutgers University, Newark, NJ, USA.
(3)Frances Payne Bolton School of Nursing, Case Western Reserve University, 2120
Cornell Road, Cleveland, OH, USA.
Health literacy significantly impacts health-related outcomes among people living

with HIV. Our aim was to systematically review current literature on health
literacy interventions for people living with HIV. The authors conducted a
thorough literature search following the PRISMA statement and the AMSTAR
checklist as a guide, and found six studies that met inclusion/exclusion
criteria. The majority of these interventions were designed to improve HIV
treatment adherence as well as HIV knowledge and treatment-related skills, with
one study focusing on e-Health literacy. Several of the studies demonstrated
trends toward improvement in medication adherence, but most did not achieve
statistical significance primarily due to methodological limitations. Significant
improvements in knowledge, behavioral skills, and e-Health literacy were found
following interventions (p = 0.001-0.05). Health literacy interventions have the
potential to promote HIV-related knowledge, behavioral skills, and
self-management practices. More research is needed to assess the efficacy of
interventions to promote a variety of self-management practices.
DOI: 10.1007/s10461-016-1329-6
PMCID: PMC5484044

eCollection 2016.
Avoiding Treatment Interruptions: What Role Do Australian Community Pharmacists

Play?
Abukres SH(1), Hoti K(1)(2), Hughes JD(1).
Author information:
(1)School of Pharmacy, Curtin University, Perth, Western Australia, Australia.
(2)Faculty of Medicine, Pharmacy Department, University of Prishtina, Prishtina,
Kosovo.
OBJECTIVE: To explore the reported practice of Australian community pharmacists

when dealing with medication supply requests in absence of a valid prescription.
METHODS: Self-administered questionnaire was posted to 1490 randomly selected
community pharmacies across all Australian states and territories. This sample
was estimated to be a 20% of all Australian community pharmacies.
RESULTS: Three hundred eighty five pharmacists participated in the study
(response rate achieved was 27.9% (there were 111 undelivered questionnaires).
Respondents indicated that they were more likely to provide medications to
regular customers without a valid prescription compared to non-regular customers
(p<0.0001). However, supply was also influenced by the type of prescription and
the medication requested. In the case of type of prescription (Standard,
Authority or Private) this relates to the complexity/probability of obtaining a
valid prescription from the prescriber at a later date (i.e. supply with an
anticipated prescription). Decisions to supply and/or not supply related to
medication type were more complex. For some cases, including medication with
potential for abuse, the practice and/or the method of supply varied
significantly according to age and gender of the pharmacist, and pharmacy
location (p<0.05).
CONCLUSIONS: Although being a regular customer does not guarantee a supply,
results of this study reinforce the importance for patients having a regular
pharmacy, where pharmacists were more likely to continue medication supply in
cases of patients presenting without a valid prescription. We would suggest, more
flexible legislation should be implemented to allow pharmacists to continue
supplying of medication when obtaining a prescription is not practical.
PMCID: PMC4865180
1235. Am J Pharm Educ. 2017 Aug;81(6):117. doi: 10.5688/ajpe816117.

A Team, Case-based Examination and Its Impact on Student Performance in a Patient
Safety and Informatics Course.
Beckett RD(1), Etheridge K(1), DeLellis T(2).
Author information:
(1)Manchester University College of Pharmacy, Natural and Health Sciences, Fort
Wayne, Indiana.
(2)Dupont Hospital, Fort Wayne, Indiana.
Objective. To describe the redesigned assessment plan for a patient safety and
informatics course and assess student pharmacist performance and perceptions.
Methods. The final examination of a patient safety course was redesigned from
traditional multiple choice and short answer to team-based, open-ended, and
case-based. Faculty for each class session developed higher level activities,
focused on developing key skills or attitudes deemed essential for practice, for
a progressive patient case consisting of nine activities. Student performance and
perceptions were analyzed with pre- and post-surveys using 5-point scales.
Results. Mean performance on the examination was 93.6%; median scores for each
assessed course outcome ranged from 90% to 100%. Eighty-five percent of students
completed both surveys. Confidence performing skills and demonstrating attitudes
improved for each item on post-survey compared with pre-survey. Eighty-one
percent of students indicated the experience of taking the examination was
beneficial for their professional development. Conclusion. A team, case-based
examination was associated with high student performance and improved
self-confidence in performing medication safety-related skills.
DOI: 10.5688/ajpe816117
PMCID: PMC5607727
1236. Dermatol Online J. 2017 Apr 15;23(4). pii: 13030/qt26d525z5.
Web app based patient education in psoriasis - a randomized controlled trial.
Hawkins SD(1), Barilla S, Feldman SR.
Author information:
(1)Department of Dermatology, Wake Forest School of Medicine, Winston-Salem,
North Carolina. spencerhawkins@gmail.com.
PURPOSE: Patients report wanting more information about psoriasis and clear
expectations from the onset of therapy. Dermatologists do not think patients
receive or internalize adequate information. There isa need for further
explanation of treatment regimens to increase knowledge, compliance, and patient
satisfaction. Recent advancements in web technology have the potential to improve
these psoriasis outcomes.
METHODS: A web based application was created to educate psoriasis patients using
video, graphics, and textual information. An investigator blinded, randomized,
controlled study evaluated the website's efficacy in 50 psoriasis patients at
Wake Forest Baptist Health Dermatology. Patients were randomized into two groups:
Group 1 received a link to the educational web app and a survey following their
visit; Group 2 received a link to the survey with no educational web app. The
survey assessed patient knowledge, self reported adherence to medication, and
adequacy of addressing concerns. Twenty two patients completed the study.
RESULTS: Patients in the web app group scored an average of 11/14 on the
psoriasis knowledge quiz, whereas patients in the control group scored an average
of 9/14 for an improvement of roughly 18% (p=0.008, n=22).
CONCLUSION: Web app based education via DermPatientEd.Com is an efficient way to
improve knowledge, but we did not demonstrate improvements in self-reported
medication adherence or the ability to address concerns of psoriasis patients.
1237. Trop Med Health. 2019 Jan 25;47:10. doi: 10.1186/s41182-019-0140-2.

eCollection
2019.
Malaria among foreign migrant workers in Savannakhet Province, Lao People's

Democratic Republic.
Pongvongsa T(1)(2), Nonaka D(2)(3), Iwagami M(2)(4)(5), Soundala P(2)(5),

Khattignavong P(2)(5), Xangsayarath P(2)(6), Nishimoto F(7), Kobayashi J(2)(3),
Hongvanthon B(2)(8), Brey PT(2)(5), Kano S(2)(4).
Author information:
(1)Savannakhet Provincial Health Department, Phonsavangnuea village,
Kaysone-Phomvihan district, Savannakhet, Lao PDR.
(2)SATREPS Project for Parasitic Diseases, Vientiane Capital, Lao PDR.
(3)3Department of Global Health, School of Health Sciences, University of the
Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215 Japan.
(4)4Department of Tropical Medicine and Malaria, Research Institute, National
Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo,
162-8655 Japan.
(5)5Institut Pasteur du Laos, Ministry of Health, Sisattanak district, Vientiane
Capital, Lao PDR.
(6)6National Center for Laboratory and Epidemiology, Ministry of Health,
Sisattanak district, Vientiane Capital, Lao PDR.
(7)7Graduate School of International Health Development, Nagasaki University,
1-12-4 Sakamoto, Nagasaki-shi, Nagasaki, 852-8523 Japan.
(8)8Center of Malariology, Parasitology and Entomology, Ministry of Health,
Sisattanak district, Vientiane Capital, Lao PDR.
Background: Although mobile and migrant populations are considered an important

group in malaria elimination settings, there is currently a lack of understanding
about foreign migrant workers in the Lao People's Democratic Republic (Lao PDR).
The present study aimed to document the migration characteristics, positive rate
of malaria infection, and preventive and treatment-seeking behavior for malaria
among foreign migrant workers in the malaria-endemic districts of Savannakhet
province, Lao PDR.
Methods: A community-based survey was undertaken in four districts of Savannakhet
province between February and June, 2015. Questionnaire-based interviews and
blood examinations, including rapid diagnostic tests and PCR assays, were
conducted with 391 migrant workers who were registered at local police
departments.
Results: Most of the study participants were men (75.7%) and Vietnamese (92.6%).
The median age (interquartile range) was 31 (25 to 41) years old. Most common
occupation was factory worker (47.6%), followed by trader/shopkeeper (21.5%) and
plantation worker/farmer (16.4%). The median length of stay (interquartile range)
in the districts was 405 (183 to 1207) days. The majority of the participants
(85.9%) had not worked in a province other than the study province, nor had the
majority (92.6%) worked in a foreign country other than the Lao PDR. Although
most of the participants (62.7%) reportedly used a bed net daily, these nets were
mostly conventional untreated ones. No one tested positive for malaria. However,
10.0% of the participants reported a malaria-like illness episode that had
occurred in the Lao PDR. The most common measure taken for the episode was to
visit a hospital/health center in the Lao PDR, followed by conducting
self-medication alone. Forty-one participants reported an experience of working
in the forest while living in the Lao PDR.
Conclusions: Foreign migrant workers who are registered at local police
departments are unlikely to play a major role in maintaining local transmissions
and spreading drug-resistant malaria in the study province. However, some of them
were involved in forest-related activities, suggesting that these workers are
potentially at risk of malaria. The Lao National Malaria Control Program should
educate foreign migrant workers about the risk of malaria when living in Lao PDR.
DOI: 10.1186/s41182-019-0140-2
PMCID: PMC6346530
PMID: 30700969
Conflict of interest statement: The protocol for the present study was approved
by the National Ethics Committee for Health Research, Ministry of Health, Lao PDR
(No. 003/2015). Prior to the survey, surveyors explained to the participants the
details of this study, such as its purpose, that participation was voluntary, the
information that would be collected, and how data would be kept and managed.
Written informed consent was obtained from each respondent.Not applicable.The
authors declare that they have no competing interests.Springer Nature remains
neutral with regard to jurisdictional claims in published maps and institutional
affiliations.

10.1002/14651858.CD009957.pub2.
Antibiotics for infection prevention after excision of the cervical

transformation zone.
Kietpeerakool C(1), Chumworathayi B(1), Thinkhamrop J(1), Ussahgij B(2),

Lumbiganon P(1).
Author information:
(1)Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen
University, 123 Mitraparb Road, Amphur Muang, Khon Kaen, Thailand, 40002.
(2)Medical Library, Faculty of Medicine, Khon Kaen University, 123 Mittraparp
Highway, Khon Kaen, Thailand, 40002.
BACKGROUND: Excision of the transformation zone of the cervix is the most

commonly used approach to treat cervical precancerous lesions (cervical
intraepithelial neoplasia (CIN)) to reduce the risk of developing cervical
cancer. As the excision of the transformation zone leaves a raw area on the
cervix, there is a risk of infection following the procedure. The incidence of
infection after cold knife conization (CKC) is 36%, whereas the incidence for
large loop excision of the transformation zone (LLETZ, also known as loop
electrical excision procedure (LEEP)) is much lower (0.8% to 14.4%). Prophalytic
antibiotics may prevent an infection developing and are often prescribed for CKC.
However, there are no formal recommendations regarding the use of prophylactic
antibiotics for infection prevention in women undergoing surgical excisional
treatment for cervical precancerous lesions.
OBJECTIVES: To evaluate the effectiveness and safety of antibiotics for infection
prevention following excision of the cervical transformation zone.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (2016, Issue 4), MEDLINE, Embase, LILACS to May 2016. We also checked
registers of clinical trials, citation lists of included studies, key textbooks
and previous systematic reviews for potentially relevant studies SELECTION
CRITERIA: We included randomised controlled trials (RCTs) evaluating the
effectiveness and safety of prophylactic antibiotics versus a placebo or no
treatment in women having excision of the cervical transformation zone,
regardless of the type of surgical excisional method used.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected
by Cochrane. Two review authors independently selected potentially relevant
trials, extracted data, and assessed risk of bias, compared results and resolved
disagreements by discussion. We contacted investigators for additional data,
where possible.
MAIN RESULTS: Of the 370 records that we identified as a result of the search
(excluding duplicates), we regarded six abstracts and titles as potentially
relevant studies. Of these six studies, three met the inclusion criteria
involving 708 participants; most trials were at moderate or high risk of bias
(risk mainly due to lack of blinding and high rate of incomplete data). We did
not identify any ongoing trials. Although all included studies had been published
in peer-reviewed journals at the time of the search and data extraction,
numerical data regarding the outcome measured in one trial involving 77
participants were insufficient for inclusion in a meta-analyses.The difference in
the rates of prolonged vaginal discharge or presumed cervicitis (one study; 348
participants; risk ratio (RR), 1.29; 95% confidence interval (CI) 0.72 to 2.31;
low-quality evidence) and severe vaginal bleeding (two studies; 638 participants;
RR 1.21; 95% CI 0.52 to 2.82; very low-quality evidence) among the two comparison
groups did not reach the level for clinically important effect. In addition,
there was no difference in adverse events related to antibiotics i.e.
nausea/vomiting, diarrhoea, and headache among the two comparison groups (two
studies; 638 participants; RR 1.69; 95% CI 0.85 to 3.34; very low-quality
evidence). There were no differences in the incidence of fever (RR, 2.23; 95% CI
0.20 to 24.36), lower abdominal pain (RR, 1.03; 95% CI 0.61 to 1.72), unscheduled
medical consultation (RR 2.68, 95% CI 0.97 to 7.41), and additional
self-medication (RR 1.22; 95% CI 0.56 to 2.67) between the two comparison groups
(one study; 290 participants; low to very low-quality evidence).
AUTHORS' CONCLUSIONS: As only limited data are available from three trials with
overall moderate to high risk of bias, there is insufficient evidence to support
use of antibiotics to reduce infectious complications following excision of the
cervical transformation zone. In addition, there were minimal data about
antibiotic-related adverse events and no information on the risk of developing
antibiotic resistance. Antibiotics given for infection prevention after excision
of the cervical transformation zone should only be used in the context of
clinical research, to avoid unnecessary prescription of antibiotics and to
prevent further increases in antibiotic resistance.
DOI: 10.1002/14651858.CD009957.pub2
PMCID: PMC6464760

eCollection 2015.
Complex antithrombotic therapy: determinants of patient preference and impact on

Abraham NS(1), Naik AD(2), Street RL Jr(3), Castillo DL(4), Deswal A(5),
Richardson PA(2), Hartman CM(4), Shelton G Jr(2), Fraenkel L(6).
Author information:
(1)Division of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA ; Divison of
Healthcare Policy and Research, Department of Health Services Research,
Rochester, MN, USA.
(2)Center for Innovations in Quality, Effectiveness, and Safety at the Michael E
DeBakey VA Medical Center, Houston, TX, USA ; Department of Medicine, Baylor
College of Medicine, Houston, TX, USA.
DeBakey VA Medical Center, Houston, TX, USA ; Department of Medicine, Baylor
College of Medicine, Houston, TX, USA ; Department of Communication, Texas A&M
University, College Station, TX, USA.
DeBakey VA Medical Center, Houston, TX, USA.
(5)Cardiology, Michael E DeBakey VAMC, Houston, TX, USA.
(6)Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA ;
Department of Medicine, Yale University, New Haven, CT, USA.
PURPOSE: For years, older patients have been prescribed multiple blood-thinning
medications (complex antithrombotic therapy [CAT]) to decrease their risk of
cardiovascular events. These therapies, however, increase risk of adverse
bleeding events. We assessed patient-reported trade-offs between cardioprotective
benefit, gastrointestinal bleeding risk, and burden of self-management using
adaptive conjoint analysis (ACA). As ACA could be a clinically useful tool to
obtain patient preferences and guide future patient-centered care, we examined
the clinical application of ACA to obtain patient preferences and the impact of
ACA on medication adherence.
PATIENTS AND METHODS: An electronic ACA survey led 201 respondents through
medication risk-benefit trade-offs, revealing patients' preferences for the CAT
risk/benefit profile they valued most. The post-ACA prescription regimen was
categorized as concordant or discordant with elicited preferences. Adherence was
measured using VA pharmacy refill data to measure persistence of use prior to and
1 year following preference-elicitation. Additionally, we analyzed qualitative
interviews of 56 respondents regarding their perception of the ACA and the
preference elicitation experience.
RESULTS: Participants prioritized 5-year cardiovascular benefit over preventing
adverse events. Medication side effects, medication-associated activity
restrictions, and regimen complexity were less important than bleeding risk and
cardioprotective benefit. One year after the ACA survey, a 15% increase in
adherence was observed in patients prescribed a preference-concordant CAT
strategy. An increase of only 6% was noted in patients prescribed a
preference-discordant strategy. Qualitative interviews showed that the ACA
exercise contributed to increase inpatient activation, patient awareness of
preferences, and patient engagement with clinicians about treatment decisions.
CONCLUSION: By working through trade-offs, patients actively clarified their
preferences, learning about CAT risks, benefits, and self-management. Patients
with medication regimens concordant with their preferences had increased
medication adherence at 1 year compared to those with discordant medication
regimens. The ACA task improved adherence through enhanced patient engagement
regarding treatment preferences.
DOI: 10.2147/PPA.S91553
PMCID: PMC4657793
PMID: 26640372
1240. Ophthalmology. 2015 Apr;122(4):748-54. doi: 10.1016/j.ophtha.2014.11.001.

Epub
2014 Dec 24.
Ophthalmologist-patient communication, self-efficacy, and glaucoma medication

adherence.
Sleath B(1), Blalock SJ(2), Carpenter DM(2), Sayner R(2), Muir KW(3), Slota C(2),
Lawrence SD(4), Giangiacomo AL(5), Hartnett ME(6), Tudor G(7), Goldsmith JA(6),
Robin AL(8).
Author information:
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Cecil
G. Sheps Center for Health Services Research, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina. Electronic address:
betsy_sleath@unc.edu.
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
(3)Department of Ophthalmology, School of Medicine, Duke University, and Durham
VA Medical Center, Health Services Research and Development, Durham, North
Carolina.
(4)Glaucoma Service, Kittner Eye Center, University of North Carolina at Chapel
Hill, Chapel Hill, North Carolina.
(5)Department of Ophthalmology, Emory University School of Medicine, Atlanta,
Georgia.
University of Utah, Salt Lake City, Utah.
(7)Department of Science and Mathematics, Husson University, Bangor, Maine.
(8)Department of Ophthalmology, University of Maryland, Baltimore, Maryland;
Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan;
Department of International Health, Bloomberg School of Public Health, and
Department of Ophthalmology, School of Medicine, Johns Hopkins University,
OBJECTIVE: To examine the associations of provider-patient communication,

glaucoma medication adherence self-efficacy, and outcome expectations with
glaucoma medication adherence.
DESIGN: Prospective, observational cohort study.
PARTICIPANTS: Two hundred seventy-nine patients with glaucoma who were newly
prescribed or taking glaucoma medications were recruited at 6 ophthalmology
clinics.
METHODS: Patients' visits were video recorded and communication variables were
coded using a detailed coding tool developed by the authors. Adherence was
measured using Medication Event Monitoring Systems for 60 days after their
visits.
MAIN OUTCOME MEASURES: The following adherence variables were measured for the
60-day period after their visits: whether the patient took 80% or more of the
prescribed doses, percentage of the correct number of prescribed doses taken each
day, and percentage of the prescribed doses taken on time.
RESULTS: Higher glaucoma medication adherence self-efficacy was associated
positively with better adherence with all 3 measures. Black race was associated
negatively with percentage of the correct number of doses taken each day (β =
-0.16; P < 0.05) and whether the patient took 80% or more of the prescribed doses
(odds ratio, 0.37; 95% confidence interval, 0.16-0.86). Physician education about
how to administer drops was associated positively with percentage of the correct
number of doses taken each day (β = 0.18; P < 0.01) and percentage of the
prescribed doses taken on time (β = 0.15; P < 0.05).
CONCLUSIONS: These findings indicate that provider education about how to
administer glaucoma drops and patient glaucoma medication adherence self-efficacy
are associated positively with adherence.
Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc.

DOI: 10.1016/j.ophtha.2014.11.001
PMCID: PMC4994530
Conflict of interest statement: Drs. Sleath, Blalock, Carpenter, Muir, Sayner,

Giangiacomo, and Slota indicate no conflict of interest.
1241. BMC Womens Health. 2018 Mar 19;18(1):48. doi: 10.1186/s12905-018-0522-3.
Relationships between determinants of adjuvant endocrine therapy adherence in

breast cancer.
Lee JY(1), Min YH(2).
Author information:
(1)College of Nursing, Gachon University, 191 Hambakmeo-ro, Yeonsu-gu, Incheon,
21936, South Korea.
(2)College of Nursing, Gachon University, 191 Hambakmeo-ro, Yeonsu-gu, Incheon,
21936, South Korea. yulhamin@gmail.com.
BACKGROUND: Interventions that promote adjuvant endocrine therapy (AET) adherence

are critical to improve breast cancer survival. The development of interventions
would benefit from a better understanding of the reasons for adherence and the
causal relationships of determinants using theoretical or model approaches. The
aim of the present study was to identify reasons for AET adherence in breast
cancer patients with sequential relationships and inter-relationships.
METHODS: A total of 210 participants with estrogen receptor positive breast
cancer who received AET completed a questionnaire assessing demographic/medical,
psychological, and endocrine therapy (ET)-specific factors. A descriptive
analysis was performed to identify meaningful variables. Selected variables were
subjected to hierarchical regression and path analyses. The path model was tested
and modified based on the research framework and the results of regression
weights and model fit.
RESULTS: Analysis of sequential effects showed that ET-specific factors
contributed the largest proportion of variance (13.4%) to predict AET adherence,
followed by psychological factors (4.6%) and demographic/medical factors (3.1%).
Analysis of inter-relationships showed that demographic/medical factors such as
AET regimen type and cancer stage have direct effects on AET adherence, whereas
psychological factors contribute indirectly through the mediating effects of
ET-specific factors.
CONCLUSION: Assessments and interventions that encompass the patient's medication
beliefs, self-efficacy, and depression are needed to promote AET adherence.
DOI: 10.1186/s12905-018-0522-3
PMCID: PMC5858147
1242. AIDS Behav. 2016 May;20(5):1049-59. doi: 10.1007/s10461-015-1192-x.
A Randomized Controlled Trial of Personalized Text Message Reminders to Promote

Medication Adherence Among HIV-Positive Adolescents and Young Adults.
Garofalo R(1)(2), Kuhns LM(3)(4), Hotton A(5), Johnson A(3)(6), Muldoon A(3),
Rice D(3).
Author information:
(1)Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital,
225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA.
rgarofalo@luriechildrens.org.
(2)Department of Pediatrics, Northwestern University, Feinberg School of
Medicine, Chicago, IL, USA. rgarofalo@luriechildrens.org.
(3)Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital,
225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA.
(4)Department of Pediatrics, Northwestern University, Feinberg School of
Medicine, Chicago, IL, USA.
(5)Division of Infectious Diseases, John H. Stroger Hospital of Cook County,
Chicago, IL, USA.
(6)AIDS Foundation of Chicago, Chicago, IL, USA.
HIV-positive adolescents and young adults often experience suboptimal medication

adherence, yet few interventions to improve adherence in this group have shown
evidence of efficacy. We conducted a randomized trial of a two-way, personalized
daily text messaging intervention to improve adherence to antiretroviral therapy
(ART) among N = 105 poorly adherent HIV-positive adolescents and young adults,
ages 16-29. Adherence to ART was assessed via self-reported visual analogue scale
(VAS; 0-100 %) at 3 and 6-months for mean adherence level and proportion ≥90 %
adherent. The average effect estimate over the 6-month intervention period was
significant for ≥90 % adherence (OR = 2.12, 95 % CI 1.01-4.45, p < .05) and
maintained at 12-months (6 months post-intervention). Satisfaction scores for the
intervention were very high. These results suggest both feasibility and initial
efficacy of this approach. Given study limitations, additional testing of this
intervention as part of a larger clinical trial with objective and/or clinical
outcome measures of adherence is warranted.
DOI: 10.1007/s10461-015-1192-x
PMCID: PMC4788595
1243. J Dev Behav Pediatr. 2014 Oct;35(8):486-93. doi:

10.1097/DBP.0000000000000093.
Effects of family treatment on parenting beliefs among caregivers of youth with

poorly controlled asthma.
Ellis DA(1), King P, Naar-King S, Lam P, Cunningham PB, Secord E.
Author information:
(1)*Carman and Ann Adams Department of Pediatrics, Wayne State University,
Detroit, MI; †Department of Psychiatry, Medical University of South Carolina,
Charleston, SC.
OBJECTIVE: Caregiver involvement is critical in ensuring optimal adolescent

asthma management. The study investigated whether multisystemic therapy (MST), an
intensive home-based family therapy, was superior to family support for changing
beliefs regarding asthma-related positive parenting among caregivers of
African-American youth with poorly controlled asthma. The relationship between
parenting beliefs and asthma management at the conclusion of the intervention was
also assessed.
METHODS: A randomized controlled trial was conducted with 167 adolescents with
moderate-to-severe, persistent, poorly controlled asthma and their primary
caregivers. Families were randomly assigned to MST or family support (FS), a
home-based family support condition. Data were collected at baseline and 7-month
posttest. Changes in caregiver ratings of importance and confidence for engaging
in asthma-related positive parenting were assessed through questionnaire. Illness
management was assessed by the Family Asthma Management System Scale.
RESULTS: Participation in MST was associated with more change in caregiver
beliefs as compared with FS for both importance (t = 2.39, p = .02) and
confidence (t = 2.04, p = .04). Caregiver beliefs were also significantly related
to youth controller medication adherence at the conclusion of treatment
(importance: r = .21, p = .01; confidence: r = .23, p = .004).
CONCLUSION: Results support the effectiveness of MST for increasing parental
beliefs in the value of asthma-related positive parenting behaviors and parental
self-efficacy for these behaviors among families of minority adolescents with
poorly controlled asthma.
DOI: 10.1097/DBP.0000000000000093
PMCID: PMC4180784
1244. Intern Med J. 2018 Apr;48(4):414-421. doi: 10.1111/imj.13687.
Barriers to medication adherence and links to cardiovascular disease risk factor

control: the Framingham Heart Study.
Hennein R(1)(2), Hwang SJ(1)(2), Au R(3)(4)(5), Levy D(1)(2), Muntner P(6), Fox
CS(1)(2)(7), Ma J(1)(2).
Author information:
(1)Framingham Heart Study, Framingham, Massachusetts, USA.
(2)Population Sciences Branch, Division of Intramural Research, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland,
USA.
(3)Department of Neurology, Boston University School of Medicine, Boston,
Massachusetts, USA.
(4)Department of Anatomy and Neurobiology, Boston University School of Medicine,
Boston, Massachusetts, USA.
(5)Department of Epidemiology, Boston University School of Public Health, Boston,
Massachusetts, USA.
Alabama, USA.
(7)Department of Genetics and Pharmacogenomics, Merck Research Labs, Boston,
Massachusetts, USA.
BACKGROUND: In the elderly, impaired cognition may weaken medication adherence

and compromise treatment for cardiovascular disease (CVD).
AIM: We examined risk factors for medication adherence and the relationship
between adherence and levels of CVD risk factors among older participants with
hypertension, dyslipidaemia and diabetes in the Framingham Heart Study.
METHODS: The four-item Morisky Medication Adherence Scale was administered to
1559 participants, median age 70 years, 53% women. We created an adherence score,
ranging from 0 to 4, with low adherence defined as a score ≥2. CVD risk factors
were assessed using standard protocols. Cognition was measured using the
Mini-Mental State Examination (MMSE) and depressive symptoms were measured using
the Center for Epidemiologic Studies of Depression (CES-D) scale.
RESULTS: Among participants who self-reported taking antihypertensive,
lipid-lowering and/or hyperglycaemic medication(s), 12% (n = 191) had low
medication adherence. The risk of low adherence increased by 45% (95% confidence
interval (CI): 25-68%, P < 0.001) per five-unit increase in CES-D score. In
participants taking antihypertensive medication (n = 1017), low adherence was
associated with higher mean diastolic blood pressure (73 mmHg, 95% CI: 71-75 vs
71 mmHg, 95% CI: 70-71; P = 0.04) after adjusting for covariates. Among
participants taking lipid-lowering medication (n = 937), low adherence was
associated with higher mean low-density lipoprotein cholesterol (92 mg/dL, 95%
CI: 87-96 vs 86 mg/dL, 95% CI: 84-88; P = 0.03). Low adherence was not associated
with fasting plasma glucose (P = 0.10) or haemoglobin A1c (P = 0.68) in the
subgroup of participants (n = 192) taking hypoglycaemic medication.
CONCLUSIONS: Depressive symptoms might act as a barrier for medication adherence,
which exacerbates CVD risk factors in older-aged adults.
© 2017 Royal Australasian College of Physicians. This article has been

contributed to by US Government employees and their work is in the public domain
in the USA.
DOI: 10.1111/imj.13687
PMCID: PMC5889324
1245. BMC Health Serv Res. 2015 Aug 17;15:332. doi: 10.1186/s12913-015-0998-6.
The effects of patient education programs on medication use among asthma and COPD
patients: a propensity score matching with a difference-in-difference regression
approach.
Sari N(1), Osman M(2).
Author information:
(1)Department of Economics, University of Saskatchewan, S7N5A5, Saskatoon, SK,
Canada. Nazmi.Sari@usask.ca.
(2)Saskatchewan Health Quality Council, Saskatoon, Canada. mosman@hqc.sk.ca.
BACKGROUND: Adherence to medication is one of the critical determinants of

successful management of chronic diseases including asthma and chronic
obstructive pulmonary disease (COPD). Given that poor adherence with
self-management medication is very common among asthma and COPD patients,
interventions that improve the use of chronic disease management medications for
this patient group have potential to generate positive health outcomes. In an
effort to improve asthma and COPD care, the Lung Association of Saskatchewan has
implemented an intervention by providing access to effective and high quality
asthma and COPD education for both patients and health care professionals along
with increasing access to spirometry. By evaluating the impacts of this
intervention, our purpose in this paper is to examine the effectiveness of
spirometry use, and asthma and COPD education in primary care setting on
medication use among asthma and COPD patients.
METHODS: At the time of the intervention, the Lung Association of Saskatchewan
has not assigned a control group. Therefore we used a propensity score matching
to create a control group using administrative health databases spanning 6 years
prior to the intervention. Using Saskatchewan administrative health databases,
the impacts of the intervention on use of asthma and COPD medications were
estimated for one to four years after the intervention using a difference in
difference regression approach.
RESULTS: The paper shows that overall medication use for the intervention group
is higher than that of the control group. On average, intervention group uses
more asthma and COPD drugs. Within the asthma and COPD drugs, this intervention
creates a persistent effect over time in the form of higher utilization of
chronic management drugs equivalent to $157 and $195 in a given year during four
years after the intervention.
CONCLUSIONS: The study suggests that effective patient education and increasing
access to spirometry increases the utilization of chronic disease management
drugs among asthma and COPD patients. This type of interventions with patient
education focus has potential to save healthcare dollars by providing better
disease management among this patient group.
DOI: 10.1186/s12913-015-0998-6
PMCID: PMC4537780
1246. AMB Express. 2019 Jun 21;9(1):91. doi: 10.1186/s13568-019-0817-2.
Development of high-throughput quantitative analytical method for

L-cysteine-containing dipeptides by LC-MS/MS toward its fermentative production.
Kawano Y(1)(2)(3), Shiroyama M(1), Kanazawa K(4), Suzuki YA(4), Ohtsu I(5)(6)(7).
Author information:
(1)Graduate School of Life and Environmental Sciences, University of Tsukuba,
Tsukuba, Japan.
(2)Microbiology Research Center for Sustainability, University of Tsukuba,
Tsukuba, Japan.
(3)Euglena Co., Ltd, Tokyo, Japan.
(4)Biochemical Laboratory, Saraya Co. Ltd, Kashiwara, Japan.
(5)Graduate School of Life and Environmental Sciences, University of Tsukuba,
Tsukuba, Japan. ohtsu.iwao.fm@u.tsukuba.ac.jp.
(6)Microbiology Research Center for Sustainability, University of Tsukuba,
Tsukuba, Japan. ohtsu.iwao.fm@u.tsukuba.ac.jp.
(7)Euglena Co., Ltd, Tokyo, Japan. ohtsu.iwao.fm@u.tsukuba.ac.jp.
L-Cysteine (Cys) is metabolically fundamental sulfur compound and important

components in various cellular factors. Interestingly, free-form Cys itself as a
simple monomeric amino acid was recently shown to function in a novel
antioxidative system (cysteine/cystine shuttle system) in Escherichia coli.
However, as for Cys-containing dipeptides, the biological functions, effects, and
even contents have still remained largely elusive. The potential functions should
be a part of cellular redox system and important in basic and applied biology.
For its progress, establishment of reliable quantitation method is the first.
However, such accurate analysis is unexpectedly difficult even in Cys, because
thiol compounds convert through disulfide-exchange and air oxidation during
sample preparation. Addressing this problem, in this study, thiol molecules like
Cys-containing dipeptides were derivatized by using monobromobimane
(thiol-specific alkylating reagent) and detected as S-bimanyl derivatives by
liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). Sample
separation was processed with a C18 column (2.1 mm × 150 mm, 1.7 μm) and with
water-acetonitrile gradient mobile phase containing 0.1% (v/v) formic acid at
flow rate of 0.25 ml/min. The mass spectrometer was operated in the multiple
reaction monitoring in positive/negative mode with electrospray ionization. The
derivatization could indeed avoid the unfavorable reactions, namely, developed
the method reflecting their correct contents on sampling. Furthermore, the method
was successfully applied to monitoring Cys-containing dipeptides in E. coli Cys
producer overexpressing bacD gene. This is the first report of the quantitative
analysis of Cys-containing dipeptides, which should be useful for further study
of fermentative production of Cys-containing dipeptides.
DOI: 10.1186/s13568-019-0817-2
PMCID: PMC6588663
PMID: 31227937
1247. J Youth Adolesc. 2018 Aug;47(8):1755-1770. doi: 10.1007/s10964-018-0860-3.

Epub
2018 May 17.
Different Kinds of Lonely: Dimensions of Isolation and Substance Use in
Adolescence.
Copeland M(1), Fisher JC(2), Moody J(2)(3), Feinberg ME(4).
Author information:
(1)Duke University, Durham, NC, USA. molly.copeland@duke.edu.
(2)Duke University, Durham, NC, USA.
(3)King Abdulaziz University, Jeddah, Saudi Arabia.
(4)The Pennsylvania State University, University Park, PA, 16801, USA.
Social isolation is broadly associated with poor mental health and risky
behaviors in adolescence, a time when peers are critical for healthy development.
However, expectations for isolates' substance use remain unclear. Isolation in
adolescence may signal deviant attitudes or spur self-medication, resulting in
higher substance use. Conversely, isolates may lack access to substances, leading
to lower use. Although treated as a homogeneous social condition for teens in
much research, isolation represents a multifaceted experience with structurally
distinct network components that present different risks for substance use. This
study decomposes isolation into conceptually distinct dimensions that are then
interacted to create a systematic typology of isolation subtypes representing
different positions in the social space of the school. Each isolated position's
association with cigarette, alcohol, and marijuana use is tested among 9th grade
students (n = 10,310, 59% female, 83% white) using cross-sectional data from the
PROSPER study. Different dimensions of isolation relate to substance use in
distinct ways: unliked isolation is associated with lower alcohol use, whereas
disengagement and outside orientation are linked to higher use of all three
substances. Specifically, disengagement presents risks for cigarette and
marijuana use among boys, and outside orientation is associated with cigarette
use for girls. Overall, the adolescents disengaged from their school network who
also identify close friends outside their grade are at greatest risk for
substance use. This study indicates the importance of considering the distinct
social positions of isolation to understand risks for both substance use and
social isolation in adolescence.
DOI: 10.1007/s10964-018-0860-3
PMCID: PMC6045973
1248. Addict Behav. 2016 Sep;60:64-70. doi: 10.1016/j.addbeh.2016.03.036. Epub 2016

Apr
2.
Directions of the relationship between substance use and depressive symptoms from
adolescence to young adulthood.
Wilkinson AL(1), Halpern CT(2), Herring AH(3).
Author information:
(1)Carolina Population Center, University of North Carolina at Chapel Hill, 206
West Franklin St., Room 208, Chapel Hill, NC 27516, United States; Department of
Maternal and Child Health, Gillings School of Global Public Health, University of
North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC
27599-7445, United States. Electronic address: wilkina@live.unc.edu.
Maternal and Child Health, Gillings School of Global Public Health, University of
North Carolina at Chapel Hill, 401 Rosenau Hall, CB #7445, Chapel Hill, NC
27599-7445, United States.
Biostatistics, Gillings School of Global Public Health, University of North
Carolina at Chapel Hill, 135 Dauer Drive, CB #7420, Chapel Hill, NC 27599-7420,
United States.
PURPOSE: Both substance use and depression are common in adolescence and often
comorbid. Past research has produced conflicting results on whether there is a
temporal relationship and if so, in which direction it operates and how it may
vary by sex. The purpose of this paper is to explore the longitudinal,
potentially bidirectional, relationships between high-frequency substance use and
depressive symptoms from adolescence into young adulthood for males and females.
METHODS: Using data from the National Longitudinal Study of Adolescent to Adult
Health we investigated longitudinal associations between high frequency substance
use (alcohol, cigarettes, and marijuana) and depressive symptoms. The linear
mixed effects models were stratified by sex and used a lagged measure of the
dependent variable to test temporal relationships. A random intercept was used
for respondent ID.
RESULTS: Increases in depressive symptoms were significantly associated with a
later increase of about a half day in marijuana use frequency for males and
nearly a two day increase in smoking frequency for females. Conversely, increases
in smoking frequency were significantly associated with approximately a 0.6-point
increase for females and 0.4-point increase for males in depressive symptoms at a
later wave.
CONCLUSIONS: Results indicate a bidirectional relationship between smoking and
depressive symptoms for females. For males, there was evidence supporting
self-medication with marijuana and for smoking being associated with later
increases in depressive symptoms. Results inform how substance use and depression
screening, prevention and treatment efforts should be paired and targeted for
males and females.
DOI: 10.1016/j.addbeh.2016.03.036
PMCID: PMC4884464
1249. BMC Nurs. 2016 Jul 18;15:43. doi: 10.1186/s12912-016-0165-3. eCollection

2016.
Medication administration error reporting and associated factors among nurses

working at the University of Gondar referral hospital, Northwest Ethiopia, 2015.
Bifftu BB(1), Dachew BA(2), Tiruneh BT(1), Beshah DT(1).
Author information:
(1)Department of Nursing, University of Gondar College of Medicine and Health
Science, P. O. Box: 196, Gondar, Ethiopia.
(2)Department of Epidemiology and Biostatistics, Institute of Public Health,
University of Gondar College of Medicine and Health Science, P. O. Box: 196,
Gondar, Ethiopia.
BACKGROUND: Medication administration is the final step/phase of medication

process in which its error directly affects the patient health. Due to the
central role of nurses in medication administration, whether they are the source
of an error, a contributor, or an observer they have the professional, legal and
ethical responsibility to recognize and report. The aim of this study was to
assess the prevalence of medication administration error reporting and associated
factors among nurses working at The University of Gondar Referral Hospital,
Northwest Ethiopia.
METHODS: Institution based quantitative cross - sectional study was conducted
among 282 Nurses. Data were collected using semi-structured, self-administered
questionnaire of the Medication Administration Errors Reporting (MAERs). Binary
logistic regression with 95 % confidence interval was used to identify factors
associated with medication administration errors reporting.
RESULTS: The estimated medication administration error reporting was found to be
29.1 %. The perceived rates of medication administration errors reporting for
non-intravenous related medications were ranged from 16.8 to 28.6 % and for
intravenous-related from 20.6 to 33.4 %. Education status (AOR =1.38, 95 % CI:
4.009, 11.128), disagreement over time - error definition (AOR = 0.44, 95 % CI:
0.468, 0.990), administrative reason (AOR = 0.35, 95 % CI: 0.168, 0.710) and fear
(AOR = 0.39, 95 % CI: 0.257, 0.838) were factors statistically significant for
the refusal of reporting medication administration errors at p-value <0.05.
CONCLUSION: In this study, less than one third of the study participants reported
medication administration errors. Educational status, disagreement over time -
error definition, administrative reason and fear were factors statistically
significant for the refusal of errors reporting at p-value <0.05. Therefore, the
results of this study suggest strategies that enhance the cultures of error
reporting such as providing a clear definition of reportable errors and
strengthen the educational status of nurses by the health care organization.
DOI: 10.1186/s12912-016-0165-3
PMCID: PMC4949890
PMID: 27436991
1250. J Asthma. 2016;53(3):301-10. doi: 10.3109/02770903.2015.1057846. Epub 2016

Jan
19.
Effectiveness of a multi-level asthma intervention in increasing controller

medication use: a randomized control trial.
Canino G(1), Shrout PE(2), Vila D(1), Ramírez R(1), Rand C(3).
Author information:
(1)a Behavioral Sciences Institute, University of Puerto Rico, Medical Sciences
Campus , San Juan , Puerto Rico .
(2)b Department of Psychology , New York University , New York , NY , USA , and.
(3)c The Johns Hopkins School of Medicine , Baltimore , MD , USA.
INTRODUCTION: Poor self-management by families is an important factor in

explaining high rates of asthma morbidity in Puerto Rico, and for this reason we
previously tested a family intervention called CALMA that was found effective in
improving most asthma outcomes, but not effective in increasing the use of
controller medications. CALMA-plus was developed to address this issue by adding
to CALMA, components of provider training and screening for asthma in clinics.
METHODS: Study participants were selected from claims Medicaid data in San Juan,
Puerto Rico. After screening, 404 children in eight clinics were selected after
forming pairs of clinics and randomizing the clinics) to CALMA-only or
CALMA-plus.
RESULTS: For all three primary outcomes at 12 months, the mean differences
between treatment arms were small but in the predicted direction. However, after
adjusting for clinic variation, the study failed to demonstrate that the
CALMA-plus intervention was more efficacious than the CALMA-only intervention for
increasing controller medication use, or decreasing asthma symptoms. Both groups
had lower rates of asthma symptoms and service utilization, consistent with
previous results of the CALMA-only intervention.
CONCLUSIONS: Compliance of providers with the intervention and training, small
number of clinics available and the multiple barriers experienced by providers
for medicating may have been related to the lack of difference observed between
the groups. Future interventions should respond to the limitations of the present
study design and provide more resources to providers that will increase provider
participation in training and implementation of the intervention.
DOI: 10.3109/02770903.2015.1057846
PMCID: PMC4811660
1251. Prev Med Rep. 2017 Feb 16;6:66-73. doi: 10.1016/j.pmedr.2017.02.010.

eCollection
2017 Jun.
Determinants of preferences for lifestyle changes versus medication and beliefs

in ability to maintain lifestyle changes. A population-based survey.
Jarbøl DE(1), Larsen PV(2), Gyrd-Hansen D(3), Søndergaard J(1), Brandt C(1),
Leppin A(4), Barfoed BL(1), Nielsen JB(1).
Author information:
(1)Research Unit of General Practice, Department of Public Health, University of
Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark.
(2)Research Unit of Epidemiology, Biostatistics and Biodemography, Department of
Public Health, University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000
Odense C, Denmark.
(3)COHERE, Department of Public Health & Department of Business and Economics,
University of Southern Denmark, J.B. Winsløws Vej 9, DK-5000 Odense C, Denmark.
(4)Unit for Health Promotion Research, Department of Public Health, University of
Southern Denmark, Niels Bohrs Vej 9, DK-6700 Esbjerg, Denmark.
Preferences for medication treatment versus lifestyle changes are of major

importance in the management of chronic diseases. This study aims to investigate
determinants of preference for lifestyle changes versus medication for prevention
of cardiovascular disease as well as determinants of respondents' beliefs in
their ability to maintain lifestyle changes. A representative sample of
40-60-year old Danish inhabitants was in 2012 invited to a survey and were asked
to imagine that they had been diagnosed as being at increased risk of heart
disease. Subsequently they were presented with a choice between a preventive
medical intervention versus lifestyle change. The study population for the
present paper comprises 1069 participants. A total of 962 participants preferred
lifestyle changes to medication treatment. Significant determinants for
preferring lifestyle changes were female gender and high level of physical
activity. Significant determinants for not opting for lifestyle changes were
being self-employed, poor self-rated health and smoking. Low educational
attainment, lifestyle risk factors, self-reported health-related challenges and
prior experience with heart disease were associated with a low belief in ability
to maintain lifestyle changes. For conclusion we found a pervasive preference for
lifestyle changes over medical treatment when individuals were promised the same
benefits. Lifestyle risk factors and socioeconomic characteristics were
associated with preference for lifestyle changes as well as belief in ability to
maintain lifestyle changes. For health professionals risk communication should
not only focus on patient preferences but also on patients' beliefs in their own
ability to initiate lifestyle changes and possible barriers against maintaining
changes.
DOI: 10.1016/j.pmedr.2017.02.010
PMCID: PMC5331161
PMID: 28271023
1252. AIDS Patient Care STDS. 2016 Jul;30(7):324-38. doi: 10.1089/apc.2015.0351.
Predictors and Profiles of Antiretroviral Therapy Adherence Among African

American Adolescents and Young Adult Males Living with HIV.
Gross IM(1), Hosek S(1), Richards MH(2), Fernandez MI(3).
Author information:
(1)1 Department of Psychiatry, John H. Stroger Hospital of Cook County , Chicago,
Illinois.
(2)2 Department of Psychology, Loyola University Chicago , Illinois.
(3)3 Nova Southeastern University , Fort Lauderdale, Florida.
Adherence to antiretroviral therapy (ART) is crucial for thwarting HIV disease

progression and reducing secondary HIV transmission, yet youth living with HIV
(YLH) struggle with adherence. The highest rates of new HIV infections in the
United States occur in young African American men. A sample of 387 HIV-positive
young African American males on ART was selected from a cross-sectional
assessment of (YLH) receiving medical care within the Adolescent Trials Network
for HIV/AIDS Interventions (ATN) from 2010 to 2012 (12-24 years old, median
22.00, SD 2.08). Participants completed self-reported adherence, demographic,
health, and psychosocial measures. Sixty-two percent self-reported 100% ART
adherence. Optimal data analysis identified frequency of cannabis use during the
past 3 months as the strongest independent predictor of adherence, yielding
moderate effect strength sensitivity (ESS) = 27.1, p < 0.001. Among participants
with infrequent cannabis use, 72% reported full adherence; in contrast, only 45%
of participants who used cannabis frequently reported full adherence.
Classification tree analysis (CTA) was utilized to improve classification
accuracy and to identify the pathways of ART adherence and nonadherence. The CTA
model evidenced a 38% improvement above chance for correctly classifying
participants as ART adherent or nonadherent. Participants most likely to be
adherent were those with low psychological distress and minimal alcohol use (82%
were adherent). Participants least likely to be adherent were those with higher
psychological distress and engaged in weekly cannabis use (69% were nonadherent).
Findings suggest multiple profiles of ART adherence for young African American
males living with HIV and argue for targeted psychosocial interventions.
DOI: 10.1089/apc.2015.0351
PMCID: PMC4948258
1253. BJOG. 2017 Dec;124(13):2001-2008. doi: 10.1111/1471-0528.14690. Epub 2017 Jun

14.
Self-management of first trimester medical termination of pregnancy: a

qualitative study of women's experiences.
Purcell C(1), Cameron S(2), Lawton J(3), Glasier A(4), Harden J(3).
Author information:
(1)MRC/CSO Social and Public Health Sciences Unit, University of Glasgow,
Glasgow, UK.
(2)Chalmers Centre for Sexual and Reproductive Health (NHS Lothian), Edinburgh,
UK.
(3)Usher Institute of Population Health Sciences and Informatics, University of
(4)Obstetrics and Gynaecology, Queen's Medical Research Institute, University of
OBJECTIVE: To explore the experiences of women in Scotland who return home to

complete medical termination of pregnancy (TOP) ≤63 days of gestation, after
being administered with mifepristone and misoprostol at an NHS TOP clinic.
DESIGN: Qualitative interview study.
SETTING: One National Health Service health board (administrative) area in
Scotland.
POPULATION OR SAMPLE: Women in Scotland who had undergone medical TOP ≤63 days,
and self-managed passing the pregnancy at home; recruited from three clinics in
one NHS health board area between January and July 2014.
METHODS: In-depth, semi-structured interviews with 44 women in Scotland who had
recently undergone TOP ≤63 days of gestation, and who returned home to pass the
pregnancy. Data were analysed thematically using an approach informed by the
Framework method.
MAIN OUTCOME MEASURES: Women's experiences of self-management of TOP ≤63 days of
gestation.
RESULTS: Key themes emerging from the analysis related to self-administration of
misoprostol in clinic; reasons for choosing home self-management; facilitation of
self-management and expectation-setting; experiences of getting home;
self-managing and monitoring treatment progress; support for self-management (in
person and remotely); and pregnancy self-testing to confirm completion.
CONCLUSIONS: Participants primarily found self-administration of misoprostol and
home self-management to be acceptable and/or preferable, particularly where this
was experienced as a decision made jointly with health professionals. The way in
which home self-management is presented to women at clinic requires ongoing
attention. Women could benefit from the option of home administration of
misoprostol.
TWEETABLE ABSTRACT: Women undergoing medical TOP 63 days found home
self-management to be acceptable and/or preferable.
© 2017 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology

published by John Wiley& Sons Ltd on behalf of Royal College of Obstetricians and
Gynaecologists.
DOI: 10.1111/1471-0528.14690
PMCID: PMC5724679
1254. Rheumatol Ther. 2015 Jun;2(1):73-84. Epub 2015 May 13.
Assessing Methotrexate Adherence in Rheumatoid Arthritis: A Cross-Sectional

Survey.
DiBenedetti DB(1), Zhou X(2), Reynolds M(2), Ogale S(3), Best JH(3).
Author information:
(1)RTI Health Solutions, Research Triangle Park, NC, USA. ddibenedetti@rti.org.
(2)RTI Health Solutions, Research Triangle Park, NC, USA.
(3)Genentech, Inc., South San Francisco, CA, USA.
INTRODUCTION: Limited data are available to explain nonadherence to methotrexate

(MTX) therapy in patients with rheumatoid arthritis (RA). Better understanding of
patterns of MTX use and reasons for nonadherence may help identify patients who
would benefit from alternative RA treatments and potentially aid in developing
strategies to increase overall adherence. The purpose of this study was to assess
patients' self-reported adherence to MTX and to identify reasons for
nonadherence.
METHODS: Patient panel members in the US self-reporting a diagnosis of RA of
≥3 months' and current MTX use of ≥4 weeks' duration, with or without concomitant
use of another RA prescription medication, participated in this cross-sectional,
web-based survey.
RESULTS: The sample population (251 MTX monotherapy, 250 MTX combination therapy)
was predominantly female, white, non-Hispanic, and educated; 48% were
18-44 years-old, 47% had medical comorbidities, 66% were first diagnosed with RA
≤5 years earlier, 51% reported MTX use of <1 year, and 83% reported oral MTX use.
Forty-two percent reported not taking MTX exactly as prescribed. Reasons for
nonadherence included forgetting to take it (33%), not needing it when feeling
well (24%), and concern about long-term safety (24%). Among nonadherent patients,
53% took smaller doses, 52% skipped doses, and 6% reported other nonprescribed
ways of taking MTX. Younger age, male sex, and shorter duration of MTX use were
associated with poorer self-reported adherence. Compared with monotherapy
patients, combination therapy patients, particularly those taking ≥2 other RA
prescriptions, were less likely to report high adherence.
CONCLUSION: Nearly half the sample reported poor MTX adherence because they
forgot to take it, thought it was not needed when they felt well, or had
long-term safety concerns. Patients taking ≥2 other RA prescription medications
were less likely to report good adherence. Reducing treatment burden without
sacrificing efficacy may be a strategy worth evaluating.
DOI: 10.1007/s40744-015-0011-1
PMCID: PMC4883252
PMID: 27747496
1255. BMJ Clin Evid. 2015 Sep 21;2015. pii: 0220.
Cardiovascular medication: improving adherence using prompting mechanisms.
Glynn L(1), Fahey T.
Author information:
(1)National University of Ireland, Galway, Ireland.
INTRODUCTION: Adherence to medication is generally defined as the extent to which

people take medications as prescribed by their healthcare providers. It can be
assessed in many ways (e.g., by self-reporting, pill counting, direct
observation, electronic monitoring, or by pharmacy records). This overview
reports effects of prompting mechanisms on adherence to cardiovascular
medications, however adherence has been measured.
METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the
following clinical question: What are the effects of prompting mechanisms to
improve adherence to long-term medication for cardiovascular disease in adults?
We searched Medline, Embase, The Cochrane Library, and other important databases
up to May 2014 (Clinical Evidence reviews are updated periodically; please check
our website for the most up-to-date version of this review).
RESULTS: At this update, searching of electronic databases retrieved 174 studies.
After deduplication and removal of conference abstracts, 80 records were screened
for inclusion in the overview. Appraisal of titles and abstracts led to the
exclusion of 45 studies and the further review of 35 full publications. Of the 35
full articles evaluated, one RCT was added at this update. We performed a GRADE
evaluation of seven PICO combinations.
CONCLUSIONS: In this systematic overview, we categorised the efficacy for seven
comparisons based on information relating to the effectiveness and safety of
prompting mechanisms, alone and in combination with reminder packaging or patient
education.
PMCID: PMC4577014
Impact of a community pharmacist-led medication review on medicines use in

patients on polypharmacy--a prospective randomised controlled trial.
Messerli M(1), Blozik E(2), Vriends N(3), Hersberger KE(4).
Author information:
University of Basel, Basel, Switzerland. markus.messerli@unibas.ch.
(2)Division of General Practice, Department of Medicine, University Medical
Centre Freiburg, Freiburg, Germany.
(3)Division of Clinical Psychology and Psychiatry, Department of Psychology,
BACKGROUND: In 2010 the 'Polymedication Check' (PMC), a pharmacist-led medication

review, was newly introduced to be delivered independently from the prescriber
and reimbursed by the Swiss health insurances. This study aimed at evaluating the
impact of this new cognitive service focusing on medicines use and patients'
adherence in everyday life.
METHODS: This randomised controlled trial was conducted in 54 Swiss community
pharmacies. Eligible patients used ≥4 prescribed medicines over >3 months. The
intervention group received a PMC at study start (T-0) and after 28 weeks (T-28)
while the control group received only a PMC at T-28. Primary outcome measure was
change in patients' objective adherence, calculated as Medication Possession
Ratio (MPR) and Daily Polypharmacy Possession Ratio (DPPR), using refill data
from the pharmacies and patient information of dosing. Subjective adherence was
assessed as secondary outcome by self-report questionnaires (at T-0 and T-28) and
telephone interviews (at T-2 and T-16), where participants estimated their
overall adherence on a scale from 0-100%.
RESULTS AND DISCUSSION: A total of 450 patients were randomly allocated to
intervention (N = 218, 48.4%) and control group (N = 232, 51.6%). Dropout rate
was fairly low and comparable for both groups (N Int = 37 (17.0%), NCont = 41
(17.7%), p = 0.845). Main addressed drug-related problem (DRP) during PMC at T-0
was insufficient adherence to at least one medicine (N = 69, 26.7%). At T-28,
1020 chronic therapies fulfilled inclusion criteria for MPR calculation,
representing 293 of 372 patients (78.8%). Mean MPR and adherence to polypharmacy
(DPPR) for both groups were equally high (MPRInt = 88.3, SD = 19.03; MPRCont =
87.5, SD = 20.75 (p = 0.811) and DPPRInt = 88.0, SD = 13.31; DPPRCont = 87.5, SD
= 20.75 (p = 0.906), respectively). Mean absolute change of subjective adherence
between T-0 and T-2 was +1.03% in the intervention and -0.41% in the control
group (p = 0.058). The number of patients reporting a change of their adherence
of more than ±5 points on a scale 0-100% between T-0 and T-2 was significantly
higher in the intervention group (NImprovement = 30; NWorsening = 14) than in the
control group (NImprovement = 20; NWorsening = 24; p = 0.028).
CONCLUSION: Through the PMC pharmacist were able to identify a significant number
of DRPs. Participants showed high baseline objective adherence of 87.5%,
providing little potential for improvement. Hence, no significant increase of
objective adherence was observed. However, regarding changes in subjective
adherence of more than ±5% the PMC showed a positive effect.
TRIAL REGISTRATION: Clinical trial registry database, NCT01739816; first entry on
November 27, 2012.
DOI: 10.1186/s12913-016-1384-8
PMCID: PMC4842295
1257. Lancet Psychiatry. 2017 Aug;4(8):627-633. doi: 10.1016/S2215-0366(17)30233-X.

Epub 2017 Jul 10.
Poor medication adherence and risk of relapse associated with continued cannabis
use in patients with first-episode psychosis: a prospective analysis.
Schoeler T(1), Petros N(1), Di Forti M(1), Klamerus E(1), Foglia E(1), Murray
R(1), Bhattacharyya S(2).
Author information:
(1)Department of Psychosis Studies, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London, UK.
Neuroscience, King's College London, London, UK. Electronic address:
sagnik.2.bhattacharyya@kcl.ac.uk.
Comment in
Lancet Psychiatry. 2017 Aug;4(8):578-579.
BACKGROUND: Cannabis use following the onset of first-episode psychosis has been
linked to both increased risk of relapse and non-adherence with antipsychotic
medication. Whether poor outcome associated with cannabis use is mediated through
an adverse effect of cannabis on medication adherence is unclear.
METHODS: In a prospective analysis of data acquired from four different adult
inpatient and outpatient units of the South London and Maudsley Mental Health
National Health Service Foundation Trust in London, UK, 245 patients were
followed up for 2 years from the onset of first-episode psychosis. Cannabis use
after onset of psychosis was assessed by self-reports in face-to-face follow-up
interviews. Relapse data were collected from clinical notes using the WHO Life
Chart Schedule. This measure was also used to assess medication adherence on the
basis of both face-to-face interviews and clinical notes. Patients were included
if they had a diagnosis of first-episode non-organic or affective psychosis
according to ICD-10 criteria, and were aged between 18 and 65 years when referred
to local psychiatric services. We used structural equation modelling analysis to
estimate whether medication adherence partly mediated the effects of continued
cannabis use on risk of relapse. The primary outcome variable was relapse,
defined as admission to a psychiatric inpatient unit after exacerbation of
symptoms within 2 years of first presentation to psychiatric services.
Information on cannabis use over the first 2 years after onset of psychosis was
investigated as a predictor variable for relapse. Medication adherence was
assessed as a mediator variable on the basis of clinical records and self-report
data. Study researchers (TS, NP, EK, and EF) rated the adherence.
FINDINGS: 397 patients who presented with their first episode of psychosis
between April 12, 2002, and July 26, 2013 had a follow-up assessment until
September, 2015. Of the 397 patients approached for followed up, 133 refused to
take part in this study and 19 could not be included because of missing data. 91
(37%) of 245 patients with first-episode psychosis had a relapse over the 2 years
of follow-up. Continued cannabis use predicted poor outcome, including risk of
relapse, number of relapses, length of relapse, and care intensity at follow-up.
In controlled structural equation modelling analyses, medication adherence partly
mediated the effect of continued cannabis use on outcome, including risk of
relapse (proportion mediated=26%, βindirect effects=0·08, 95% CI 0·004 to 0·16),
number of relapses (36%, βindirect effects=0·07, 0·003 to 0·14), time until
relapse (28%, βindirect effects=-0·26, -0·53 to 0·001) and care intensity (20%,
βindirect effects=0·06, 0·004 to 0·11) but not length of relapse (6%, βindirect
effects=0·03, -0·03 to 0·09). The adjusted models explained moderate amounts of
variance for outcomes defined as risk of relapse (R2=0·25), number of relapses
(R2=0·21), length of relapse (R2=0·07), time until relapse (R2=0·08), and care
intensity index (R2=0·15).
INTERPRETATION: Between 20% and 36% of the adverse effects of continued cannabis
use on outcome in psychosis might be mediated through the effects of cannabis use
on medication adherence. Interventions directed at medication adherence could
partly help mitigate the harm from cannabis use in psychosis.
FUNDING: This study is funded by the National Institute of Health Research (NIHR)
Clinician Scientist award.
Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access
article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights
reserved.
DOI: 10.1016/S2215-0366(17)30233-X
PMCID: PMC5522816
1258. Digit Health. 2016 Dec 1;2:2055207616678707. doi: 10.1177/2055207616678707.

eCollection 2016 Jan-Dec.
Understanding the use of contextual cues: design implications for medication

adherence technologies that support remembering.
Stawarz K(1), Rodríguez MD(2), Cox AL(1), Blandford A(1).
Author information:
(1)UCL Interaction Centre, University College London, UK.
(2)Faculty of Engineering, Universidad Autónoma Baja California, Mexicali,
Mexico.
Objective: Forgetfulness is one of the main reasons of unintentional medication

non-adherence. Adherence technologies that help people remember to take their
medications on time often do not take into account the context of people's
everyday lives. Existing evidence that highlights the effectiveness of
remembering strategies that rely on contextual cues is largely based on research
with older adults, and thus it is not clear whether it can be generalized to
other populations or used to inform the design of wider adherence technologies
that support medication self-management. Understanding how younger populations
currently remember medications can inform the design of future adherence
technologies that take advantage of existing contextual cues to support
remembering.
Methods: We conducted three surveys with a total of over a thousand participants
to investigate remembering strategies used by different populations: women who
take oral contraception, parents and carers who give antibiotics to their
children, and older adults who take medications for chronic conditions.
Results: Regardless of the population or the type of regimen, relying on
contextual cues-routine events, locations, and meaningful objects-is a common and
often effective strategy; combinations of two or more types of cues are more
effective than relying on a single cue.
Conclusions: To effectively support remembering, adherence technologies should
help users recognize contextual cues they already have at their disposal and
reinforce relevant cues available in their environment. We show that, given the
latest developments in technology, such support is already feasible.
DOI: 10.1177/2055207616678707
PMCID: PMC6001179
PMID: 29942574

interest with respect to the research, authorship, and/or publication of this
article.
1259. BMC Res Notes. 2019 Apr 8;12(1):212. doi: 10.1186/s13104-019-4258-4.
Self-care practices regarding diabetes among diabetic patients in West Ethiopia.
Dedefo MG(1), Ejeta BM(2), Wakjira GB(3), Mekonen GF(3), Labata BG(3).
Author information:
(1)Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences,
Wollega University, Nekemte, Oromia, Ethiopia. mohamedg@wollegauniversity.edu.et.
(2)Pharmaceutics Unit, Department of Pharmacy, College of Health Sciences,
Wollega University, Nekemte, Oromia, Ethiopia.
(3)Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences,
Wollega University, Nekemte, Oromia, Ethiopia.
OBJECTIVE: To assess the self-care practices and associated factors among

diabetic patients in West Ethiopia.
RESULTS: A total of 252 study participants were included in the study, of this
54.8% were male. Of the participants more than half 150 (59.5%) had poor glycemic
control and 153 (60.7%) of the participants had good self-care. Majority of the
study participants 209 (82.9%) had adequate foot care and more than half 175
(69.4%) and 160 (63.5%) had adequate dietary plan and exercise management
respectively. However of the total diabetic patients only 38 (15.1%) had adequate
blood glucose testing practices. On multivariable logistic analysis poor
self-care practices were more likely to occur among male patients (AOR = 5.551,
95% CI = 2.055-14.997, p = 0.001), patients living in rural area (AOR = 5.517,
95% CI = 2.184-13.938, p < 0.001), patients with duration of diabetes < 6 years
(AOR = 41.023, 95% CI = 7.373-228.257, p < 0.001), patients with no access for
self-monitoring blood glucose (AOR = 9.448, 95% CI = 2.198-40.617, p = 0.003),
patients with poor knowledge about diabetes (AOR = 67.917, 95%
CI = 8.212-561.686, p < 0.001) and patients with comorbidities (AOR = 18.621, 95%
CI = 4.415-78.540, p < 0.001).
DOI: 10.1186/s13104-019-4258-4
PMCID: PMC6454742

eCollection 2018.
Adherence to diabetic self-care practices and its associated factors among

patients with type 2 diabetes in Addis Ababa, Ethiopia.
Bonger Z(1), Shiferaw S(2), Tariku EZ(3).

Author information:
(1)TB/HIV Control and Prevention, Ethiopian Public Health Institute, Adama,
Ethiopia.
(2)School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
(3)Department of Public Health, Arba Minch University, Arba Minch, Ethiopia.
Background: Self-care practices in diabetes patients are crucial to keep the

illness under control and prevent complications. Effective management of diabetes
will be a difficult task without adequate understanding of the existing level of
practice related to diabetes self-care. This study is, therefore, aimed at
assessing the self-care practice and its associated factors among patients with
type 2 diabetes in Tikur Anbessa Specialized Hospital, Ethiopia.
Materials and methods: A health facility-based cross-sectional study was
conducted among 419 type 2 diabetes patients from March 29, 2013, to May 16,
2013. The data were collected by face-to-face interview using structured and
pretested questionnaire. Binary logistic regression was performed to assess the
association between determinant factors and adherence to self-monitoring of blood
glucose. Adjusted odds ratios (AOR) with its 95% confidence interval (CI) were
estimated to identify factors associated with the outcome variables in the
multivariable analysis.
Result: In this study, 318 (75.9%) diabetes patients did not adhere to the
recommended diet management, 350 (83.5%) did not adhere to self-monitoring of
blood glucose level, while 18 (4.3%) of the respondents did not adhere to the
prescribed medications. Diabetic patients who were unemployed were 2.4 times more
likely to practice blood glucose monitoring than merchants (AOR [95% CI] =2.4
[1.3-5.9]). Those who attended primary education were 70% less likely to adhere
to blood glucose self-monitoring than those educated to a tertiary educational
level (AOR [95% CI] =0.3 [0.1-0.9]). Respondents within the age group of 40-49
years were 11 times more likely to adhere to their medication than those aged
60-76 years (AOR [95% CI] =11 [1.03-13.6]).
Conclusion: The study showed that the extent to which individuals adhere to the
recommended management of type 2 diabetes is substantially low. Improving
awareness of patients and the community at large is imperative especially on
medication adherence, glycemic control and diet management.
DOI: 10.2147/PPA.S156043
PMCID: PMC5995298
PMID: 29922042

1261. J Diabetes Sci Technol. 2017 Mar;11(2):233-239. doi:

10.1177/1932296816666538.
Epub 2016 Sep 25.
Self-Management Behaviors in Adults on Insulin Pump Therapy.
Groat D(1), Grando MA(1)(2), Soni H(1), Thompson B(2), Boyle M(2), Bailey M(2),
Cook CB(1)(2).
Author information:
(1)1 Arizona State University Department of Biomedical Informatics, Scottsdale,
AZ, USA.
(2)2 Mayo Clinic Arizona Division of Endocrinology, Scottsdale, AZ, USA.
BACKGROUND: Successful diabetes management requires behavioral changes. Little is

known about self-management behaviors (SMB) in adults on insulin pump (IP)
therapy.
OBJECTIVE: Analyze and characterize observed common diabetes SMB in adult
participants with type 1 diabetes (T1D) using IPs and to correlate behaviors with
glycemic outcomes based on participant's individual glucose targets.
MATERIALS AND METHODS: One month of IP data from adults with T1D were downloaded.
Computer programs were written to automatically quantify the observed frequency
of expected behaviors such as: insulin bolusing, checking blood glucose (BG), and
recording carbohydrate intake, and other interactions with the IP.
RESULTS: Nineteen participants were recruited and 4,249 IP interactions were
analyzed to ascertain behaviors. Intersubject variability of adherence to
minimally expected behaviors was observed: daily documentation of carbohydrates
and BG checks in 76.6 (31.7)% and 60.0 (32.5)%, respectively, and bolusing
without consulting the IPBC in 13.0 (16.9)% of delivered boluses, while daily
insulin bolus delivery was consistent 96.8 (5.7)%. Higher frequency of adherence
to daily behaviors correlated with a higher number of glucose readings at target.
CONCLUSION: Results indicate variability in SMB and do not always match
recommendations. Case-scenarios based on observed real-life SMB could be
incorporated into interviews/surveys to elucidate ways to improve SMB.
DOI: 10.1177/1932296816666538
PMCID: PMC5478025
1262. Can Pharm J (Ott). 2019 Feb 27;152(3):193-203. doi: 10.1177/1715163519827980.

eCollection 2019 May-Jun.
Community pharmacists' experiences with the Saskatchewan Medication Assessment

Program.
Currie K(1)(2), Evans C(1)(2), Mansell K(1)(2), Perepelkin J(1)(2), Jorgenson

D(1)(2).
Author information:
(1)Rosetown Pharmasave (Currie), Rosetown.
(2)College of Pharmacy and Nutrition (Evans, Mansell, Perepelkin, Jorgenson),
University of Saskatchewan, Saskatoon, Saskatchewan.
Background: The Saskatchewan Medication Assessment Program (SMAP) is a publicly

funded community pharmacy-based medication assessment service with limited
previous evaluation. The purpose of this study was to explore community
pharmacists' experiences with the SMAP.
Methods: Online, self-administered questionnaire that consisted of a combination
of 53 Likert scale and free-text questions. All licensed pharmacists who were
practising in a community pharmacy setting in Saskatchewan were eligible to
participate.
Results: Response rate was 20.3% (n = 228/1124). Most respondents agreed that the
SMAP is achieving all of its intended purposes. For example, 89.7% agreed that
the SMAP improved medication safety for patients who receive the service. Most
pharmacists enjoyed performing the assessments (84.6%) and were confident in
their ability to identify drug-related problems (88.3%). Pharmacists reported
lack of time, patients having difficulty coming to the pharmacy and restrictive
eligibility criteria as the top barriers to the SMAP. Good teamwork, employer
support and personal professional commitment were the top recognized
facilitators. Respondents made several suggestions to improve the SMAP in the
free-text areas of the questionnaire.
Conclusions: Community pharmacists in Saskatchewan were positive and confident
about performing medication assessments, and most agreed that the SMAP is
achieving all of the intended purposes. Respondents also identified several
barriers to providing SMAP services, which have resulted in specific
recommendations that should be addressed to improve the program.
DOI: 10.1177/1715163519827980
PMCID: PMC6512182
PMID: 31156733
Conflict of interest statement: Statement of Conflicting Interests:The authors

have no conflicts of interest to report.
1263. Pharmacist-Led Chronic Disease Management: A Systematic Review of

Effectiveness
and Harms Compared to Usual Care [Internet].
Greer N, Bolduc J, Geurkink E, Koeller E, Rector T, Olson K, MacDonald R, Wilt

TJ.
Washington (DC): Department of Veterans Affairs (US); 2015 Oct.
VA Evidence-based Synthesis Program Reports.
Increased involvement of clinical pharmacists in patient care may offer increased

access to health care and improved patient outcomes. Defined by Hepler and Strand
in 1989, pharmaceutical care involves pharmacist collaboration with health team
members to optimize therapeutic outcomes by identifying, solving, and preventing
actual and potential drug therapy problems. Since 1995, the Department of
Veterans Affairs has allowed Clinical Pharmacy Specialists (CPS) an expanded
scope of practice with independent prescribing privileges. In this capacity, CPS
have been detailed to perform “pharmaceutical care” or comprehensive medication
management along with chronic disease state management services, in addition to
less complex services such as patient medication counseling or responding to drug
information questions. In the VA primary care setting, CPS are likely to be
responsible for therapeutic outcomes for a multitude of conditions for any
patient referred to CPS or proactively identified by CPS as a high-risk patient.
The purpose of this review is to determine the effectiveness and harms of
pharmacist-led chronic disease management for community-dwelling adults. Chronic
disease management aims to control symptoms and slow or stop disease progression.
Chronic disease management is typically a multi-component intervention that
includes medication therapy review, patient medication education, medication
monitoring, immunizations, disease self-care and support, and/or prescribing
authority.
PMID: 27252999
1264. BMC Nurs. 2018 Mar 12;17:9. doi: 10.1186/s12912-018-0280-4. eCollection 2018.
Proportion of medication error reporting and associated factors among nurses: a

Jember A(1), Hailu M(1), Messele A(2), Demeke T(3), Hassen M(1).
Author information:
(1)1Department of Medical Nursing, School of Nursing, College of Medicine and
(2)2Unit of Community Health Nursing, School of Nursing, College of Medicine and
(3)3Department of Pediatric and Child Health Nursing, School of Nursing, College
of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Background: A medication error (ME) is any preventable event that may cause or
lead to inappropriate medication use or patient harm. Voluntary reporting has a
principal role in appreciating the extent and impact of medication errors. Thus,
exploration of the proportion of medication error reporting and associated
factors among nurses is important to inform service providers and program
implementers so as to improve the quality of the healthcare services.
Methods: Institution based quantitative cross-sectional study was conducted among
397 nurses from March 6 to May 10, 2015. Stratified sampling followed by simple
random sampling technique was used to select the study participants. The data
were collected using structured self-administered questionnaire which was adopted
from studies conducted in Australia and Jordan. A pilot study was carried out to
validate the questionnaire before data collection for this study. Bivariate and
multivariate logistic regression models were fitted to identify factors
associated with the proportion of medication error reporting among nurses. An
adjusted odds ratio with 95% confidence interval was computed to determine the
level of significance.
Result: The proportion of medication error reporting among nurses was found to be
57.4%. Regression analysis showed that sex, marital status, having made a
medication error and medication error experience were significantly associated
with medication error reporting.
Conclusion: The proportion of medication error reporting among nurses in this
study was found to be higher than other studies.
DOI: 10.1186/s12912-018-0280-4
PMCID: PMC5848571
PMID: 29563855
Conflict of interest statement: Ethical clearance and approval was obtained from
Ethical Review Committee of School of Nursing, College of Medicine and Health
Sciences, University of Gondar and permission was obtained from the Ethical
Review Committees of each respective hospital. Consent form was put as a first
page of each questionnaire, and included the name of the researcher, the purpose
of the study, and a number of ethically based instructions. Participants were
assured that their involvement in the study was after having been informed about
the study without undue influence and could withdraw from the study at any time
without the need to give reason. The privacy of the participants was maintained
while they fill the questionnaire and confidentiality of the participants was
maintained by keeping anonymity and keeping the data only accessible by the
investigator. Although there may not be immediate and direct benefits for the
participants, nurses were informed of the benefits from the nursing knowledge
gained through the process. The participants were informed that there were no
financial benefits for participating in the research, no potential harms that
impact on employment, or social status, the utilization of the gathered data to
be used only for the intended research, and the publication of the results of the
study in a reputable journal with no identifiable information that links to the
participants.Not applicable.The authors declare that they have no competing
interests.Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
1265. AIDS Behav. 2015 Jan;19(1):34-40. doi: 10.1007/s10461-014-0802-3.
Depressive symptoms, lifestyle structure, and ART adherence among HIV-infected

individuals: a longitudinal mediation analysis.
Magidson JF(1), Blashill AJ, Safren SA, Wagner GJ.
Author information:
(1)Department of Psychiatry, Massachusetts General Hospital/Harvard Medical
School, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA,
jmagidson@partners.org.
Despite the well-documented relationship between depression and antiretroviral

therapy (ART) nonadherence, few studies have identified explanatory pathways
through which depression affects adherence. The current study tested lifestyle
structure-the degree of organization and routinization of daily activities-as a
mediator of this relationship, given previous evidence of lifestyle structure
being associated with both depression and ART nonadherence. HIV-infected
individuals starting or re-starting ART in the California Collaborative Treatment
Group 578 study (n = 199) were assessed over 48 weeks. Adherence was measured
using electronic monitoring caps to determine dose timing and doses taken, and
viral load was assessed. The mediating role of lifestyle structure was tested
using generalized linear mixed-effects modeling and bootstrapping. Lifestyle
significantly mediated the relationship between depression and both measures of
ART adherence behavior. Interventions that minimize disruptions to lifestyle
structure and link adherence to daily activities may be useful for individuals
with depression and ART nonadherence.
DOI: 10.1007/s10461-014-0802-3
PMCID: PMC4247996
1266. JMIR Cardio. 2017 Jul-Dec;1(2):e7. doi: 10.2196/cardio.8543. Epub 2017 Dec
12.
The Atrial Fibrillation Health Literacy Information Technology System: Pilot

Assessment.
Magnani JW(1)(2), Schlusser CL(1), Kimani E(3), Rollman BL(2), Paasche-Orlow

MK(4), Bickmore TW(3).
Author information:
(1)Division of Cardiology, Department of Medicine, UPMC Heart and Vascular
Institute, University of Pittsburgh, Pittsburgh, PA, United States.
(2)Center for Behavioral Health Smart Technology, Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, United States.
(3)College of Computer and Information Science, Northeastern University, Boston,
MA, United States.
(4)Section of General Internal Medicine, Department of Medicine, Boston
University, Boston, MA, United States.
Background: Atrial fibrillation (AF) is a highly prevalent heart rhythm condition

that has significant associated morbidity and requires chronic treatment. Mobile
health (mHealth) technologies have the potential to enhance multiple aspects of
AF care, including education, monitoring of symptoms, and encouraging and
tracking medication adherence. We have previously implemented and tested
relational agents to improve outcomes in chronic disease and sought to develop a
smartphone-based relational agent for improving patient-centered outcomes in AF.
Objective: The objective of this study was to pilot a smartphone-based relational
agent as preparation for a randomized clinical trial, the Atrial Fibrillation
Health Literacy Information Technology Trial (AF-LITT).
Methods: We developed the relational agent for use by a smartphone consistent
with our prior approaches. We programmed the relational agent as a
computer-animated agent to simulate a face-to-face conversation and to serve as a
health counselor or coach specific to AF. Relational agent's dialogue content,
informed by a review of literature, focused on patient-centered domains and
qualitative interviews with patients with AF, encompassed AF education, common
symptoms, adherence challenges, and patient activation. We established that the
content was accessible to individuals with limited health or computer literacy.
Relational agent content coordinated with use of the smartphone AliveCor Kardia
heart rate and rhythm monitor. Participants (N=31) were recruited as a
convenience cohort from ambulatory clinical sites and instructed to use the
relational agent and Kardia for 30 days. We collected demographic, social, and
clinical characteristics and conducted baseline and 30-day assessments of
health-related quality of life (HRQoL) with the Atrial Fibrillation Effect on
Quality of life (AFEQT) measure; self-reported medication adherence with the
Morisky 8-item Medication Adherence Scale (MMAS-8); and patient activation with
the Patient Activation Measure (PAM).
Results: Participants (mean age 68 [SD 11]; 39% [12/31] women) used the
relational agent for an average 17.8 (SD 10.0) days. The mean number of
independent log-ins was 19.6 (SD 10.7), with a median of 20 times over 30 days.
The mean number of Kardia uses was 26.5 (SD 5.9), and participants using Kardia
were in AF for 14.3 (SD 11.0) days. AFEQT scores improved significantly from 64.5
(SD 22.9) at baseline to 76.3 (SD 19.4) units at 30 days (P<.01). We observed
marginal but statistically significant improvement in self-reported medication
adherence (baseline: 7.3 [SD 0.9], 30 days: 7.7 [SD 0.5]; P=.01). Assessments of
acceptability identified that most of the participants found the relational agent
useful, informative, and trustworthy.
Conclusions: We piloted a 30-day smartphone-based intervention that combined a
relational agent with dedicated content for AF alongside Kardia heart rate and
rhythm monitoring. Pilot participants had favorable improvements in HRQoL and
self-reported medication adherence, as well as positive responses to the
intervention. These data will guide a larger, enhanced randomized trial
implementing the smartphone relational agent and the Kardia monitor system.
DOI: 10.2196/cardio.8543
PMCID: PMC5818980
PMID: 29473644
Conflict of interest statement: Conflicts of Interest None declared.
1267. Diabetes Metab Syndr Obes. 2019 May 24;12:789-800. doi: 10.2147/DMSO.S208324.
eCollection 2019.
Mobile application intervention to promote self-management in insulin-requiring

type 1 and type 2 diabetes individuals: protocol for a mixed methods study and
non-blinded randomized controlled trial.
Adu MD(1), Malabu UH(1), Malau-Aduli AE(2), Malau-Aduli BS(1).
Author information:
(1)College of Medicine and Dentistry, James Cook University, Townsville, QLD
4811, Australia.
(2)College of Public Health, Medical and Veterinary Sciences, James Cook
University, Townsville, QLD 4811, Australia.
Background: Mobile applications (apps) have proven to be useful in supporting

diabetes self-care, but non-consideration of users' needs and non-inclusion of
educational features are reasons for low continual use. Well-designed mobile apps
that meet the needs of diabetes patients and provide ongoing self-management
education and support are required. It was hypothesized that apps designed with
such features can improve a range of measures including clinical outcomes,
knowledge of diabetes, medication adherence, perceived ability for
self-management, and quality-of-life. This may eventually facilitate a more
robust and cost-effective approach for improving skills and motivation for the
management of diabetes. Methods: This project will be conducted in two phases. It
will initially employ a mixed methods study design to investigate the
self-management needs and perceptions of diabetes patients on the use of mobile
apps to support diabetes self-management. Results of the mixed methods study will
inform the content and design of an app which will be employed as an intervention
tool in a 12-month parallel randomized controlled trial (RCT). The RCT will
compare outcomes in relation to standard-of-care alone with standard-of-care plus
a mobile phone diabetes app among 150 insulin-requiring types 1 and 2 diabetes
patients. The primary outcome measures are clinical parameters such as hemoglobin
A1c (HbA1c), lipids, urine albumin-to-creatinine ratio, blood pressure, frequency
in events of emergency hyperglycemia and hypoglycemia. Secondary outcomes include
knowledge of diabetes, medication intake and adherence, perception of self-care,
and quality-of-life. Discussion: Results from this study will provide empirical
evidence on the usefulness of a mobile app developed based on self-management
needs analysis of diabetic patients. The long-term goal is to harness knowledge
gained from this study to provide evidenced-based data, which promote the
scale-up or adoption of mobile applications that provide regular, ongoing
education and self-management support to people living with diabetes. Trial
registration: Australian New Zealand Clinical Trials Registry,
ACTRN12618000065291, Registered on 17 January, 2018 (prospectively registered).
DOI: 10.2147/DMSO.S208324
PMCID: PMC6538012
PMID: 31213866

this work.
1268. Diabetes Metab Res Rev. 2019 Mar;35(3):e3112. doi: 10.1002/dmrr.3112. Epub
2018
Dec 21.
Effect of simulation education and case management on glycemic control in type 2

diabetes.
Ji H(1), Chen R(1), Huang Y(1), Li W(1), Shi C(1), Zhou J(1).
Author information:
(1)Department of Endocrinology, Danyang People's Hospital of Jiangsu Province,
Danyang, China.
BACKGROUND: The aim of the study was to investigate whether simulation education
(SE) and case management had any effect on glycemic control in type 2 diabetes
(T2DM) patients.
METHODS: In this single center pilot trial, 100 T2DM patients who received
medication and basic diabetes self-management education (DSME) were randomly
divided into a control group (n = 50) and an experimental group (n = 50), who
received SE and a case management program. Evaluation of biochemical indices was
conducted at baseline and after 6 months. DSME consisted of 2-hour group
trainings weekly for 2 consecutive weeks followed by 2 × 30 minute education
sessions after 3 and 6 months. The SE program comprised additional 50-minute
video sessions 3 times in the first week and twice in the second week. The
experimental group was supervised by a nurse case manager, who followed up
participants at least once a month, and who conducted group sessions once every
3 months, focusing on realistic aspects of physical activity and nutrition, with
open discussions about setting goals and strategies to overcome barriers.
RESULTS: After 6 months, HbA1c, fasting plasma glucose, and postprandial blood
glucose level improvements were superior in the experimental group compared with
the control group (P < 0.05). Self-care behavior adherence scores of healthy diet
(P = 0.001), physical activity (P = 0.043), self-monitoring of blood glucose
(P < 0.001), and reducing risks (P < 0.001) were significantly increased in the
experimental group compared with the control group.
CONCLUSIONS: Simulation education and case management added to routine DSME
effectively improved glycemic control in T2DM patients.
© 2018 The Authors. Diabetes/Metabolism Research and Reviews Published by John

Wiley & Sons Ltd.
DOI: 10.1002/dmrr.3112
PMCID: PMC6590464
1269. J Hypertens. 2015 May;33(5):1108-13. doi: 10.1097/HJH.0000000000000503.
Are two commonly used self-report questionnaires useful for identifying

antihypertensive medication nonadherence?
Gallagher BD(1), Muntner P, Moise N, Lin JJ, Kronish IM.
Author information:
(1)aCenter for Behavioral Cardiovascular Health, Department of Medicine, Columbia
University Medical Center, New York, New York bDepartment of Epidemiology,
University of Alabama at Birmingham, Birmingham, Alabama cDivision of General
Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York,
USA.
OBJECTIVE: Medication nonadherence is a major cause of uncontrolled hypertension,

but clinicians are poor at judging adherence, and the gold standard for measuring
adherence, electronic monitoring, is rarely available in clinical settings.
Self-report questionnaires (SRQs), by contrast, are inexpensive, easy to
administer, and hence, may be useful for 'diagnosing' nonadherence. In this
study, we evaluated the validity of two commonly used medication adherence SRQs
among patients with uncontrolled hypertension, using electronic pillbox
measurement as the gold standard.
METHODS: A total of 149 patients with uncontrolled hypertension had adherence to
their antihypertensive medication regimen monitored using a four-compartment
electronic pillbox (MedSignals) between two primary care visits (median 50 days).
Participants completed the 8-item Morisky Medication Adherence Scale (MMAS-8) and
the Visual Analog Scale (VAS) at the second visit. Likelihood ratios were
calculated using less than 80% correct dosing adherence by electronic measurement
as the gold standard.
RESULTS: SRQ scores indicating low adherence (MMAS-8 <6 and VAS <80%, 23 and 9%
of participants, respectively) had likelihood ratios of 2.00 [95% confidence
interval (CI) 1.10-3.65] and 7.72 (95% CI 1.77-33.6), respectively, for detecting
nonadherence compared to electronic measurement. SRQ scores indicating highest
adherence (MMAS-8 = 8 and VAS = 100%, 43 and 61% of participants, respectively)
had likelihood ratios of 0.55 (95% CI 0.35-0.85) and 0.76 (95% CI 0.57-1.01),
respectively, for detecting nonadherence.
CONCLUSION: The MMAS-8 and VAS are modestly useful in identifying
antihypertensive medication nonadherence. Other tools, including electronic
measurement, may be needed to guide titration of antihypertensive medications
among patients with uncontrolled hypertension.
DOI: 10.1097/HJH.0000000000000503
PMCID: PMC4500106
1270. Seizure. 2015 Nov;32:37-42. doi: 10.1016/j.seizure.2015.07.012. Epub 2015 Jul
29.
Gender differences in depression, but not in anxiety in people with epilepsy.
Gaus V(1), Kiep H(2), Holtkamp M(2), Burkert S(3), Kendel F(3).
Author information:
(1)Epilepsy-Center Berlin-Brandenburg, Department of Neurology,
Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin,
Germany. Electronic address: verena.gaus@charite.de.
(2)Epilepsy-Center Berlin-Brandenburg, Department of Neurology,
Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin,
Germany.
(3)Institute of Medical Psychology, Charité-Universitaetsmedizin Berlin,
Luisenstr. 57, 10117 Berlin, Germany.
PURPOSE: Anxiety and depression are frequent comorbidities in people with

epilepsy (PWE), but possible gender differences are often neglected. The aim of
the present study was to analyze if men and women with epilepsy differ with
regard to anxiety and depressive symptoms and to identify possible predictors.
METHODS: Adult consecutive PWE (N=302; 53% women) completed self-report
questionnaires, including the depression module of the Patient Health
Questionnaire (PHQ-9), the anxiety module of the Hospital Anxiety and Depression
Scale (HADS-A) and the subscales "medication effects" and "seizure worry" of the
Patient-weighted Quality of Life in Epilepsy Inventory-31-P (QOLIE-31-P).
RESULTS: There was no gender difference in extent of anxiety (p=.532), which was
mainly due to higher anxiety levels in men compared to the general population.
The gender difference in depressive symptoms was significant (p=.009), with
female patients being more affected. The most important predictors for anxiety
and depressive symptoms were detrimental effects of medication (QOL medication
effects) and of seizure worry (QOL seizure worry). Moreover, these predictors
were more closely associated with anxiety and depressive symptoms in men.
CONCLUSION: Future intervention studies could show whether providing more
information about the illness and medication effects may improve anxiety and
depression. Our results suggest that such interventions should be tailored to the
different needs of men and women.

rights reserved.
DOI: 10.1016/j.seizure.2015.07.012
1271. Int J Neuropsychopharmacol. 2018 Nov 1;21(11):997-1006. doi:

10.1093/ijnp/pyy070.
Delay Aversion and Executive Functioning in Adults With

Attention-Deficit/Hyperactivity Disorder: Before and After Stimulant Treatment.
Low AM(1)(2), le Sommer J(2)(3), Vangkilde S(1), Fagerlund B(1)(2), Glenthøj

B(2)(3), Sonuga-Barke E(4), Habekost T(1), Jepsen JRM(2)(5).
Author information:
(1)Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
(2)Center for Neuropsychiatric Schizophrenia Research and Center for Clinical
Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre
Glostrup, University of Copenhagen, Copenhagen, Denmark.
(3)Faculty of Health and Medical Sciences, Department of Clinical Medicine,
University of Copenhagen, Copenhagen, Denmark.
(4)Department of Child and Adolescent Psychiatry, Institute of Psychiatry,
Psychology & Neuroscience, King's College, London, United Kingdom.
(5)Child and Adolescent Mental Health Center, Mental Health Services, Copenhagen,
Denmark.
Background: Attention deficit hyperactivity disorder is a heterogeneous disorder,

associated with deficits in motivation (e.g., delay aversion) and cognition.
Methylphenidate is recommended as a first line treatment for attention deficit
hyperactivity disorder symptoms, but little is known about its nonacute effects
on motivational and cognitive deficits, particularly in adults with attention
deficit hyperactivity disorder.
Methods: We utilized a prospective, non-randomized, non-blinded, 6-week follow-up
design with 42 initially stimulant medication-naïve adult patients with moderate
to severe attention deficit hyperactivity disorder, and 42 age- and parental
education-matched healthy controls. Delay aversion and executive functioning were
assessed with 2 questionnaires and 5 performance-based tests.
Results: At baseline, patients and controls differed significantly on
performance-based measures (moderate to large effect sizes), and self-report of
delay aversion and executive functioning (very large effect sizes). Treatment
with methylphenidate medication (mean dose 65.54 mg/d, SD=10.39) was not
associated with improvements in performance-based measures of delay aversion and
executive functioning compared to controls, although improvements in self-report
executive functioning and delay aversion were found. Self-reported delay aversion
was most consistently associated with ADHD symptomatology at baseline and after
medication.
Conclusion: Methylphenidate treatment does not have an effect on
performance-based measures of delay aversion and executive functioning, but may
have significant effects on self-reported delay aversion and executive
functioning. The latter finding should be interpreted cautiously, given the
subjective nature of these measures and design limitations. Self-reported delay
aversion is most consistently associated with attention deficit hyperactivity
disorder symptomatology.
DOI: 10.1093/ijnp/pyy070
PMCID: PMC6209856
1272. JMIR Hum Factors. 2018 Mar 15;5(1):e13. doi: 10.2196/humanfactors.8004.
Evaluating the Usability and Usefulness of a Mobile App for Atrial Fibrillation
Using Qualitative Methods: Exploratory Pilot Study.
Hirschey J(#)(1), Bane S(#)(1), Mansour M(2), Sperber J(1)(3), Agboola

S(1)(3)(4), Kvedar J(1)(3)(4), Jethwani K(1)(3)(4).
Author information:
(1)Partners Connected Health, Partners Healthcare, Boston, MA, United States.
(2)Heart Center, Massachusetts General Hospital, Boston, MA, United States.
(3)Harvard Medical School, Cambridge, MA, United States.
(4)Massachusetts General Hospital, Boston, MA, United States.
BACKGROUND: Atrial fibrillation (AFib) is the most common form of heart

arrhythmia and a potent risk factor for stroke. Nonvitamin K antagonist oral
anticoagulants (NOACs) are routinely prescribed to manage AFib stroke risk;
however, nonadherence to treatment is a concern. Additional tools that support
self-care and medication adherence may benefit patients with AFib.
OBJECTIVE: The aim of this study was to evaluate the perceived usability and
usefulness of a mobile app designed to support self-care and treatment adherence
for AFib patients who are prescribed NOACs.
METHODS: A mobile app to support AFib patients was previously developed based on
early stage interview and usability test data from clinicians and patients. An
exploratory pilot study consisting of naturalistic app use, surveys, and
semistructured interviews was then conducted to examine patients' perceptions and
everyday use of the app.
RESULTS: A total of 12 individuals with an existing diagnosis of nonvalvular AFib
completed the 4-week study. The average age of participants was 59 years. All
participants somewhat or strongly agreed that the app was easy to use, and 92%
(11/12) reported being satisfied or very satisfied with the app. Participant
feedback identified changes that may improve app usability and usefulness for
patients with AFib. Areas of usability improvement were organized by three
themes: app navigation, clarity of app instructions and design intent, and
software bugs. Perceptions of app usefulness were grouped by three key variables:
core needs of the patient segment, patient workflow while managing AFib, and the
app's ability to support the patient's evolving needs.
CONCLUSIONS: The results of this study suggest that mobile tools that target
self-care and treatment adherence may be helpful to AFib patients, particularly
those who are newly diagnosed. Additionally, participant feedback provided
insight into the varied needs and health experiences of AFib patients, which may
improve the design and targeting of the intervention. Pilot studies that
qualitatively examine patient perceptions of usability and usefulness are a
valuable and often underutilized method for assessing the real-world
acceptability of an intervention. Additional research evaluating the AFib Connect
mobile app over a longer period, and including a larger, more diverse sample of
AFib patients, will be helpful for understanding whether the app is perceived
more broadly to be useful and effective in supporting patient self-care and
©Jaclyn Hirschey, Sunetra Bane, Moussa Mansour, Jodi Sperber, Stephen Agboola,
Joseph Kvedar, Kamal Jethwani. Originally published in JMIR Human Factors
PMCID: PMC5876493
PMID: 29549073
1273. BMC Health Serv Res. 2015 Oct 1;15:445. doi: 10.1186/s12913-015-1086-7.
Assessing the relationship between neighborhood factors and diabetes related

health outcomes and self-care behaviors.
Smalls BL(1), Gregory CM(2), Zoller JS(3)(4), Egede LE(5)(6).
Author information:
(1)Center for Surgery and Public Health, Brigham and Women's Hospital, 1620
Tremont Street, Suite 4-020, Boston, MA, 02120, USA. Bsmalls@partners.org.
Tremont Street, Suite 4-020, Boston, MA, 02120, USA. Gregoryc@musc.edu.
Tremont Street, Suite 4-020, Boston, MA, 02120, USA. zollerjs@musc.edu.
(4)Department of Healthcare Leadership and Management, College of Health
Professions, Medical University of South Carolina, 151-B Rutledge Ave, MSC 962,
Charleston, SC, 29425, USA. zollerjs@musc.edu.
(5)Center for Health Disparities Research, Medical University of South Carolina,
135 Rutledge Ave, Room 280, MSC 593, Charleston, SC, 29425, USA. egedel@musc.edu.
Medical University of South Carolina, 135 Rutledge Ave, RT 12th Floor, P.O. Box
250591, Charleston, SC, 29425, USA. egedel@musc.edu.
BACKGROUND: Studies have shown that community and neighborhood characteristics

can impact health outcomes of those with chronic illness, including T2DM.
Factors, such as crime, violence, and lack of resources have been shown to be
barriers to optimal health outcomes in diabetes. Thus, the objective of this
study is to assess the effects of neighborhood factors on diabetes-related health
outcomes and self-care behaviors.
METHODS: Adult patients (N = 615) with type 2 diabetes mellitus (T2DM) were
recruited from an academic medical center and a Veterans Affairs medical center
in the southeastern United States. Validated scales and indices were used to
assess neighborhood factors and diabetes-related self-care behaviors. The most
recent HbA1c, blood pressure, and LDL cholesterol were abstracted from each
patients' electronic medical record.
RESULTS: In the fully adjusted model, significant associations were between
neighborhood aesthetics and diabetes knowledge (β = 0.141) and general diet
(β = -0.093); neighborhood comparison and diabetes knowledge (β = 0.452);
neighborhood activities and general diet (β = -0.072), exercise (β = -0.104), and
foot care (β = -0.114); food insecurity and medication adherence (β = -0.147),
general diet (β = -0.125), and blood sugar testing (β = -0.172); and social
support and medication adherence (β = 0.009), foot care (β = 0.010), and general
diet (β = 0.016). Significant associations were also found between neighborhood
violence and LDL Cholesterol (β = 4.04), walking environment and exercise
(β = -0.040), and social cohesion and HbA1c (β = -0.086).
DISCUSSION: We found that neighborhood violence, aesthetics, walking environment,
activities, food insecurity, neighborhood comparison, social cohesion and social
support have statistically significant associations with self-care behaviors and
outcomes to varying degrees. However, the key neighborhood factors that had
independent associations with multiple self-care behaviors and outcomes were food
insecurity, neighborhood activities and social support.
CONCLUSION: This study suggests that food insecurity, neighborhood activities,
aesthetics, and social support may be important targets for interventions in
individuals with T2DM.
DOI: 10.1186/s12913-015-1086-7
PMCID: PMC4589943
1274. Ann Am Thorac Soc. 2017 Sep;14(9):1419-1427. doi: 10.1513/AnnalsATS.201701-

026OC.
Association between Social Support and Self-Care Behaviors in Adults with Chronic
Obstructive Pulmonary Disease.
Chen Z(1), Fan VS(2)(3), Belza B(1), Pike K(1), Nguyen HQ(1)(4).
Author information:
(1)1 School of Nursing and.
(2)3 Division of Pulmonary and Critical Care Medicine, University of Washington,
Seattle, Washington.
(3)2 Veterans Affairs Puget Sound Health Care System, Seattle, Washington; and.
(4)4 Kaiser Permanente Southern California, Pasadena, California.
Comment in
Ann Am Thorac Soc. 2017 Sep;14(9):1385-1386.
RATIONALE: Higher social support is associated with a better quality of life and
functioning in adults with chronic obstructive pulmonary disease (COPD).
OBJECTIVES: To determine the association between structural and functional social
support and self-care behaviors in adults with COPD.
METHODS: This was a longitudinal study using data from the CASCADE (COPD
Activity: Serotonin Transporter, Cytokines, and Depression) study, which was
focused on depression and functioning in COPD. Physical activity was measured
with a validated accelerometer at baseline, year 1, and year 2. Additional
self-care behaviors included pulmonary rehabilitation attendance, smoking status,
receipt of influenza and/or pneumococcal vaccinations, and medication adherence.
Structural social support indicators included living status, being partnered,
number of close friends/relatives, and presence of a family caregiver. Functional
social support was measured with the Medical Outcomes Social Support Survey
(MOSSS). Mixed-effects and logistic regression models were used.
RESULTS: A total of 282 participants with Global Initiative for Chronic
Obstructive Lung Disease stage II to IV COPD were included (age, 68 ± 9 yr; 80%
men; FEV1% predicted, 45 ± 16). For physical activity, participants who lived
with others accrued 903 more steps per day than those who lived alone (95%
confidence interval [CI], 373-1,433; P = 0.001); increases in the MOSSS total
score were associated with more steps per day (β = 10; 95% CI, 2-18; P = 0.02).
The odds of pulmonary rehabilitation participation were more than 11 times higher
if an individual had a spouse or partner caregiver compared with not having a
caregiver (odds ratio [OR], 11.03; 95% CI, 1.93-62.97; P < 0.01). Higher
functional social support (MOSSS total score) was associated with marginally
lower odds of smoking (OR, 0.99; 95% CI, 0.98-1.00; P = 0.03) and higher odds of
pneumococcal vaccination (OR, 1.02; 95% CI, 1.00-1.03; P = 0.02). Social support
was not associated with influenza vaccination or medication adherence.
CONCLUSIONS: Structural social support, which was measured by reports of living
with others and having a caregiver, was respectively associated with higher
levels of physical activity and greater participation in pulmonary rehabilitation
in adults with COPD. Our findings reinforce the critical importance of the social
environment in shaping patients' success with self-care. Clinical Trial
registered with clinicaltrials.gov (NCT01074515).
DOI: 10.1513/AnnalsATS.201701-026OC
PMCID: PMC5711401
1275. J Oncol Pract. 2014 Nov;10(6):373-6. doi: 10.1200/JOP.2014.001482. Epub 2014

Oct
21.
Home medication support for childhood cancer: family-centered design and testing.
Walsh KE(1), Biggins C(2), Blasko D(2), Christiansen SM(2), Fischer SH(2), Keuker
C(2), Klugman R(2), Mazor KM(2).
Author information:
(1)Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care
Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth
Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA;
and InterVision Media, Eugene, OR Kathleen.walsh@cchmc.org.
(2)Cincinnati Children's Hospital, Cincinnati, OH; The Meyers Primary Care
Institute; University of Massachusetts; Reliant Medical Group, Worcester; Beth
Israel Deaconess Medical Center, Boston; Kindred Healthcare, North Andover, MA;
and InterVision Media, Eugene, OR.
Comment in
J Oncol Pract. 2014 Nov;10(6):377-9.
PURPOSE: Errors in the use of medications at home by children with cancer are
common, and interventions to support correct use are needed. We sought to (1)
engage stakeholders in the design and development of an intervention to prevent
errors in home medication use, and (2) evaluate the acceptability and usefulness
of the intervention.
METHODS: We convened a multidisciplinary team of parents, clinicians, technology
experts, and researchers to develop an intervention using a two-step
user-centered design process. First, parents and oncologists provided input on
the design. Second, a parent panel and two oncology nurses refined draft
materials. In a feasibility study, we used questionnaires to assess usefulness
and acceptability. Medication error rates were assessed via monthly telephone
interviews with parents.
RESULTS: We successfully partnered with parents, clinicians, and IT experts to
develop Home Medication Support (HoMeS), a family-centered Web-based
intervention. HoMeS includes a medication calendar with decision support, a
communication tool, adverse effect information, a metric conversion chart, and
other information. The 15 families in the feasibility study gave HoMeS high
ratings for acceptability and usefulness. Half recorded information on the
calendar to indicate to other caregivers that doses were given; 34% brought it to
the clinic to communicate with their clinician about home medication use. There
was no change in the rate of medication errors in this feasibility study.
CONCLUSION: We created and tested a stakeholder-designed, Web-based intervention
to support home chemotherapy use, which parents rated highly. This tool may
prevent serious medication errors in a larger study.
Copyright © 2014 by American Society of Clinical Oncology.
DOI: 10.1200/JOP.2014.001482
PMCID: PMC4223710
1276. Eur Respir J. 2017 Mar 8;49(3). pii: 1600987. doi: 10.1183/13993003.00987-
2016.
Print 2017 Mar.
Variation in lung function as a marker of adherence to oral and inhaled

medication in cystic fibrosis.
White H(1)(2), Shaw N(2), Denman S(2), Pollard K(2), Wynne S(2), Peckham
DG(2)(3).
Author information:
(1)Nutrition and Dietetic Group, School of Clinical and Applied Science, Leeds
Beckett University, Leeds, UK H.White@leedsbeckett.ac.uk.
(2)Adult Cystic Fibrosis Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
(3)Leeds Institute of Biomedical and Clinical Sciences, Faculty of Medicine and
Health, University of Leeds, Leeds, UK.
The aim of this study was to characterise adherence in an adult population with
cystic fibrosis (CF) and to investigate if variation in lung function was a
predictor of adherence to treatment.The adherence of patients aged ≥16 years from
an adult CF centre was measured by medication possession ratio (MPR) and
self-report. Patients were assigned to one of three adherence categories (<50%,
50 to <80%, ≥80%) by their composite score (MPR). Ordinal regression was used to
identify predictors of adherence, including coefficient variation measures for
forced expiratory volume in 1 s (FEV1), weight and C-reactive protein
concentration, measured from 6 months and 12 months before baseline.MPR data for
106 of 249 patients (mean age 29.8±9.2 years) was retrieved, indicating a mean
adherence of 63%. The coefficient of variation for FEV1 was inversely related to
adherence and was a univariate predictor of adherence (6 months: OR 0.92, 95% CI
0.87-0.98, p=0.005; 12 months: OR 0.94, 95% CI 0.93-0.99, p=0.03) and remained
significant in the final models. The coefficient of variation of weight and
C-reactive protein were not predictive of adherence.The coefficient of variation
of FEV1 was identified as an objective predictor of adherence. Further evaluation
of this potential marker of adherence is now required.
Copyright ©ERS 2017.
DOI: 10.1183/13993003.00987-2016
Association between gaps in antihypertensive medication adherence and injurious

falls in older community-dwelling adults: a prospective cohort study.
Dillon P(1), Smith SM(2), Gallagher PJ(1), Cousins G(1).
Author information:
(1)School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland.
(2)Department of General Practice, HRB Centre for Primary Care Research, Royal
College of Surgeons in Ireland, Dublin, Ireland.
OBJECTIVE: Growing evidence suggests that older adults are at an increased risk
of injurious falls when initiating antihypertensive medication, while the
evidence regarding long-term use of antihypertensive medication and the risk of
falling is mixed. However, long-term users who stop and start these medications
may have a similar risk of falling to initial users of antihypertensive
medication. Our aim was to evaluate the association between gaps in
antihypertensive medication adherence and injurious falls in older (≥65 years)
community-dwelling, long-term (≥≥1 year) antihypertensive users.
DESIGN: Prospective cohort study.
SETTING: Irish Community Pharmacy.
PARTICIPANTS: Consecutive participants presenting a prescription for
antihypertensive medication to 106 community pharmacies nationwide,
community-dwelling, ≥65 years, with no evidence of cognitive impairment, taking
antihypertensive medication for ≥1 year (n=938).
MEASURES: Gaps in antihypertensive medication adherence were evaluated from
linked dispensing records as the number of 5-day gaps between sequential supplies
over the 12-month period prior to baseline. Injurious falls during follow-up were
recorded via questionnaire during structured telephone interviews at 12 months.
RESULTS: At 12 months, 8.1% (n=76) of participants reported an injurious fall
requiring medical attention. The mean number of 5-day gaps in medication refill
behaviour was 1.47 (SD 1.58). In adjusted, modified Poisson models, 5-day
medication refill gaps at baseline were associated with a higher risk of an
injurious fall during follow-up (aRR 1.18, 95% CI 1.02 to 1.37, p=0.024).
CONCLUSION: Each 5-day gap in antihypertensive refill adherence increased the
risk of self-reported injurious falls by 18%. Gaps in antihypertensive adherence
may be a marker for increased risk of injurious falls. It is unknown whether
adherence-interventions will reduce subsequent risk. This finding is hypothesis
generating and should be replicated in similar populations.
DOI: 10.1136/bmjopen-2018-022927
PMCID: PMC6429731
PMID: 30837246
1278. Glob Pediatr Health. 2019 May 7;6:2333794X19848670. doi:

10.1177/2333794X19848670. eCollection 2019.
Medication and Medication Wastage: Short-Term and Long-Term Effects of an

Educational Intervention Among School Children.
West LM(1), Cordina M(1).
Author information:
(1)Medicines Use Research Group, Department of Clinical Pharmacology and
Therapeutics, University of Malta, Msida, Malta.
Background. Education should support the gradual development of students'

necessary abilities to empower them in participating in decision-making together
with health care professionals. Aim. The aim of this study was (1) to evaluate
baseline knowledge regarding medication and medication wastage among primary
school children and (2) to determine the short- and long-term effects of an
educational intervention. Methods. Ten primary state schools around Malta were
invited to participate; 5 accepted participation (3 control and 2 intervention).
Children aged 9 to 12 years attending the sixth grade completed a self-reported
questionnaire containing 20 questions, with total scores ranging from 0 to 20.
Students from the intervention classes filled in a questionnaire pre and post an
educational seminar. All students answered the questionnaire again after 8
months. ANOVA (analysis of variance) with repeated measures was used to compare
difference between preintervention and postintervention mean scores. Results.
Overall, 40.8% (160/392) of children participated. Mean ± SD age was 10 ±
0.4years; 52.5% (n = 84) were boys. Average preintervention knowledge score for
all 5 schools was 11.5 ± 3.6, with 43.1% (n = 69) obtaining responses ≥13
(median). A repeated-measures ANOVA with a Greenhouse-Geisser correction
determined that mean knowledge scores differed significantly between
preintervention and postintervention (F[1, 81.000] = 75.190, P < .0005).
Intervention students retained a significant increase in knowledge scores at 8
months (P = .026). Discussion and Conclusion. The significantly improved
knowledge score following the educational intervention both in the short- and
long-term demonstrated the success of the intervention. These findings provide a
basis for the introduction of education about medication and medication wastage
in schools.
DOI: 10.1177/2333794X19848670
PMCID: PMC6506913
PMID: 31106250

1279. Scand J Prim Health Care. 2017 Jun;35(2):186-191. doi:

10.1080/02813432.2017.1333302. Epub 2017 Jun 6.
Factors related to poor asthma control in Latvian asthma patients between 2013
and 2015.
Smits D(1), Brigis G(1), Pavare J(2), Maurina B(3), Barengo NC(4).
Author information:
(1)a Faculty of Public Health and Social Welfare , Riga Stradins University ,
Riga , Latvia.
(2)b Faculty of Medicine , Riga Stradins University , Riga , Latvia.
(3)c Faculty of Pharmacy , Riga Stradins University , Riga , Latvia.
(4)d Herbert Wertheim College of Medicine , Florida International University ,
Miami , Florida , USA.
OBJECTIVES: To investigate whether beliefs about asthma medication, cognitive and

emotional factors are related to poor asthma control in a sample of Latvian
asthma patients in 2015.
DESIGN: Cross-sectional, self-administered survey.
SUBJECTS: Three hundred and fifty two asthma patients (mean age 57.5 years)
attending outpatient pulmonologist consultations in Riga, Latvia during September
2013 to December 2015. The sample size was calculated to detect a prevalence of
poor asthma control of 50% with a margin of error of 5% and a power of 95%.
MAIN OUTCOME MEASURES: The validated Beliefs about Medication Questionnaire (BMQ)
and the Brief Illness Perception Questionnaire (brief IPQ) were used. Good asthma
control was assessed using the asthma control test (ACT), a validated five-item
scale that reliably assesses asthma control over a recall period of four weeks.
Logistic regression models were used to predict poor asthma control.
RESULTS: Patients who had a good control of asthma medication (OR 0.70; 95% CI
0.61-0.79) or were confident that their asthma medication improves illness (OR
0.84; 95% CI 0.74-0.95) had a reduced risk of poor asthma control. The more
symptoms (OR 1.63; 95% CI 1.44-1.84) the asthma patients perceived or the more
their illness affects their life, the higher the probability of poor asthma
control (OR 1.47; 95% CI 1.31-1.65). Some beliefs of necessity and concerns of
asthma medication were also statistically significantly related to poor asthma
control.
CONCLUSIONS: Beliefs of necessity of asthma medication, cognitive and emotional
illness perception factors correlate well with poor asthma control in Latvian
patients.
DOI: 10.1080/02813432.2017.1333302
PMCID: PMC5499319
1280. Health Expect. 2016 Oct;19(5):1002-14. doi: 10.1111/hex.12392. Epub 2015 Aug
10.
Shared decision making for psychiatric medication management: beyond the

micro-social.
Morant N(1), Kaminskiy E(2), Ramon S(3).
Author information:
(1)Division of Psychiatry, UCL, London. n.morant@ucl.ac.uk.
(2)Department of Psychology, Anglia Ruskin University, Cambridge, UK.
(3)Department of Education and Social Care, Anglia Ruskin University, Cambridge,
UK.
BACKGROUND: Mental health care has lagged behind other health-care domains in
developing and applying shared decision making (SDM) for treatment decisions.
This is despite compatibilities with ideals of modern mental health care such as
self-management and recovery-oriented practice, and growing policy-level
interest. Psychiatric medication is a mainstay of mental health treatment, but
there are known problems with prescribing practices, and service users report
feeling uninvolved in medication decisions and concerned about adverse effects.
SDM has potential to produce better tailoring of psychiatric medication to
individuals' needs.
OBJECTIVES: This conceptual review argues that several aspects of mental health
care that differ from other health-care contexts (e.g. forms of coercion,
questions about service users' insight and disempowerment) may impact on
processes and possibilities for SDM. It is therefore problematic to uncritically
import models of SDM developed in other health-care contexts. We argue that
decision making for psychiatric medication is better understood in a broader way
that moves beyond the micro-social focus of a medical consultation.
Contextualizing specific medication-related consultations within longer term
relationships, and broader service systems enables recognition of the multiple
processes, actors and agendas that shape how psychiatric medication is
prescribed, managed and used, and which may facilitate or impede SDM.
CONCLUSION: A broad conceptualization of decision making for psychiatric
medication that moves beyond the micro-social can account for why SDM in this
domain remains a rarity. It has both conceptual and practical utility for
evaluating research evidence, identifying future research priorities and
highlighting fruitful ways of developing and implementing SDM in mental health
care.
© 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.
DOI: 10.1111/hex.12392
PMCID: PMC5053275
1281. Oncol Lett. 2015 May;9(5):2341-2346. Epub 2015 Mar 11.
Adherence and awareness of the therapeutic intent of oral anticancer agents in an

outpatient setting.
Kimura M(1), Nakashima K(1), Usami E(1), Iwai M(1), Nakao T(1), Yoshimura T(1),
Mori H(1), Teramachi H(2).
Author information:
(1)Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu 503-8502, Japan.
(2)Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Ogaki, Gifu
501-1196, Japan.
The aim of the present study was to clarify the adherence and awareness of oral
anticancer agents by type and therapeutic purpose in outpatients prescribed with
tegafur/gimeracil/oteracil potassium (S-1) or capecitabine. Outpatients
undergoing treatment with the S-1 or capecitabine oral anticancer agents at Ogaki
Municipal Hospital (Ogaki, Japan) in June 2013 completed a questionnaire survey
and the survey findings were evaluated. No significant differences in medication
adherence were identified between the patients administered S-1 and the patients
administered capecitabine (P=0.4586). In addition, no significant differences
were identified in therapeutic purpose between adjuvant therapy, and advanced and
recurrent therapies. However, for S-1 and capecitabine, medication adherence was
significantly higher in those undergoing combination therapy compared with those
undergoing monotherapy (P=0.0046). In addition, for patients taking S-1, the
median age for good adherence was significantly lower than that for insufficient
adherence (66.1±10.5 vs. 72.1±7.9 years, respectively; P=0.0035). Furthermore, a
significant negative correlation was identified between the awareness score of
research regarding the medication and age (n=109; P=0.0045). In conclusion, for
patients treated with S-1 or capecitabine, the type and therapeutic purpose of
oral anticancer agents did not affect medication adherence. Elderly patients
expressed a low interest in medications and typically exhibited insufficient
medication adherence. Therefore, patient guidance by pharmacists is important, as
it may result in improved medication adherence and an improved understanding of
the treatment side-effects in patients self-administering prescribed drugs.
DOI: 10.3892/ol.2015.3027
PMCID: PMC4467346
PMID: 26137068
1282. Neuropsychiatr Dis Treat. 2018 Oct 30;14:2905-2913. doi: 10.2147/NDT.S178839.

eCollection 2018.
Neurofeedback versus psychostimulants in the treatment of children and

adolescents with attention-deficit/hyperactivity disorder: a systematic review.
Razoki B(1).
Author information:
(1)Department of Psychology, Erasmus School of Social and Behavioural Sciences,
Erasmus University Rotterdam, Rotterdam, the Netherlands,
bashar.razoki@gmail.com.
This systematic review aimed to evaluate the efficacy of neurofeedback (NF)

compared to stimulant medication in treating children and adolescents with
attention-deficit/hyperactivity disorder (ADHD). Included in this review are
eight randomized controlled trials that compared an NF condition, either alone or
combined with medication, to a medication condition, which was mainly
methylphenidate. Outcome measures included behavioral assessments by parents and
teachers, self-reports, neurocognitive measures, electroencephalogram power
spectra and event-related potentials. When only trials are considered that
include probably blinded ratings or those that are sham-NF or semi-active
controlled or those that employed optimally titration procedures, the findings do
not support theta/beta NF as a standalone treatment for children or adolescents
with ADHD. Nevertheless, an additive treatment effect of NF was observed on top
of stimulants and theta/beta NF was able to decrease medication dosages, and both
results were maintained at 6-month follow-up. This review concludes that the
present role of NF in treating children diagnosed with ADHD should be considered
as complementary in a multimodal treatment approach, individualized to the needs
of the child, and may be considered a viable alternative to stimulants for a
specific group of patients. Particularly patients with the following
characteristics may benefit from NF treatment: low responders to medication,
intolerable side effects due to medication, higher baseline theta power spectra
and possibly having no comorbid psychiatric disorders. Future research should
prioritize the identification of markers that differentiate responders from
nonresponders to NF treatment, the potential of NF to decrease stimulant dosage,
the standardization of NF treatment protocols and the identification of the most
favorable neurophysiological treatment targets.
DOI: 10.2147/NDT.S178839
PMCID: PMC6214599
PMID: 30464474
Conflict of interest statement: Disclosure The author reports no conflicts of
1283. Pharmacy (Basel). 2019 May 29;7(2). pii: E51. doi: 10.3390/pharmacy7020051.
A Study to Identify Medication-Related Problems and Associated Cost Avoidance by

Community Pharmacists during a Comprehensive Medication Review in Patients One
Week Post Hospitalization.
Took RL(1), Liu Y(2), Kuehl PG(3).
Author information:
(1)Division of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, MO
63110, USA. roxane.took@stlcop.edu.
(2)Division of Pharmacy Practice and Administration, School of Pharmacy,
University of Missouri-Kansas City, Kansas City, MO 64108, USA. liuyif@umkc.edu.
(3)Division of Pharmacy Practice and Administration, School of Pharmacy,
University of Missouri-Kansas City, Kansas City, MO 64108, USA. kuehlp@umkc.edu.
Objectives: To determine the numbers of medication discrepancies and

medication-related problems (MRPs) identified and resolved when providing a
transitions of care comprehensive medication review (CMR) after hospital
discharge within a community pharmacy; and to estimate the cost-avoidance value
of this service. Methods: Community pharmacists provided CMRs to covered
employees and dependents of a self-insured regional grocery store chain who were
discharged from the hospital. Data was collected prospectively over 4 months.
Discrepancies were identified among patients' medication regimens by comparing
the hospital discharge record, the pharmacy profile, and what the patient
reported taking. MRPs were categorized into ten categories, as defined by the
OutcomesMTM® Encounter Worksheet. Interventions were categorized using the
severity scale developed by OutcomesMTM®, a Cardinal Health company. Data were
analyzed using descriptive statistics and bivariate correlations. Results:
Nineteen patients were enrolled in the program. Pharmacists identified 34 MRPs
and 81 medication discrepancies, 1.8 and 4.3 per patient, respectively. The most
common type of MRP was underuse of medication (70.6%). Significant positive
correlations were found between the number of scheduled prescription medications
and the number of medications with discrepancies (p ≤ 0.01; r = 0.825) and number
of scheduled prescription medications and the number of MRPs (p ≤ 0.01; r =
0.697). Most commonly, the severity levels associated with the MRPs involved the
prevention of physician office visits or addition of new prescription medications
(n = 10 each); however, four emergency room visits and three hospitalizations
were also avoided. The total estimated cost avoidance was $92,143, or $4850 per
patient. Extrapolated annual cost savings related to this service would be
$276,428. Conclusions: This transitions of care service was successful in
identifying and addressing MRPs and discrepancies for this patient population. By
providing this service, community pharmacists were able to prevent outcomes of
various severities and to avoid patient care costs.
DOI: 10.3390/pharmacy7020051
PMCID: PMC6630417
PMID: 31146447
1284. JMIR Hum Factors. 2016 Oct 12;3(2):e27.
Medication Management: The Macrocognitive Workflow of Older Adults With Heart

Failure.
Mickelson RS(1), Unertl KM, Holden RJ.
Author information:
(1)Vanderbilt School of Nursing, Vanderbilt University, The Center for Research
and Innovation in Systems Safety (CRISS), Vanderbilt University Medical Center,
Nashville, TN, United States.
BACKGROUND: Older adults with chronic disease struggle to manage complex

medication regimens. Health information technology has the potential to improve
medication management, but only if it is based on a thorough understanding of the
complexity of medication management workflow as it occurs in natural settings.
Prior research reveals that patient work related to medication management is
complex, cognitive, and collaborative. Macrocognitive processes are theorized as
how people individually and collaboratively think in complex, adaptive, and messy
nonlaboratory settings supported by artifacts.
OBJECTIVE: The objective of this research was to describe and analyze the work of
medication management by older adults with heart failure, using a macrocognitive
workflow framework.
METHODS: We interviewed and observed 61 older patients along with 30 informal
caregivers about self-care practices including medication management. Descriptive
qualitative content analysis methods were used to develop categories,
subcategories, and themes about macrocognitive processes used in medication
management workflow.
RESULTS: We identified 5 high-level macrocognitive processes affecting medication
management-sensemaking, planning, coordination, monitoring, and decision
making-and 15 subprocesses. Data revealed workflow as occurring in a highly
collaborative, fragile system of interacting people, artifacts, time, and space.
Process breakdowns were common and patients had little support for macrocognitive
workflow from current tools.
CONCLUSIONS: Macrocognitive processes affected medication management performance.
Describing and analyzing this performance produced recommendations for technology
supporting collaboration and sensemaking, decision making and problem detection,
and planning and implementation.
PMCID: PMC5081481
PMID: 27733331
Conflict of interest statement: Conflicts of Interest: None declared.
1285. BMC Med Res Methodol. 2019 May 9;19(1):95. doi: 10.1186/s12874-019-0743-7.
Prior medication adherence of participants and non participants of a randomized

controlled trial to improve patient adherence in cardiovascular risk management.
Sieben A(1), Bredie SJH(2), Luijten JCHBM(3), van Laarhoven CJHM(3), van Dulmen
S(4)(5)(6), van Onzenoort HAW(7)(8).
Author information:
(1)Department of Surgery, Division of Vascular Surgery, Radboud university
medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB, Nijmegen, the
Netherlands. angelien.sieben@radboudumc.nl.
(2)Department of General Internal Medicine, Division of Vascular Medicine,
Radboud university medical center, Nijmegen, the Netherlands.
(3)Department of General Surgery, Radboud university medical center, Nijmegen,
the Netherlands.
(4)Department of Primary and Community Care, Radboud university medical center,
Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
(5)NIVEL (Netherlands institute for health services research), Utrecht, the
Netherlands.
(6)Faculty of Health and Social Sciences, University of South-Eastern Norway,
Drammen, Norway.
(7)Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands.
(8)Department of Clinical Pharmacy and Toxicology, Maastricht University Medical
Center+, Maastricht, the Netherlands.
BACKGROUND: Poor medication adherence is a major factor in the secondary

prevention of cardiovascular diseases (CVD) and contributes to increased
morbidity, mortality, and costs. Interventions for improving medication adherence
may have limited effects as a consequence of self selection of already highly
adherent participants into clinical trials.
METHODS: In this retrospective cohort study, existing levels of medication
adherence were examined in self-decided participants and non-participants prior
to inclusion in a randomized controlled study (RCT), evaluating the effect of an
intervention to improve adherence. In addition, the non-participants were further
divided into 'responders' and 'non responders'. All individuals had manifest
cardiovascular disease and completed a questionnaire with baseline
characteristics, the Beliefs about Medicines Questionnaire (BMQ) and the Modified
Morisky Scale® (MMS®) as part of a regular screening program. A logistic
regression was conducted to examine the relationship between study participation
willingness, adherence level and the beliefs about medication.
RESULTS: According to the MMS® the adherence level was comparable in all groups.
In both (non)-participants groups, 36% was classified as high adherent; 46%
participants versus 44% non-participants were classified as medium adherent and
19% of the participants versus 20% of the non-participants were low adherent
(p = 0.91. The necessity concern differential (NCD) from the BMQ was 3.8 for
participants and 3.4 for non-participants (p = 0.32).
CONCLUSION: This study shows that adherence to medication and beliefs about
medication do not differ between participants and non-participants before
consenting to participate in an RCT. The study design seems not to have led to
greater adherence in the study group.
DOI: 10.1186/s12874-019-0743-7
PMCID: PMC6506957
PMID: 31072304
1286. Compr Psychiatry. 2015 Apr;58:29-36. doi: 10.1016/j.comppsych.2014.11.023.

Epub
2014 Dec 27.
Trajectories of medication attitudes and adherence behavior change in

non-adherent bipolar patients.
Levin JB(1), Tatsuoka C(2), Cassidy KA(3), Aebi ME(3), Sajatovic M(4).
Author information:
Cleveland, OH 44106, USA; Neurological and Behavioral Outcomes Center, University
Hospitals Case Medical Center, Cleveland, OH, USA. Electronic address:
Jennifer.levin@uhhospitals.org.
(2)Neurological and Behavioral Outcomes Center, University Hospitals Case Medical
Center, Cleveland, OH, USA; Department of Neurology, Case Western Reserve
University School of Medicine, Cleveland, OH 44106, USA.
Cleveland, OH 44106, USA.
Cleveland, OH 44106, USA; Neurological and Behavioral Outcomes Center, University
Hospitals Case Medical Center, Cleveland, OH, USA.
OBJECTIVES: While medication treatment is necessary for the successful management

of bipolar disorder (BD), non-adherence rates are up to 60%. Although medication
attitudes are believed to be relevant to adherence behavior, few studies have
investigated the trajectories of adherence change. This study evaluated
attitudinal correlates of adherence conversion in 86 poorly adherent individuals
with BD.
METHODS: This secondary analysis pooled data from two uncontrolled prospective
trials of customized adherence enhancement (CAE), a psychosocial intervention
delivered over 4-6 weeks. Poor adherence was defined as missing at least 20% of
prescribed BD medication based on the self-reported Tablets Routine Questionnaire
(TRQ). The sample was dichotomized into converters who achieved good adherence
(N=44) and non-converters who remained poorly adherent (N=21). Converters vs.
non-converters were compared on adherence, attitudes, and symptoms at baseline, 6
weeks and 3 months.
RESULTS: At baseline, converters and non-converters were similar demographically
and clinically, but converters were less non-adherent (32% doses missed) than
non-converters (59% missed). At 6 weeks, converters had better attitudes than
non-converters. At 3 months, converters maintained improvements, but group
differences were less pronounced due to some improvement in non-converters.
Converters had better adherence at 3 months and trajectories differed for the
groups on attitudes. Symptoms gradually improved for both converters and
non-converters.
CONCLUSIONS: Over two-thirds of poorly adherent BD patients who received CAE
converted to good adherence. Improved medication attitudes may be a driver of
improved adherence behavior and ultimately reduce BD symptoms.
DOI: 10.1016/j.comppsych.2014.11.023
PMCID: PMC4369431
1287. Asia Pac Allergy. 2015 Jan;5(1):32-9. doi: 10.5415/apallergy.2015.5.1.32.

Epub
2015 Jan 28.
Reduced severity and improved control of self-reported asthma in Finland during

2001-2010.
Kauppi P(1), Peura S(2), Salimäki J(2), Järvenpää S(3), Linna M(4), Haahtela
T(1).
Author information:
(1)Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki
00250, Finland.
(2)Association of Finnish Pharmacies, Helsinki 00500, Finland.
(3)MedCare Ltd., Äänekoski 44100, Finland.
(4)The Institute of Healthcare Engineering, Management and Architecture, Aalto
00076, Finland.
BACKGROUND: Asthma and allergies are common and cause substantial burden in
symptoms and suffering, hospitalizations and medication costs. However, despite
the high prevalence, asthma burden has already decreased in Finland in 2000s.
OBJECTIVE: We carried out an asthma barometer survey in all Finnish pharmacies to
study changes in asthma severity and control, and use of health care services
from 2001 to 2010.
METHODS: Asthma severity, comorbid allergic conditions, and use of medication and
health care services were assessed in subjects who purchased asthma or allergy
medication from the pharmacies all across the country during one week in 2001 and
again in 2010. In 2001, 3,062 patients (mean age, 49 years), and in 2010, 1,114
patients (mean age, 51 years) participated.
RESULTS: In 2001 90% and in 2010 73% of the respondents reported
physician-diagnosed asthma and were entitled to special reimbursement for their
drug costs, i.e., they needed regular maintenance treatment. In 2001, 10% of the
asthmatics regarded their disease as severe, compared with 4% in 2010, while the
figures for mild asthma were 45% and 62%, respectively (p < 0.001). The
proportion of patients needing emergency care during the last year decreased from
34% (2001) to 14% (2010) (p < 0.001) and the need for hospitalizations from 18%
to 6% (p < 0.001). Smoking reduced from 24% to 18% among asthmatics ( p = 0.002).
In 2010, risk factors for severe asthma were older age, comorbid atopic eczema,
and food allergy.
CONCLUSION: During ten years, self-reported asthma severity has reduced and
disease control improved in Finland.
DOI: 10.5415/apallergy.2015.5.1.32
PMCID: PMC4313758
PMID: 25653918
1288. J Clin Pharmacol. 2015 Jan;55(1):33-8. doi: 10.1002/jcph.368. Epub 2014 Jul
28.
The accuracy of self-reported drug ingestion histories in emergency department

patients.
Monte AA(1), Heard KJ, Hoppe JA, Vasiliou V, Gonzalez FJ.
Author information:
(1)University of Colorado Department of Emergency Medicine, Aurora, CO, USA;
Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA;
Rocky Mountain Poison & Drug Center, Denver, Colorado, USA.
Inaccuracies in self-reports may lead to duplication of therapy, failure to

appreciate non-compliance leading to exacerbation of chronic medical conditions,
or inaccurate research conclusions. Our objective is to determine the accuracy of
self-reported drug ingestion histories in patients presenting to an urban
academic emergency department (ED). We conducted a prospective cohort study in ED
patients presenting for pain or nausea. We obtained a structured drug ingestion
history including all prescription drugs, over-the-counter medication (OTC)
drugs, and illicit drugs for the 48 hours prior to ED presentation. We obtained
urine comprehensive drug screens (CDS) and determined self-report/CDS
concordance. Fifty-five patients were enrolled. Self-reported drug ingestion
histories were poor in these patients; only 17 (30.9%) of histories were
concordant with the CDS. For the individual drug classes, prescription drug-CDS
was concordant in 32 (58.2%), OTC-CDS was concordant in 33 (60%), and illicit
drug-CDS was concordant in 45 (81.8%) of subjects. No demographic factors
predicted an accurate self-reported drug history. Sixteen patients had drugs
detected by CDS that were unreported by history. Nine of these 16 included an
unreported opioid. In conclusion, self-reported drug ingestion histories are
often inaccurate and resources are needed to confirm compliance and ensure
unreported drugs are not overlooked.
© 2014, The American College of Clinical Pharmacology.

DOI: 10.1002/jcph.368
PMCID: PMC4276443
1289. Pilot Feasibility Stud. 2017 Mar 20;3:14. doi: 10.1186/s40814-017-0129-8.

eCollection 2017.
Improving medication management for patients with multimorbidity in primary care:

a qualitative feasibility study of the MY COMRADE implementation intervention.
Sinnott C(1), Byrne M(2), Bradley CP(1).
Author information:
(1)Department of General Practice, Western Gateway Building, University College
Cork, Cork, Ireland.
(2)Health Behaviour Change Research Group, School of Psychology, National
University of Ireland, Galway, Ireland.
BACKGROUND: For the majority of patients with multimorbidity, the prescription of

multiple long-term medications (polypharmacy) is indicated. However, polypharmacy
poses a risk of adverse drug events, drug interactions and excessive treatment
burdens. To help general practitioners (GPs) conduct more comprehensive
medication reviews for patients with multimorbidity, we developed the
theoretically-informed MultimorbiditY COllaborative Medication Review And
DEcision Making (MY COMRADE) implementation intervention. In this study, we
assessed the feasibility and acceptability of MY COMRADE by GPs.
METHODS: A non-randomised feasibility study using a qualitative framework
approach was conducted. General practices were recruited by purposively sampling
from interested GPs attending continuing professional development meetings (CPD)
in southwest Ireland. Participating practices were instructed on the MY COMRADE
implementation intervention which has five components: (i) action planning; (ii)
allocation of protected time; (iii) peer-supported medication review; (iv) use of
a prescribing checklist and (v) self-incentives (allocation of CPD points). GPs
in participating practices agreed to conduct medication reviews on multimorbid
patients from their own caseload using the MY COMRADE approach. After completing
these reviews, qualitative interviews were conducted to evaluate GPs' experiences
of the intervention and were analysed using the framework method.
RESULTS: GPs from ten practices participated in the study. The GPs reported that
MY COMRADE was an acceptable approach to implementing medication review in
general practice, especially for complex patients with multimorbidity. Action
plans for the medication reviews varied between practices, but all reviews led to
recommendations for optimising medications and patient safety. Many GPs felt that
using the MY COMRADE approach would ultimately lead to more efficient use of
their time, but a minority felt that the time and cost implications of using two
GPs to review medications would not be sustainable unless greater incentives were
used.
CONCLUSIONS: This study demonstrates that MY COMRADE is an acceptable and
feasible approach to supporting comprehensive medication reviews for patients
with multimorbidity. These findings indicate that a large scale trial of the
effectiveness of MY COMRADE is now required to fully evaluate its potential to
change prescribing behaviour and improve downstream outcomes such as prescribing
appropriateness and treatment burden.
TRIAL REGISTRATION: ISRCTN registry: ISRCTN34837446.
DOI: 10.1186/s40814-017-0129-8
PMCID: PMC5357807
PMID: 28331631
1290. Front Pharmacol. 2019 Jul 5;10:721. doi: 10.3389/fphar.2019.00721.
eCollection
2019.
Comparing Self-Report Pre-Exposure Prophylaxis Adherence Questions to

Pharmacologic Measures of Recent and Cumulative Pre-Exposure Prophylaxis
Exposure.
Blumenthal J(1), Pasipanodya EC(2), Jain S(3), Sun S(3), Ellorin E(1), Morris
S(1), Moore DJ(2).
Author information:
(1)Department of Medicine, University of California San Diego, La Jolla, CA,
United States.
United States.
(3)Family Medicine and Public Health, University of California San Diego, La
Jolla, CA, United States.
As pre-exposure prophylaxis (PrEP) effectiveness is strongly linked to adherence,

we sought to determine if certain self-report measures could be used to inform
objective PrEP adherence. We studied participants from the TAPIR study (a
multicenter randomized study of daily text messages to support adherence to PrEP
In At-Risk), a 48-week randomized controlled trial of HIV-uninfected men who have
sex with men (MSM) randomized to receive text message to support adherence versus
standard of care. Self-reported medication adherence was assessed using several
validated measures modified for PrEP. Objective PrEP adherence was determined
through dried blood spot (DBS) measurement of intracellular tenofovir diphosphate
(TFV-DP) and emtricitabine triphosphate (FTC-TP). A summary of adherence was
estimated using responses to the seven adherence items at weeks 12 and 48 using
confirmatory factor analysis. Correlations between self-report questions and drug
concentrations were estimated with Pearson's correlations for continuous outcomes
and point-biserial correlations for dichotomous outcomes. Receiver operating
characteristic (ROC) analyses were conducted to assess the performance of
self-report measures in predicting protective or perfect TFV-DP concentrations.
Of the 369 participants who completed week 12 or 48 visits, the mean age was 35
(standard deviation 9 years), with 79% White, 12% Black, and 29% Hispanic.
Correlations between self-report measures of adherence (both individual items and
the adherence factor) and quantifiable FTC-TP and continuous TFV-DP
concentrations showed that all self-report measures were significantly associated
with these objective measures. Compared to a summary measure of self-reported
adherence, the 4-week percent taken question medication recall was the only
self-report item similarly or more strongly associated with recent adherence and
long-term protective and perfect adherence at weeks 12 and 48. ROC analysis also
showed that 4-week percent taken question had a reasonable AUC (0.798 at week 12
and 0.758 at week 48) in predicting protective TFV-DP concentrations. All
single-item self-report questions assessing PrEP adherence were significantly
associated with biomarker quantification, with the 4-week percent taken question
performing best. Therefore, in the absence of drug concentration measurements, a
4-week self-report percent taken question may be a good single-item measure of
PrEP adherence.
DOI: 10.3389/fphar.2019.00721
PMCID: PMC6624646
PMID: 31333454
1291. Ann Behav Med. 2015 Oct;49(5):696-703. doi: 10.1007/s12160-015-9702-7.

The Relationship of Perceived Risk and Biases in Perceived Risk to Fracture
Prevention Behavior in Older Women.
Jones SM(1), Gell NM, Roth JA, Scholes D, LaCroix AZ.
Author information:
(1)Group Health Research Institute, 1730 Minor Ave #1600, Seattle, WA, 98101,
USA, wu.582@osu.edu.
BACKGROUND: A bias in perceived risk for health outcomes, including fracture,

exists.
PURPOSE: We compared perceived risk and biases in perceived risk for fracture to
fracture preventive behavior.
METHODS: Women over age 55 (n = 2874) completed a survey five times over 5 years,
and data was pulled from the medical record. Perceived risk was measured by
asking women to rate their risk of fracture compared to similar women. Actual
risk was measured using FRAX score. Bias was measured using an interaction
between perceived and actual risk.
RESULTS: Higher perceived risk was related to lower quality of life and
self-reported health, more medication and calcium use, increased bone density
scan use, and less walking. Bias was only associated with less medication use.
Neither perceived risk nor bias predicted medication adherence.
CONCLUSIONS: Perceived risk, but not bias, may predict different fracture
prevention behaviors. Clinicians may need to base interventions on risk
perceptions.
DOI: 10.1007/s12160-015-9702-7
PMCID: PMC4561195
1292. Diabetes Care. 2016 Dec;39(12):2182-2189. Epub 2016 Oct 17.
Tangled Up in Blue: Unraveling the Links Between Emotional Distress and Treatment
Adherence in Type 2 Diabetes.
Gonzalez JS(1)(2), Kane NS(3), Binko DH(3), Shapira A(3), Hoogendoorn CJ(3).
Author information:
(1)Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
jeffrey.gonzalez@einstein.yu.edu.
(2)Departments of Medicine (Endocrinology) and Epidemiology & Population Health,
Albert Einstein College of Medicine, Bronx, NY.
(3)Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.
OBJECTIVE: We conducted comprehensive assessments of emotional distress to

examine relations with diabetes medication adherence over time.
RESEARCH DESIGN AND METHODS: Ethnically and socioeconomically diverse adults
treated for type 2 diabetes completed validated self-reports (SRs) for diabetes
distress and depression, were administered semistructured depression interviews,
and provided blood samples for A1C. Medication adherence among 104 participants
was electronically monitored (EM) over the subsequent 3 months; validated SRs of
medication adherence were also obtained. Hierarchical linear regression evaluated
independent effects of diabetes distress and depression on adherence.
RESULTS: Mean ± SD 3-month medication adherence was 76.1% ± 25.7% for EM and
83.7% ± 21.9% for SR. Higher levels of SR (P < 0.001) and interview-based (P <
0.05) depressive symptom severity (P < 0.05) and diabetes-related distress (P <
0.01) showed a significant bivariate association with EM and SR nonadherence.
Regression models showed baseline diabetes distress was a significant independent
predictor of EM (β = -0.29; P = 0.001) and SR adherence (β = -0.24; P < 0.02) at
follow-up. SR depression was an independent predictor of EM and SR adherence and
reduced the effects of diabetes distress to nonsignificance. Subsequent models
indicated this effect was driven by somatic rather than cognitive-affective
symptoms of depression. Results were consistent but weaker for interview-based
depressive symptoms.
CONCLUSIONS: Findings support diabetes-related distress and depression symptom
severity as risk factors for type 2 diabetes medication nonadherence. Somatic
symptoms captured by depression measures, but not cognitive-affective symptoms,
independently predict nonadherence and should be further investigated as a
potential link between emotional distress and nonadherence.
© 2016 by the American Diabetes Association.
DOI: 10.2337/dc16-1657
PMCID: PMC5127225
1293. Am J Geriatr Psychiatry. 2018 Jul;26(7):812-816. doi:

10.1016/j.jagp.2018.03.012.
Epub 2018 Mar 23.
Health Beliefs and Medication Adherence in Black Patients with Diabetes and Mild
Cognitive Impairment.
Rovner BW(1), Casten RJ(2).
Author information:
(1)Department of Neurology, Sidney Kimmel Medical College of Thomas Jefferson
University, Philadelphia, PA; Department of Psychiatry, Sidney Kimmel Medical
College of Thomas Jefferson University, Philadelphia, PA; Department of
Ophthalmology, Sidney Kimmel Medical College of Thomas Jefferson University,
Philadelphia, PA. Electronic address: barry.rovner@jefferson.edu.
(2)Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College of
Thomas Jefferson University, Philadelphia, PA.
OBJECTIVES: To evaluate determinants of medication adherence and glycemic control

in black patients with diabetes and mild cognitive impairment (MCI).
METHODS: Cross-sectional study of 143 participants with mean age of 68.8 (SD:
6.7) years; 66.4% were women.
RESULTS: Eighty-seven participants (60.8%) self-reported medication nonadherence;
they had more negative beliefs about medicines, greater diabetes-related
distress, and more difficulty with daily living activities and affording
medications than adherent participants. There were no group differences in
cognition, depressive symptoms, or glycemic control. Glycemic control negatively
correlated with regimen distress, emotional burden, interpersonal distress,
beliefs that physicians overprescribe medications, and beliefs that medications
are harmful.
CONCLUSIONS: Beliefs about medications, diabetes-related distress, functional
disability, and medication affordability are associated with medication
nonadherence in black individuals with diabetes and MCI. Interventions that
respect personal health beliefs and compensate for impaired cognition may improve
medication adherence and glycemic control in this population.
Copyright © 2018 American Association for Geriatric Psychiatry. Published by

DOI: 10.1016/j.jagp.2018.03.012
PMCID: PMC6008206
PMID: 29673896

eCollection 2015.
Barriers to medication taking among Kuwaiti patients with type 2 diabetes: a

qualitative study.
Jeragh-Alhaddad FB(1), Waheedi M(2), Barber ND(3), Brock TP(4).
Author information:
(1)Department of Practice and Policy, University College London School of
Pharmacy, London, UK ; Department of Pharmacy Practice, Faculty of Pharmacy,
Kuwait University, Kuwait City, Kuwait.
Kuwait City, Kuwait.
(3)Department of Practice and Policy, University College London School of
Pharmacy, London, UK.
(4)Department of Clinical Pharmacy, School of Pharmacy, University of California,
San Francisco, CA, USA.
BACKGROUND: Nonadherence to medications among Kuwaitis with type 2 diabetes

mellitus (T2DM) is believed to be a major barrier to appropriate management of
the disease. Published studies of barriers to medication adherence in T2DM
suggest a Western bias, which may not adequately describe the Kuwaiti experience.
AIM: The purpose of this study was to explore barriers to medication adherence
among Kuwaiti adults with T2DM.
METHODS: Semi-structured interviews were conducted with 20 Kuwaiti patients with
type 2 diabetes. The interviews were digitally recorded, transcribed, and
analyzed using thematic analysis.
RESULTS: Barriers to medication adherence were identified. Emerging themes were:
1) lack of education/awareness about diabetes/medications, 2) beliefs about
medicines/diabetes, 3) spirituality and God-centered locus of control, 4)
attitudes toward diabetes 5) perceptions of self-expertise with the disease and
body awareness, 6) social stigma, 7) perceptions of social support, 8) impact of
illness on patient's life, 9) perceptions of health care providers' attitudes
toward patients, and 10) health system-related factors, such as access
difficulties and inequalities of medication supply and services.
CONCLUSION: Personal, sociocultural, religious, health care provider, and health
care system-related factors may impede medication adherence among Kuwaitis with
type 2 diabetes. Interventions to improve care and therapeutic outcomes in this
particular population must recognize and attempt to resolve these factors.
DOI: 10.2147/PPA.S86719
PMCID: PMC4629974
PMID: 26604702
1295. JMIR Mhealth Uhealth. 2016 Apr 6;4(2):e34. doi: 10.2196/mhealth.4149.
Characterization of Apps and Other e-Tools for Medication Use: Insights Into
Possible Benefits and Risks.
van Kerkhof LW(1), van der Laar CW, de Jong C, Weda M, Hegger I.
Author information:
(1)National Institute for Public Health and the Environment (RIVM), Centre for
Health Protection, Bilthoven, Netherlands. linda.van.kerkhof@rivm.nl.
BACKGROUND: In the past years, an enormous increase in the number of available

health-related applications (apps) has occurred, from approximately 5800 in 2011
to over 23,000 in 2013, in the iTunes store. However, little is still known
regarding the use, possible effectiveness, and risks of these applications. In
this study, we focused on apps and other e-tools related to medicine use. A large
subset of the general population uses medicines and might benefit from tools that
aid in the use of medicine.
OBJECTIVE: The aim of the present study was to gain more insight into the
characteristics, possible risks, and possible benefits of health apps and e-tools
related to medication use.
METHODS: We first made an inventory of apps and other e-tools for medication use
(n=116). Tools were coded by two independent researchers, based on the
information available in the app stores and websites. Subsequently, for one type
of often downloaded apps (aimed at people with diabetes), we investigated users'
experiences using an online questionnaire.
RESULTS: Results of the inventory show that many apps for medication use are
available and that they mainly offer simple functionalities. In line with this,
the most experienced benefit by users of apps for regulating blood glucose levels
in the online questionnaire was "information quick and conveniently available".
Other often experienced benefits were improving health and self-reliance. Results
of the inventory show that a minority of the apps for medication use has
potentially high risks and for many of the apps it is unclear whether and how
personal data are stored. In contrast, online questionnaire among users of apps
for blood glucose regulation indicates that they hardly ever experience problems
or doubts considering reliability and/or privacy. Although, respondents do
mention to experience disadvantages of use due to incomplete apps and apps with
poor ease of use. Respondents not using app(s) indicate that they might use them
in the future if reliability of the apps and instructions on how to use them are
more clear.
CONCLUSIONS: This study shows that for apps and e-tools related to medicine use a
small subset of tools might involve relatively high risks. For the large group of
nonmedical devices apps, risks are lower, but risks lie in the enormous
availability and low levels of regulation. In addition, both users and nonusers
indicated that overall quality of apps (ease of use, completeness, good
functionalities) is an issue. Considering that important benefits (eg, improving
health and self-reliance) are experienced by many of the respondents using apps
for regulating blood glucose levels, improving reliability and quality of apps is
likely to have many profits. In addition, creating better awareness regarding the
existence and how to use apps will likely improve proper use by more people,
enhancing the profits of these tools.
PMCID: PMC4838755
PMID: 27052946
1296. Malawi Med J. 2017 Jun;29(2):118-123.
A qualitative study of health education experiences and self-management practices

among patients with type 2 diabetes at Malamulo Adventist Hospital in Thyolo
District, Malawi.
Ogunrinu T(1)(2), Gamboa-Maldonado T(1)(3), Ngewa RN(4), Saunders J(1), Crounse

J(5)(6), Misiri J(6).
Author information:
(1)School of Public Health, Loma Linda University, Loma Linda, California, USA.
(2)Department of Public Health, Malamulo Adventist Hospital, Makwasa, Malawi.
(3)Promotores Academy, Institute for Community Partnerships, Loma Linda
University, Loma Linda, California, USA.
(4)Global Health Institute, Loma Linda University, Loma Linda, California, USA.
(5)Department of Family and Preventive Medicine, Loma Linda University Health,
Loma Linda, California, USA.
(6)Department of Medicine, Malamulo Adventist Hospital, Makwasa, Malawi.
BACKGROUND: The aim of this study was to understand the perceptions and
experiences of health education and self-management practices on Malamulo
Adventist Hospital type 2 diabetic patients.
METHODS: In this qualitative study, key informant interviews (KIIs; n=4) and
focus group discussions (3 FGDs; n=16) were conducted amongst type 2 diabetes
patients who had been treated at Malamulo Adventist Hospital in southern Malawi
at least once. Key informant interviews and focus group discussions were audio
recorded, transcribed verbatim and translated for analysis. Grounded theory
methods were used to identify line-by-line emerging codes and were categorized
and examined in Atlas.ti. The data was analyzed for emergent themes and supported
by critical quotes.
RESULTS: Content analysis revealed participants had a positive regard for the
diabetes education classes and had satisfactory health literacy. Participants
expressed their ability to integrate diabetes education, such as exercise into
their lifestyle. Due to financial constraints subjects experienced trouble
maintaining their medication regimen, and had difficulty adopting healthier
nutritional alternatives. Although patients expressed efficacy in controlling
their blood sugar they subsequently expressed having limited knowledge when
dealing with diabetes complications.
CONCLUSIONS: Diabetes self-management is comprised of a complex set of processes.
Patients with type 2 diabetes at Malamulo Adventist Hospital are deeply impacted
by these processes which includes their understanding of the disease process,
effects of medication, economic challenges to acquiring health care services and
medications, and one's unique life experience. For all patients with type 2
diabetes to successfully manage their condition, support from their family, the
medical community, and health policies must be readily available.
PMCID: PMC5610281
1297. Medicine (Baltimore). 2018 May;97(1S Suppl 1):S38-S45. doi:

10.1097/MD.0000000000009015.
Monitoring self-reported adherence to antiretroviral therapy in public HIV care

facilities in Brazil: A national cross-sectional study.
Santos MA(1), Guimarães MDC(2), Helena ETS(3), Basso CR(1), Vale FC(1), Carvalho
WMDES(1), Alves AM(1), Rocha GM(4), Acurcio FA(2), Ceccato MDGB(2), do Prado RR,
Menezes PR(1), Nemes MIB(1).
Author information:
(1)Faculty of Medicine of University of Sao Paulo, Department of Preventive
Medicine, São Paulo, São Paulo.
(2)Federal University of Minas Gerais, Belo Horizonte, Minas Gerais.
(3)University of Blumenau, Blumenau, Santa Catarina.
(4)Federal University of São João Del-Rei, Divinópolis, Minas Gerais, Brazil.
INTRODUCTION: Patient adherence to antiretroviral therapy (ART) is critical for

HIV treatment success. Monitoring rates of adherence in public HIV outpatient
care facilities can improve outcomes in Brazil where ART is universally
available.
METHODS: We conducted a national cross-sectional survey of ART adherence in 2010.
Participants were selected using a multistage probability sample. First, HIV
outpatient care facilities were stratified according to 7 Organizational Quality
Classification (OQC) groups and regions. Second, 1 or 2 facilities were selected
per region for each OQC group. Finally, patients were randomly selected at each
facility. In a first component, patients were invited to answer to a web-based
questionnaire (WebAd-Q), a validated self-reported tool that includes 3 questions
on adherence to ART in the past 7 days (time scheduling-timing, drug
regimen-medication, and pill counts-dose), herein named indicators of potential
nonadherence (IPN). In addition, a subsample of participants were interviewed in
order to obtain further data on sociodemographic and clinical characteristics
(second component). The proportion of each IPN was estimated using weighted data
to account for the sampling design with 95% confidence interval (CI) and
descriptive analysis was carried out.
RESULTS: Fifty-five facilities were chosen and 2424 patients completed the
WebAd-Q in the first component of the study, while 598 patients were interviewed
for the second component. The weighted proportions of the IPN were 50.9%, 31.8%,
and 19.5%, for timing, medication, and dose, respectively, while11.7% had all 3
indicators, varying from 5.9% in the Southeast and 21.9% in the Northeast
regions. Overall, 61.1% of the patients had at least 1 IPN (95% CI: 58.5-63.7%).
Patients reporting depression symptoms, illicit drug use and those who missed
medical appointments had worse nonadherence outcomes.
CONCLUSIONS: Overall, there was a high proportion of all indicators IPN and
timing was the main component associated with low adherence. Although these
indicators may not necessarily indicate individual nonadherence, they represent a
worrisome scenario in the public Brazilian HIV care facilities. On a routine
basis, these facilities can identify gaps in providing counseling and ART
orientation to their clientele and develop innovative strategies to prevent
nonadherence.
DOI: 10.1097/MD.0000000000009015
PMCID: PMC5991539
1298. J Family Med Prim Care. 2019 Apr;8(4):1313-1318. doi:

10.4103/jfmpc.jfmpc_176_19.
Medication concordance in modern medicine - A critical appraisal from an Indian

perspective.
Atal S(1), Sadasivam B(1), Ahmed SN(1), Ray A(1).
Author information:
(1)Department of Pharmacology, All India Institute of Medical Sciences, Bhopal,
Madhya Pradesh, India.
Modern medicine encompasses a holistic approach toward patient care that seeks to
integrate the social, psychological, and pathological aspects of a disease. In
line with this, the traditional model of improving treatment outcomes through
improved compliance or adherence has given way to the concept of "concordance"
that respects the integrity of the patient, autonomy, and self-determination. A
self-conscious patient actively and equally participating in her or his
comprehensive healthcare can bring a paradigm shift in the perceptions and
functioning of the healthcare sector. Medication concordance can be expected to
play a key role in improving patient well-being, clinical outcomes, and
healthcare delivery. However, it is fraught with numerous questions to be
addressed ranging from lack of clarity or standard protocol, medicolegal
intricacies, cultural-linguistic barriers, illiteracy, shortage of time,
infrastructure, and manpower. There are major challenges in the effective
implementation of this initiative which has definite potential to prove
beneficial in Indian healthcare settings. The success of this novel approach can
only be accomplished by coordinated, inclusive, and persistent efforts from all
participants of healthcare with fostering of a milieu of trust, belief, and
communication. A systematic literature search was conducted using key words from
relevant articles and MeSh terms on Google Scholar and PubMed. Data were
abstracted according to their relevance to subheadings of the review and
synthesis of concepts was done through multiple reviews by atleast two reviewers
for any subsection.
PMCID: PMC6510085
PMID: 31143713
1299. Pilot Feasibility Stud. 2018 Jul 23;4:128. doi: 10.1186/s40814-018-0320-6.

eCollection 2018.
Personalized behavior change program for glaucoma patients with poor adherence: a
pilot interventional cohort study with a pre-post design.
Newman-Casey PA(1), Niziol LM(1), Mackenzie CK(1), Resnicow K(2), Lee PP(1),
Musch DC(1)(3), Heisler M(4).
Author information:
(1)1Department of Ophthalmology and Visual Sciences, University of Michigan
Medical School, 1000 Wall Street, Ann Arbor, MI 48105 USA.
(2)2Department of Health Behavior and Health Education, University of Michigan
School of Public Health, Ann Arbor, MI 48105 USA.
(3)3Department of Epidemiology, University of Michigan School of Public Health,
Ann Arbor, MI 48105 USA.
(4)4Department of Internal Medicine, University of Michigan Medical School, Ann
Arbor, MI 48109 USA.
Background: About half of people with glaucoma do not adhere to their recommended
medications. Interventions for other chronic conditions have successfully
utilized reminder systems and motivational interviewing (MI)-based counseling.
This study was designed to pilot a personalized intervention that leverages these
strategies to assess their impact on medication adherence in glaucoma patients.
Methods: Glaucoma patients taking ≥ 1 medication will be pre-screened by
telephone survey for adherence to their medication(s). Those who self-report poor
adherence will be enrolled in a 3-month monitoring period to measure medication
adherence using electronic medication monitors. Participants who are non-adherent
(take </=80% of their medication doses) over the 3-month run in phase will be
eligible for the study. We plan to enroll 57 participants who are non-adherent to
their medications. Participants' adherence will then be continuously measured
with electronic medication monitors, by self-report, and via pharmacy refill data
over 2 years, during which two successively more resource-intensive components of
an intervention aimed to improve medication adherence will be administered. The
first component is a 3-month period of reminders (audio and/or visual) and text
message or automated phone call if a dose of medication is not taken within a
pre-specified time frame. The second component is a 6-month MI-based counseling
program with a trained glaucoma counselor. This component uses the eyeGuide, a
computer-based personalized behavior change program that enables
para-professional staff to provide personalized education and counseling for
glaucoma. The primary outcome is change in medication adherence. The secondary
outcomes include changes in clinical outcomes (intraocular pressure, IOP, and IOP
fluctuation) and psychosocial mediators of adherence (e.g., competence, energy
for change and satisfaction). Participants will undergo semi-structured
interviews at 12 months to give feedback about the counseling program in order to
improve it.
Discussion: This pilot study will provide insight into ways to deliver more
personalized health care to non-adherent glaucoma patients in order to better
support them in managing their chronic disease.
Trial registration: Retrospectively registered with ClinicalTrials.gov
(NCT03159247).
DOI: 10.1186/s40814-018-0320-6
PMCID: PMC6055343
PMID: 30062043
Conflict of interest statement: This study was approved by the Institutional

Review Board of the University of Michigan (Ann Arbor, MI). Informed consent will
be obtained from all eligible and interested participants.Not applicable.PANC is
a consultant in Blue Health Intelligence. None of the authors have any financial
interest or financial conflict with the subject matter and materials discussed in
the manuscript, and all authors listed their potential conflicts of
interest.Springer Nature remains neutral with regard to jurisdictional claims in
1300. Gac Med Mex. 2019;155(2):124-129. doi: 10.24875/GMM.18004417.
Validación de Belief Medicines Questionnaire y Self-efficacy for Appropriate

Medication Use Scale para medir adherencia al tratamiento farmacológico en
pacientes con enfermedad inflamatoria intestinal.
Bozada-Gutiérrez KE(1), Fresán-Orellana A(2), Yamamoto-Furusho JK(1).
Author information:
(1)Secretaría de Salud, Instituto Nacional de Ciencias Médicas y Nutrición
"Salvador Zubirán", Clínica de Enfermedad Inflamatoria Intestinal. Ciudad de
México, México.
(2)Secretaría de Salud, Instituto Nacional de Psiquiatría "Ramón de la Fuente
Muñiz", Subdirección de Investigaciones Clínicas. Ciudad de México, México.
Introduction: Treatment adherence is crucial in inflammatory bowel disease (IBD)

to prevent relapses and complications. In Mexico, there is not a validated tool
to assess adherence in patients with IBD.
Objective: To translate the beliefs about medicines questionnaire (BMQ) and
self-efficacy for appropriate medication use scale (SEAMS) instruments, as well
as to determine their validity, reliability and sensitivity in IBD-diagnosed
Mexican patients.
Method: After informed consent was obtained, 149 IBD-diagnosed patients were
included. The instruments were translated into Spanish and were subsequently
applied during medical consultation. For SEAMS, exploratory factorial analysis
and ROC curve analysis were carried out and Cronbach's alpha was determined; for
the BMQ, Cohen's kappa coefficient and its predictive capacity were employed.
Results: Seventy-five women (50.3%) were included, with an average age of 44
years. The SEAMS scale showed a single factor that was highly reliable
(Cronbach's alpha = 0.92) and a cutoff point of 33 to identify adherent patients.
The "adherence" and "recall barrier" dimensions of the BMQ were adequate
adherence predictors.
Conclusions: The SEAMS and BMQ Spanish versions are valid for measuring
self-efficacy and barriers to pharmacological treatment adherence in Mexican
patients with IBD.
Publisher: La adherencia terapéutica es crucial en la enfermedad inflamatoria

intestinal (EII) para evitar recaídas y complicaciones. En México no se dispone
de una herramienta validada para evaluar adherencia en pacientes con EII.Traducir
los instrumentos Belief Medicines Questionnaire (BMQ) y Self-Efficacy for
Appropriate Medication Use Scale (SEAMS), y determinar su validez, fiabilidad y
sensibilidad en pacientes mexicanos con diagnóstico de EII.Se incluyeron 149
pacientes con diagnóstico de EII, previo consentimiento informado. Se tradujeron
los instrumentos al español y posteriormente fueron aplicados durante la consulta
médica. Para la SEAMS se realizó análisis factorial exploratorio, análisis de
curva ROC y determinación del alpha de Cronbach; para el BMQ se empleó el
coeficiente kappa de Cohen y su capacidad predictiva.Se incluyeron 75 mujeres
(50.3 %) con edad promedio de 44 años. La escala SEAMS mostró un único factor
altamente confiable (alfa de Cronbach = 0.92) y un punto de corte de 33 para
identificar a los pacientes adherentes. Las dimensiones “adherencia” y “barrera
de recuerdo” del BMQ fueron adecuados predictores de adherencia.Las versiones en
español SEAMS y BMQ son válidas para medir autoeficacia y barreras para la
adherencia al tratamiento farmacológico en pacientes mexicanos con EII.
Copyright: © 2019 SecretarÍa de Salud.
DOI: 10.24875/GMM.18004417
PMID: 31056588
1301. Child Adolesc Psychiatry Ment Health. 2017 Dec 29;11:68. doi:
10.1186/s13034-017-0207-y. eCollection 2017.
The role of self-esteem in the development of psychiatric problems: a three-year

prospective study in a clinical sample of adolescents.
Henriksen IO(1), Ranøyen I(1)(2), Indredavik MS(1)(2), Stenseng F(1)(3).
Author information:
(1)Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty
of Medicine, NTNU, Trondheim, Norway.
(2)Department of Child and Adolescent Psychiatry, St. Olavs Hospital, Trondheim
University Hospital, Trondheim, Norway.
(3)Queen Maud University College, Trondheim, Norway.
Background: Self-esteem is fundamentally linked to mental health, but its' role

in trajectories of psychiatric problems is unclear. In particular, few studies
have addressed the role of self-esteem in the development of attention problems.
Hence, we examined the role of global self-esteem in the development of symptoms
of anxiety/depression and attention problems, simultaneously, in a clinical
sample of adolescents while accounting for gender, therapy, and medication.
Methods: Longitudinal data were obtained from a sample of 201 adolescents-aged
13-18-referred to the Department of Child and Adolescent Psychiatry in Trondheim,
Norway. In the baseline study, self-esteem, and symptoms of anxiety/depression
and attention problems were measured by means of self-report. Participants were
reassessed 3 years later, with a participation rate of 77% in the clinical
sample.
Results: Analyses showed that high self-esteem at baseline predicted fewer
symptoms of both anxiety/depression and attention problems 3 years later after
controlling for prior symptom levels, gender, therapy (or not), and medication.
Conclusions: Results highlight the relevance of global self-esteem in the
clinical practice, not only with regard to emotional problems, but also to
attention problems. Implications for clinicians, parents, and others are
discussed.
DOI: 10.1186/s13034-017-0207-y
PMCID: PMC5747942
PMID: 29299058
1302. JMIR Mhealth Uhealth. 2017 May 2;5(5):e57. doi: 10.2196/mhealth.7168.
Mobile Technology Interventions for Asthma Self-Management: Systematic Review and

Meta-Analysis.
Miller L(1), Schüz B(1), Walters J(2), Walters EH(2).
Author information:
(1)School of Medicine, Psychology, University of Tasmania, Hobart, Australia.
(2)University of Tasmania, Hobart, Australia.
BACKGROUND: Mobile technology interventions (MTI) are becoming increasingly

popular in the management of chronic health behaviors. Most MTI allow individuals
to monitor medication use, record symptoms, or store and activate
disease-management action plans. Therefore, MTI may have the potential to improve
low adherence to medication and action plans for individuals with asthma, which
is associated with poor clinical outcomes.
OBJECTIVE: A systematic review and meta-analysis were conducted to evaluate the
efficacy of MTI on clinical outcomes as well as adherence in individuals with
asthma. As the use of evidence-based behavior change techniques (BCT) has been
shown to improve intervention effects, we also conducted exploratory analyses to
determine the role of BCT and engagement with MTI as moderators of MTI efficacy.
METHODS: We searched electronic databases for randomized controlled trials up
until June 2016. Random effect models were used to assess the effect of MTI on
clinical outcomes as well as adherence to preventer medication or symptom
monitoring. Mixed effects models assessed whether the features of the MTI (ie,
use of BCT) and how often a person engaged with MTI moderated the effects of MTI.
RESULTS: The literature search located 11 studies meeting the inclusion criteria,
with 9 providing satisfactory data for meta-analysis. Compared with standard
treatment, MTI had moderate to large effect sizes (Hedges g) on medication
adherence and clinical outcomes. MTI had no additional effects on adherence or
clinical outcomes when compared with paper-based monitoring. No moderator effects
were found, and the number of studies was small. A narrative review of the two
studies, which are not included in the meta-analysis, found similar results.
CONCLUSIONS: This review indicated the efficacy of MTI for self-management in
individuals with asthma and also indicated that MTI appears to be as efficacious
as paper-based monitoring. This review also suggested a need for robust studies
to examine the effects of BCT use and engagement on MTI efficacy to inform the
evidence base for MTI in individuals with asthma.
©Lisa Miller, Benjamin Schüz, Julia Walters, E Haydn Walters. Originally

PMCID: PMC5434254
PMID: 28465281
1303. Clinics (Sao Paulo). 2015 Feb;70(2):102-6. doi: 10.6061/clinics/2015(02)06.

Improvement in medication adherence and self-management of diabetes with a
clinical pharmacy program: a randomized controlled trial in patients with type 2
diabetes undergoing insulin therapy at a teaching hospital.
Cani CG(1), Lopes Lda S(1), Queiroz M(1), Nery M(1).
Author information:
(1)Unidade de Diabetes, Serviço de Endocrinologia e Metabologia, Hospital das
Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São
Paulo, SP/Brazil.
OBJECTIVE: To evaluate the impact of a clinical pharmacy program on health

outcomes in patients with type 2 diabetes undergoing insulin therapy at a
teaching hospital in Brazil.
METHOD: A randomized controlled trial with a 6-month follow-up period was
performed in 70 adults, aged 45 years or older, with type 2 diabetes who were
taking insulin and who had an HbA1c level ≥8%. Patients in the control group (CG)
(n = 36) received standard care, patients in the intervention group (IG) (n = 34)
received an individualized pharmacotherapeutic care plan and diabetes education.
The primary outcome measure was change in HbA1c. Secondary outcomes included
diabetes and medication knowledge, adherence to medication, insulin injection and
home blood glucose monitoring techniques and diabetes-related quality of life.
Outcomes were evaluated at baseline and 6 months using questionnaires.
RESULTS: Diabetes knowledge, medication knowledge, adherence to medication and
correct insulin injection and home blood glucose monitoring techniques
significantly improved in the intervention group but remained unchanged in the
control group. At the end of the study, mean HbA1c values in the control group
remained unchanged but were significantly reduced in the intervention group.
Diabetes-related quality of life significantly improved in the intervention group
but worsened significantly in the control group.
CONCLUSION: The program improved health outcomes and resulted in better glycemic
control in patients with type 2 diabetes undergoing insulin therapy.
DOI: 10.6061/clinics/2015(02)06
PMCID: PMC4351311
1304. J Family Med Prim Care. 2017 Oct-Dec;6(4):832-835. doi:

10.4103/jfmpc.jfmpc_172_17.
Evaluation of skill-based training program on rational drug treatment for medical

interns.
Venkatesan M(1), Dongre AR(1), Ganapathy K(1).
Author information:
(1)Department of Community Medicine, Sri Manakula Vinayagar Medical College and
Hospital, Puducherry, India, Iran.
Context: A module-based training program for medical interns using World Health
Organization guide for good prescription along with the individual feedback on
their prescription was developed and implemented.
Objective: The objective of the study was to obtain the medical interns'
reactions to newly developed skill-based training program on rational treatment.
Study Setting: This study was conducted at the Department of Community Medicine.
Participants: A total of 96 medical interns were included in the study.
Study Design: A cross-sectional study consisting of retro-prefeedback and
open-ended questions about self-assessment of perceived skill on rational
treatment.
Analysis: Collected data were entered in Epi Info (3.5.4) and analyzed.
Results: After training, there was a significant increase in self-perceived
posttest scores of setting up the therapeutic objective for the treatment
(2.9-4.9), ability to select the correct drug (2.8-5.1), ability to select right
dose, schedule, and duration of drugs (2.5-4.9). and overall prescription skill
(2.9-4.9). There is a significant decrease in self-perceived scores in the skill
of practicing polypharmacy (4.1-2.5).
Conclusions: Overall, the training program was taken well and interns perceived
their skill on rational treatment was improved as shown by the feedback.
PMCID: PMC5848407
PMID: 29564272
1305. Trials. 2017 Jan 19;18(1):29. doi: 10.1186/s13063-016-1696-3.
The (cost-)effectiveness of a patient-tailored intervention programme to enhance

adherence to antihypertensive medication in community pharmacies: study protocol
of a randomised controlled trial.
van der Laan DM(1), Elders PJ(2), Boons CC(3), Bosmans JE(4), Nijpels G(2),
Hugtenburg JG(5).
Author information:
Health Research Institute, VU University Medical Center, Amsterdam, The
Netherlands. d.vanderlaan1@vumc.nl.
(2)Department of General Practice and Elderly Care Medicine and the Amsterdam
Public Health Research Institute, VU University Medical Center, Amsterdam, The
Netherlands.
(3)Department of Clinical Pharmacology and Pharmacy, VU University Medical
Center, Amsterdam, The Netherlands.
(4)Department of Health Sciences and the Amsterdam Public Health Research
Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The
Netherlands.
Health Research Institute, VU University Medical Center, Amsterdam, The
Netherlands.
BACKGROUND: Medication non-adherence is a complex health care problem. Due to

non-adherence, substantial numbers of cardiovascular patients benefit from their
medication to only a limited extent. In order to improve adherence, a variety of
pharmacist-led interventions have been developed. However, even the most
effective interventions achieved only a modest positive effect. To be effective,
interventions should be targeted at underlying barriers to adherence, developed
in a systematic manner and tailored to specific features of a target group and
setting. The current paper describes the design of the Cardiovascular medication
non-Adherence Tailored Intervention (CATI) study aimed to evaluate the
(cost-)effectiveness of a patient-tailored intervention programme in patients
using antihypertensive medication.
METHODS: The CATI study is a randomised controlled trial that will be performed
in 13 community pharmacies. Patients aged 45-75 years using antihypertensive
medication and considered non-adherent according to pharmacy dispensing data, as
well according to a self-report questionnaire, are eligible to participate.
Patients in the intervention condition will receive a patient-tailored,
pharmacist-led intervention programme. This programme consists of a structured
interview at the pharmacy to identify patients' barriers to adherence and to
counsel patients in order to overcome these barriers. The primary outcome is
self-reported medication adherence measured with the MARS-5 questionnaire.
Secondary outcome measures are blood pressure, illness perceptions, quality of
life and societal costs. A cost-effectiveness analysis and process evaluation
will also be performed.
DISCUSSION: This study will provide insight into the (cost-)effectiveness of a
patient-tailored, pharmacist-led intervention programme in non-adherent patients
using antihypertensive medication. This intervention programme allows community
pharmacists to support their patients in overcoming barriers to adherence and
improving medication adherence in a structured and patient-tailored manner. An
effective intervention will not only enhance medication adherence, but may also
improve health outcomes and decrease health care utilisation and costs.
TRIAL REGISTRATION: Netherlands Trial Register (identifier: NTR5017), registered
on 2 February 2015.
DOI: 10.1186/s13063-016-1696-3
PMCID: PMC5244518
1306. Patient Educ Couns. 2016 May;99(5):830-5. doi: 10.1016/j.pec.2015.11.025.

Epub
2015 Nov 27.
Health beliefs and desire to improve cholesterol levels among patients with
hyperlipidemia.
Zullig LL(1), Sanders LL(2), Thomas S(3), Brown JN(4), Danus S(5), McCant F(5),
Bosworth HB(6).
Author information:
(1)Center of Excellence for Health Services Research in Primary Care, Durham
Veterans Affairs Medical Center, Durham, USA; Department of Medicine, Duke
University, Durham, USA.
(2)Department of Medicine, Duke University, Durham, USA.
(3)Department of Biostatistics and Bioinformatics, Duke University, Durham, USA.
(4)Investigational Drug Service, Durham Veterans Affairs Medical Center, Durham,
USA.
Veterans Affairs Medical Center, Durham, USA.
Veterans Affairs Medical Center, Durham, USA; Department of Medicine, Duke
University, Durham, USA; Departments of Psychiatry and School of Nursing, Duke
University, Durham, USA. Electronic address: boswo001@mc.duke.edu.
OBJECTIVE: Because hyperlipidemia is asymptomatic, many veterans affairs (VA)

patients may not perceive it seriously. We assessed key Health Belief model
concepts to describe patients' cholesterol-related health beliefs and examine
associations between patient-level factors and desire to improve cholesterol
control.
METHODS: We used baseline data from an ongoing randomized clinical trial.
Eligible patients were receiving care at the Durham VA and had CVD risk-total
cholesterol levels >130 mg/dL and/or <80% medication adherence in the previous 12
months. A survey assessed patients' health beliefs about high cholesterol and
self-reported medication adherence. Multivariable logistic regression examined
whether there was an association between desire to control cholesterol and
cholesterol status.
RESULTS: Approximately 64% (n=155) of patients perceived high cholesterol as
'very serious'. In multivariable logistic regression analysis, patients who
perceived high cholesterol as 'very serious' (OR 2. 26, p=0.032) and/or with high
self-efficacy (OR 4.70, p<0.001) had increased odds of desiring cholesterol
control.
CONCLUSION: The factors most significantly associated with desire to improve
cholesterol control were perceiving hyperlipidemia as 'very serious and
self-efficacy for cholesterol control.
PRACTICE IMPLICATION: Educating patients, with the goal of appropriately
increasing their perceived risk of disease, is likely necessary to impact
cholesterol control.
DOI: 10.1016/j.pec.2015.11.025
PMCID: PMC5007622

disclose. The content is solely the responsibility of the authors and does not
necessarily reflect the position or policy of Duke University, the U.S.
Department of Veterans Affairs, or the U.S. government.
1307. J Clin Diagn Res. 2016 Mar;10(3):FC09-11. doi: 10.7860/JCDR/2016/18387.7396.

Epub
2016 Mar 1.
Assessment of Knowledge of Self Blood Glucose Monitoring and Extent of Self

Titration of Anti-Diabetic Drugs among Diabetes Mellitus Patients - A Cross
Sectional, Community Based Study.
Krishnan V(1), Thirunavukkarasu J(2).
Author information:
(1)Assistant Professor, Department of Pharmacology, Saveetha Medical College ,
Chennai, India .
(2)Professor, Department of Pharmacology, Saveetha Medical College , Chennai,
India .
INTRODUCTION: Self blood glucose monitoring is an important context of self care

in the management of diabetes mellitus. All the guidelines must be followed while
performing self blood glucose monitoring and tracking of values is essential to
facilitate the physician while titrating the drugs and /or doses of anti diabetes
medication. Self titration by patients following self monitoring must be
discouraged.
AIM: To assess the knowledge and practice of self blood glucose monitoring among
diabetes patients and extent of self titration of anti diabetes medicines among
diabetes patients based on self blood glucose monitoring.
MATERIALS AND METHODS: This pilot, cross-sectional, observational study was
conducted using a validated questionnaire among adult male and female diabetes
patients performing self blood glucose monitoring at home. Diabetes patients with
complications and juvenile diabetes patients were excluded.
RESULTS: Out of 153 patients surveyed, only 37 (24.1%) (20 males, 17 females)
patients were aware and have been following self blood glucose monitoring
appropriately. About 116 (75.8%) (64 males, 52 females) of patients were devoid
of adequate knowledge and did not practice self blood glucose monitoring in a
proper way. Ninety eight (64.05%) accepted that they self titrate their anti
diabetic medicines based on self monitoring.
CONCLUSION: Self monitoring of blood glucose should be encouraged and patients
should be taught importance of following correct steps and tracking of self
monitoring by physician or diabetes educator.
DOI: 10.7860/JCDR/2016/18387.7396
PMCID: PMC4843274
PMID: 27134888
1308. Osteoporos Int. 2017 Jan;28(1):77-84. doi: 10.1007/s00198-016-3721-5. Epub

2016
Aug 22.
The relationship between maternal self-efficacy, compliance and outcome in a

trial of vitamin D supplementation in pregnancy.
Barker M(1)(2), D'Angelo S(3), Ntani G(3), Lawrence W(3)(4), Baird J(3)(4),
Jarman M(5), Vogel C(3)(4), Inskip H(3)(4), Cooper C(3)(4)(6), Harvey NC(3)(4);
MAVIDOS Study Group.
Collaborators: Bishop NJ, Kennedy S, Papageorghiou AT, Schoenmakers I, Fraser R,

Gandhi SV, Carr A, Crozier SR, Moon RJ, Arden NK, Dennison EM, Godfrey KM,
Prentice A, Mughal MZ, Eastell R, Reid DM, Javaid MK.
Author information:
(1)MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of
Southampton, Southampton, SO16 6YD, UK. meb@mrc.soton.ac.uk.
(2)NIHR Southampton Biomedical Research Centre, University Hospital Southampton
NHS Foundation Trust, University of Southampton, Southampton, UK.
meb@mrc.soton.ac.uk.
(3)MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of
Southampton, Southampton, SO16 6YD, UK.
(4)NIHR Southampton Biomedical Research Centre, University Hospital Southampton
NHS Foundation Trust, University of Southampton, Southampton, UK.
(5)Li Ka Shing Centre for Health Research Innovation, Department of Agriculture,
Food and Nutritional Science, University of Alberta, Edmonton, Canada.
(6)NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of
Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research
Centre, University of Oxford, Oxford, UK.
In a randomised controlled trial of vitamin D during pregnancy, we demonstrated

that women with lower self-efficacy were more likely to experience practical
problems with taking the trial medication and that this was associated with lower
compliance and achieved 25(OH)-vitamin D concentrations.INTRODUCTION: The
relationship between self-efficacy (the belief that one can carry out a
behaviour), compliance with study protocol and outcome was explored within a
randomised, double-blind, placebo-controlled trial of vitamin D supplementation
in pregnancy.
METHODS: In the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial, women with
circulating plasma 25(OH)-vitamin D of 25-100 nmol/l in early pregnancy were
randomised to either 1000 IU cholecalciferol/day or matched placebo from 14 weeks
until delivery. Circulating 25(OH)-vitamin D concentrations were assessed at 14
and 34 weeks' gestation. A sequential sub-sample completed Schwarzer's General
Self-Efficacy Scale at 14 and 34 weeks and the Problematic Experiences of Therapy
Scale at 34 weeks. Women were interviewed about their experiences of the trial
and interview transcripts analysed thematically.
RESULTS: In 203 women, those with higher self-efficacy were less likely to
experience practical problems taking the study medication (odds ratio (OR) 0.81
(95 % confidence interval (CI) 0.69-0.95), p = 0.01). Over half reported
practical problems associated with poorer compliance with the protocol requiring
women to take the medication daily. Compliance in women who experienced practical
problems was 94 % compared with 98 % for those with no problems (p < 0.001).
Poorer compliance was also associated with lower concentrations of 25(OH)-D in
late pregnancy in the treatment group (β = 0.54 nmol/l (95 % CI 0.18-0.89),
p = 0.003). Thematic analysis suggested common difficulties were remembering to
take the medication every day and swallowing the large capsules.
CONCLUSIONS: These findings suggest that differences in self-efficacy influence
trial outcomes. Such information may help clinicians anticipate responses to
routine vitamin D supplementation in pregnancy and identify those who may need
more support to comply.
TRIAL REGISTRATION: ISRCTN82927713, registered 11/04/2008.
DOI: 10.1007/s00198-016-3721-5
PMCID: PMC5404713
1309. Health Psychol Res. 2015 Nov 30;3(3):1545. doi: 10.4081/hpr.2015.1545.

eCollection 2015 Nov 30.
Understanding the Missing Link Between Musical Attitudes, Preferences and

Psychological Profiles: Music as Auto-Medication and Self-Administered Therapy?
Implications for Music Therapy.
Bragazzi NL(1), Ratto G(2), Luche ND(3), Canfori T(4), Proietti C(4), Del Puente
G(5).
Author information:
(1)Department of Health Sciences, School of Public Health, University of Genoa.
(2)Giacomo Puccini Conservatory of Music, La Spezia; Carlo Soliva School of
Music, Casale Monferrato.
(3)La Scala Theatre , Milan.
(4)Niccolò Paganini Conservatory of Music , Genoa.
(5)Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal
and Child Health, Section of Psychiatry, University of Genoa , Italy.
DOI: 10.4081/hpr.2015.1545
PMCID: PMC4768526
PMID: 26973965
1310. Int J Med Inform. 2014 Nov;83(11):841-8. doi: 10.1016/j.ijmedinf.2014.07.004.

Epub 2014 Jul 27.
Assessing the impact of cognitive impairment on the usability of an electronic

medication delivery unit in an assisted living population.
Ligons FM(1), Mello-Thoms C(2), Handler SM(3), Romagnoli KM(1), Hochheiser H(4).
Author information:
(1)Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh,
PA, United States; Geriatric Pharmaceutical Outcomes and Geroinformatics Research
& Training Program, University of Pittsburgh, Pittsburgh, PA, United States.
PA, United States; Medical Radiation Sciences, The University of Sydney, Sydney,
NSW, Australia.
& Training Program, University of Pittsburgh, Pittsburgh, PA, United States;
Division of Geriatric Medicine, University of Pittsburgh School of Medicine,
United States.
& Training Program, University of Pittsburgh, Pittsburgh, PA, United States;
Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, United
States. Electronic address: harryh@pitt.edu.
PURPOSE: To examine the relationship between cognitive status and the usability
of an integrated medication delivery unit (MDU) in older adults who reside in an
Assisted Living Facility (ALF).
METHODS: Subjects were recruited from a single ALF in Pittsburgh, PA. Usability
testing sessions required subjects to execute tasks essential to using EMMA(®)
(Electronic Medication Management Assistant), a Class II Federal Drug
Administration (FDA) approved integrated MDU. Video coding allowed for
quantification of usability errors observed during the testing sessions. Each
subject's cognitive status was assessed using the Mini Mental State Exam
(MMSE(®)) with scores <24 indicating cognitive impairment. Functional status was
assessed using the Lawton Instrumental Activities of Daily Living (IADL)
questionnaire, and a global assessment of subjective usability was assessed by
completing the System Usability Scale (SUS). Non-parametric statistics and
correlation analysis were used to determine whether significant differences
existed between cognitively impaired and non-impaired subjects.
RESULTS: Nineteen subjects were recruited and completed the protocol. The subject
pool was primarily white, female, 80+ and in possession of above average
education. There was a significant relationship between MMSE(®) scores and the
percentage of task success (z=-2.03, p=0.04). Subjects with MMSE(®) scores of 24+
(no cognitive impairment) successfully completed an average of 69.0% of tasks vs.
the 34.7% performance for those in the cognitively impaired group (<24). Six of
the unimpaired group also succeeded at meeting the 85% (6 out of 7 correct)
threshold. No subject with cognitive impairments (<24 MMSE(®)) completed more
than 5/7 (71.4%) of their tasks. Two of the impaired subjects failed all of the
tasks. Three of the MMSE(®)'s subsections (Date, Location and Spell 'world'
backwards) were found to be significantly related (p<0.05) to the percentage of
task success. Tasks success rates were related with IADL scores (z=-3.826,
p<0.0001), and SUS scores (r=0.467, p=0.0429).
CONCLUSIONS: Medication delivery units like EMMA(®) have the potential to improve
medication management by combining reminder systems with telemedical monitoring
and control capabilities. However, subjects judged to be "cognitively impaired"
(<24 MMSE(®)) scored a significantly smaller percentage of task success than the
"unimpaired" (>=24), suggesting that cognitive screening of patients prior to the
use of EMMA(®) may be advisable. Further studies are needed to test the use of
EMMA(®) amongst ALF residents without cognitive impairment to see if this
technology can improve medication adherence.
DOI: 10.1016/j.ijmedinf.2014.07.004
PMCID: PMC4268135
1311. J Gen Intern Med. 2014 Nov;29(11):1506-12. doi: 10.1007/s11606-014-2940-8.

Epub
2014 Aug 5.
Strategies used by older adults with asthma for adherence to inhaled

corticosteroids.
Brooks TL(1), Leventhal H, Wolf MS, O'Conor R, Morillo J, Martynenko M,
Wisnivesky JP, Federman AD.
Author information:
(1)New York University, New York, NY, USA.
Comment in
J Gen Intern Med. 2014 Nov;29(11):1531.
BACKGROUND: Older adults with asthma have low levels of adherence to their
prescribed inhaled corticosteroids (ICS). While prior research has identified
demographic and cognitive factors associated with ICS adherence among elderly
asthmatics, little is known about the strategies that older adults use to achieve
daily use of their medications. Identifying such strategies could provide
clinicians with useful advice for patients when counseling their patients about
ICS adherence.
OBJECTIVE: To identify medication use strategies associated with good ICS
adherence in older adults.
PARTICIPANTS: English-speaking and Spanish-speaking adults ages 60 years and
older with moderate or severe asthma were recruited from primary care and
pulmonary practices in New York City, NY, and Chicago, IL. Patients with chronic
obstructive pulmonary disease, other chronic lung diseases or a smoking history
of greater than 10 pack-years were excluded.
MAIN MEASURES: Medication adherence was assessed with the Medication Adherence
Rating Scale (MARS). Medication use strategies were assessed via open-ended
questioning. "Good adherence" was defined as a mean MARS score of 4.5 or greater.
KEY RESULTS: The rate of good adherence to ICS was 37 %. We identified six
general categories of medication adherence strategies: keeping the medication in
a usual location (44.2 %), integrating medication use with a daily routine (32.6
%), taking the medication at a specific time (21.7 %), taking the medication with
other medications (13.4 %), using the medication only when needed (13.4 %), and
using other reminders (11.9 %). The good adherence rate was greater among
individuals who kept their ICS medication in the bathroom (adjusted odds ration
[AOR] 3.05, 95 % CI 1.03-9.02, p = 0.04) or integrated its use into a daily
routine (AOR 3.77, 95 % CI: 1.62-8.77, p = 0.002).
CONCLUSIONS: Keeping ICS medications in the bathroom and integrating them into
daily routines are strategies associated with good ICS adherence. Clinicians
concerned with adherence should consider recommending these strategies to their
older asthmatic patients, although additional research is needed to determine
whether such advice would improve adherence behaviors.
DOI: 10.1007/s11606-014-2940-8
PMCID: PMC4238202
1312. Clin Interv Aging. 2017 Jun 8;12:949-954. doi: 10.2147/CIA.S103359.

eCollection
2017.
Elder self-neglect: research and practice.
Dong X(1).
Author information:
(1)Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, IL,
USA.
Elder self-neglect is a global public health and human rights issue that
threatens older people's health and safety. It commonly refers to refusal or
failure to provide oneself with care and protection in areas of food, water,
clothing, hygiene, medication, living environments, and safety precautions. While
prevalent, the status of self-neglecting individuals remains largely unclear, in
particular within community-dwelling populations. By reviewing the epidemiology
of elder self-neglect (definition, prevalence, risk factors, and consequences) to
date, the present paper identifies key research gaps such as methodological
inconsistency in case identification and measurement, and study designs that are
inadequate to determine risk factors of self-neglect. More importantly, in light
of the rapidly growing older population, relevant stakeholders (researchers,
healthcare providers, social service providers, legal professionals, community
organizations, and policymakers) must be prepared for an expected increasing
number of self-neglect cases and enlarging scope of the problem. Hence, in this
article, I present an overview regarding the management issues of elderly
self-neglect related to the detection, assessment, reporting and referral, and
decision-making capacity. Based on the current literature, the paper is aimed to
explore the present knowledge and challenges, and how they can pave the way for
solutions to self-neglect research, practice, and policy.
DOI: 10.2147/CIA.S103359
PMCID: PMC5472408
Conflict of interest statement: Disclosure The author reports no conflict of

1313. Diabetes Educ. 2015 Dec;41(6):706-15. doi: 10.1177/0145721715606806. Epub

2015
Sep 11.
Family Model of Diabetes Education With a Pacific Islander Community.
McElfish PA(1), Bridges MD(1), Hudson JS(1), Purvis RS(1), Bursac Z(2), Kohler
PO(1), Goulden PA(3).
Author information:
(1)University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas
(Dr McElfish, Dr Bridges, Prof Hudson, Dr Purvis, Dr Kohler)
(2)Division of Biostatistics and the Center for Population Sciences, Department
of Preventive Medicine for the College of Medicine at the University of Tennessee
Health Science Center, Memphis, Tennessee (Dr Bursac)
(3)Department of Medicine, Division of Endocrinology and Metabolism at the
University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Goulden)
PURPOSE: The purpose of the study was to use a community-based participatory

research approach to pilot-test a family model of diabetes education conducted in
participants' homes with extended family members.
METHODS: The pilot test included 6 families (27 participants) who took part in a
family model of diabetes self-management education (DSME) using an
intervention-driven pre- and posttest design with the aim of improving glycemic
control as measured by A1C. Questionnaires and additional biometric data were
also collected. Researchers systematically documented elements of feasibility
using participant observations and research field reports.
RESULTS: More than three-fourths (78%) of participants were retained in the
study. Posttest results indicated a 5% reduction in A1C across all participants
and a 7% reduction among those with type 2 diabetes. Feasibility of an in-home
model with extended family members was documented, along with observations and
recommendations for further DSME adaptations related to blood glucose monitoring,
physical activity, nutrition, and medication adherence.
CONCLUSIONS: The information gained from this pilot helps to bridge the gap
between knowledge of an evidence-based intervention and its actual implementation
within a unique minority population with especially high rates of type 2 diabetes
and significant health disparities. Building on the emerging literature of family
models of DSME, this study shows that the family model delivered in the home had
high acceptance and that the intervention was more accessible for this
hard-to-reach population.
DOI: 10.1177/0145721715606806
PMCID: PMC5286927
Conflict of interest statement: Duality of Interest. Authors have no conflicts of

interest to disclose.

A qualitative exploration of hypertensive patients' perception towards quality

use of medication and hypertension management at the community level.
Tan CS(1), Hassali MA(2), Neoh CF(3), Saleem F(4).
Author information:
(1)Program Coordinator. School of Pharmacy, KPJ International College. Penang
(Malaysia). chingsiang9@hotmail.com.
(2)Professor of Social and Administrative Pharmacy. School of Pharmaceutical
Sciences, Universiti Sains Malaysia. Penang (Malaysia). azmihassali@gmail.com.
(3)Faculty of Pharmacy, Universiti Teknologi MARA. Selangor (Malaysia).
chinfenneoh@gmail.com.
(4)Associate Professor. Faculty of pharmacy & Health Sciences, University of
Balochistan. Quetta (Pakistan). fahaduob@gmail.com.
Objective: This study aimed to explore hypertensive patients' perspectives on

quality use of medication and issues related to hypertension management at the
community level in Malaysia.
Methods: Focus groups discussion was employed in this qualitative study. A total
of 17 hypertensive patients were purposively recruited. Three focus group
discussions with semi-structured interview were carried out at Flat Desa Wawasan,
Penang. All the conversations were audio recorded, transcribed verbatim and
thematically analysed.
Results: Three major themes were developed, including medication adherence among
hypertensive patients, self-management of hypertension and patients' knowledge
towards hypertension. Poor medication adherence was found and different
strategies were taken to overcome the barriers towards adherence. Use of herbal
and traditional therapies was perceived as alternative method in controlling
blood pressure instead of taking antihypertensive medication. The participants
were found to have poor knowledge on side effect and mechanism of action of
hypertensive medication.
Conclusions: The misconception about the side effect of antihypertensive
medication has led to poor adherence among the participants. Lack of knowledge on
targeted blood pressure level has led to poor blood pressure monitoring among the
participants. Health awareness program and counselling from health care
professional should be advocated among the hypertensive patients in addressing
the above gaps.
DOI: 10.18549/PharmPract.2017.04.1074
PMCID: PMC5742001
PMID: 29317924
Conflict of interest statement: CONFLICT OF INTEREST No conflict of interest.
Interpersonal Mechanisms Contributing to the Association Between HIV-Related

Internalized Stigma and Medication Adherence.
Blake Helms C(1), Turan JM(2), Atkins G(1), Kempf MC(3), Clay OJ(1), Raper JL(4),
Mugavero MJ(4), Turan B(5).
Author information:
(1)The Department of Psychology, University of Alabama at Birmingham, 415
Campbell Hall, Birmingham, AL, 35294-1170, USA.
(2)Department of Health Care Organization and Policy, University of Alabama at
(3)Department of Family, Community and Health Systems and Department of Health
Behavior, University of Alabama at Birmingham, Birmingham, AL, USA.
(4)The Department of Medicine, University of Alabama at Birmingham, Birmingham,
AL, USA.
Campbell Hall, Birmingham, AL, 35294-1170, USA. bturanb@gmail.com.
Previous research suggests that people living with HIV (PLWH) sometimes
internalize HIV-related stigma existing in the community and experience feelings
of inferiority and shame due to their HIV status, which can have negative
consequences for treatment adherence. PLWH's interpersonal concerns about how
their HIV status may affect the security of their existing relationships may help
explain how internalized stigma affects adherence behaviors. In a cross-sectional
study conducted between March 2013 and January 2015 in Birmingham, AL, 180 PLWH
recruited from an outpatient HIV clinic completed previously validated measures
of internalized stigma, attachment styles, and concern about being seen while
taking HIV medication. Participants also self-reported their HIV medication
adherence. Higher levels of HIV-related internalized stigma, attachment-related
anxiety (i.e., fear of abandonment by relationship partners), and concerns about
being seen by others while taking HIV medication were all associated with worse
medication adherence. The effect of HIV-related internalized stigma on medication
adherence was mediated by attachment-related anxiety and by concerns about being
seen by others while taking HIV medication. Given that medication adherence is
vitally important for PLWH to achieve long-term positive health outcomes,
understanding interpersonal factors affecting medication adherence is crucial.
Interventions aimed at improving HIV treatment adherence should address
interpersonal factors as well as intrapersonal factors.
DOI: 10.1007/s10461-016-1320-2
PMCID: PMC4980279
1316. AIDS Care. 2017 Apr;29(4):449-457. doi: 10.1080/09540121.2016.1258451. Epub

2016
Nov 15.
Impact of food, housing, and transportation insecurity on ART adherence: a
hierarchical resources approach.
Cornelius T(1)(2), Jones M(1), Merly C(2), Welles B(2), Kalichman MO(2),
Kalichman SC(1)(2).
Author information:
(1)a Department of Psychological Sciences , University of Connecticut , Storrs ,
CT , USA.
(2)b Institute for Collaboration on Health, Intervention, and Policy, University
of Connecticut , Storrs , CT , USA.
Antiretroviral therapy (ART) has transformed HIV into a manageable illness.

However, high levels of adherence must be maintained. Lack of access to basic
resources (food, transportation, and housing) has been consistently associated
with suboptimal ART adherence. Moving beyond such direct effects, this study
takes a hierarchical resources approach in which the effects of access to basic
resources on ART adherence are mediated through interpersonal resources (social
support and care services) and personal resources (self-efficacy). Participants
were 915 HIV-positive men and women living in Atlanta, GA, recruited from
community centers and infectious disease clinics. Participants answered baseline
questionnaires, and provided prospective data on ART adherence. Across a series
of nested models, a consistent pattern emerged whereby lack of access to basic
resources had indirect, negative effects on adherence, mediated through both lack
of access to social support and services, and through lower treatment
self-efficacy. There was also a significant direct effect of lack of access to
transportation on adherence. Lack of access to basic resources negatively impacts
ART adherence. Effects for housing instability and food insecurity were fully
mediated through social support, access to services, and self-efficacy,
highlighting these as important targets for intervention. Targeting service
supports could be especially beneficial due to the potential to both promote
adherence and to link clients with other services to supplement food, housing,
and transportation. Inability to access transportation had a direct negative
effect on adherence, suggesting that free or reduced cost transportation could
positively impact ART adherence among disadvantaged populations.
DOI: 10.1080/09540121.2016.1258451
PMCID: PMC5291788
1317. BMC Health Serv Res. 2018 Aug 8;18(1):623. doi: 10.1186/s12913-018-3440-z.
Studying the impact of a medication use evaluation for polymedicated older

patients by the community pharmacist (SIMENON): study protocol.
Wuyts J(1), Maesschalck J(2), De Wulf I(2), Foubert K(3), Boussery K(3), De
Lepeleire J(4), Foulon V(5).
Author information:
(1)Department of Pharmaceutical and Pharmacological Sciences, KU Leuven,
Herestraat 49 O&N2, Box 521, 3000, Leuven, Belgium. Joke.wuyts@kuleuven.be.
(2)Association of Belgian Pharmacies (APB), Archimedesstraat 11, 1000, Brussels,
Belgium.
(4)Department Public Health and Primary Care, ACHG, KU Leuven, Leuven, Belgium.
(5)Department of Pharmaceutical and Pharmacological Sciences, KU Leuven,
Herestraat 49 O&N2, Box 521, 3000, Leuven, Belgium.
BACKGROUND: Aged polymedicated patients are particularly vulnerable for
drug-related problems. A medication review aims to optimize the medication use of
patients and improve health outcomes. In this study, the effect of a
pharmacist-led medication use review is investigated for polymedicated ambulatory
older patients with the aim of implementing this pharmaceutical care intervention
across Belgium.
METHODS: This article describes the study protocol of the SIMENON study and
reports the results of the feasibility study, which aimed to test and optimize
this study protocol. In the SIMENON intervention study, 75 Belgian community
pharmacies each recruit 12 patients for a medication use review. For each
patient, the identified drug-related problems and subsequent interventions are
registered using the PharmDISC classification. In a subset of Dutch speaking
patients, a pretest-posttest single group design is used to measure the impact of
this review on patient related outcomes using questionnaires. The main outcome of
the study is the type and number of drug-related problems and related
interventions. A second outcome is the impact of the medication use review on
adherence, objectively measured with dispensing data. Evolution in medication
related quality of life is another outcome, measured with the Living with
Medicines Questionnaire version 3. Other patient reported outcomes include
adherence, self-management, patient satisfaction, fall incidents and use of
emergency healthcare services.
DISCUSSION: The findings of this study can provide data on the effectiveness of a
medication use review in the Belgian primary care setting. Furthermore, it will
provide insights in which patients benefit most of this intervention and
therefore facilitate the implementation of medication review in Belgium.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03179722 . Retrospectively registered 7
June 2017.
DOI: 10.1186/s12913-018-3440-z
PMCID: PMC6083518
1318. Clin Transl Allergy. 2017 Nov 10;7:39. doi: 10.1186/s13601-017-0175-6.

eCollection 2017.
Differences in medication adherence are associated with beliefs about medicines

in asthma and COPD.
Brandstetter S(1), Finger T(1), Fischer W(1), Brandl M(1), Böhmer M(2), Pfeifer
M(3), Apfelbacher C(1).
Author information:
(1)Medical Sociology, Institute of Epidemiology and Preventive Medicine,
University of Regensburg, Dr.-Gessler-Str. 17, 93051 Regensburg, Germany.
(2)Department of Public Health Microbiology and Infectious Disease Epidemiology,
Bavarian Health and Food Safety Authority, Oberschleissheim, Germany.
(3)Department of Pneumology, Klinik Donaustauf, Donaustauf, Germany.
Adherence to medication is crucial for achieving treatment control in chronic

obstructive lung diseases. This study refers to the "necessity-concerns
framework" and examines the associations between beliefs about medicines and
self-reported medication adherence in people with chronic obstructive lung
disease. 402 patients (196 with asthma, 206 with COPD) participated in the study
and completed a questionnaire comprising the "Beliefs about
Medicines-Questionnaire" (BMQ) and the "Medication Adherence Report Scale"
(MARS). Multivariable logistic regression analyses with the BMQ-subscales as
explanatory and the dichotomized MARS-score as dependent variable were computed
for the asthma and the COPD sample, respectively, and adjusted for potentially
confounding variables. 19% of asthma patients and 34% of COPD patients were
completely adherent to their prescribed medication. While specific beliefs about
the necessity of medicines were positively associated with medication adherence
both in patients with asthma and with COPD, general beliefs about harm and
overuse of medicines by doctors were negatively associated with medication
adherence only among patients with asthma. The findings of this study suggest
that patients' specific beliefs about the necessity of medicines represent an
important modifiable target for improving patient-doctor consultations when
prescribing medicines.
DOI: 10.1186/s13601-017-0175-6
PMCID: PMC5680826
PMID: 29152167
1319. Osteoporos Int. 2017 Dec;28(12):3495-3500. doi: 10.1007/s00198-017-4200-3.

Epub
2017 Aug 31.
Self-perception of fracture risk: what can it tell us?
Litwic AE(1), Compston JE(2), Wyman A(3), Siris ES(4), Gehlbach SH(3), Adachi
JD(5), Chapurlat R(6), Díez-Pérez A(7), LaCroix AZ(8), Nieves JW(9), Netelenbos
JC(10), Pfeilschifter J(11), Rossini M(12), Roux C(13), Saag KG(14), Silverman
S(15), Watts NB(16), Greenspan SL(17), March L(18), Gregson CL(1)(19), Cooper
C(1)(20), Dennison EM(21); Global Longitudinal Study of Osteoporosis in Women
(GLOW) Investigators.
Author information:
(1)MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton
General Hospital, Southampton, SO16 6YD, UK.
(2)Cambridge Biomedical Centre, Cambridge, UK.
(3)Center for Outcomes Research, University of Massachusetts Medical School,
Worcester, MA, USA.
(4)Department of Medicine, Columbia University Medical Center, New York, NY, USA.
(5)St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.
(6)INSERM U831, Division of Rheumatology, Hôpital E. Herriot, Université de Lyon,
Lyon, France.
(7)Hospital del Mar-IMIM-Autonomous, University of Barcelona, Barcelona, Spain.
(8)Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
(9)Helen Hayes Hospital and Columbia University, West Haverstraw, NY, USA.
(10)Department of Endocrinology, VU University Medical Center, Amsterdam, The
Netherlands.
(11)Department of Internal Medicine III, Alfried Krupp Krankenhaus, Essen,
Germany.
(12)Department of Rheumatology, University of Verona, Verona, Italy.
(13)Cochin Hospital, Paris Descartes University, Paris, France.
(14)University of Alabama-Birmingham, Birmingham, AL, USA.
(15)Department of Rheumatology, Cedars-Sinai/UCLA, Los Angeles, CA, USA.
(16)Bone Health and Osteoporosis Center, University of Cincinnati, Cincinnati,
OH, USA.
(17)University of Pittsburgh, Pittsburgh, PA, USA.
(18)Faculty of Medicine and Department of Public Health, University of Sydney,
Sydney, Australia.
(19)Musculoskeletal Research Unit, Learning and Research Building, Southmead
Hospital, University of Bristol, Bristol, UK.
(20)Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK.
(21)MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton
General Hospital, Southampton, SO16 6YD, UK. emd@mrc.soton.ac.uk.
In this study, we report that self-perception of fracture risk captures some

aspect of fracture risk not currently measured using conventional fracture
prediction tools and is associated with improved medication uptake. It suggests
that adequate appreciation of fracture risk may be beneficial and lead to greater
healthcare engagement and treatment.INTRODUCTION: This study aimed to assess how
well self-perception of fracture risk, and fracture risk as estimated by the
fracture prediction tool FRAX, related to fracture incidence and uptake and
persistence of anti-osteoporosis medication among women participating in the
Global Longitudinal study of Osteoporosis in Women (GLOW).
METHODS: GLOW is an international cohort study involving 723 physician practices
across 10 countries in Europe, North America and Australia. Aged ≥ 55 years,
60,393 women completed baseline questionnaires detailing medical history,
including co-morbidities, fractures and self-perceived fracture risk (SPR).
Annual follow-up included self-reported incident fractures and anti-osteoporosis
medication (AOM) use. We calculated FRAX risk without bone mineral density
measurement.
RESULTS: Of the 39,241 women with at least 1 year of follow-up data, 2132 (5.4%)
sustained an incident major osteoporotic fracture over 5 years of follow-up.
Within each SPR category, risk of fracture increased as the FRAX categorisation
of risk increased. In GLOW, only 11% of women with a lower baseline SPR were
taking AOM at baseline, compared with 46% of women with a higher SPR. AOM use
tended to increase in the years after a reported fracture. However, women with a
lower SPR who were fractured still reported lower AOM rates than women with or
without a fracture but had a higher SPR.
CONCLUSIONS: These results suggest that SPR captures some aspect of fracture risk
not currently measured using conventional fracture prediction tools and is also
associated with improved medication uptake.
DOI: 10.1007/s00198-017-4200-3
PMCID: PMC5759929
1320. East Mediterr Health J. 2015 Dec 13;21(10):722-8.
Reliability and known-group validity of the Arabic version of the 8-item Morisky
Medication Adherence Scale among type 2 diabetes mellitus patients.
Ashur ST(1), Shamsuddin K(1), Shah SA(1), Bosseri S(2), Morisky DE(3).
Author information:
Health, Los Angles, California, United States of America.
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.
Publisher: ‫موثوقية النسخة العربية من مقياس موريسكي ذي البنود الثمانية الخاص‬

‫ ومصداقية هذه النسخة لدى مجموعات‬،2 ‫باللتزام بالمداواة بن مرضى السكري من النمط‬
‫ دونالد‬،‫ سعاد البصيري‬،‫ شامسول أزهر شاه‬،‫ خديجة شمس الدين‬،‫سناء طاهر عاشور‬.‫معروفة‬
‫لم يسبق أن أجريت دراسة لتوثيق مصداقية النسخة العربية من مقياس موريسكي ذي‬.‫مورسكي‬
‫©( البنود الثمانية‬MMAS-8) ‫ لقد قامت هذه‬.‫كمقياس لللتزامبالمداواة بن مرضى السكري‬
‫ باختبار موثوقية ومصداقية النسخة العربية من‬2013 ‫ الدراسة في عام‬MMAS-8 ‫لدى مرضى‬
‫ حيث قامت عينة راحة‬.‫ الذين يراجعون مركز إحالة في طرابلس بليبيا‬2 ‫السكري من النمط‬
‫ وتم اختبار الموثوقية باستخدام كرونباخ ألفا‬.‫ مريض ا ا بملء ذاتي للستبيان‬103 ‫تضم‬
‫ وتم اختبار المصداقية لدى مجموعات‬.‫ براون‬-‫ووسطي الرتباط بن البنود وبمعامل سبيرمان‬
‫© معروفة بمقارنة الدرجات المحررزة عى‬MMAS-8 ‫لمرضى مصنفن في مجموعات بحسب ضبط سكر‬
‫ فأظهرت النسخة العربية اتساقا ا داخليا ا كافيا ا‬.‫( الدم‬α=0.70) ‫وموثوقية متوسطة لدى‬
‫( النصف المشطور‬r=0.65). ‫كا أ بدديدت مصداقية المجموعات المعروفة بوجود ارتباط كبر بن‬
‫ مع وجود حجم تأثر معتدل‬،‫( اللتزام بالمداواة وبن ضبط سكر الدم‬ϕc=0.34). ‫أثبتت‬
‫ وبذا يمكنها أن تدعم البحاث‬،‫الدراسة أنه لدى النسخة العربية خصائص سيكومترية جيدة‬
‫والممارسات المتعلقة بالسكري في البلدان العربية‬.Publisher: Fiabilité et validité
par groupe connu de la version en langue arabe du questionnaire de Morisky à 8
items sur l'adhésion au traitement chez des patients atteints de diabète de type
2.Aucune étude de validation n’a été menée pour la version en langue arabe du
questionnaire de Morisky à 8 items (Morisky Medication Adherence Scale – MMAS-8©)
visant à mesurer l’adhésion au traitement du diabète. La présente étude menée en
2013 a testé la fiabilité et la validité de la version en langue arabe de
l’échelle MMAS-8 chez des patients atteints de diabète de type 2 consultant dans
une clinique de recours à Tripoli (Libye). Dans un échantillon de proximité, 103
patients ont rempli l’autoquestionnaire. La fiabilité a été testée à l’aide de
l’alpha de Cronbach, de la corrélation moyenne entre item et du coefficient de
Spearman–Brown. La validité par groupe connu a été testée en comparant les scores
MMAS-8 des patients regroupés par contrôle glycémique. La version en langue arabe
a révélé une cohérence interne adéquate (α = 0,70) et une fiabilité fractionnée
modérée (r = 0,65). La validité par groupe connu a été confirmée par une
association significative observée entre l'adhésion au traitement et le contrôle
de la glycémie, avec une taille d’effet modérée (ϕc = 0,34). La version en langue
arabe avait des propriétés psychométriques satisfaisantes et pourrait être utile
pour la recherche sur le diabète et la pratique y afférente dans les pays arabes.

eCollection 2015.
Assessing the adherence behavior of glaucoma patients to topical eye drops.
Welge-Lussen U(1), Weise S(2), Yu AL(3).
Author information:
(1)Department of Ophthalmology, Friedrich-Alexander University, Erlangen,
Germany.
(2)Department of Ophthalmology, University of Cologne, Cologne, Germany.
(3)Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany.
PURPOSE: The goal of this study was to determine the adherence of glaucoma
patients to their topical glaucoma medication. Furthermore, the relationships
between the adherence behavior and the patients' demographic data, clinical
characteristics, and their knowledge about glaucoma were evaluated.
METHODS: This was a prospective study of 123 patients with primary open-angle
glaucoma who were given two standardized questionnaires. The first questionnaire
at time point T1 comprised a knowledge assessment and the self-reported adherence
measures Adherence to Refills and Medication Scale 2 (ARMS2), visual analogue
scale for adherence (VAS-AD), and missed doses in the past 14 days. Two months
later at time point T2, a second questionnaire reevaluated the adherence measures
ARMS2, VAS-AD, and missed doses in the past 14 days.
RESULTS: There was a good correlation among all the three adherence measures at
T1 and T2. The mean values of ARMS2 were in the lower range, with 3.38 at T1 and
2.8 at T2. The VAS-AD detected that 18.5% of patients always took their eye drops
correctly, and 77.9% of patients reported not to have missed a single dose in the
past 14 days. There was no significant correlation between the patients'
demographic data or knowledge about glaucoma and the adherence measures ARMS2 or
VAS-AD. Among the clinical characteristics, only single-eye blindness showed a
significant correlation with VAS-AD.
CONCLUSION: In this study, no general relationships were found between medication
adherence and the patients' demographic data, clinical characteristics, or
knowledge about glaucoma. It may be assumed that more individualized strategies
are required to optimize adherence behavior.
DOI: 10.2147/PPA.S69943
PMCID: PMC4274150
PMID: 25565780
1322. Pharm Pract (Granada). 2015 Jan-Mar;13(1):533. Epub 2015 Mar 15.
Adherence to oral anti-diabetic drugs among patients attending a Ghanaian

teaching hospital.
Bruce SP(1), Acheampong F(2), Kretchy I(3).
Author information:
(1)Clinical Pharmacist, Pharmacy Department, Korle Bu Teaching Hospital. Accra (
Ghana ). suliben@yahoo.com.
(2)Principal Clinical Pharmacist, Emergency Department, Korle Bu Teaching
Hospital. Accra ( Ghana ). franklinach@hotmail.co.uk.
(3)Lecturer, School of Pharmacy, University of Ghana . Legon, Accra ( Ghana ).
iakretchy@yahoo.com.
BACKGROUND: The burden of diabetes mellitus, especially Type-2, continues to

increase across the world. Medication adherence is considered an integral
component in its management. Poor glycemic controls due to medication
nonadherence accelerates the development of long-term complications which
consequently leads to increased hospitalization and mortality.
OBJECTIVE: This study examined the level of adherence to oral antidiabetic drugs
among patients who visited the teaching hospital and explored the probable
contributory factors to non-adherence.
METHODS: A cross-sectional descriptive study using systematic sampling to collect
quantitative data was undertaken. Questionnaires were administered to outpatients
of the medical department of a teaching hospital in Ghana. Logistic regression
was performed with statistical significance determined at p<0.05.
RESULTS: A total of 200 diabetic patients participated in the study. Using the
Morisky Medication Adherence scale, the level of adherence determined was 38.5%.
There were significant correlations between level of adherence and educational
level [(OR)=1.508; (CI 0.805-2.825), P=0.019), and mode of payment [(OR)=1.631;
(CI 0.997-2.669), P=0.05).
CONCLUSION: Adherence in diabetic patients was low among respondents and this can
be improved through education, counseling and reinforcement of self-care. There
were several possible factors that contributed to the low adherence rate which
could benefit from further studies.
PMCID: PMC4384271
PMID: 25883693

eCollection 2016.
Impact of a Daily SMS Medication Reminder System on Tuberculosis Treatment

Outcomes: A Randomized Controlled Trial.
Mohammed S(1), Glennerster R(2), Khan AJ(1).
Author information:
(1)Interactive Research and Development, Karachi, Pakistan.
(2)Abdul Latif Jameel Poverty Action Lab, Massachusetts Institute of Technology,
Cambridge, MA, United States of America.
IMPORTANCE: The rapid uptake of mobile phones in low and middle-income countries
over the past decade has provided public health programs unprecedented access to
patients. While programs have used text messages to improve medication adherence,
there have been no high-powered trials evaluating their impact on tuberculosis
treatment outcomes.
OBJECTIVE: To measure the impact of Zindagi SMS, a two-way SMS reminder system,
on treatment success of people with drug-sensitive tuberculosis.
DESIGN: We conducted a two-arm, parallel design, effectiveness randomized
controlled trial in Karachi, Pakistan. Individual participants were randomized to
either Zindagi SMS or the control group. Zindagi SMS sent daily SMS reminders to
participants and asked them to respond through SMS or missed (unbilled) calls
after taking their medication. Non-respondents were sent up to three reminders a
day.
SETTING: Public and private sector tuberculosis clinics in Karachi, Pakistan.
PARTICIPANTS: Newly-diagnosed patients with smear or bacteriologically positive
pulmonary tuberculosis who were on treatment for less than two weeks; 15 years of
age or older; reported having access to a mobile phone; and intended to live in
Karachi throughout treatment were eligible to participate. We enrolled 2,207
participants, with 1,110 randomized to Zindagi SMS and 1,097 to the control
group.
MAIN OUTCOME: The primary outcome was clinically recorded treatment success based
upon intention-to-treat.
RESULTS: We found no significant difference between the Zindagi SMS or control
groups for treatment success (719 or 83% vs. 903 or 83%, respectively, p =
0·782). There was no significant program effect on self-reported medication
adherence reported during unannounced visits during treatment.
CONCLUSION: In this large-scale randomized controlled effectiveness trial of SMS
medication reminders for tuberculosis treatment, we found no significant impact.
TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov,
NCT01690754.
PMCID: PMC5089745

interests exist.
1324. Sage Open. 2015 Jan-Mar;5(1). doi: 10.1177/2158244015574938.
Consistency between beliefs and behavior regarding use of substances in recovery.
Kaskutas LA(1), Ritter LA(2).
Author information:
(1)Senior Scientist, Alcohol Research Group at the Public Health Institute, 6475
Christie Avenue, Suite 400, Emeryville CA 94608-1010; and Adjunct Associate
Professor, School of Public Health, University of California Berkeley.
(2)Senior Research Associate, Alcohol Research Group at the Public Health
Institute, 6475 Christie Avenue, Emeryville CA 94608-1010; and Lecturer,
California State University, East Bay.
This paper addresses the assumption that pathways to recovery from substance
abuse and dependence, and the language used to define one's relationship to
substances, translate to actual beliefs and behaviors in terms of substance use.
We draw on social representation theory, and use data from a large web-based
study (n=9,341) whose goal was to understand how individuals in recovery define
what recovery means to them. We often hear people say that they are "in
recovery," and present findings now provide empirical evidence of the prevalent
meanings of this ubiquitous expression. The belief that recovery is abstinence
was broadly held in our sample, especially among those exposed to treatment and
12-step self-help groups and who define themselves as in recovery-and most (but
not all) of such individuals are complete abstainers (no alcohol or drugs). In
contrast, among the "self-changers" who did not attend treatment or self-help
groups, the most common self-definition was used to have an alcohol or drug
problem but don't any more, half of whom believe that recovery is abstinence
while half do not, and only one-third are abstainers. Findings are of public
health relevance, as it is estimated that among American adults alone, 10% report
having had alcohol or drug problems but no longer do (The New York State Office
of Alcoholism and Substance Abuse Services (OASAS), 2012). In line with the
central concepts of social representation theory, people's pathways to recovery
have a strong effect on how they define themselves and their behaviors and
beliefs, but it is not universal.
DOI: 10.1177/2158244015574938
PMCID: PMC4566927
PMID: 26366325
1325. Trials. 2014 Sep 25;15:374. doi: 10.1186/1745-6215-15-374.
Smartphone- and internet-assisted self-management and adherence tools to manage

Parkinson's disease (SMART-PD): study protocol for a randomised controlled trial
(v7; 15 August 2014).
Lakshminarayana R(1), Wang D, Burn D, Chaudhuri KR, Cummins G, Galtrey C, Hellman

B, Pal S, Stamford J, Steiger M, Williams A; SMART-PD Investigators.
Author information:
(1)uMotif Ltd, London, UK. rashmi@umotif.com.
BACKGROUND: Nonadherence to treatment leads to suboptimal treatment outcomes and

enormous costs to the economy. This is especially important in Parkinson's
disease (PD). The progressive nature of the degenerative process, the complex
treatment regimens and the high rates of comorbid conditions make treatment
adherence in PD a challenge. Clinicians have limited face-to-face consultation
time with PD patients, making it difficult to comprehensively address
non-adherence. The rapid growth of digital technologies provides an opportunity
to improve adherence and the quality of decision-making during consultation. The
aim of this randomised controlled trial (RCT) is to evaluate the impact of using
a smartphone and web applications to promote patient self-management as a tool to
increase treatment adherence and working with the data collected to enhance the
quality of clinical consultation.
METHODS/DESIGN: A 4-month multicentre RCT with 222 patients will be conducted to
compare use of a smartphone- and internet-enabled Parkinson's tracker smartphone
app with treatment as usual for patients with PD and/or their carers. The study
investigators will compare the two groups immediately after intervention. Seven
centres across England (6) and Scotland (1) will be involved. The primary
objective of this trial is to assess whether patients with PD who use the app
show improved medication adherence compared to those receiving treatment as usual
alone. The secondary objectives are to investigate whether patients who receive
the app and those who receive treatment as usual differ in terms of quality of
life, quality of clinical consultation, overall disease state and activities of
daily living. We also aim to investigate the experience of those receiving the
intervention by conducting qualitative interviews with a sample of participants
and clinicians, which will be administered by independent researchers.
TRIAL REGISTRATION: ISRCTN45824264 (registered 5 November 2013).
DOI: 10.1186/1745-6215-15-374
PMCID: PMC4283131

eCollection 2018.
Humanistic outcomes and patient acceptance of the pharmacist-led medication

review "Polymedication Check" in primary care in Switzerland: a prospective
Messerli M(1), Vriends N(2), Hersberger KE(1).
Author information:
(2)Division of Clinical Psychology, Department of Psychology, University of
Basel, Basel, Switzerland.
Background: Since 2010, Swiss pharmacists have been offering their patients a
Polymedication Check (PMC), a new cognitive pharmacy service in the form of a
medication review for patients taking ≥4 prescribed medicines for a period >3
months. While a first publication of this project reported on the impact of the
PMC on patients' adherence, the present paper focuses on humanistic outcomes.
Methods: This randomized controlled trial was conducted in 54 Swiss community
pharmacies. After recruitment, the intervention group underwent a PMC in the
pharmacy (T-0) and 28 weeks after T-0 (T-28), while the control group did not
receive the PMC until 28 weeks after the study started (T-28). A clinical
psychologist, blinded to the intervention, interviewed the patients 2 weeks (T-2)
and 16 weeks (T-16) after T-0. Interviewer and patient both rated patient's
knowledge of own medicines use. Furthermore, patients reported satisfaction with
their pharmacy and appraisal of their medicines use. The availability of a
written medication plan was assessed at T-16. Acceptance of the service was
measured using a patient's self-report questionnaire at T-28.
Results: General linear model analysis for knowledge about medicines revealed a
significant effect on the factor "group" (P=5.86, p=0.016), indicating that the
intervention group had higher ratings for knowledge about their medication at T-2
and T-16 compared to controls. The majority (83%) of patients judged the
counseling by the pharmacist as being helpful for their daily medication
management. Availability of a written medication plan was comparable in both
groups (52.5% vs 52.7%, p>0.05).
Conclusion: For the first time, the benefits of a complex pharmacist-led
intervention were evaluated in Swiss primary care with a randomized controlled
trial. The PMC increased patients' subjective knowledge of their medicines
compared to no medication review. The effect remained sustainable over time.
Recommendations resulting from the pharmacist-led service were highly appreciated
by the patients.
DOI: 10.2147/PPA.S160789
PMCID: PMC6016257
PMID: 29950820
Conflict of interest statement: Disclosure The authors report no other conflicts

of interest in this work.
1327. BMC Res Notes. 2016 Mar 8;9:148. doi: 10.1186/s13104-016-1948-z.
Adherence to interferon β-1a therapy using an electronic self-injector in

multiple sclerosis: a multicentre, single-arm, observational, phase IV study.
Devonshire VA(1), Feinstein A(2), Moriarty P(3).
Author information:
(1)Department of Neurology, University of British Columbia, Vancouver, Canada.
vdev@shaw.ca.
(2)Department of Psychiatry, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Canada. antfeinstein@aol.com.
(3)A division of EMD Inc., EMD Serono, 2695 North Sheridan Way, Suite 200,
Mississauga, ON, L5K 2N6, Canada. Patrick.moriarty@emdserono.com.
BACKGROUND: In a multicentre, single-arm, observational, phase IV study, we

evaluated 24-week treatment adherence of relapsing multiple sclerosis (RMS)
patients using an electronic auto-injection device (RebiSmart(®)) for
subcutaneous injection of interferon (IFN) β-1a.
METHODS: A total of 162 adult participants with RMS were enrolled into the study
to use RebiSmart(®) to self-administer IFN β-1a 44 μg three times weekly for a
maximum of 96 weeks. The number of administered injections was recorded in the
electronic device log. Adherence to treatment was defined as the administration
of ≥80% of expected injections. Cognitive impairment and injection anxiety were
assessed via questionnaires.
RESULTS: Overall, 91.8 and 82.9% of participants were adherent to treatment at
weeks 12 and 24, respectively. By weeks 12 and 24, 8.2 and 13.9% of participants
had discontinued treatment. There were no statistically significant differences
in adherence rates at weeks 12 and 24 according to cognitive impairment status or
injection anxiety. By week 24, 69.9% of participants were less fearful of
injection than when they started the study. According to participant evaluations,
the absence of a visible needle, comfort settings, and the calendar for tracking
the injection schedule were all important features of the RebiSmart(®) injection
system. At week 24, 99.3% of participants reported that they would like to
continue using RebiSmart(®) as their injector.
CONCLUSIONS: RebiSmart(®) use is associated with high treatment adherence, as
objectively assessed using electronic injection logs. Future research should
examine if RebiSmart(®) use improves long-term treatment outcomes in RMS. This
study was registered with ClinicalTrials.gov as NCT01128075, on May 20, 2010.
DOI: 10.1186/s13104-016-1948-z
PMCID: PMC4782351
1328. Front Psychol. 2017 Oct 11;8:1769. doi: 10.3389/fpsyg.2017.01769. eCollection

2017.
Smartphone Applications for Educating and Helping Non-motivating Patients Adhere

to Medication That Treats Mental Health Conditions: Aims and Functioning.
Kassianos AP(1), Georgiou G(2), Papaconstantinou EP(3), Detzortzi A(4), Horne

R(5).
Author information:
(1)Department of Applied Health Research, University College London, London,
United Kingdom.
(2)Department of Psychology, University of Cyprus, Nicosia, Cyprus.
(3)Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
(4)Private Practice, Athens, Greece.
(5)School of Pharmacy, University College London, London, United Kingdom.
Background: Patients prescribed with medication that treats mental health

conditions benefit the most compared to those prescribed with other types of
medication. However, they are also the most difficult to adhere. The development
of mobile health (mHealth) applications ("apps") to help patients monitor their
adherence is fast growing but with limited evidence on their efficacy. There is
no evidence on the content of these apps for patients taking psychotropic
medication. The aim of this study is to identify and evaluate the aims and
functioning of available apps that are aiming to help and educate patients to
adhere to medication that treats mental health conditions. Method: Three platform
descriptions (Apple, Google, and Microsoft) were searched between October 2015
and February 2016. Included apps need to focus on adherence to medication that
treats mental health conditions and use at least a reinforcement strategy.
Descriptive information was extracted and apps evaluated on a number of
assessment criteria using content analysis. Results: Sixteen apps were
identified. All apps included self-monitoring properties like reminders and
psycho-educational properties like mood logs. It was unclear how the latter were
used or how adherence was measured. Major barriers to medication adherence like
patients' illness and medication beliefs and attitudes were not considered nor
where information to patients about mediation side effects. Very few apps were
tailored and none was developed based on established theories explaining the
processes for successful medication adherence like cognitions and beliefs.
Reported information on app development and validation was poor. Discussion: A
variety of apps with different properties that tackle both intentional and
unintentional non-adherence from a different perspective are identified. An
evidence-based approach and co-creation with patients is needed. This will ensure
that the apps increase the possibility to impact on non-adherence. Theories like
social cognition models can be useful in ensuring that patients' education,
motivation, skills, beliefs, and type of adherence are taken into consideration
when developing the apps. Findings from this study can help clinicians and
patients make informed choices and pursue policy-makers to integrate evidence
when developing future apps. Quality-assurance tools are needed to ensure the
apps are systematically evaluated.
DOI: 10.3389/fpsyg.2017.01769
PMCID: PMC5641822
PMID: 29075216
1329. BMC Med Res Methodol. 2017 Aug 3;17(1):118. doi: 10.1186/s12874-017-0394-5.
Validity and reliability of a Malay version of the brief illness perception

questionnaire for patients with type 2 diabetes mellitus.
Chew BH(1)(2), Vos RC(3), Heijmans M(4), Shariff-Ghazali S(5), Fernandez A(6),
Rutten GEHM(3).
Author information:
(1)Department of Family Medicine, Faculty of Medicine and Health Sciences,
Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
chewboonhow@gmail.com.
(2)Julius Center for Health Sciences and Primary Care, Department of General
Practice, University Medical Center Utrecht, Huispost Str.6.131, P.O. Box 85500,
3508, GA, Utrecht, The Netherlands. chewboonhow@gmail.com.
(3)Julius Center for Health Sciences and Primary Care, Department of General
Practice, University Medical Center Utrecht, Huispost Str.6.131, P.O. Box 85500,
3508, GA, Utrecht, The Netherlands.
(4)NIVEL, Netherlands Institute for Health Services Research, Utrecht,
Netherlands.
(5)Department of Family Medicine, Faculty of Medicine and Health Sciences,
Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
(6)Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti
Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
BACKGROUND: Illness perceptions involve the personal beliefs that patients have
about their illness and may influence health behaviours considerably. Since an
instrument to measure these perceptions for Malay population in Malaysia is
lacking, we translated and examined the psychometric properties of the Malay
version of the Brief Illness Perception Questionnaire (MBIPQ) in adult patients
with type 2 diabetes mellitus.
METHODS: The MBIPQ has nine items, all use a 0-10 response scale, except the
ninth item about causal factors, which is an open-ended item. A standard
procedure was used to translate and adapt the English BIPQ into Malay language.
Construct validity was examined comparing item scores and scores on the Diabetes
Management Self-Efficacy Scale, the Morisky Medication Adherence Scale, the World
Health Organization Quality of Life-brief, the 9-item Patient Health
Questionnaire, the 17-item Diabetes Distress Scale, HbA1c and the presence of
complications. In addition, 2-week and 4-week test-retest reliability were
studied.
RESULTS: A total of 312 patients completed the MBIPQ. Out of this, 97 and 215
patients completed the 2- or 4-weeks test-retest reliability questionnaire,
respectively. Moderate inter-items correlations were observed between illness
perception dimensions (r = -0.31 to 0.53). MBIPQ items showed the expected
correlations with self-efficacy (r = 0.35), medication adherence (r = 0.29),
quality of life (r = -0.17 to 0.31) and depressive symptoms (r = -0.18 to 0.21).
People with severe diabetes-related distress also were more concern
(t-test = 4.01, p < 0.001) and experienced lower personal control (t-test = 2.07,
p = 0.031). People with any diabetes-related complication perceived the
consequences as more serious (t-test = 2.04, p = 0.044). The 2-week and 4-week
test-retest reliabilities varied between ICCagreement 0.39 to 0.70 and 0.58 to
0.78, respectively.
CONCLUSIONS: The psychometric properties of items in the MBIPQ are moderate. The
MBIPQ showed good cross-cultural validity and moderate construct validity.
Test-retest reliability was moderate. Despite the moderate psychometric
properties, the MBIPQ may be useful in clinical practice as it is a useful
instrument to elicit and communicate on patient's personal thoughts and feelings.
Future research is needed to establish its responsiveness and predictive
validity.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02730754 registered on March 29, 2016;
NCT02730078 registered on March 29, 2016.
DOI: 10.1186/s12874-017-0394-5
PMCID: PMC5543429
1330. East Mediterr Health J. 2015 Oct 2;21(9):621-8.
Self-management practices among type 2 diabetes patients attending primary

health-care centres in Medina, Saudi Arabia.
Al Johani KA(1), Kendall GE(2), Snider PD(2).
Author information:
(1)Ministry of Health, Medina, Saudi Arabia.
(2)Curtin University of Technology, School of Nursing and Midwifery, Perth,
Western Australia, Australia.
The purpose of this study was to estimate the frequency of self-management

activities among people who have type 2 diabetes in Saudi Arabia. The Arabic
version of the Summary of Diabetes Self-care Activities questionnaire was used to
identify self-management practices among 210 patients with type 2 diabetes
mellitus. Only 15% of participants had a blood glucose level indicative of good
glycaemic control (glycosylated haemoglobin ≤ 7 mmol/L). Most reported that they
took their medication as prescribed, but many demonstrated low levels of
compliance with other self-management practices (overall mean 3.7 days per week).
Males and those with lower incomes were less likely to practise self-care
activities. Most were given basic advice to undertake self-care activities, but
only some were given more detailed information. There are opportunities to
improve type 2 diabetes mellitus self-management practices in Saudi Arabia and
increase the proportion of patients who achieve good glycaemic control.
Publisher: ‫ الذين يراجعون مراكز‬2 ‫ممارسات العاج الذاتي لدى مرضى السكري من النمط‬
‫خالد الجهني‬.‫الرعاية الصحية الولية في المدينة المنورة بالمملكة العربية السعودية‬،
‫لقد كان الغرض من هذه الدراسة تقدير تواتر أنشطة العاج‬.‫ بول سنايدر‬،‫جارث كيندل‬
‫ فتم استخدام النسخة‬.‫ في المملكة العربية السعودية‬2 ‫الذاتي لدى مرضى السكري من النمط‬
‫ للتعرف عى ممارسات‬،‫العربية للستبيان الخاص بملخص أنشطة العناية الذاتية بالسكري‬
‫ فكان مستوى جلوكوز الدم لدى‬.2 ‫ مريضا ا مصابا ا بالسكري من النمط‬210 ‫العاج الذاتي لدى‬
15% 7 > ‫فقط من المشاركين يدل عى ضبط جيد لسكر الدم )الهيموجلن الجليكوزولتي‬
‫ لكن كثيرين‬،‫ وأفاد معظمهم بأنهم أخذوا أدويتهم عى النحو الموصوف لهم‬.(‫لر‬/‫مليمول‬
‫منهم أظهروا مستويات منخفضة من اللتزام بممارسات العاج الذاتي الخرى )المتوسط‬
‫ وكان الذكور وذوو الدخل المنخفض أقل ميا ا إلى ممارسة‬.(‫ أيام في السبوع‬3.7 ‫العام‬
‫ وكان معظمهم قد تلقوا النصائح الساسية الخاصة بالضطاع‬.‫أنشطة العناية الذاتية‬
‫ هناك فرص متاحة‬.‫ لكن بعضهم فقط تلقوا معلومات أكثر تفصيا ا‬،‫بأنشطة العناية الذاتية‬
‫ في المملكة العربية السعودية ولزيادة‬2 ‫لتحسن ممارسات العاج الذاتي للسكري من النمط‬
‫نسبة المرضى الذين يحققون ضبطا ا جيدا ا لسكر الدم‬.Publisher: Pratiques d’auto-prise
en charge chez des patients atteints de diabète de type 2 fréquentant des centres
de soins de santé primaires à Médine (Arabie saoudite).L’objectif de la présente
étude était d’estimer la fréquence des activités d’auto-prise en charge chez des
personnes atteintes de diabète de type 2 en Arabie saoudite. La version en langue
arabe du questionnaire Summary of Diabetes Self-care Activities a été utilisée
pour identifier les pratiques d’auto-prise en charge chez 210 patients atteints
de diabète sucré de type 2. Seuls 15 % des participants présentaient un taux
glycémique révélateur d'un bon contrôle de leur glycémie (hémoglobine glycosylée
≤ 7 mmol/L). La plupart indiquaient avoir pris leur traitement comme prescrit,
mais ils étaient nombreux à présenter des taux d’observance faibles pour d'autres
pratiques d’auto-prise en charge (moyenne d’observance globale hebdomadaire : 3,7
jours sur sept). Les hommes et les personnes ayant des revenus plus faibles
étaient moins susceptibles de pratiquer des activités d’autosoins. Pour la
majorité, ils avaient reçu des conseils élémentaires pour réaliser des activités
d’autosoins, mais seule une minorité d'entre eux avait eu des informations plus
détaillées. Des opportunités existent pour améliorer les pratiques d’auto-prise
en charge du diabète de type 2 en Arabie saoudite et augmenter le pourcentage de
patients qui parviennent à un bon contrôle du taux de glycémie.
1331. AIDS Care. 2017 May;29(5):570-574. doi: 10.1080/09540121.2016.1234690. Epub

2016
Sep 21.
Risk behavior and access to HIV/AIDS prevention services in a community sample of

homeless persons entering permanent supportive housing.
Wenzel SL(1), Rhoades H(1), Harris T(1), Winetrobe H(1), Rice E(1), Henwood B(1).
Author information:
(1)a USC School of Social Work , Los Angeles , CA , USA.
Homeless persons suffer disproportionately high rates of HIV infection, and

moving into permanent supportive housing (PSH) can provide a stable base from
which to access needed prevention services. However, little is known about HIV
risk or prevention behavior during this critical time of transition. The current
study investigated STI and HIV risk and prevention behavior and recent use of
prevention and treatment services (i.e., education, testing, medication) among
homeless persons preparing to move into PSH. Data come from interviews with 421
homeless adults before they moved into PSH. Thirty-seven percent of the
respondents were sexually active; of those, 75.7% reported unprotected sex.
Nearly two-thirds (64%) reported past year HIV testing and 40% reported testing
for another STI. Fewer than one-third (31%) of respondents reported receiving
posttest counseling at their last HIV test. HIV seropositivity was self-reported
by 10%. Among those persons who were HIV-positive, 57.1% reported less than 100%
antiretroviral (ARV) adherence. Among HIV-negative respondents, less than 1% had
been prescribed preexposure prophylaxis (PrEP). Less than half (46.4%) of the
sample reported any HIV prevention education in the past year. This population of
homeless adults about to move into PSH report high rates of HIV risk behavior,
but low rates of HIV prevention education and very little PrEP utilization.
Further, low rates of ARV adherence among HIV-positive respondents indicate
significant risk for HIV transmission and acquisition. Entering PSH is a period
of transition for homeless persons when integrated care is critically important
to ensure positive health outcomes, but these data suggest that PrEP and other
HIV prevention services are poorly accessed among this population. As such,
multipronged services that integrate PrEP and other HIV prevention services are
needed to prevent transmission and acquisition of HIV in this high-risk,
vulnerable population and ensure the health and wellbeing of PSH residents.
DOI: 10.1080/09540121.2016.1234690
PMCID: PMC6232079
1332. AIDS Behav. 2015 Jun;19(6):981-6. doi: 10.1007/s10461-014-0925-6.
Psychosocial Syndemics are Additively Associated with Worse ART Adherence in

HIV-Infected Individuals.
Blashill AJ(1), Bedoya CA, Mayer KH, O'Cleirigh C, Pinkston MM, Remmert JE,
Mimiaga MJ, Safren SA.
Author information:
(1)Massachusetts General Hospital, Boston, MA, USA, Ablashill@mgh.harvard.edu.
Adherence to antiretroviral therapy (ART) among HIV-infected individuals is

necessary to both individual and public health, and psychosocial problems have
independently been associated with poor adherence. To date, studies have not
systematically examined the effect of multiple, co-occurring psychosocial
problems (i.e., "syndemics") on ART adherence. Participants included 333
HIV-infected individuals who completed a comprehensive baseline evaluation, as
part of a clinical trial to evaluate an intervention to treat depression and
optimize medication adherence. Participants completed self-report questionnaires,
and trained clinicians completed semi-structured diagnostic interviews. ART
non-adherence was objectively measured via an electronic pill cap (i.e., MEMS).
As individuals reported a greater number of syndemic indicators, their odds of
non-adherence increased. Co-occurring psychosocial problems have an additive
effect on the risk for poor ART adherence. Future behavioral medicine
interventions are needed that address these problems comprehensively, and/or the
core mechanisms that they share.
DOI: 10.1007/s10461-014-0925-6
PMCID: PMC4405426

eCollection 2019.
Implicit and explicit attitudes towards disease-modifying antirheumatic drugs as

possible target for improving medication adherence.
van Heuckelum M(1)(2), Linn AJ(3), Vandeberg L(3)(4), Hebing RCF(5), van Dijk
L(6)(7), Vervloet M(6), Flendrie M(1), Nurmohamed MT(5)(8), van Dulmen
S(6)(9)(10), van den Bemt BJF(2)(11)(12), van den Ende CHM(1)(13).
Author information:
(1)Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
(2)Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.
(3)Amsterdam School of Communication Research, University of Amsterdam,
(4)Centre for Language Studies, Radboud University, Nijmegen, The Netherlands.
(5)Department of Rheumatology, Amsterdam Rheumatology and Immunology Center,
Reade, Amsterdam, The Netherlands.
(6)Nivel (Netherlands Institute for Health Services Research), Utrecht, The
Netherlands.
(7)Department of PharmacoTherapy, -Epidemiology, & -Economics (PTEE), Groningen
Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences,
University of Groningen, Groningen, The Netherlands.
(8)Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU
University Medical Center, Amsterdam, The Netherlands.
(9)Radboud University Medical Center, Radboud Institute for Health Sciences,
Department of Primary and Community Care, Nijmegen, The Netherlands.
(10)Faculty of Health and Social Sciences, University of South-Eastern Norway,
Drammen, Norway.
(11)Department of Pharmacy, Radboud University Medical Center, Nijmegen, The
Netherlands.
(12)Department of Clinical Pharmacy and Toxicology, Maastricht University Medical
Centre+, Maastricht, The Netherlands.
(13)Department of Rheumatology, Radboud University Medical Center, Nijmegen, The
Netherlands.
OBJECTIVE: This study aims to explore the contribution of implicit attitudes and
associations towards conventional disease-modifying antirheumatic drugs
(cDMARDs), alongside explicit measures, on medication-taking behaviour and
clinical outcomes in adult patients with rheumatoid arthritis (RA).
METHODS: In this observational study, implicit attitudes (positive-negative) and
health-related associations (health-sickness) were measured with Single Category
Implicit Association Tests, whereas explicit outcomes were measured with a
bipolar evaluative adjective scale and the Beliefs about Medicines Questionnaire
Specific. The primary outcome of this study was medication-taking behaviour
subjectively measured by self-report (i.e. validated Compliance Questionnaire on
Rheumatology) and objectively measured with electronic drug monitors over a 3
month period. Spearman rank correlations were used to describe correlations
between implicit and explicit outcomes. Nested linear regression models were used
to assess the additional value of implicit measures over explicit measures and
patient-, clinical-, and treatment-related characteristics.
RESULTS: Of the 1659 initially-invited patients, 254 patients with RA agreed to
participate in this study. Implicit attitudes correlated significantly with
necessity-concerns differential (NCD) scores (ρ = 0.13, P = 0.05) and disease
activity scores (ρ = -0.17, P = 0.04), whereas implicit health-related
associations correlated significantly with mean scores for explicitly reported
health-related associations (ρ = 0.18, P = 0.004). Significant differences in
age, number of DMARDs, biologic DMARD use, NCD-scores, and self-reported correct
dosing were found between the four attitudinal profiles. Nested linear regression
models revealed no additional value of implicit measures in explaining
self-reported medication-taking behaviour and clinical outcomes, over and above
all other variables.
CONCLUSION: Implicit attitudes and associations had no additional value in
explaining medication-taking behaviour and clinical outcomes over and above often
used explicitly measured characteristics, attitudes and outcomes in the studied
population. Only age and NCD scores contributed significantly when the dependent
variable was correct dosing measured with self-report.
PMID: 31469852

interests exist.
1334. Int J Clin Pharm. 2019 Feb;41(1):104-112. doi: 10.1007/s11096-018-0749-y.

Epub
2018 Nov 26.
Patients' experiences with multidose drug dispensing: a cross sectional study.
Mertens BJ(1)(2), Kwint HF(3), van Marum RJ(4)(5), Bouvy ML(6)(3).
Author information:
for Pharmaceutical Sciences, University Utrecht, Utrecht, The Netherlands.
b.mertens@apotheekstevenshof.nl.
(2)SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331
JE, Leiden, The Netherlands. b.mertens@apotheekstevenshof.nl.
(3)SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5b, 2331
JE, Leiden, The Netherlands.
(4)Geriatric Department, Jeroen Bosch Hospital, 's-Hertogenbosch, The
Netherlands.
(5)Department of General Practice and Elderly Care Medicine, EMGO Institute for
Health and Care Research, VU University Medical Center, Amsterdam, The
Netherlands.
for Pharmaceutical Sciences, University Utrecht, Utrecht, The Netherlands.
Background Automated multidose drug dispensing is used to support patients with

their medication management. Though multidose drug dispensing systems are
frequently used, little is known about patients' experiences with multidose drug
dispensing systems. Objective To explore patients' experiences with the
initiation and use of multidose drug dispensing systems. Setting A survey was
carried out with patients using multidose drug dispensing systems through three
community pharmacies. Method A semi-structured interview protocol was designed
based on existing literature and a pilot study. Main outcome measures The main
outcome measures were (1) patients' experiences with initiating multidose drug
dispensing systems and (2) patients' experienced advantages and disadvantages of
multidose drug dispensing systems. Results The start of multidose drug dispensing
was discussed with 76% of the patients (n = 62). Ninety percent of patients
expressed the opinion that the multidose drug dispensing system supported them
with their medication management. Sixty patients reported 110 advantages, which
can be organized into the following categories: improved medication adherence and
medication safety (59%); patient's convenience (40%); and other (1%). Sixty-nine
percent of patients reported no disadvantages, 24% had problems opening the bags
or outer packaging and 13% had problems with the legibility of the printed text
on the bag. Conclusion In concordance with the Dutch guideline, patients are
generally involved in the decision to initiate an multidose drug dispensing
system. Patients are very satisfied using the system and report multiple
advantages. Multidose drug dispensing systems may be further improved by
simplifying the manual opening of the bags and improving the legibility of the
text on the bags.
DOI: 10.1007/s11096-018-0749-y
PMCID: PMC6394512
Predictors of HIV Care Engagement, Antiretroviral Medication Adherence, and Viral

Suppression Among People Living with HIV Infection in St. Petersburg, Russia.
Amirkhanian YA(1)(2), Kelly JA(3), DiFranceisco WJ(3), Kuznetsova AV(4), Tarima

SS(3), Yakovlev AA(4), Musatov VB(4).
Author information:
(1)Department of Psychiatry and Behavioral Medicine, Medical College of
Wisconsin, Center for AIDS Intervention Research (CAIR), 2071 North Summit
Avenue, Milwaukee, WI, 53202, USA. yuri@mcw.edu.
(2)Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS
Research and Training (ICART), St. Petersburg, Russia. yuri@mcw.edu.
(3)Department of Psychiatry and Behavioral Medicine, Medical College of
Wisconsin, Center for AIDS Intervention Research (CAIR), 2071 North Summit
Avenue, Milwaukee, WI, 53202, USA.
(4)Botkin Hospital for Infectious Diseases, Interdisciplinary Center for AIDS
Research and Training (ICART), St. Petersburg, Russia.
Over 1 million HIV infections have been diagnosed in Russia, and HIV care uptake
and viral suppression are very low. 241 HIV-positive individuals in St.
Petersburg were enrolled through social networks, provided blood for viral load
testing, and completed measures of medication-taking adherence, readiness, and
self-efficacy; psychosocial well-being; and substance use. Outcomes included
attending an HIV care appointment in the past 6 months, >90% ART adherence, and
undetectable viral load. 26% of participants had no recent care appointment, 18%
had suboptimal adherence, and 56% had detectable viral load. Alcohol use
consistently predicted all adverse health outcomes. Having no recent care visit
was additionally associated with being single and greater past-month drug
injection frequency. Poor adherence was additionally predicted by lower
medication-taking self-efficacy and lower anxiety. Detectable viral load was
additionally related to younger age. Comprehensive interventions to improve HIV
care in Russia must address substance abuse, anxiety, and medication-taking
self-efficacy.
DOI: 10.1007/s10461-016-1638-9
PMCID: PMC5476511
1336. J Manag Care Spec Pharm. 2017 May;23(5):573-582. doi:

10.18553/jmcp.2017.23.5.573.
Effect of a Pharmacist-Led Program on Improving Outcomes in Patients with Type 2

Diabetes Mellitus from Northern Cyprus: A Randomized Controlled Trial.
Korcegez EI(1), Sancar M(2), Demirkan K(3).
Author information:
(1)1 Department of Clinical Pharmacy, Near East University Faculty of Pharmacy,
Nicosia, Northern Cyprus.
(2)2 Department of Clinical Pharmacy, Marmara University Faculty of Pharmacy,
Istanbul, Turkey.
(3)3 Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy,
Ankara, Turkey.
BACKGROUND: The management of type 2 diabetes mellitus is complex, requiring

continuous medical care by health care professionals and considerable self-care
efforts by patients. Pharmacist-led care programs have been shown to help
patients with diabetes succeed in achieving treatment goals and improving
outcomes. Pharmacist-led care is a new health care concept in Northern Cyprus.
OBJECTIVE: To evaluate the effect of a pharmacist-led care program on glycemic
control, determined by hemoglobin A1c (A1c), and secondarily on blood pressure,
lipid profile, body mass index (BMI), waist circumference, medication adherence,
and self-care activities, for patients with type 2 diabetes over a 12-month
period.
METHODS: This was a prospective, randomized controlled study conducted in a
public hospital's outpatient diabetes clinic, with 152 patients who had been
diagnosed with type 2 diabetes. Of these, 75 patients were in the intervention
group, and 77 patients were in the usual care group. The intervention group
participated in a pharmacist-led care program with a clinical pharmacist who
provided 5 face-to-face educational sessions over a period of 12 months. The main
outcome measure was change in A1c, and secondary outcome measures were changes in
fasting blood glucose, systolic and diastolic blood pressure, lipid values (total
cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density
lipoprotein cholesterol [HDL-C], and serum levels of triglycerides [TGs]), BMI,
waist circumference, self-reported medication adherence (Morisky-Green test), and
self-care activities. Changes in outcome measures from baseline to the end of the
study were assessed using the Mann-Whitney U-test and Wilcoxon test.
RESULTS: At the end of the 12-month study period, the intervention patients
showed a greater reduction in A1c values than the usual care patients (-0.74% vs.
-0.04%; P < 0.001). Both groups showed significant reductions in fasting blood
glucose levels between baseline and the end of 12 months; the difference between
the groups was statistically nonsignificant (P = 0.410). When comparing the
intervention and usual care groups, there was a significant decrease in systolic
(P = 0.01) and diastolic blood pressure (P = 0.04) at the end of the trial. No
significant differences were found between the groups in LDL-C, HDL-C, or TG
values; however, total cholesterol levels did decrease significantly (P = 0.063,
0.331, 0.896, and 0.04, respectively). Significant reductions occurred in BMI (P
< 0.001) and waist circumference (P < 0.001), and improvements were observed in
self-reported medication adherence and self-care activities in the intervention
group.
CONCLUSIONS: A clinical pharmacist-led care program in a public hospital's
outpatient diabetes clinic was associated with significant improvements in
reducing A1c and other secondary outcomes in a 12-month randomized controlled
study.
DISCLOSURES: This study was conducted as a PhD thesis by Korcegez under the
supervision of Sancar for the clinical pharmacy program at Near East University,
Health Sciences Institute, Northern Cyprus, and received no external funding. The
authors have no potential conflicts of interest to report. Study concept and
design were contributed by Korcegez, with assistance from Sancar and Demirkan.
Korcegez took the lead in data collection, and data interpretation was performed
by Korcegez, along with Sancar and Korcegez. The manuscript was written and
revised by Korcegez, along with Sancar, and with assistance from Demirkan.
DOI: 10.18553/jmcp.2017.23.5.573
1337. BMC Pregnancy Childbirth. 2015 Nov 25;15:310. doi: 10.1186/s12884-015-0745-3.
Medication use during pregnancy, gestational age and date of delivery: agreement
between maternal self-reports and health database information in a cohort.
Pisa FE(1)(2), Casetta A(3), Clagnan E(4), Michelesio E(5), Vecchi Brumatti L(6),
Barbone F(7)(8)(9).
Author information:
(1)Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine,
Via Colugna 50, 33100, Udine, Italy. federica.pisa@uniud.it.
(2)Department of Medical and Biological Sciences, University of Udine, Udine,
Italy. federica.pisa@uniud.it.
Italy. anica.casetta@uniud.it.
(4)Direzione Centrale Salute, Integrazione Socio Sanitaria e Politiche Sociali,
Regione Friuli Venezia Giulia, Udine, Italy. elena.clagnan@regione.fvg.it.
(5)INSIEL SpA, Udine, Italy. elisa.michelesio@insiel.it.
(6)Scientific Direction, Institute for Maternal and Child Health - IRCCS "Burlo
Garofolo", Trieste, Italy. vecchi@burlo.trieste.it.
(7)Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine,
Via Colugna 50, 33100, Udine, Italy. fabio.barbone@uniud.it.
Italy. fabio.barbone@uniud.it.
(9)Department of Medicine, University of Trieste, Trieste, Italy.
fabio.barbone@uniud.it.
BACKGROUND: Health databases are a promising resource for epidemiological studies
on medications safety during pregnancy. The reliability of information on
medications exposure and pregnancy timing is a key methodological issue. This
study (a) compared maternal self-reports and database information on medication
use, gestational age, date of delivery; (b) quantified the degree of agreement
between sources; (c) assessed predictors of agreement.
METHODS: Pregnant women recruited in a prenatal clinic in Friuli Venezia Giulia
(FVG) region, Italy, from 2007 to 2009, completed a questionnaire inquiring on
medication use during pregnancy, gestational age and date of delivery. Redeemed
prescriptions and birth certificate records were extracted from regional
databases through record linkage. Percent agreement, Kappa coefficient,
prevalence and bias-adjusted Kappa (PABAK) were calculated. Odds Ratio (OR), with
95% confidence interval (95% CI), of ≥ 1 agreement was calculated through
unconditional logistic regression.
RESULTS: The cohort included 767 women, 39.8% reported medication use, and 70.5%
were dispensed at least one medication. Kappa and PABAK indicated almost perfect
to substantial agreement for antihypertensive medications (Kappa 0.86, PABAK
0.99), thyroid hormones (0.88, 0.98), antiepileptic medications (1.00, 1.00),
antithrombotic agents (0.70, 0.96). PABAK value was greater than Kappa for
medications such as insulin (Kappa 0.50, PABAK 0.99), antihistamines for systemic
use (0.50, 0.99), progestogens (0.28, 0.79), and antibiotics (0.12, 0.63).
Adjusted OR was 0.48 (95% CI 0.26; 0.90) in ex- vs. never smokers, 0.64 (0.38;
1.08) in < high school vs. university, 1.55 (1.01; 2.37) in women with
comorbidities, 2.25 (1.19; 4.26) in those aged 40+ vs. 30-34 years. Gestational
age matched exactly in 85.2% and date of delivery in 99.5%.
CONCLUSIONS: For selected medications used for chronic conditions, the agreement
between self-reports and dispensing data was high. For medications with low to
very low prevalence of use, PABAK provides a more reliable measure of agreement.
Maternal reports and dispensing data are complementary to each other to increase
the reliability of information on the use of medications during pregnancy. Birth
certificates provide reliable data on the timing of pregnancy. FVG health
databases are a valuable source of data for pregnancy research.
DOI: 10.1186/s12884-015-0745-3
PMCID: PMC4660837
Assessing the ability of the Drug-Associated Risk Tool (DART) questionnaire to

stratify hospitalised older patients according to their risk of drug-related
problems: a cross-sectional validation study.
Stämpfli D(1), Boeni F(1)(2), Gerber A(3), Bättig VAD(1), Weidmann R(4),
Hersberger KE(1), Lampert ML(1)(2).
Author information:
(1)Department of Pharmaceutical Sciences, University of Basel, Basel,
Switzerland.
(2)Clinical Pharmacy, Solothurner Spitaler AG, Olten, Switzerland.
(3)Gerontopharmakologie, Felix Platter-Hospital, Basel, Switzerland.
(4)Department of Psychology, University of Basel, Basel, Switzerland.
OBJECTIVES: The Drug-Associated Risk Tool (DART) has been developed as a

self-administered questionnaire for patients with the aim of stratifying patients
according to their risk of drug-related problems (DRPs). We aimed to validate the
ability of the questionnaire to distinguish between hospitalised patients showing
lower and higher numbers of DRPs.
DESIGN: Cross-sectional study assessing the questionnaire's concurrent criterion
validity.
SETTING: Five geriatric and the associated physical and neurological
rehabilitation wards of a Swiss regional secondary care hospital with 617 beds.
PARTICIPANTS: We recruited 110 patients from a total of 437 admissions. Exclusion
criteria were insufficient knowledge in spoken or written German, medical
conditions preventing meaningful conversations and already receiving pharmacy
services.
INTERVENTIONS: Comprehensive pharmacist-led clinical medication reviews were
performed, including patient interviews, to identify potential and manifest DRPs.
A cluster analysis was conducted to assess the discriminatory potential of the
DART to group patients according to number (low and high) of identified DRPs. A
subsequent discriminatory function analysis was performed to reduce the number of
items. We determined which DART items may be used to trigger what type of
medication review.
RESULTS: Recruited patients had a median age of 79 years and were prescribed a
median of 11 drugs. Patients with a median DART score of 10 and a median of 3
DRPs represented one cluster, whereas patients with a median DART score of 15 and
a median of 8 DRPs represented another cluster. Discriminatory function analysis
reduced the questionnaire to five items with a moderate to strong correlation
with the number of DRPs per patient (Spearman's rank correlation ρ=0.44).
Additional items were associated with patients benefiting from interviews.
CONCLUSIONS: As a self-administered questionnaire for patients, the DART may be
used to stratify hospitalised non-acute older patients in groups of having low
and high likelihood of DRPs. The analyses showed that a short form of the DART
can be used instead of the full tool to identify older inpatients at risk for
DRPs. Additional eight items from the DART may be used to initiate additional
clinical pharmacy services. The linkage between certain DART questions and type
of medication review enables pharmacist resource allocation.
DOI: 10.1136/bmjopen-2017-021284
PMCID: PMC6042600
PMID: 29950469

eCollection 2016.
Evaluation of patient safety culture among Malaysian retail pharmacists: results

of a self-reported survey.
Sivanandy P(1), Maharajan MK(1), Rajiah K(1), Wei TT(2), Loon TW(2), Yee LC(2).
Author information:
(1)Department of Pharmacy Practice, School of Pharmacy.
(2)School of Pharmacy, International Medical University, Wilayah Persekutuan
BACKGROUND: Patient safety is a major public health issue, and the knowledge,
skills, and experience of health professionals are very much essential for
improving patient safety. Patient safety and medication error are very much
associated. Pharmacists play a significant role in patient safety. The function
of pharmacists in the medication use process is very different from medical and
nursing colleagues. Medication dispensing accuracy is a vital element to ensure
the safety and quality of medication use.
OBJECTIVE: To evaluate the attitude and perception of the pharmacist toward
patient safety in retail pharmacies setup in Malaysia.
METHODS: A Pharmacy Survey on Patient Safety Culture questionnaire was used to
assess patient safety culture, developed by the Agency for Healthcare Research
and Quality, and the convenience sampling method was adopted.
RESULTS: The overall positive response rate ranged from 31.20% to 87.43%, and the
average positive response rate was found to be 67%. Among all the eleven domains
pertaining to patient safety culture, the scores of "staff training and skills"
were less. Communication openness, and patient counseling are common, but not
practiced regularly in the Malaysian retail pharmacy setup compared with those in
USA. The overall perception of patient safety of an acceptable level in the
current retail pharmacy setup.
CONCLUSION: The study revealed that staff training, skills, communication in
patient counseling, and communication across shifts and about mistakes are less
in current retail pharmacy setup. The overall perception of patient safety should
be improved by educating the pharmacists about the significance and essential of
patient safety.
DOI: 10.2147/PPA.S111537
PMCID: PMC4966676
PMID: 27524887
1340. Arthritis Care Res (Hoboken). 2015 Feb;67(2):161-8. doi: 10.1002/acr.22424.
Medication risk communication during rheumatology office visits.
Blalock SJ(1), DeVellis BM, DeVellis RF, Chewning B, Jonas BL, Sleath BL.
Author information:
(1)Eshelman School of Pharmacy, University of North Carolina, Chapel Hill.
OBJECTIVE: We used a multidimensional framework to describe the types of

information about medication risks that rheumatologists provide to rheumatoid
arthritis (RA) patients during routine office visits.
METHODS: We analyzed 1,094 audiotaped rheumatology office visits involving 450 RA
patients. Each patient had up to 3 visits audiotaped. In conjunction with each
office visit, patients also completed a self-administered questionnaire and
interview and the rheumatologists provided ratings of patient health status.
RESULTS: The number of medication risks discussed per visit ranged from 0-18,
with a mean ± SD of 3.23 ± 2.93. The rheumatologist initiated ∼80% of the
medication risk discussions. Approximately one-fourth of the discussions (25.6%)
were limited to an assessment of whether or not the patient was experiencing a
medication side effect. More risks were discussed during visits when changes to
the patient's regimen were discussed than when no changes were discussed (X=
3.93, SD = 3.10 and X = 2.20, SD = 2.34, respectively; P < 0.0001). When
medications were being proposed for addition to the patient's regimen, the most
frequently discussed risk dimensions were the importance of monitoring (30%),
probability (29.8%), things the patient should do to minimize risk (25.5%), and
risk severity (21.8%).
CONCLUSION: Most discussions of medication risks that we observed were quite
limited and often restricted to an assessment of whether the patient was
experiencing side effects from their current medications. The amount of
information that is optimal and how to tailor information to the preferences and
abilities of individual patients remain important areas for future research.
Copyright © 2015 by the American College of Rheumatology.

DOI: 10.1002/acr.22424
1341. J Int AIDS Soc. 2018 Sep;21(9):e25176. doi: 10.1002/jia2.25176.
STACKing the odds for adolescent survival: health service factors associated with
full retention in care and adherence amongst adolescents living with HIV in South
Africa.
Cluver L(1)(2), Pantelic M(1)(3), Toska E(4)(5), Orkin M(6), Casale M(1)(7),
Bungane N(8), Sherr L(9).
Author information:
(1)Department of Social Policy and Intervention, University of Oxford, Oxford,
United Kingdom.
(2)Department of Psychiatry and Mental Health, University of Cape Town, Cape
Town, South Africa.
(3)Secretariat, International HIV/AIDS Alliance, Brighton, United Kingdom.
(4)AIDS and Society Research Unit, University of Cape Town, Cape Town, South
Africa.
(5)Department of Sociology, University of Cape Town, Cape Town, South Africa.
(6)MRC/Wits Developmental Pathways for Health Research Unit, School of Clinical
Medicine, University of the Witwatersrand, Johannesburg, South Africa.
(7)School of Public Health, University of the Western Cape, Cape Town, South
Africa.
(8)Department of Nursing, Fort Hare University, Alice, South Africa.
(9)Research Department of Global Health, University College London, London,
United Kingdom.
INTRODUCTION: There are two million HIV-positive adolescents in southern Africa,

and this group has low retention in care and high mortality. There is almost no
evidence to identify which healthcare factors can improve adolescent
self-reported retention. This study examines factors associated with retention
amongst antiretroviral therapy (ART)-initiated adolescents in South Africa.
METHODS: We collected clinical records and detailed standardized interviews
(n = 1059) with all 10- to 19 year-olds ever initiated on ART in all 53
government clinics of a health subdistrict, and community traced to include
lost-to-follow-up (90.1% of eligible adolescents interviewed). Associations
between full self-reported retention in care (no past-year missed appointments
and 85% past-week adherence) and health service factors were tested
simultaneously in sequential multivariate regression and marginal effects
modelling, controlling for covariates of age, gender, urban/rural location,
formal/informal housing, maternal and paternal orphanhood, vertical/horizontal
HIV infection, overall health, length of time on ART and type of healthcare
facility.
RESULTS: About 56% of adolescents had self-reported retention in care, validated
against lower detectable viral load (AOR: 0.63, CI: 0.45 to 0.87, p = 0.005).
Independent of covariates, five factors (STACK) were associated with improved
retention: clinics Stocked with medication (OR: 3.0, CI: 1.6 to 5.5); staff with
Time for adolescents (OR: 2.7, CI: 1.8 to 4.1); adolescents Accompanied to the
clinic (OR: 2.3, CI: 1.5 to 3.6); enough Cash to get to clinic safely (OR: 1.4,
CI: 1.1 to 1.9); and staff who are Kind (OR: 2.6, CI: 1.8 to 3.6). With none of
these factors, 3.3% of adolescents reported retention. With all five factors,
69.5% reported retention.
CONCLUSIONS: This study identifies key intervention points for adolescent
retention in HIV care. A basic package of clinic and community services has the
potential to STACK the odds for health and survival for HIV-positive adolescents.
© 2018 The Authors. Journal of the International AIDS Society published by John
Wiley & Sons Ltd on behalf of the International AIDS Society.
DOI: 10.1002/jia2.25176
PMCID: PMC6149366
1342. Br J Nutr. 2016 Nov;116(9):1646-1655. Epub 2016 Oct 18.
Video chat technology to remotely quantify dietary, supplement and medication

adherence in clinical trials.
Peterson CM(1), Apolzan JW(1), Wright C(1), Martin CK(1).
Author information:
(1)Pennington Biomedical Research Center,6400 Perkins Road,Baton Rouge,LA
70808,USA.
We conducted two studies to test the validity, reliability, feasibility and

acceptability of using video chat technology to quantify dietary and pill-taking
(i.e. supplement and medication) adherence. In study 1, we investigated whether
video chat technology can accurately quantify adherence to dietary and
pill-taking interventions. Mock study participants ate food items and swallowed
pills, while performing randomised scripted 'cheating' behaviours to mimic
non-adherence. Monitoring was conducted in a cross-over design, with two monitors
watching in-person and two watching remotely by Skype on a smartphone. For study
2, a twenty-two-item online survey was sent to a listserv with more than 20 000
unique email addresses of past and present study participants to assess the
feasibility and acceptability of the technology. For the dietary adherence tests,
monitors detected 86 % of non-adherent events (sensitivity) in-person v. 78 % of
events via video chat monitoring (P=0·12), with comparable inter-rater agreement
(0·88 v. 0·85; P=0·62). However, for pill-taking, non-adherence trended towards
being more easily detected in-person than by video chat (77 v. 60 %; P=0·08),
with non-significantly higher inter-rater agreement (0·85 v. 0·69; P=0·21).
Survey results from study 2 (n 1076 respondents; ≥5 % response rate) indicated
that 86·4 % of study participants had video chatting hardware, 73·3 % were
comfortable using the technology and 79·8 % were willing to use it for clinical
research. Given the capability of video chat technology to reduce participant
burden and outperform other adherence monitoring methods such as dietary
self-report and pill counts, video chatting is a novel and promising platform to
quantify dietary and pill-taking adherence.
DOI: 10.1017/S0007114516003524
PMCID: PMC5282970
1343. BMC Cardiovasc Disord. 2017 Feb 13;17(1):58. doi: 10.1186/s12872-017-0494-5.
Telemonitoring and/or self-monitoring of blood pressure in hypertension

(TASMINH4): protocol for a randomised controlled trial.
Franssen M(1), Farmer A(1), Grant S(2), Greenfield S(2), Heneghan C(1), Hobbs
R(1), Hodgkinson J(2), Jowett S(2), Mant J(3), Martin U(2), Milner S(2), Monahan
M(2), Ogburn E(1), Perera-Salazar R(1), Schwartz C(1), Yu LM(1), McManus RJ(4).
Author information:
(1)Nuffield Department of Primary Care, Oxford University, Oxford, UK.
(2)Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
Cambridge, UK.
(4)Nuffield Department of Primary Care, Oxford University, Oxford, UK.
richard.mcmanus@phc.ox.ac.uk.
BACKGROUND: Self-monitoring of hypertension is associated with lower systolic

blood pressure (SBP). However, evidence for the use of self-monitoring to titrate
antihypertensive medication by physicians is equivocal. Furthermore, there is
some evidence for the efficacy of telemonitoring in the management of
hypertension but it is not clear what this adds over and above self-monitoring.
This trial aims to evaluate whether GP led antihypertensive titration using
self-monitoring results in lower SBP compared to usual care and whether
telemonitoring adds anything to self-monitoring alone.
METHODS/DESIGN: This will be a pragmatic primary care based, unblinded,
randomised controlled trial of self-monitoring of BP with or without
telemonitoring compared to usual care. Eligible patients will have poorly
controlled hypertension (>140/90 mmHg) and will be recruited from primary care.
Participants will be individually randomised to either usual care,
self-monitoring alone, or self-monitoring with telemonitoring. The primary
outcome of the trial will be difference in clinic SBP between intervention and
control groups at 12 months adjusted for baseline SBP, gender, BP target and
practice. At least 1110 patients will be sufficient to detect a difference in SBP
between self-monitoring with or without telemonitoring and usual care of 5 mmHg
with 90% power with an adjusted alpha of 0.017 (2-sided) to adjust for all three
pairwise comparisons. Other outcomes will include adherence of anti-hypertensive
medication, lifestyle behaviours, health-related quality of life, and adverse
events. An economic analysis will consider both within trial costs and a model
extrapolating the results thereafter. A qualitative sub study will gain insights
into the views, experiences and decision making processes of patients and health
care professionals focusing on the acceptability of self-monitoring and
telemonitoring in the routine management of hypertension.
DISCUSSION: The results of the trial will be directly applicable to primary care
in the UK. If successful, self-monitoring of BP in people with hypertension would
be applicable to hundreds of thousands of individuals in the UK.
TRIAL REGISTRATION: ISRCTN 83571366 . Registered 17 July 2014.
DOI: 10.1186/s12872-017-0494-5
PMCID: PMC5307789
1344. Trials. 2016 Apr 22;17(1):209. doi: 10.1186/s13063-016-1335-z.
The effectiveness of mindfulness-based stress reduction (MBSR) for survivors of

breast cancer: study protocol for a randomized controlled trial.
Huang J(1), Shi L(2).
Author information:
(1)Key Laboratory of Health Technology Assessment, Ministry of Health (Fudan
University), 130, DongAn Road, 200032, Shanghai, China. jyhuang@shmu.edu.cn.
(2)Department of Public Health Sciences, Clemson University, 525 Edwards Hall,
Clemson, SC, 29634-0745, USA.
BACKGROUND: After treatment completion, breast cancer (BC) survivors frequently

experience residual symptoms of pain, fatigue, high levels of psychological
stress, anxiety, depression, fear of recurrence, and metastasis. Post-treatment
stress, in particular, can adversely affect health-related quality of life,
which, in turn, induces onset or recurrence of chronic diseases. Effective
interventions that target these psychological symptoms and their physiological
consequences are needed, especially for economically disadvantaged patients.
However, in China, few evidence-based intervention strategies have been
established among BC survivors. This study will formally adapt, develop, and
evaluate an intensive mindfulness-based stress reduction (MBSR) intervention
protocol to improve mental health, quality of life, and compliance with
medication among Chinese BC survivors.
METHODS: A randomized, waitlist-controlled clinical trial will be conducted.
Based on our power calculation, 418 BC survivors will be recruited from 10
low-income communities in Shanghai. All subjects will be randomly assigned either
to the MBSR program or to a waitlisted usual care regimen that will offer the
MBSR program after the completion of the other trial arm (after 6 months
follow-up). Our 8-week MBSR intervention program will provide systematic training
to promote stress reduction by self-regulating arousal to stress. Assessments
will be made at baseline, 4 weeks (in the middle of the first MBSR intervention),
8 weeks (at the end of the first MBSR intervention), 6 months, and 12 months, and
will include measures of psychological symptoms (depression, anxiety, and
perceived stress), quality of life, and medication adherence. The expected
outcome will be the improvement in psychological symptoms, quality of life, and
medication compliance in the MBSR intervention group.
DISCUSSION: This study will help develop an affordable, self-care psychological
intervention protocol to help Chinese BC survivors improve their quality of life,
and could be helpful in further developing affordable disease management plans
for patients of other chronic diseases.
TRIAL REGISTRATION: ChiCTR-IOR-14005390 (10/27/2014).
DOI: 10.1186/s13063-016-1335-z
PMCID: PMC4840971
1345. Behav Cogn Psychother. 2016 Mar;44(2):129-39. doi: 10.1017/S1352465815000041.

Epub 2015 Feb 20.
Attitudes and Preferences towards Self-help Treatments for Depression in

Comparison to Psychotherapy and Antidepressant Medication.
Hanson K(1), Webb TL(2), Sheeran P(3), Turpin G(2).
Author information:
(1)Sheffield Hallam University,UK.
(2)University of Sheffield,UK.
(3)University of North Carolina at Chapel Hill,USA.
BACKGROUND: Self-help is an effective treatment for depression. Less is known,

however, about how acceptable people find different self-help treatments for
depression.
AIMS: To investigate preferences and attitudes toward different self-help
treatments for depression in comparison to psychotherapy and antidepressants.
METHOD: N = 536 people who were not actively seeking treatment for depression
were randomly assigned to read about one of five treatment options
(bibliotherapy, Internet-based self-help, guided self-help, antidepressants, or
psychotherapy) before rating how acceptable they found the treatment.
Participants also ranked the treatments in order of preference.
RESULTS: Psychotherapy and guided self-help were found to be the most acceptable
and preferred treatment options. Antidepressants and bibliotherapy were found to
be the least acceptable treatments, with antidepressants rated as the most likely
to have side effects. Preference data reflected the above findings -
psychotherapy and guided self-help were the most preferred treatment options.
CONCLUSIONS: The findings highlight differences in attitudes and preferences
between guided and unguided self-help interventions; and between self-help
interventions and psychotherapy. Future research should focus on understanding
why unguided self-help interventions are deemed to be less acceptable than guided
self-help interventions for treating depression.
DOI: 10.1017/S1352465815000041
1346. J Anaesthesiol Clin Pharmacol. 2019 Apr-Jun;35(2):220-226. doi:

10.4103/joacp.JOACP_178_18.
Drug administration errors among anesthesiologists: The burden in India - A

questionnaire-based survey.
Annie SJ(1), Thirilogasundary MR(2), Hemanth Kumar VR(1).
Author information:
(1)Department of Anaesthesiology, Mahatma Gandhi Medical College and Research
Institute, Sri Balaji Vidyapeeth (Deemed to Be University), Puducherry, India.
(2)Department of Anaesthesiology, Sri Lakshmi Narayana Institute of Medical
Sciences, Puducherry, India.
Background and Aims: Safe medication is an important part of anesthesia practice.

Even though anesthesia practice has become safer with various patient safety
initiatives, it is not completely secure from errors which can sometimes lead to
devastating complications. Multiple reports on medication errors have been
published; yet, there exists a lacuna regarding the quantum of these events
occurring in our country or the preventive measures taken. Hence, we conducted a
survey to study the occurrence of medication errors, incident reporting, and
preventive measures taken by anesthesiologists in our country.
Material and Methods: A self-reporting survey questionnaire (24 questions, 4
parts) was mailed to 9000 anesthesiologists registered in Indian Society of
Anaesthesiologists via Survey Monkey Website.
Results: A total of 978 completed surveys were returned for analysis (response
rate = 9.2%). More than two-thirds (75.6%, n = 740) had experienced drug
administration error and 7.7% (57) of respondents faced major morbidity and
complications. Haste/Hurry (23.4%) was identified as the most common contributor
to medication errors in the operation theater. Loading and double-checking of
drugs before administration by concerned anesthesiologist were identified as
safety measures to reduce drug errors.
Conclusion: Majority of our respondents have experienced drug administration
error at some point in their career. A small yet important proportion of these
errors have caused morbidity/mortality to patients. The critical incident
reporting system should be established for regular audits, an effective root
cause analysis of critical events, and to propose measures to prevent the same in
future.
DOI: 10.4103/joacp.JOACP_178_18
PMCID: PMC6598581
PMID: 31303712

1347. Syst Rev. 2016 Jun 7;5:96. doi: 10.1186/s13643-016-0278-5.
Effectiveness and content analysis of interventions to enhance medication

adherence in hypertension: a systematic review and meta-analysis protocol.
Morrissey EC(1), Durand H(2), Nieuwlaat R(3), Navarro T(3), Haynes RB(3), Walsh
JC(2), Molloy GJ(2).
Author information:
(1)School of Psychology, National University of Ireland, Galway, Ireland.
e.morrissey6@nuigalway.ie.
(2)School of Psychology, National University of Ireland, Galway, Ireland.
(3)Department of Clinical Epidemiology and Biostatistics, McMaster University,
Hamilton, Ontario, Canada.
Erratum in
Syst Rev. 2017 Feb 17;6(1):30.
BACKGROUND: Hypertension control through pharmacological treatment has led to

substantial benefits in the prevention of morbidity and mortality from
cardiovascular diseases. However, evidence from a number of studies suggests that
as many as 50 to 80 % of patients treated for hypertension have low adherence to
their treatment regimen. The objective of this systematic review is to evaluate
the effectiveness of medication adherence interventions for hypertension. In
addition, we aim to explore what barriers and facilitators in the interventions
may have been targeted and how these might be related to the effect size on blood
pressure (BP).
METHODS: This review is a hypertension-specific update to the previous Cochrane
Review by Nieuwlaat et al. (2014) on interventions to enhance medication
adherence. A systematic literature search will be carried out, and two authors
will independently screen titles and abstracts for their eligibility for
inclusion and independently extract data from the selected studies and assess the
methodological quality using the Cochrane Collaboration Risk of Bias Tool. A
meta-analysis will be conducted, and additionally, theoretical factors in
interventions will be identified using the Theoretical Domains Framework.
DISCUSSION: This review will generate new information by quantitatively
evaluating the effectiveness of adherence interventions for hypertension and
potentially identify which theoretical domains are associated with more effective
interventions and which domains have not been the subject of intervention
development.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016033358.
DOI: 10.1186/s13643-016-0278-5
PMCID: PMC4897948
1348. Epileptic Disord. 2015 Mar;17(1):47-51; quiz 51. doi: 10.1684/epd.2014.0722.
Factors influencing medication adherence after epilepsy surgery.
Liu J(1), Xu R(1), Liu Z(1), You Y(1), Meng F(1).
Author information:
(1)Affiliated Bayi Brain Hospital, Bayi Clinical College, Southern Medical
University, Beijing, China.
AIM: In drug-responsive epilepsy patients, treatment non-compliance is a major

factor in seizure recurrence, but adherence to prescribed regimens following
epilepsy surgery has not been examined. We measured adherence to prescribed
antiepileptic drugs (AEDs) after epilepsy surgery and investigated factors
influencing treatment non-compliance.
METHODS: Postsurgical epilepsy patients (n=214) were monitored for 18.1±8.1
months. Adherence was measured using the Medication Possession Ratio (MPR)
self-report questionnaire, with MPR<0.8 defined as non-adherence.
RESULTS: According to the MPR, 58 patients (27.1%) were non-adherent after
surgery. There were no differences in demographic and clinical variables, such as
age (p=0.057, t=-1.925), duration of illness (p=0.597, t=0.530), gender ratio
(p=0.714, χ2=0.134), and place of residence (urban vs. rural; p=0.874, χ2=0.025),
between adherent and non-adherent patients. Moreover, adherence was not related
to surgical outcome as evaluated by the Engel classification (p=0.635, χ2=1.628)
or to the types of AEDs after surgery (p=0.165, χ2=6.530). The most common
reasons for non-adherence were seizure-free status for an extended period
(26.5%), forgetfulness (19.1%), and an inability to buy the drugs locally
(18.6%).
CONCLUSION: Adherence to AEDs is improved after epilepsy surgery compared to
presurgical estimates, but is still a common and serious problem. Targeted
postsurgical management programs and communication strategies are necessary to
improve adherence to AEDs after epilepsy surgery.
DOI: 10.1684/epd.2014.0722

eCollection 2019.
Decomposing the effect of drug benefit program on antihypertensive medication

adherence among the elderly in urban China.
Ma X(#)(1), Zhang Y(#)(2), Zhang M(2), Li X(2), Yin H(2), Li K(3), Jing M(2).
Author information:
(1)China Center for Health Development Studies, Peking University, Beijing
100000, People's Republic of China.
(2)Department of Public Health, Shihezi University School of Medicine, Shihezi
832002, Xinjiang, People's Republic of China.
(3)Department of Orthopedics, The First Affiliated Hospital of the Medical
College, Shihezi University, Shihezi 832002, Xinjiang, People's Republic of
China.
Purpose: Hypertension is a rapidly growing epidemic in People's Republic of

China, yet it remains inadequately controlled. This study aimed to identify the
relative contributions of program effects and patients' characteristics to the
differences in antihypertensive medication nonadherence between drug benefit
program enrollees and non-enrollees.
Patients and methods: Data were from a cross-sectional survey of 1,969
community-dwelling elderly adults with hypertension. Self-reported adherence was
measured following previous studies in People's Republic of China. The
Blinder-Oaxaca nonlinear decomposition method was used to identify the relative
contributions of program effects and patients' individual characteristics.
Results: Eleven percent of the drug benefit program enrollees were nonadherent to
their medication, while 17% of non-enrollees were. Blinder-Oaxaca decomposition
identified that over 60% of the gap between the two groups was due to the program
effects (P=0.024). The rest could be explained by differences in observable
characteristics (P<0.001), such as diabetic status, duration of hypertension, and
blood pressure control.
Conclusion: The study confirmed that drug benefit program enrollees were more
likely to be adherent to their antihypertensive medication than non-enrollees in
the context of People's Republic of China.
DOI: 10.2147/PPA.S201707
PMCID: PMC6628968
PMID: 31371928

this work.
1350. Open Access Maced J Med Sci. 2018 Jun 17;6(6):1174-1179. doi:
10.3889/oamjms.2018.235. eCollection 2018 Jun 20.
How to Improve Clinical Outcome of Epileptic Seizure Control Based on Medication

Adherence? A Literature Review.
Ernawati I(1), Islamiyah WR(2), Sumarno(3).
Author information:
(1)Faculty of Pharmacy, Airlangga University, Gubeng, Surabaya, East Java,
Indonesia.
(2)Department of Neurology, Faculty of Medicine, Airlangga University, Surabaya,
Indonesia.
(3)Department of Clinical Pharmacy, Faculty of Pharmacy, Airlangga University,
Gubeng, Surabaya, East Java, Indonesia.
Anti-Epileptic Drugs (AEDs) are the main therapy for epilepsy to prevent
seizures. Non-adherence situation plays an important factor in the failure of
seizure control. Such a condition may generate several impacts on clinical,
social, and economic aspect. Several methods are used to measure adherence in
epilepsy patients, including direct and indirect measurement. The direct measure
involves measurement of drug levels in hair or body fluids such as blood and
saliva. Whereas, indirect measure involves the non-biological tools, for example,
a self-report measure, pill counts, appointment attendance, medication refills,
and seizure frequency. Numerous factors may affect adherence in epilepsy
patients, such as age, sex, and seizure aetiology, seizure sites, which are
categorised as irreversible factors and hardly to be improved. However, there are
factors that can be influenced to improve adherence such as patient knowledge,
medication, cultural, health care professionals, and national health policies,
which are related to treatment and education factor which is associated with
behaviour to be likely adherence.
DOI: 10.3889/oamjms.2018.235
PMCID: PMC6026415
PMID: 29983823

eCollection 2019.
Effects of a Proactive Interdisciplinary Self-Management (PRISMA) program on

medication adherence in patients with type 2 diabetes in primary care: a
du Pon E(1)(2), El Azzati S(1), van Dooren A(1), Kleefstra N(3)(4), Heerdink
E(1)(5), van Dulmen S(6)(7)(8).
Author information:
(1)Research Group Process Innovations in Pharmaceutical Care, Utrecht University
of Applied Sciences, Utrecht, the Netherlands, esther.dupon@hu.nl.
(2)Diabetes Centre, Isala Clinics, Zwolle, the Netherlands, esther.dupon@hu.nl.
(3)Department of Internal Medicine, University Medical Center Groningen,
University of Groningen, Groningen, the Netherlands.
(4)Medical Research Group, Langerhans, Ommen, the Netherlands.
(5)Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the
Netherlands.
(6)NIVEL (Netherlands Institute for Health Services Research), Department of
Communication in Healthcare, Utrecht, the Netherlands.
(7)Radboud University Medical Center, Radboud Institute for Health Sciences,
Department of Primary and Community care, Nijmegen, the Netherlands.
(8)Faculty of Health and Social Sciences, University of Southeast Norway,
Drammen, Norway.
Purpose: The present study aims to investigate the effect of the group-based
Proactive Interdisciplinary Self-Management (PRISMA) training program on
medication adherence in patients with type 2 diabetes (T2DM) treated in primary
care.
Patients and methods: The current study is a two-arm, parallel group, randomized,
open label trial (1:1) of 6-month duration with a 6-month extension period in
which both groups received the intervention (wait-list control). People 18 years
old or older who were diagnosed with T2DM were included. The intervention
consisted of two group meetings about T2DM guided by care providers. The control
group received usual care only (visits at the general practice). The primary
outcome was adherence based on pharmacy refill data and was measured using
medication possession ratio (MPR). The secondary outcomes were the number of drug
holidays and self-reported adherence, measured by the 5-item Medication Adherence
Rating Scale (MARS-5).
Results: Of the total sample (n=108), 66.6% were male. The mean age was 69.3
years (SD=9.1). In the 6-month period, patients were more adherent in the
intervention group (n=56) (median MPR =100.0 [51.1-100.0]) than in the control
group (n=52) (median MPR =97.7 [54.1-100.0]) (U=1,042, z=-2.783, P=0.005). The
intervention group had less drug holidays than the control group (relative risk
0.55, 95% CI, 0.37-0.80). The sum scores of the MARS did not differ between the
intervention group (median =23.98, SD=0.91) and the control group (median =24.00,
SD=1.54).
Conclusion: The PRISMA program resulted in a small improvement in MPR and fewer
drug holidays, while no improvement has been found in self-reported adherence.
However, health care providers and policy makers could take into account that
adherence might be influenced by PRISMA.
DOI: 10.2147/PPA.S188703
PMCID: PMC6512791
PMID: 31190757


eCollection 2016.
Type D Personality Predicts Poor Medication Adherence in Chinese Patients with

Type 2 Diabetes Mellitus: A Six-Month Follow-Up Study.
Li X(1), Zhang S(2), Xu H(3), Tang X(2), Zhou H(2), Yuan J(2), Wang X(2), Qu
Z(2), Wang F(2), Zhu H(4), Guo S(2), Tian D(2), Zhang W(2).
Author information:
(1)Clinics of Cadre, Department of Outpatient, General Hospital of the People's
Liberation Army (301 Hospital), Beijing, China.
(2)School of Social Development and Public Policy, China Institute of Health,
Beijing Normal University, Beijing, China.
(3)Department of Public Health Sciences, University of Rochester School of
Medicine & Dentistry, Rochester, NY, United States of America.
University Medical Center, Durham, NC, United States of America.
BACKGROUND: Type D personality and medication nonadherence have been shown to be

associated with poor health outcomes. Type D personality is associated with poor
medication adherence in patients with coronary artery disease, myocardial
infarction, and heart failure. However, the relationship between type D
personality and medication adherence in patients with Type 2 Diabetes Mellitus
(T2DM) remains unknown. This study aims to examine whether type D personality was
associated with medication adherence in patients with T2DM.
DESIGN AND SETTINGS: A follow-up study was conducted in general hospital of the
People's Liberation Army in Beijing.
METHODS: 412 T2DM patients (205 females), who were recruited by circular
systematic random sampling, provided demographic and baseline data about medical
information and completed measures of Type D personality. Then, 330 patients went
on to complete a self-report measure of medication adherence at the sixth month
after baseline data collection. Chi-square test, t tests, and hierarchical
multiple regression analyses were conducted, as needed.
RESULTS: Patients with type D personality were significantly more likely to have
poor medication adherence (p<0.001). Type D personality predicts poor medication
adherence before and after controlling for covariates when it was analyzed as a
categorical variable. However, the dimensional construct of type D personality
was not associated with medication adherence when analyzed as a continuous
variable.
CONCLUSION: Although, as a dimensional construct, type D personality may not
reflect the components of the personality associated with poor medication
adherence in patients with T2DM, screening for type D personality may help to
identify those who are at higher risk of poor medication adherence.
Interventions, aiming to improve medication adherence, should be launched for
these high-risk patients.
PMCID: PMC4760773
1353. Cardiovasc J Afr. 2017 Nov/Dec 23;28(6):350-355. doi: 10.5830/CVJA-2017-016.

Epub
2017 Mar 23.
Medication adherence among cardiac patients in Khartoum State, Sudan: a

Awad A(1), Osman N(2), Altayib S(3).
Author information:
Kuwait. Email: amoneim@hsc.edu.kw.
(2)Department of Pharmacy Practice, Faculty of Pharmacy, Qassim University, Saudi
Arabia.
(3)Department of Clinical Pharmacy, Faculty of Pharmacy, National University,
Khartoum, Sudan.
INTRODUCTION: Non-adherence to medication among cardiac patients is often the

major risk factor for poor clinical outcomes, increased mortality rates and
higher healthcare costs. The literature evaluating the prevalence of and reasons
for non-adherence in resource-poor settings is extremely limited compared to
resource-rich settings. There is a scarcity of data about medication adherence in
Sudan hence this study was performed to identify prevalence, predictors and
barriers of non-adherence to medication among cardiac patients in Khartoum State.
METHODS: A descriptive, cross-sectional survey was performed using a pre-tested,
self-administered questionnaire on a sample of 433 randomly selected cardiac
patients attending the largest three cardiac centres located in Khartoum State.
Descriptive and multivariate logistic regression analyses were used for data
analysis.
RESULTS: The response rate was 89.1%. The mean (± SD) number of chronic diseases
among respondents was 2.3 ( ± 1.3) and that of medication use was 4.2 ( ± 1.9).
The mean ( ± SD) duration of medication use among participants was 6.4 ( ± 5.4)
years. Optimal adherence was defined as having a score of greater than six on the
eight-item Morisky medication adherence scale. Using this cut-off point, 49% (95%
CI: 43.9-54.1) of respondents had optimal adherence and 51% (95% CI: 45.9-56.1)
had poor adherence. Respondents with a high level of education, low and middle
income levels, and those taking five or more medications daily were found to be
significantly more non-adherent to medication use than those with low to
intermediate education levels (p < 0.001), those with high income levels (p <
0.001), and those taking one to four medications daily (p = 0.039). The top four
barriers for poor medication adherence among the study participants were the high
cost of drugs, polypharmacy and lack of pharmacist and physician communication
with patients about their drug therapy.
CONCLUSIONS: The current findings highlight the need for urgent, multifaceted
interventions, given the burden of cardiovascular diseases and the clinical and
economic consequences of medication non-adherence. These interventions include
affordable medications, easy-to-use medication regimens with fewer daily doses,
ongoing communication between patients and healthcare providers, and improvement
of the patient-provider partnership.
DOI: 10.5830/CVJA-2017-016
PMCID: PMC5885049
1354. Curr Diab Rep. 2016 Nov;16(11):113.
Self-Care Disparities Among Adults with Type 2 Diabetes in the USA.
Mayberry LS(1)(2), Bergner EM(3)(4), Chakkalakal RJ(3)(5), Elasy TA(3)(5), Osborn

CY(3)(4).
Author information:
(1)Center for Health Behavior and Health Education, Center for Diabetes
Translation Research, Division of General Internal Medicine and Public Health,
Vanderbilt University Medical Center, Nashville, TN, USA.
lindsay.mayberry@vanderbilt.edu.
(2), 2525 West End Ave. Suite 370, Nashville, TN, 37203, USA.
lindsay.mayberry@vanderbilt.edu.
(3)Center for Health Behavior and Health Education, Center for Diabetes
Translation Research, Division of General Internal Medicine and Public Health,
Vanderbilt University Medical Center, Nashville, TN, USA.
(4), 2525 West End Ave. Suite 370, Nashville, TN, 37203, USA.
(5), 1215 Twenty-First Ave South, Ste 6000, MCE North Tower, Nashville, TN,
37232-8300, USA.
Suboptimal glycemic control is more common among non-Hispanic Blacks (NHBs) and
Hispanics than non-Hispanic Whites (NHWs). Disparities in the performance of
self-care behaviors may contribute to this. To synthesize knowledge on current
self-care disparities, we reviewed studies from January 2011-March 2016 that
included NHWs, NHBs, and Hispanics with type 2 diabetes in the USA. Self-care
behaviors included diet, exercise, medications, self-monitoring of blood glucose
(SMBG), self-foot exams, and not smoking. Of 1241 articles identified in PubMed,
25 met our inclusion criteria. These studies report consistent disparities in
medication adherence. Surprisingly, we found consistent evidence of no
disparities in exercise and some evidence of reverse disparities: compared to
NHWs, Hispanics had healthier diets and NHBs had more regular SMBG. Consistent
use of validated measures could further inform disparities in diet and exercise.
Additional research is needed to test for disparities in self-foot exams, not
smoking, and diabetes-specific problem solving and coping.
DOI: 10.1007/s11892-016-0796-5
PMCID: PMC5096842
Conflict of interest statement: Lindsay Satterwhite Mayberry, Erin Bergner,

Rosette Chakkalakal, Tom A. Elasy, and Chandra Y. Osborn declare that they have
no conflict of interest.
1355. J Consult Clin Psychol. 2015 Apr;83(2):387-94. doi: 10.1037/a0038635. Epub

2015
Jan 26.
Predicting meaningful outcomes to medication and self-help treatments for

binge-eating disorder in primary care: The significance of early rapid response.
Grilo CM(1), White MA(1), Masheb RM(1), Gueorguieva R(2).
Author information:
(1)Department of Psychiatry, Yale University School of Medicine.
(2)Department of Biostatistics, Yale University School of Public Health.
Erratum in
J Consult Clin Psychol. 2015 Aug;83(4):747.
OBJECTIVE: We examined rapid response among obese patients with binge-eating

disorder (BED) in a randomized clinical trial testing antiobesity medication and
self-help cognitive-behavioral therapy (shCBT), alone and in combination, in
primary-care settings.
METHOD: One hundred four obese patients with BED were randomly assigned to 1 of 4
treatments: sibutramine, placebo, shCBT + sibutramine, or shCBT + placebo.
Treatments were delivered by generalist primary-care physicians and the
medications were given double-blind. Independent assessments were performed by
trained and monitored doctoral research clinicians monthly throughout treatment,
posttreatment (4 months), and at 6- and 12-month follow-ups (i.e., 16 months
after randomization). Rapid response, defined as ≥65% reduction in binge eating
by the fourth treatment week, was used to predict outcomes.
RESULTS: Rapid response characterized 47% of patients, was unrelated to
demographic and baseline clinical characteristics, and was significantly
associated, prospectively, with remission from binge eating at posttreatment (51%
vs. 9% for nonrapid responders), 6-month (53% vs. 23.6%), and 12-month (46.9% vs.
23.6%) follow-ups. Mixed-effects model analyses revealed that rapid response was
significantly associated with greater decreases in binge-eating or
eating-disorder psychopathology, depression, and percent weight loss.
DISCUSSION: Our findings, based on a diverse obese patient group receiving
medication and shCBT for BED in primary-care settings, indicate that patients who
have a rapid response achieve good clinical outcomes through 12-month follow-ups
after ending treatment. Rapid response represents a strong prognostic indicator
of clinically meaningful outcomes, even in low-intensity medication and self-help
interventions. Rapid response has important clinical implications for
stepped-care treatment models for BED.
CLINICAL TRIAL REGISTRATION: clinicaltrials.gov: NCT00537810 (PsycINFO Database
Record
DOI: 10.1037/a0038635
PMCID: PMC4380674
1356. BMC Health Serv Res. 2017 Feb 7;17(1):119. doi: 10.1186/s12913-017-2020-y.
The challenges of assessing patients' medication beliefs: a qualitative study.
Thorneloe RJ(1)(2), Griffiths CE(3)(4), Ashcroft DM(5), Cordingley L(6).
Author information:
(1)Division of Pharmacy and Optometry, Manchester Academic Health Sciences
Centre, University of Manchester, Manchester, M13 9PB, UK.
Rachael.Thorneloe@manchester.ac.uk.
(2)Centre for Dermatology Research, Manchester Academic Health Sciences Centre,
University of Manchester, Manchester, UK. Rachael.Thorneloe@manchester.ac.uk.
(3)Centre for Dermatology Research, Manchester Academic Health Sciences Centre,
University of Manchester, Manchester, UK.
(4)Salford Royal NHS Foundation Trust, Salford, UK.
(5)Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and
Optometry, Manchester Academic Health Sciences Centre, University of Manchester,
Manchester, UK.
(6)Division of Musculoskeletal and Dermatological Sciences, Manchester Academic
Health Sciences Centre, University of Manchester, Manchester, UK.
BACKGROUND: An estimated 50% of patients do not take their medication as

prescribed, with medication adherence associated with adverse outcomes and higher
costs of care. The Necessity-Concerns Framework identified individual's beliefs
about their medication as playing a key role in adherence, and UK Clinical
Adherence Guidelines recommend eliciting and incorporating individual's
perceptions of their medication within the consultation. The Beliefs about
Medicines Questionnaire (BMQ) is widely used to assess medication beliefs,
however, given the condition-specific nature of some self-management regimens, it
is unknown whether this tool is able to fully capture beliefs about more complex
medication regimens.
METHODS: We examined the challenges of assessing medication beliefs using the BMQ
in 20 people with a complex relapsing-remitting condition recruited from
community sources. Data were collected from people with psoriasis; a patient
group characterised by complex medication regimens, which include therapies that
are applied topically, phototherapy/photochemotherapy, and therapies that are
administered orally or via subcutaneous or intravenous injections.
Semi-structured cognitive interviews were undertaken, with responses coded using
established schedules and analysed using Content analysis.
RESULTS: Individual's beliefs about their condition specific therapies were not
accurately captured by the BMQ. Medication beliefs as expressed during
'real-time' completion of the BMQ were underestimated, or failed to be captured,
by the corresponding scores given by participants. There was mismatch between the
terminology used in the scale and individuals perceptions of their condition and
the complexity of its management and treatment outcomes. Currently the BMQ cannot
represent beliefs about medicines underuse, even though some individuals with
psoriasis viewed access to therapies as overly restrictive. Some the BMQ items
were misinterpreted in part due to ambiguous item wording or due to misreading by
participants.
CONCLUSIONS: This is the first study to identify general and condition-specific
difficulties experienced by individuals completing the BMQ in 'real time'. The
main implication of this research is the need to develop condition-specific
versions of the BMQ in order that this important instrument can capture the full
range of medication beliefs in individuals living with a complex
relapsing-remitting condition. Access to condition-specific versions could
significantly increase our understanding of beliefs which facilitate or reduce
DOI: 10.1186/s12913-017-2020-y
PMCID: PMC5297180
eCollection 2019.
The relationship between patients' perception of type 2 diabetes and medication

adherence: a cross-sectional study in Japan.
Hashimoto K(#)(1), Urata K(#)(1), Yoshida A(1), Horiuchi R(2), Yamaaki N(3), Yagi
K(4), Arai K(1).
Author information:
(1)1Faculty of Pharmacy, Institute of Medical, Pharmaceutical, and Health
Sciences, Kanazawa University, Kakuma-machi, Kanazawa, 920-1192 Japan.
(2)Gran Pharma Inc., 1-5-2 Hon-machi, Kanazawa, 920-0853 Japan.
(3)3Department of Internal Medicine, Japan Community Healthcare Organization
Kanazawa Hospital, Ha-15 Oki-machi, Kanazawa, 920-8610 Japan.
(4)4Department of Internal Medicine, Graduate School of Medical Science, Kanazawa
University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan.
Background: The self-management of type 2 diabetes mellitus (T2DM), which

involves adherence to medical instructions on diet and nutritional advice,
physical activity, medication regimen, and weight and stress management, is
necessary for the treatment of T2DM.In this study, we investigated the
relationship between patients' perceptions of their disease and their adherence
to their medications. And we attempted to determine whether distinct
subphenotypes of behavioral change of medication adherence can be discerned based
on a patients' perceptions.
Method: A cross-sectional study using a questionnaire was conducted among 157
patients with T2DM from October 2015 to September 2017. Questionnaires were
administered to assess the participants' demographic and clinical
characteristics, medication adherence, diabetes knowledge, and perception of
being diabetic. Principal component analysis (PCA) and cluster analyses were
performed to classify medication adherence patterns in the total cohort. Multiple
regression analyses were performed to identify the determinant factors of
Results: PCA showed the interpretable medication adherence of patients with
diabetes by using component 1 ("accessibility to medical treatment") and
component 2 ("status of taking medicines"). We identified four groups that show
significantly different medication adherence by using cluster analysis on the
basis of the two components. Multiple regression analysis showed that body mass
index (BMI), family history of diabetes, one factor of patient's perception
(living an orderly life), and diabetes knowledge were found to be significant
predictors of medication adherence in patients with T2DM.
Conclusions: In patients with T2DM, the patient's diabetes perception of "living
an orderly life" is associated with medication adherence. A poor adherence group
may be able to change their adherence to diabetes treatment by developing the
perception of "living an orderly life."
DOI: 10.1186/s40780-019-0132-8
PMCID: PMC6341584
PMID: 30693091
Conflict of interest statement: The study was approved by the each institution’s
ethics committees of Kanazawa University, and Japan Community Healthcare
Organization (JCHO) Kanazawa Hospital.Not applicable.The authors declare that
they have no competing interests.Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
1358. BMC Public Health. 2018 Nov 20;18(1):1282. doi: 10.1186/s12889-018-6209-8.
Impact of financial burden, resulting from prescription co-payments, on

antihypertensive medication adherence in an older publically insured population.
Dillon P(1), Smith SM(2), Gallagher P(3), Cousins G(3).
Author information:
(1)School of Pharmacy, RCSI, St. Stephen's Green, Dublin 2, Ireland.
pauldillon@rcsi.com.
(2)Primary Care Medicine, Department of General Practice and HRB Centre for
Primary Care Research, RCSI, St. Stephen's Green, Dublin 2, Ireland.
(3)School of Pharmacy, RCSI, St. Stephen's Green, Dublin 2, Ireland.
INTRODUCTION: Medication co-payments represent a financial barrier to

antihypertensive medication adherence. The introduction of co-payments for Irish
publically insured patients was associated with a 5% reduction in adherence.
However there is socioeconomic variability within this population, and the impact
may be greater for those on lower income. We evaluated medication-related
financial burden of the co-payment in a cohort of Irish publically insured
antihypertensive users and tested its association with adherence at 12 months.
METHODS: This was a prospective cohort study of community dwelling older
(> 65 yrs) adults (n = 1152) from 106 Irish community pharmacies. Participants
completed a structured telephone interview at baseline, and a follow-up interview
at 12-months, which we linked to pharmacy records. We assessed medication-related
financial burden at baseline using a single questionnaire item, and adherence at
12 months via questionnaire and refill-adherence as Proportion of Days Covered
(PDC).
RESULTS: A third of participants (30.1%) reported financial burden due to
medication costs. In adjusted linear regression models financially burdened
participants had significantly lower self-reported adherence (β = - 0.29, 95% CI
-0.48 to - 0.11), although this was not evident with PDC (β = - 2.76, 95% CI
-5.65 to 0.14).
CONCLUSION: This co-payment represents a financial barrier to antihypertensive
adherence for many older Irish publically insured patients. The negative impact
to adherence will potentially increase the risk of adverse outcomes, such as
stroke, and increase long-term healthcare costs.
DOI: 10.1186/s12889-018-6209-8
PMCID: PMC6247632

eCollection 2017.
Medication adherence, medical record accuracy, and medication exposure in

real-world patients using comprehensive medication monitoring.
Ryan TP(1), Morrison RD(1), Sutherland JJ(1), Milne SB(1), Ryan KA(1), Daniels
JS(1), Misra-Hebert A(2), Hicks JK(3), Vogan E(4), Teng K(3), Daly TM(5).
Author information:
(1)Sano Laboratories, Sano Informed Prescribing, Franklin, Tennessee, United
States of America.
(2)Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, United
States of America.
(3)Medicines Department, Cleveland Clinic, Cleveland, Ohio, United States of
America.
(4)Reporting and Analytics, Cleveland Clinic, Cleveland, Ohio, United States of
America.
(5)Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland
Clinic, Cleveland, Ohio, United States of America.
BACKGROUND: Poor adherence to medication regimens and medical record

inconsistencies result in incomplete knowledge of medication therapy in
polypharmacy patients. By quantitatively identifying medications in the blood of
patients and reconciling detected medications with the medical record, we have
defined the severity of this knowledge gap and created a path toward optimizing
medication therapy.
METHODS AND FINDINGS: We validated a liquid chromatography-tandem mass
spectrometry assay to detect and/or quantify 38 medications across a broad range
of chronic diseases to obtain a comprehensive survey of patient adherence,
medical record accuracy, and exposure variability in two patient populations. In
a retrospectively tested 821-patient cohort representing U.S. adults, we found
that 46% of medications assessed were detected in patients as prescribed in the
medical record. Of the remaining medications, 23% were detected, but not listed
in the medical record while 30% were prescribed to patients, but not detected in
blood. To determine how often each detected medication fell within
literature-derived reference ranges when taken as prescribed, we prospectively
enrolled a cohort of 151 treatment-regimen adherent patients. In this cohort, we
found that 53% of medications that were taken as prescribed, as determined using
patient self-reporting, were not within the blood reference range. Of the
medications not in range, 83% were below and 17% above the lower and upper range
limits, respectively. Only 32% of out-of-range medications could be attributed to
short oral half-lives, leaving extensive exposure variability to result from
patient behavior, undefined drug interactions, genetics, and other
characteristics that can affect medication exposure.
CONCLUSIONS: This is the first study to assess compliance, medical record
accuracy, and exposure as determinants of real-world treatment and response.
Variation in medication detection and exposure is greater than previously
demonstrated, illustrating the scope of current therapy issues and opening
avenues that warrant further investigation to optimize medication therapy.
PMCID: PMC5619774
1360. Am Health Drug Benefits. 2015 Jul-Aug;8(5):263-71.
Value-Based Benefit Design to Improve Medication Adherence for Employees with

Anxiety or Depression.
Reid KJ(1), Aguilar KM(2), Thompson E(3), Miller RM(4).
Author information:
(1)Biostatistician, Cerner Population Health Services, Kansas City, MO.
(2)Scientist, Cerner Research Services, Culver City, CA.
(3)Director of Business Intelligence and Analytics, KaMMCO Health Solutions,
Topeka, KS, and Senior Financial Analyst II, Children's Mercy Hospital, Topeka,
KS.
(4)Medical Director, Population Health Services, Cerner Health Connections,
Culver City, CA.
BACKGROUND: Through reduced out-of-pocket costs and wellness offerings,

value-based benefit design (VBBD) is a promising strategy to improve medication
adherence and other health-related outcomes across populations. There is limited
evidence, however, of the effectiveness of these policy-level changes among
individuals with anxiety or depression.
OBJECTIVES: To assess the impact of a multifaceted VBBD policy that incorporates
waived copayments, wellness offerings, and on-site services on medication
adherence among plan members with anxiety or depression, and to explore how this
intervention and its resulting improved adherence affects other health-related
outcomes.
METHODS: A retrospective longitudinal pre/post design was utilized to measure
outcomes before and after the VBBD policy change. Repeated measures statistical
regression models with correlated error terms were utilized to evaluate outcomes
among employees of a self-insured global health company and their spouses (N =
529) who had anxiety or depression after the VBBD policy change. A multivariable
linear regression model was chosen as the best fit to evaluate a change in
medication possession ratio (MPR) after comparing parameters for several
distributions. The repeated measures multivariable regression models were
adjusted for baseline MPR and potential confounders, including continuous age,
sex, continuous modified Charlson Comorbidity Index, and the continuous number of
prescriptions filled that year. The outcomes were assessed for the 1 year before
the policy change (January 1, 2011, through December 31, 2011) and for 2 years
after the change (January 1, 2012, through December 31, 2013). The primary
outcome was a change in MPR. The secondary outcomes included healthcare
utilization, medical or pharmacy costs, the initiation of medication, generic
medication use, and employee absenteeism (the total number of sick days).
RESULTS: The implementation of the VBBD strategy was associated with a
significant increase in average MPR (0.65 vs 0.61 in the pre-VBBD period; P =
.004), the initiation of new medications for anxiety or depression (31.4% vs
29.5%, respectively; P = .033), and the filling of generic medications for
anxiety or depression (85.1% vs 80.5%, respectively; P <.001). A multivariable
adjusted analysis revealed a 0.05 increase in MPR after the benefit enhancement
(P = .002). Healthcare utilization, costs, and absenteeism were not statistically
different before and after the VBBD policy change.
CONCLUSION: The VBBD strategy was associated with improved medication adherence
and cost-conscious medication use. Future analyses should explore whether these
trends persist over time, and if they can further impact healthcare utilization,
cost, and absenteeism.
PMCID: PMC4567057
PMID: 26380032

eCollection 2017.
Predictors of Medication Adherence and Blood Pressure Control among Saudi

Hypertensive Patients Attending Primary Care Clinics: A Cross-Sectional Study.
Khayyat SM(1), Khayyat SM(2), Hyat Alhazmi RS(2), Mohamed MM(1)(3), Abdul Hadi
M(4).
Author information:
(1)Department of Clinical Pharmacy, Faculty of Pharmacy, Umm Al-Qura University,
Makkah, Saudi Arabia.
(2)Public Health Centers, Ministry of Health, Makkah, Saudi Arabia.
(3)Pharmaceutical Research Center, Deanship of Scientific Research, Umm Al-Qura
University, Makkah, Saudi Arabia.
(4)School of Healthcare, University of Leeds, Leeds, United Kingdom.
Erratum in
PLoS One. 2017 Oct 31;12 (10 ):e0187614.
PURPOSE: To assess the level of medication adherence and to investigate

predictors of medication adherence and blood pressure control among hypertensive
patients attending primary healthcare clinics in Makkah, Saudi Arabia.
PATIENTS AND METHODS: Hypertensive patients meeting the eligibility criteria were
recruited from eight primary care clinics between January and May 2016 for this
study. The patients completed Arabic version of Morisky Medication Adherence
Scale (MMAS-8), an eight-item validated, self-reported measure to assess
medication adherence. A structured data collection form was used to record
patients' sociodemographic, medical and medication data.
RESULTS: Two hundred and four patients, of which 71.6% were females, participated
in the study. Patients' mean age was 59.1 (SD 12.2). The mean number of
medication used by patients was 4.4 (SD 1.89). More than half (110; 54%) of the
patients were non-adherent to their medications (MMAS score < 6). Binary
regression analysis showed that highly adherent patients (MMAS score = 8) were
about five times (OR 4.91 [95%CI: 1.85-12.93; P = 0.01]) more likely to have
controlled blood pressure compared to low adherent patients. Female gender (OR
0.40 [95% CI: 0.20-0.80; P = 0.01]), Age > 65 years (OR 2.0 [95% CI: 1.0-4.2; P =
0.04]), and being diabetic (OR 0.25 [95% CI: 0.1-0.6; P = 0.04]) were found to be
independent predictors of medication adherence.
CONCLUSION: Medication adherence is alarmingly low among hypertensive patients
attending primary care clinics in Saudi Arabia which may partly explain observed
poor blood pressure control. There is a clear need to educate patients about the
importance of medication adherence and its impact on improving clinical outcomes.
Future research should identify barriers to medication adherence among Saudi
hypertensive patients.
PMCID: PMC5279800

interests exist.
1362. AIDS Behav. 2018 Apr;22(4):1174-1183. doi: 10.1007/s10461-017-1958-4.
Predictors of Over-Reporting HIV Pre-exposure Prophylaxis (PrEP) Adherence Among

Young Men Who Have Sex With Men (YMSM) in Self-Reported Versus Biomarker Data.
Baker Z(1), Javanbakht M(2), Mierzwa S(3), Pavel C(3), Lally M(4), Zimet G(5),
Gorbach P(2)(6).
Author information:
(1)Department of Epidemiology, University of California Los Angeles, Los Angeles,
CA, USA. zoebaker@ucla.edu.
(2)Department of Epidemiology, University of California Los Angeles, Los Angeles,
CA, USA.
(3)Population Council, New York, NY, USA.
(4)Department of Infectious Diseases, Brown University Warren Alpert Medical
School, Providence, RI, USA.
(5)Department of Pediatrics, Indiana University School of Medicine, Indianapolis,
IN, USA.
(6)Division of Infectious Diseases, David Geffen School of Medicine, University
of California Los Angeles, Los Angeles, CA, USA.
Young men who have sex with men (YMSM) face a disproportionately high burden of
HIV. Oral pre-exposure prophylaxis (PrEP) is effective in preventing HIV
acquisition, but adherence to PrEP among YMSM may be inadequate. Medication
adherence may be assessed via biomarkers, which are expensive and invasive, or
via self-report through Audio Computer Assisted Self-Interview (ACASI), which may
result in over-reporting of adherence. In this paper we assess the potential of a
new method of self-report, the Interactive Questionnaire System (iQS), in validly
estimating true adherence rates. PrEP adherence among 167 YMSM aged 15-23 was
measured via dried blood spot (DBS), ACASI, and iQS twice over a 24-week study
period. Both ACASI- and iQS-reported data revealed that over 40% of individuals
self-reporting adequate PrEP adherence had DBS-estimated drug levels indicating
inadequate adherence. Adjusted logistic repeated measures random intercept
regression analyses indicated that younger YMSM had higher odds of over-reporting
adherence than older YMSM-each 1 year increase in age was associated with 0.79
times the odds of over-reporting adherence (95% CI 0.63, 0.98; p value = 0.031),
and being African American was associated with 3.22 times greater odds of
over-reporting than non-African Americans (95% CI 1.51, 6.90; p-value = 0.0003).
These results suggest that ACASI and iQS methods of self-report significantly
overestimate true PrEP adherence rates among YMSM, and that the odds of
over-reporting adherence may be affected by both age and race.
DOI: 10.1007/s10461-017-1958-4
PMCID: PMC6038811
1363. Osteoporos Int. 2018 Feb;29(2):329-337. doi: 10.1007/s00198-017-4271-1. Epub

2017
Nov 6.
The impact of GI events on persistence and adherence to osteoporosis treatment:

3-, 6-, and 12-month findings in the MUSIC-OS study.
Modi A(1), Sen S(2), Adachi JD(3), Adami S(4), Cortet B(5), Cooper AL(6), Geusens
P(7), Mellström D(8), Weaver JP(2), van den Bergh JP(7)(9), Keown P(10), Sajjan
S(2).
Author information:
(1)Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc.,
600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ, 07033, USA.
ankita.modi@merck.com.
(2)Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc.,
600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ, 07033, USA.
(3)St Joseph's Healthcare and McMaster University, Hamilton, ON, Canada.
(4)Department of Medicine, University of Verona, Verona, Italy.
(5)Department of Rheumatology, University Hospital of Lille, Lille Cedex, France.
(6)Bridge Medical Center, Crawley, West Sussex, UK.
(7)Department of Rheumatology, Maastricht University Medical Center, Maastricht,
The Netherlands.
(8)Department of Internal Medicine and Geriatrics, Gothenburg University,
Gothenburg, Sweden.
(9)Department of Internal Medicine, VieCuri Medical Center, Venlo, The
Netherlands.
(10)Syreon Corporation, Vancouver, Canada.
The goal of this multinational, prospective, observational study was to examine

the relationship between gastrointestinal (GI) events and self-reported levels of
medication adherence and persistence in postmenopausal women. A total of 73.9% of
patients remained on their osteoporosis (OP) therapy at month 12, although the
presence of a GI event at baseline, month 3, and month 6 significantly reduced
month 12 persistence among new users. The odds of a month-12 ADEOS score ≥ 20
were significantly lower among patients who experienced a GI event between
baseline and month 6. The occurrence of GI events was observed to be associated
with a lower likelihood of patient adherence and persistence to OP
medication.INTRODUCTION: This study examines the relationship between
gastrointestinal (GI) events and self-reported adherence and persistence with
initial osteoporosis (OP) therapy over the course of the first 12 months of
treatment.
METHODS: The Medication Use Patterns, Treatment Satisfaction, and Inadequate
Control of Osteoporosis Study was a multinational, prospective, observational
study examining the impact of GI events on OP management in postmenopausal women.
Information regarding GI events was collected at the time of enrollment and at
months 3, 6, and 12 of follow-up. Patients reported GI events and medication
persistence and completed the 12-item Adherence Evaluation of Osteoporosis
treatment (ADEOS) questionnaire. Multivariate logistic and general linear models
examined the association between GI events at various time points and persistence
and adherence at month 12.
RESULTS: The study enrolled 2943 women; 22.8% were classified as new users of OP
therapy and the remainder were considered experienced users. Across all patients,
68.1% reported GI events at baseline; by month 12, over 80% of subjects who
completed follow-up reported at least one GI problem. The majority of patients
(86.7%) were treated only with bisphosphonates at baseline. At month 12, 73.9% of
patients remained on therapy; logistic regression revealed that those with GI
problems by month 6 were significantly less likely to persist with treatment,
after adjusting for other factors. The odds of a month 12 ADEOS score ≥ 20
(considered predictive of adherence) were significantly lower among patients who
experienced a GI event between baseline and month 6.
CONCLUSIONS: The occurrence of GI events was associated with a lower likelihood
of patient adherence to and persistence with OP medication.
DOI: 10.1007/s00198-017-4271-1
PMCID: PMC5818582

eCollection 2019.
Adherence to diabetes medication among diabetic patients in the Bisha governorate

of Saudi Arabia - a cross-sectional survey.
Alqarni AM(1)(2), Alrahbeni T(2), Qarni AA(3)(4), Qarni HMA(1)(2).
Author information:
(1)Clinical Pharmacy Department, Bisha Health Affairs, Ministry of Health, Bisha,
Saudi Arabia, abuayed.alq@gmail.com.
(2)Department of Pharmacy and Allied Sciences, Riyadh Elm University, Riyadh,
Saudi Arabia, abuayed.alq@gmail.com.
(3)Department of Rehabilitation Sciences, College of Applied Medical Sciences,
King Saud University, Riyadh, Saudi Arabia.
(4)Department of Physical Therapy, King Abdullah Hospital, Bisha Health Affairs,
Ministry of Health, Bisha, Saudi Arabia.
Erratum in
Patient Prefer Adherence. 2019 Feb 08;13:249.
Background: Patients' non-adherence to diabetes medication is associated with

poor glycemic control and suboptimal benefits from their prescribed medication,
which can lead to worsening of medical condition, development of comorbidities,
reduced quality of life, elevated health care costs, and increased mortality.
Objective: This study aimed to assess medication adherence among patients with
diabetes and associated factors in Bisha primary health care centers (PHCCs) in
Saudi Arabia.
Patients and methods: A cross-sectional study was conducted with a sample of 375
type 1 and 2 Saudi diabetic patients attending PHCCs under the Health Affairs of
the Bisha governorate. The participants were aged 18 years and above, and had
been taking diabetes medications for at least 3 months. Pregnant women, patients
with mental illnesses, and those who were not willing to participate were
excluded. Adherence to diabetes medications was measured using the four-item
Morisky Green Levine Medication Adherence Scale (MGLS). All participants
completed a self-report questionnaire including sociodemographic and clinical
variables. Univariate and multivariate analyses were carried out using SPSS
version 22.
Results: Of all the respondents, 134 (35.7%), 161 (42.9%), and 80 (21.4%),
patients had high (MGLS score 0), intermediate (MGLS score 1 or 2), and low
adherence (MGLS score ≥3), respectively. Factors associated with the level of
adherence in univariate analysis were occupational status (P=0.037), current
medication (P<0.001), glycated hemoglobin (A1c) (P<0.001), and number of
associated comorbidities (P<0.001). In multivariable analyses, A1c <7 (P<0.001)
and no associated comorbidities (P<0.003) variables remained significantly
associated with adherence.
Conclusion: The level of adherence to medication in diabetes mellitus patients in
the Bisha PHCCs was found to be suboptimal. The findings point toward the need
for better management of primary health care providers' approaches to individual
patients, by taking into account their medication adherence levels. Better
identification of patients' level of adherence remains essential for successful
diabetes treatment.
DOI: 10.2147/PPA.S176355
PMCID: PMC6309134
PMID: 30636871

1365. Sex Med. 2019 Mar;7(1):54-60. doi: 10.1016/j.esxm.2018.10.006. Epub 2018 Dec
3.
Degree of Planning of Sexual Intercourse Among Men From China, Japan, and Taiwan
Taking Medication for Erectile Dysfunction: Findings of an Observational,
Cross-Sectional Survey.
Jiann BP(1), Nakajima K(2), Dighe S(3), Harshman-Smith CD(4), Hassan TA(3).
Author information:
(1)Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung and
School of Medicine, National Yang-Ming Medical University, Taipei City, Taiwan.
Electronic address: bpjiann@gmail.com.
(2)Department of Urology, Faculty of Medicine, Toho University, Tokyo, Japan.
(3)Pfizer Inc, New York, NY, USA.
(4)ZS Associates, Inc (a strategic consulting partner to Pfizer), New York, NY,
USA.
INTRODUCTION: Management of erectile dysfunction (ED) is beset with assumptions

around spontaneity of sexual intercourse, requiring candor between the physician
and patient if appropriate treatment is to be implemented.
AIM: To evaluate the degree to which men who take ED medications plan for and
have sex.
METHODS: Men from China, Japan, and Taiwan aged 40-70 years who had taken ED
medications within the past 3 months were invited to participate anonymously in
an online, self-administered survey that enquired about frequency and advance
planning of sex, time between taking ED medication and intercourse, and treatment
satisfaction. Data were analyzed using descriptive statistics.
MAIN OUTCOME MEASURE: Frequency of planning of sexual intercourse, planning and
ED medication dosing interval, and frequency of ED medication use.
RESULTS: Data from 604 respondents (mean age 50.8 years) from China (n = 254),
Japan (n = 250), and Taiwan (n = 100) were collected. Men used ED medications a
median of ≤4 times per month in all 3 territories. 76% who used ED medication
during the past 3 months planned for sex on specific occasions, with 59% and 52%
agreeing that they plan for sex on specific days of the week and times of the
day, respectively. Most commonly, men planned for sex up to several hours to a
day beforehand, with 94% taking ED medication within 4 hours of sex. Satisfaction
with ED medication was generally high and related to erection rigidity, speed of
onset, and safety.
CONCLUSION: Knowledge of the degree to which individuals with ED plan for sex may
have important implications for the appropriate prescription of ED medication.
The high degree of planning around sexual activities exhibited by men taking ED
medication suggests there is a need for appropriate counseling to ensure that
treatment is aligned with patient behavior. Jiann B-P, Nakajima K, Dighe S,
et al. Degree of planning of sexual intercourse among men from China, Japan, and
Taiwan taking medication for erectile dysfunction: Findings of an observational,
cross-sectional survey. Sex Med 2019;7:54-60.
DOI: 10.1016/j.esxm.2018.10.006
PMCID: PMC6377368
PMID: 30522975
1366. Epilepsy Behav. 2015 May;46:242-5. doi: 10.1016/j.yebeh.2015.01.034. Epub

2015
Apr 4.
Psychosocial factors associated with medication adherence in ethnically and
socioeconomically diverse patients with epilepsy.
Shallcross AJ(1), Becker DA(2), Singh A(2), Friedman D(2), Jurd R(2), French
JA(2), Devinsky O(2), Spruill TM(3).
Author information:
(1)Department of Population Health, New York University, School of Medicine, USA.
Electronic address: Amanda.shallcross@nyumc.org.
(2)Department of Neurology, New York University, School of Medicine, USA.
(3)Department of Population Health, New York University, School of Medicine, USA.
The current study examined psychosocial correlates of medication adherence in a

socioeconomically and racially diverse sample of patients with epilepsy.
Fifty-five patients with epilepsy completed standardized self-report
questionnaires measuring depression, stress, social support, and medication and
illness beliefs. Antiepileptic drug (AED) adherence was measured using the 8-item
Morisky Medication Adherence Scale 36% reported poor adherence. We tested which
psychosocial factors were independently and most strongly associated with AED
adherence. Stress and depression were negatively correlated with adherence, while
perceived social support was positively correlated with adherence (Ps<.05). When
all three of these variables and relevant covariates in a multiple regression
model were included, only perceived social support remained a significant
predictor of adherence (P=.015). This study is one of the first to suggest the
importance of targeting social support in screening and intervention approaches
in order to improve AED adherence among low-income, racially/ethnically diverse
patients with epilepsy.
DOI: 10.1016/j.yebeh.2015.01.034
PMCID: PMC4701194

eCollection 2017.
Self-reported adherence and pharmacy refill adherence are both predictive for an
undetectable viral load among HIV-infected migrants receiving cART.
Been SK(1), Yildiz E(1)(2), Nieuwkerk PT(3), Pogány K(4), van de Vijver DAMC(5),
Verbon A(1)(2).
Author information:
(1)Department of Internal Medicine, division of Infectious Diseases, Erasmus
University Medical Center, Rotterdam, The Netherlands.
(2)Department of Medical Microbiology and Infectious Diseases, Erasmus University
Medical Center, Rotterdam, The Netherlands.
(3)Department of Medical Psychology, Academic Medical Center, Amsterdam, The
Netherlands.
(4)Department of Internal Medicine, Maasstad Hospital, Rotterdam, The
Netherlands.
(5)Viroscience department, Erasmus University Medical Center, Rotterdam, The
Netherlands.
HIV-infected migrants were shown to have poorer treatment outcomes than Dutch
HIV-infected patients, often due to worse treatment adherence. Self-reported
adherence would be an easy way to monitor adherence, but its validity relative to
pharmacy refill adherence has not been extensively evaluated in migrants. All
HIV-infected migrants older than 18 years and in care at the two Rotterdam
HIV-treatment centers were eligible. Refill data with leftover medication (PRL)
(residual pill count) were obtained from their pharmacies up to 15 months prior
to inclusion. Self-reported adherence to combination Antiretroviral Therapy was
assessed by four questions about adherence at inclusion. Additionally, risk
factors for pharmacy refill non-adherence were examined. In total, 299
HIV-infected migrants were included. Viral load (VL) was detectable in 11% of the
patients. Specificity of PRL was 53% for patients with an adherence of 100% and
decreased with lower cut-off values. Sensitivity and negative predictive value
(NPV) were 68% and 15% and increased with lower cut-off values. Positive
predictive value (PPV) was around 93% for all cut-off values. Using the
self-reported questions, 139 patients (47%) reported to be adherent. Sensitivity
was 49% and specificity was 72%. PPV and NPV were 95% and 13%. No risk factors
for pharmacy refill non-adherence were found in multivariable analyses. Both PRL
and self-reported adherence, can predict undetectable VL in HIV-infected
migrants. PPV and NPV are similar for both methods. This study shows that using
four self-reported items is sufficient to predict adherence which is crucial for
optimal clinical outcome in HIV-infected migrants.
PMCID: PMC5679639
1368. Psychooncology. 2015 Dec;24(12):1714-22. doi: 10.1002/pon.3783. Epub 2015 Apr

14.
National study of chronic disease self-management: 6-month and 12-month findings

among cancer survivors and non-cancer survivors.
Salvatore AL(1), Ahn S(2)(3), Jiang L(4), Lorig K(5), Ory MG(3).
Author information:
(1)College of Public Health, University of Oklahoma Health Sciences Center,
Oklahoma City, OK, USA.
(2)Division of Health Systems Management and Policy, The University of Memphis,
School of Public Health, Memphis, TN, USA.
(3)Department of Health Promotion and Community Health Sciences, Texas A&M Health
Science Center, School of Rural Public Health, College Station, TX, USA.
(4)Department of Epidemiology, University of California Irvine, Irvine, CA, USA.
(5)Department of Medicine, Stanford University, Stanford, CA, USA.
OBJECTIVE: This study examined the applicability of the Stanford Chronic Disease
Self-Management Program (CDSMP) for cancer survivors and compared outcomes among
cancer survivors and participants with other chronic diseases (non-cancer
survivors).
METHODS: Participants were older adults (n = 1170) enrolled in the National Study
of CDSMP. Detailed information about physical and psychosocial health status and
health and healthcare behaviors was collected from participants (n = 116 cancer
survivors and n = 1054 non-cancer survivors) via self-report before CDSMP
participation and at 6-month and 12-month follow-ups. Linear and generalized
linear mixed models were used to assess baseline-to-6-month and
baseline-to-12-month changes.
RESULTS: Among cancer survivors, general health, depression, and sleep
significantly improved from baseline to 6 months. These significant changes were
sustained at 12 months. Communication with physician, medication compliance,
pain, days in poor physical health, days in poor mental health, and days kept
from usual activities and physical activity also improved significantly from
baseline to 12 months. Among non-cancer survivors, all outcomes except medication
compliance and stress improved significantly from baseline to 6 months. At 12
months, medication compliance also improved significantly.
CONCLUSIONS: Findings suggest that participation in CDSMP, an evidence-based
chronic disease self-management intervention not specifically tailored for cancer
survivorship, may significantly improve physical and psychosocial health status
and key health and healthcare behaviors among cancer survivors. Additional
research is needed to elucidate cancer survivors' unique needs and examine the
benefits of tailored versions of CDSMP. Nevertheless, CDSMP, available at scale
nationally and internationally, is a promising intervention for cancer survivors
and should be considered a valuable component of survivorship care.
DOI: 10.1002/pon.3783
1369. Iran J Nurs Midwifery Res. 2017 Mar-Apr;22(2):97-101. doi:

10.4103/ijnmr.IJNMR_220_15.
Nonadherence Behaviors and Some Related Factors in Kidney Transplant Recipients.
Hedayati P(1), Shahgholian N(2), Ghadami A(3).
Author information:
(1)Student Research Center, School of Nursing and Midwifery, Isfahan University
of Medical Sciences, Isfahan, Iran.
(2)Department of Critical Care Nursing, Kidney Diseases Research Center, Faculty
of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
(3)Ulcer Repair Research Center, School of Nursing and Midwifery, Isfahan
BACKGROUND: Kidney transplantation is the renal replacement therapy of choice for

most patients with end-stage renal disease (ESRD), however, adherence to the
recommended lifestyle is critical for a positive prognosis. The purpose of this
study was to assess adherence to immunosuppressive therapy and lifestyle
recommendations along with some related factors among kidney transplant patients.
MATERIALS AND METHODS: In this descriptive analytical study, all patients
completed a questionnaire regarding medication intake and lifestyle
recommendations (preventing of infection, self-monitoring, prevention of
cardiovascular disease (CVD), and sun protection). The participants were divided
into 4 groups according to the level of adherence (good, partial, poor, and
nonadherent) indicated in their responses.
RESULTS: Most kidney recipients were adherent to their drug prescriptions, but
were partial, poor, or nonadherent regarding lifestyle recommendations. Increased
passage of time since transplantation and low family support and educational
level resulted in nonadherence. Men showed greater adherence to medication intake
than women. Patients with lower number of drugs and reported drug side-effects
illustrated better adherence to medication intake. Women adhered to infection
protection recommendations more than men, and older and married patients adhered
to cardiovascular prevention recommendations more than others. However, younger
patients showed greater adherence to self-monitoring recommendations, and
singles, young individuals, and women were adherent to sun protection
recommendations.
CONCLUSIONS: Nonadherence is common among kidney transplant recipients. Thus, it
is necessary to determine patients who are at risk of nonadherence and to
introduce more educational programs to improve their adherence and their quality
of life (QOL).
DOI: 10.4103/ijnmr.IJNMR_220_15
PMCID: PMC5443003
PMID: 28584545
1370. Diabetol Metab Syndr. 2016 Jul 29;8:54. doi: 10.1186/s13098-016-0162-4.

eCollection 2016.
Comparison between adherence assessments and blood glucose monitoring measures to

predict glycemic control in adults with type 1 diabetes: a cross-sectional study.
Telo GH(1), de Souza MS(1), Andrade TS(1), Schaan BD(2).
Author information:
(1)Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Rua
Ramiro Barcellos, 2350, Porto Alegre, CEP 90035-903 Brazil.
(2)Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Rua
Ramiro Barcellos, 2350, Porto Alegre, CEP 90035-903 Brazil ; Endocrine Division,
Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
BACKGROUND: Adherence to treatment has been defined as the degree to which a

patient's behavior corresponds to medical or health advice; however, the most
appropriate method to evaluate adherence to diabetes care has yet to be
identified. We conducted analyses to compare adherence assessments and blood
glucose monitoring measures with regard to their ability to predict glycemic
control in adults with type 1 diabetes.
METHODS: We analyzed four instruments to evaluate adherence: Self-Care
Inventory-Revised, a self-administered survey; Diabetes Self-Monitoring Profile
(DSMP), administered by trained researchers; a categorical (yes/no/sometimes)
adherence self-evaluation; and a continuous (0-100) adherence self-evaluation.
Blood glucose monitoring frequency was evaluated by self-report, diary, and meter
download.
RESULTS: Participants (n = 82) were aged 39.0 ± 13.1 years with a mean diabetes
duration of 21.2 ± 11.1 years; 27 % monitored blood glucose >4 times/day. The
DSMP score was the strongest predictor of glycemic control (r = -0.32, P = 0.004)
among adherence assessments, while blood glucose monitoring frequency assessed by
meter download was the strongest predictor among blood glucose monitoring
measures (r = -40, P < 0.001). All the self-report assessments had a significant
but weak correlation with glycemic control (r ≤ 0.28, P ≤ 0.02). The final
adjusted model identified the assessment of blood glucose monitoring frequency by
meter download as the most robust predictor of HbA1c (estimate effect
size = -0.58, P = 0.003).
CONCLUSIONS: In efforts to evaluate adherence, blood glucose monitoring frequency
assessed by meter download has the strongest relationship with glycemic control
in adults with type 1 diabetes.
DOI: 10.1186/s13098-016-0162-4
PMCID: PMC4966590
PMID: 27478510
1371. Diabetes Technol Ther. 2016 Oct;18(10):644-649. Epub 2016 Aug 19.
Patient-Centered Care, Glycemic Control, Diabetes Self-Care, and Quality of Life

in Adults with Type 2 Diabetes.
Williams JS(1)(2), Walker RJ(1)(2)(3), Smalls BL(4), Hill R(1)(2), Egede
LE(1)(2)(3).
Author information:
(1)1 Department of Medicine, Center for Health Disparities Research, Medical
University of South Carolina , Charleston, South Carolina.
(2)2 Division of General Internal Medicine and Geriatrics, Department of
Medicine, Medical University of South Carolina , Charleston, South Carolina.
(3)3 Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H.
Johnson Department of Veterans Affairs Medical Center , Charleston, South
Carolina.
(4)4 Center for Surgery and Public Health , Brigham and Women's Hospital, Boston,
Massachusetts.
BACKGROUND: The Affordable Care Act places a newfound emphasis on

patient-centered medical home and patient-centered care (PCC). The purpose of
this study was to evaluate the relationship between PCC, diabetes self-care,
glycemic control, and quality of life (QOL) in a sample of adults with type 2
diabetes.
METHODS: Six hundred fifteen patients were recruited from two adult primary care
clinics in the southeastern United States. Primary outcome variables were
self-care behaviors (medication adherence, diet, exercise, blood sugar testing,
and foot care), glycemic control, and QOL (physical component summary [PCS] score
and mental component summary [MCS] score of SF12). PCC was assessed using a
modified 7-item Picker Patient Experience Questionnaire. Regression modeling was
used to assess independent associations while adjusting for relevant covariates.
RESULTS: In adjusted analyses, PCC was significantly associated with PCS QOL
(β = -0.03, 95% confidence interval [CI] -0.05 to -0.01), MCS QOL (β = 0.09, 95%
CI 0.04-0.14), medication adherence (β = 0.12, 95% CI 0.08-0.17), general diet
(β = 0.12, 95% CI 0.07-0.17), specific diet (β = 0.05, 95% CI 0.01-0.08), blood
sugar testing (β = 0.09, 95% CI 0.04-0.15), and foot care (β = 0.12, 95% CI
0.07-0.18).
CONCLUSION: PCC is associated with diabetes self-management and QOL, but was not
significantly associated with glycemic control in patients with diabetes. PCC may
be an important factor in self-care behaviors, but the process of focusing care
around the patient may need to expand throughout the healthcare system before
changes in outcomes such as glycemic control are noted.
DOI: 10.1089/dia.2016.0079
PMCID: PMC5069713
Conflict of interest statement: Author Disclosure Statement No competing

financial interests exist.
1372. BMC Geriatr. 2018 Jun 7;18(1):136. doi: 10.1186/s12877-018-0827-y.
Determinants of adherence and effects on health-related quality of life after

myocardial infarction: a prospective cohort study.
Krack G(1)(2), Holle R(3), Kirchberger I(4)(5)(6), Kuch B(7), Amann U(4)(5)(6),
Seidl H(3).
Author information:
(1)Munich Center of Health Sciences (MC-Health), Institute for Health Economics
and Management, Ludwig-Maximilians-Universität München, Ludwigstr. 28 RG, 80539,
Munich, Germany. krack@bwl.lmu.de.
(2)Helmholtz Zentrum München, Institute of Health Economics and Health Care
Management, Neuherberg, Germany. krack@bwl.lmu.de.
(3)Helmholtz Zentrum München, Institute of Health Economics and Health Care
Management, Neuherberg, Germany.
(4)UNIKA-T Augsburg, Chair of Epidemiology, Ludwig-Maximilians Universität
München, Augsburg, Germany.
(5)Helmholtz Zentrum München, Institute of Epidemiology II, Neuherberg, Germany.
(6)Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry,
Augsburg, Germany.
(7)Hospital of Nördlingen, Department of Internal Medicine/Cardiology,
Nördlingen, Germany.
BACKGROUND: Adherence to recommendations and medication is deemed to be important

for effectiveness of case management interventions. Thus, reasons for
non-adherence and effects on health-related quality of life (HRQoL) should be
fully understood. The objective of this research was to identify determinants of
non-adherence to medication and recommendations, and to test whether increased
adherence improved HRQoL in patients after myocardial infarction (MI) in a case
management intervention.
METHODS: Data were obtained from the intervention group of the KORINNA study, a
randomized controlled trail of a nurse-led case management intervention with
targeted recommendations in the elderly after MI in Germany. Reasons for
non-adherence were described. Logistic mixed effects models and OLS (ordinary
least squares) were used to analyze the effect of recommendations on the
probability of adherence and the association between adherence and HRQoL.
RESULTS: One hundred and twenty-seven patients with 965 contacts were included.
Frequent reasons for non-adherence to medication and recommendations were
"forgotten" (22%; 11%), "reluctant" (18%; 18%), "side effects" (38%; 7%), "the
problem disappeared" (6%; 13%), and "barriers" (0%; 13%). The probability of
adherence was lowest for disease and self-management (38%) and highest for visits
to the doctor (61%). Only if patients diverging from prescribed medication
because of side effects were also considered as adherent, 3-year medication
adherence was associated with a significant gain of 0.34 quality-adjusted life
years (QALYs).
CONCLUSIONS: Most important determinants of non-adherence to medication were side
effects, and to recommendations reluctance. Recommended improvements in disease
and self-management were least likely adhered. Medication adherence was
associated with HRQoL.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN02893746 , retrospectively
registered, date assigned 27/03/2009.
DOI: 10.1186/s12877-018-0827-y
PMCID: PMC6001009
1373. BMC Public Health. 2016 Feb 11;16:141. doi: 10.1186/s12889-016-2798-2.
Receipt of evidence-based brief cessation interventions by health professionals

and use of cessation assisted treatments among current adult cigarette-only
smokers: National Adult Tobacco Survey, 2009-2010.
Kruger J(1)(2), O'Halloran A(3), Rosenthal AC(4), Babb SD(5), Fiore MC(6).
Author information:
(1)Office on Smoking and Health, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA,
30341, USA. Ezk0@cdc.gov.
(2)Office on Smoking and Health, Centers for Disease Control and Prevention, 4770
Buford Highway, N.E., F-79, Atlanta, GA, 30341-3724, USA. Ezk0@cdc.gov.
(3)Contractor (NGIS) for Office on Smoking and Health, National Center for
Chronic Disease Prevention, Atlanta, GA, 30341, USA.
(4)Health Systems Consulting, Atlanta, GA, 30341, USA.
(5)Office on Smoking and Health, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA,
30341, USA.
(6)Center for Tobacco Research and Intervention, University of Wisconsin School
of Medicine and Public Health, Madison, WI, 53711, USA.
BACKGROUND: Helping tobacco smokers to quit during a medical visit is a clinical

and public health priority. Research suggests that most health professionals
engage their patients in at least some of the '5 A's' of the brief cessation
intervention recommended in the U.S. Public Health Service Clinical Practice
Guideline, but information on the extent to which patients act on this
intervention is uncertain. We assessed current cigarette-only smokers'
self-reported receipt of the 5 A's to determine the odds of using optimal
cessation assisted treatments (a combination of counseling and medication).
METHODS: Data came from the 2009-2010 National Adult Tobacco Survey (NATS), a
nationally representative landline and mobile phone survey of adults aged ≥18
years. Among current cigarette-only smokers who visited a health professional in
the past 12 months, we assessed patients' self-reported receipt of the 5 A's, use
of the combination of counseling and medication for smoking cessation, and use of
other cessation treatments. We used logistic regression to examine whether
receipt of the 5 A's during a recent clinic visit was associated with use of
cessation treatments (counseling, medication, or a combination of counseling and
medication) among current cigarette-only smokers.
RESULTS: In this large sample (N = 10,801) of current cigarette-only smokers who
visited a health professional in the past 12 months, 6.3 % reported use of both
counseling and medication for smoking cessation within the past year. Other
assisted cessation treatments used to quit were: medication (19.6 %); class or
program (3.8 %); one-on-one counseling (3.7 %); and telephone quitline (2.6 %).
Current cigarette-only smokers who reported receiving all 5 A's during a recent
clinic visit were more likely to use counseling (odds ratio [OR]: 11.2, 95 %
confidence interval [CI]: 7.1-17.5), medication (OR: 6.2, 95 % CI: 4.3-9.0), or a
combination of counseling and medication (OR: 14.6, 95 % CI: 9.3-23.0), compared
to smokers who received one or none of the 5 A's components.
CONCLUSIONS: Receipt of the '5 A's' intervention was associated with a
significant increase in patients' use of recommended counseling and medication
for cessation. It is important for health professionals to deliver all 5 A's when
conducting brief cessation interventions with patients who smoke.
DOI: 10.1186/s12889-016-2798-2
PMCID: PMC4751655
1374. J Gen Intern Med. 2016 Mar;31(3):282-8. doi: 10.1007/s11606-015-3500-6. Epub

2015
Aug 27.
Disparities in the Use of Internet and Telephone Medication Refills among

Linguistically Diverse Patients.
Moreno G(1), Lin EH(2), Chang E(2), Johnson RL(2), Berthoud H(2), Solomon CC(3),
Morales LS(2)(4).
Author information:
(1)UCLA Department of Family Medicine, David Geffen School of Medicine at UCLA,
10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA.
gemoreno@mednet.ucla.edu.
(2)Group Health Research Institute, Seattle, WA, USA.
(3)School of Social Work, University of Washington, Seattle, WA, USA.
(4)Center for Health Equity, Diversity and Inclusion, School of Medicine,
University of Washington School Medicine, Seattle, WA, USA.
Comment in
J Gen Intern Med. 2016 Mar;31(3):322.
BACKGROUND: Health systems are increasingly implementing remote telephone and

Internet refill systems to enhance patient access to medication refills. Remote
refill systems may provide an effective approach for improving medication
non-adherence, but more research is needed among patients with limited English
proficiency with poor access to remote refill systems.
OBJECTIVE: To compare the use of remote medication refill systems among
limited-English-proficiency (LEP) and English-proficient (EP) patients with
chronic conditions.
METHODS: Cross-sectional survey in six languages/dialects (English, Cantonese,
Mandarin, Korean, Vietnamese, and Spanish) of 509 adults with diabetes,
hypertension, or hyperlipidemia. Primary study outcomes were self-reported use of
1) Internet refills, 2) telephone refills, and 3) any remote refill system. LEP
was measured by patient self-identification of a primary language other than
English and a claims record of use of an interpreter. Other measures were age,
gender, education, years in the U.S., insurance, health status, chronic
conditions, and number of prescribed medications. Analyses included multivariable
logistic regression weighted for survey non-response.
RESULTS: Overall, 33.1 % of patients refilled their medications by telephone and
31.6 % by Internet. Among LEP patients (n = 328), 31.5 % refilled by telephone
and 21.2 % by Internet, compared with 36.7 % by telephone and 52.7 % by Internet
among EP patients (n = 181). Internet refill by language groups were as follows:
English (52.7 %), Cantonese (34.9 %), Mandarin (17.4 %), Korean (16.7 %),
Vietnamese (24.4 %), and Spanish (12.6 %). Compared to EP patients, LEP patients
had lower use of any remote refill system (adjusted odds ratio [AOR] 0.18;
p < 0.001), CONCLUSIONS: LEP patients are significantly less likely than EP
patients to use any remote medication refill system. Increased reliance on
current systems for remote medication refills may increase disparities in health
outcomes affecting LEP patients with poor access to telephone and Internet
medication refills.
DOI: 10.1007/s11606-015-3500-6
1375. J Pediatr Oncol Nurs. 2015 Mar-Apr;32(2):103-13. doi:

10.1177/1043454214553707.
Epub 2014 Nov 3.
Medical and psychosocial associates of nonadherence in adolescents with cancer.
Hullmann SE(1), Brumley LD(2), Schwartz LA(3).
Author information:
(1)Indiana University School of Nursing, Indianapolis, IN, USA
hullmann@iupui.edu.
(2)University of Pennsylvania, Philadelphia, PA, USA.
(3)University of Pennsylvania, Philadelphia, PA, USA The Children's Hospital of
Philadelphia, Philadelphia, PA, USA.
The current study examined adherence to medication regimens among adolescents
with cancer by applying the Pediatric Self-Management Model. Adolescents and
their parents reported on adherence to medication, reasons for nonadherence, and
patient-, family-, and community-level psychosocial variables. Adolescent- and
parent-reported adherence were significantly correlated, with about half of the
sample reporting perfect adherence. The majority reported "just forgot" as the
most common reason for missed medication. Patient-, family-, and community-level
variables were examined as predictors of adherence. With regard to individual
factors, adolescents who endorsed perfect adherence reported a greater proportion
of future-orientated goals and spent fewer days in outpatient clinic visits. For
family factors, adolescents who endorsed perfect adherence reported greater
social support from their family and were more likely to have a second caregiver
who they perceived as overprotective. The community-level variable (social
support from friends) tested did not emerge as a predictor of adherence. The
results of this study provide direction for intervention efforts to target
adolescent goals and family support in order to increase adolescent adherence to
cancer treatment regimens.
© 2014 by Association of Pediatric Hematology/Oncology Nurses.
DOI: 10.1177/1043454214553707
PMCID: PMC4410359
1376. World J Diabetes. 2015 Mar 15;6(2):225-33. doi: 10.4239/wjd.v6.i2.225.
Technology and diabetes self-management: An integrative review.
Hunt CW(1).
Author information:
(1)Caralise W Hunt, School of Nursing, Auburn University, Auburn, AL 36849,
United States.
Technology can be used to supplement healthcare provider diabetes care by

providing both educational and motivational support. Education can be provided
using technology allowing patients to learn new practices and routines related to
diabetes management. Technology can support daily diabetes self-management
activities including blood glucose monitoring, exercising, healthy eating, taking
medication, monitoring for complications, and problem-solving. This article
describes an integrative review conducted to evaluate the types of technology
being used to facilitate diabetes self-management and the effect of that
technology on self-management and diabetes outcomes for adults living with type 2
diabetes mellitus. A literature review was conducted by searching Medline,
PubMed, and Psych INFO databases using the search terms: diabetes
self-management, technology, type 2 diabetes, smartphones, cell phones, and
diabetes mellitus covering the years from 2008-2013. Articles relying on
secondary data (editorials, systematic reviews) and articles describing study
protocol only were excluded. Fourteen studies including qualitative,
quasi-experimental, and randomized controlled trial designs were identified and
included in the review. The review found that technological interventions had
positive impacts on diabetes outcomes including improvements in hemoglobin A1C
levels, diabetes self-management behaviors, and diabetes self-efficacy. Results
indicate that technological interventions can benefit people living with diabetes
when used in conjunction with diabetes care delivered by healthcare providers.
DOI: 10.4239/wjd.v6.i2.225
PMCID: PMC4360416
PMID: 25789104
1377. Medicina (B Aires). 2017;77(4):279-282.
Treatment of hereditary angioedema due to C1 inhibitor deficiency in Argentina.
Malbrán E(1), Menéndez A(2), Malbrán A(3).
Author information:
(1)Unidad de Alergia, Asma e Inmunología Clínica, Buenos Aires, Argentina.
E-mail: elomalbran@hotmail.com.
(2)Asociación Argentina de Pacientes con Angioedema Hereditario, Buenos Aires,
Argentina.
(3)Unidad de Alergia, Asma e Inmunología Clínica, Buenos Aires, Argentina.
The benefits of the worldwide approval of new drugs for the treatment of acute
C1-INH-HAE attacks may still not reach all patients. Identifying the current
barriers in the access to medication, as well as conducting a detailed assessment
of the progress in this area, is essential to achieve universal treatment. Two
hundred and twenty five patients registered in the Argentina Hereditary
Angioedema Patient Association (AHAEPA) were randomly selected and invited to
participate in a web based questionnaire on accessibility to icatibant and
pdC1-INH, self-treatment, delay to treatment, and coverage. The data retrieved
was compared to our previous reports in 2008 and 2013. We collected 156/225
answers. One hundred and eighteen (76%) patients have either pdC1-INH (n = 86),
icatibant (n = 10) or both (n = 22), while 38 (24%) do not have access to
treatment. In 2008, 26% had access while 82% had it in 2013. Thirty-two subjects
(22%) self-inject themselves, similar to 29% in 2013, even though between
studies, widespread self-injection training activities have taken place. However,
considering injections by proxy, home treatment reached 56%. Only half of the
patients decide to receive treatment early during the attack. Ninety-nine
patients (63%) have full coverage, thirty (19%) have no coverage at all and the
rest only obtain partial reimbursement. Twenty-nine families (31%) share a single
treatment dose of the medication, better than 36% in 2013. Argentina's C1-INH-HAE
patients had a sustained improvement in their access to medication. Efforts
should continue to further improve accessibility and optimal management of HAE
acute attacks to all patients in the country.
1378. Digit Health. 2016 Aug 3;2:2055207616663069. doi: 10.1177/2055207616663069.

eCollection 2016 Jan-Dec.
MedLink: A mobile intervention to improve medication adherence and processes of

care for treatment of depression in general medicine.
Corden ME(1), Koucky EM(1), Brenner C(1), Palac HL(1), Soren A(2), Begale M(1),
Ruo B(3), Kaiser SM(1), Duffecy J(4), Mohr DC(1).
Author information:
(1)Center for Behavioral Intervention Technologies, Department of Preventative
Medicine, Northwestern University, USA.
(2)Department of Design and Environmental Analysis, Cornell University, USA.
Northwestern University, USA.
(4)Department of Psychiatry, University of Illinois, USA.
Background: Major depressive disorder is a common psychological problem affecting

up to 20% of adults in their lifetime. The majority of people treated for
depression receive antidepressant medication through their primary care
physician. This commonly results in low rates of recovery. Failure points in the
process of care contributing to poor outcomes include patient non-adherence to
medications, failure of physicians to optimize dose and absence of communication
between patients and physicians.
Objective: This pilot study evaluated the feasibility of a systemic digital
intervention (MedLink) designed to address failure points and improve treatment
of depression in primary care among patients during the first eight weeks of
initiating a new course of antidepressant therapy.
Methods: Participants were provided with the MedLink mobile app that provided
dose reminders, information and surveys of symptoms and side effects. A
cellularly enabled pillbox monitored antidepressant medication adherence. Reports
were provided to physicians and participants to prompt changes in medication
regimen. Study outcomes were assessed via self-report and interview measures at
baseline, week 4 and week 8.
Results: Medication adherence detected by the MedLink system was 82%.
Participants demonstrated significant decreases in depressive symptoms on the
patient health questionnaire-9 (PHQ-9) (p = 0.0005) and the Quick Inventory of
Depressive Symptomatology (p = 0.0008) over the eight-week trial. Usability was
generally rated favorably.
Conclusions: The MedLink system demonstrated promise as an intervention to
address failure points in the primary care treatment of major depressive
disorder. Current findings support the further development of MedLink through a
randomized controlled trial to evaluate the efficacy of improving processes of
care, patient adherence and symptoms of depression.
DOI: 10.1177/2055207616663069
PMCID: PMC6001228
PMID: 29942564

article.
1379. BMC Public Health. 2014 Nov 6;14:1150. doi: 10.1186/1471-2458-14-1150.
Inverse probability weighting and doubly robust methods in correcting the effects
of non-response in the reimbursed medication and self-reported turnout estimates
in the ATH survey.
Härkänen T(1), Kaikkonen R, Virtala E, Koskinen S.
Author information:
(1)Department of Health, Functional Capacity and Welfare National Institute for
Health and Welfare (THL), P,O, Box 30, FI-00271 Helsinki, Finland.
tommi.harkanen@thl.fi.
BACKGROUND: To assess the nonresponse rates in a questionnaire survey with

respect to administrative register data, and to correct the bias statistically.
METHODS: The Finnish Regional Health and Well-being Study (ATH) in 2010 was based
on a national sample and several regional samples. Missing data analysis was
based on socio-demographic register data covering the whole sample. Inverse
probability weighting (IPW) and doubly robust (DR) methods were estimated using
the logistic regression model, which was selected using the Bayesian information
criteria. The crude, weighted and true self-reported turnout in the 2008
municipal election and prevalences of entitlements to specially reimbursed
medication, and the crude and weighted body mass index (BMI) means were compared.
RESULTS: The IPW method appeared to remove a relatively large proportion of the
bias compared to the crude prevalence estimates of the turnout and the
entitlements to specially reimbursed medication. Several demographic factors were
shown to be associated with missing data, but few interactions were found.
CONCLUSIONS: Our results suggest that the IPW method can improve the accuracy of
results of a population survey, and the model selection provides insight into the
structure of missing data. However, health-related missing data mechanisms are
beyond the scope of statistical methods, which mainly rely on socio-demographic
information to correct the results.
DOI: 10.1186/1471-2458-14-1150
PMCID: PMC4246429
1380. Eur Arch Psychiatry Clin Neurosci. 2018 Jun;268(4):337-347. doi:

10.1007/s00406-017-0850-6. Epub 2017 Nov 15.
Six-year outcome in subjects diagnosed with attention-deficit/hyperactivity

disorder as adults.
Edvinsson D(1), Ekselius L(2).
Author information:
(1)Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University
Hospital, Uppsala, Sweden.
(2)Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University
Hospital, Uppsala, Sweden. lisa.ekselius@neuro.uu.se.
There are very few studies on the long-term outcome in subjects diagnosed with
ADHD as adults. The objective of the present study was to assess this and relate
the outcome to whether there was current medication or not and to other potential
predictors of favourable outcome. A prospective clinical cohort of adults
diagnosed with ADHD according to DSM-IV criteria was followed-up on an average of
6 years after first evaluation (n = 124; mean age 42 years, 51% males). ADHD
symptom trajectories were assessed as well as medication, global functioning,
disability, health-related quality of life, and alcohol and drug consumption at
follow-up. Ninety percent of those diagnosed were initially treated
pharmacologically and half of them discontinued treatment. One-third reported
remission, defined as not fulfilling any ADHD subtype and a GAF-value last year
≥ 70, which was not affected by comorbidity at baseline. Current medication was
not associated with remission. Subjects evaluated and first diagnosed with ADHD
as adults are functionally improved at follow-up 6 years later despite a high
percentage of psychiatric comorbidity at baseline. Half dropped out of
medication, and there was no difference in ADHD remission between subjects with
on-going medication at follow-up or subjects without medication, although current
medication was related to a higher degree of self-reported global improvement.
DOI: 10.1007/s00406-017-0850-6
PMCID: PMC5956008
1381. Singapore Med J. 2015 Aug;56(8):460-7. doi: 10.11622/smedj.2015069.
The 11-item Medication Adherence Reasons Scale: reliability and factorial

validity among patients with hypertension in Malaysian primary healthcare
settings.
Shima R(1), Farizah H(2), Majid HA(2).
Author information:
of Malaya, Malaysia ; Ministry of Health, Malaysia.
of Malaya, Malaysia ; Centre for Population Health, Faculty of Medicine,
University of Malaya, Malaysia.
INTRODUCTION: The aim of this study was to assess the reliability and validity of
a modified Malaysian version of the Medication Adherence Reasons Scale
(MAR-Scale).
METHODS: In this cross-sectional study, the 15-item MAR-Scale was administered to
665 patients with hypertension who attended one of the four government primary
healthcare clinics in the Hulu Langat and Klang districts of Selangor, Malaysia,
between early December 2012 and end-March 2013. The construct validity was
examined in two phases. Phase I consisted of translation of the MAR-Scale from
English to Malay, a content validity check by an expert panel, a face validity
check via a small preliminary test among patients with hypertension, and
exploratory factor analysis (EFA). Phase II involved internal consistency
reliability calculations and confirmatory factor analysis (CFA).
RESULTS: EFA verified five existing factors that were previously identified (i.e.
issues with medication management, multiple medications, belief in medication,
medication availability, and the patient's forgetfulness and convenience), while
CFA extracted four factors (medication availability issues were not extracted).
The final modified MAR-Scale model, which had 11 items and a four-factor
structure, provided good evidence of convergent and discriminant validities.
Cronbach's alpha coefficient was > 0.7, indicating good internal consistency of
the items in the construct. The results suggest that the modified MAR-Scale has
good internal consistencies and construct validity.
CONCLUSION: The validated modified MAR-Scale (Malaysian version) was found to be
suitable for use among patients with hypertension receiving treatment in primary
healthcare settings. However, the comprehensive measurement of other factors that
can also lead to non-adherence requires further exploration.
DOI: 10.11622/smedj.2015069
PMCID: PMC4545136
1382. MMWR Morb Mortal Wkly Rep. 2018 Apr 20;67(15):437-442. doi:
10.15585/mmwr.mm6715a1.
Active Epilepsy and Seizure Control in Adults - United States, 2013 and 2015.
Tian N, Boring M, Kobau R, Zack MM, Croft JB.
Approximately 3 million American adults reported active epilepsy* in 2015 (1).

Active epilepsy, especially when seizures are uncontrolled, poses substantial
burdens because of somatic, neurologic, and mental health comorbidity; cognitive
and physical dysfunction; side effects of antiseizure medications; higher injury
and mortality rates; poorer quality of life; and increased financial cost (2).
Thus, prompt diagnosis and seizure control (i.e., seizure-free in the 12 months
preceding the survey) confers numerous clinical and social advantages to persons
with active epilepsy. To obtain recent and reliable estimates of active epilepsy
and seizure control status in the U.S. population, CDC analyzed aggregated data
from the 2013 and the 2015 National Health Interview Surveys (NHISs). Overall, an
annual estimated 2.6 million (1.1%) U.S. adults self-reported having active
epilepsy, 67% of whom had seen a neurologist or an epilepsy specialist in the
past year, and 90% of whom reported taking epilepsy medication. Among those
taking epilepsy medication, only 44% reported having their seizures controlled. A
higher prevalence of active epilepsy and poorer seizure control were associated
with low family income, unemployment, and being divorced, separated, or widowed.
Use of epilepsy medication was higher among adults who saw an epilepsy specialist
in the past year than among those who did not. Health care and public health
should ensure that adults with uncontrolled seizures have appropriate care and
self-management support in order to promote seizure control, improve health and
social outcomes, and reduce health care costs.
DOI: 10.15585/mmwr.mm6715a1
PMCID: PMC6191103
Conflict of interest statement: No conflicts of interest were reported.
1383. Am J Pharm Educ. 2016 Feb 25;80(1):16. doi: 10.5688/ajpe80116.
Impact of a Paper vs Virtual Simulated Patient Case on Student-Perceived

Confidence and Engagement.
Barnett SG(1), Gallimore CE(1), Pitterle M(1), Morrill J(2).
Author information:
(1)University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin.
(2)University of Wisconsin-Madison, Madison, Wisconsin.
OBJECTIVE: To evaluate online case simulation vs a paper case on student

confidence and engagement.
DESIGN: Students enrolled in a pharmacotherapy laboratory course completed a
patient case scenario as a component of an osteoarthritis laboratory module. Two
laboratory sections used a paper case (n=53); three sections used an online
virtual case simulation (n=81). Student module performance was assessed through a
submitted subjective objective assessment plan (SOAP) note. Students completed
pre/post surveys to measure self-perceived confidence in providing medication
management. The simulation group completed postmodule questions related to
realism and engagement of the online virtual case simulation. Group assessments
were performed using chi-square and Mann Whitney tests.
ASSESSMENT: A significant increase in all 13 confidence items was seen in both
student groups following completion of the laboratory module. The simulation
group had an increased change of confidence compared to the paper group in
assessing medication efficacy and documenting a thorough assessment. Comparing
the online virtual simulation to a paper case, students agreed the learning
experience increased interest, enjoyment, relevance, and realism. The simulation
group performed better on the subjective SOAP note domain though no differences
in total SOAP note scores was found between the two groups.
CONCLUSION: Virtual case simulations result in increased student engagement and
may lead to improved documentation performance in the subjective domain of SOAP
notes. However, virtual patient cases may offer limited benefit over paper cases
in improving overall student self-confidence to provide medication management.
DOI: 10.5688/ajpe80116
PMCID: PMC4776294
1384. Front Psychiatry. 2015 Nov 25;6:167. doi: 10.3389/fpsyt.2015.00167.
eCollection
2015.
Use of Cognitive Behavioral Therapy and Token Economy to Alleviate Dysfunctional

Behavior in Children with Attention-Deficit Hyperactivity Disorder.
Coelho LF(1), Barbosa DL(1), Rizzutti S(1), Muszkat M(1), Bueno OF(1), Miranda
MC(1).
Author information:
(1)Psychobiology Department, Universidade Federal de São Paulo , São Paulo ,
Brazil.
Medication has proved highly efficacious as a means of alleviating general

symptoms of attention-deficit hyperactivity disorder (ADHD). However, many
patients remain functionally impaired by inappropriate behavior. The present
study analyzed the use of cognitive behavioral therapy (CBT) with the
Token-Economy (TE) technique to alleviate problem behavior for 25 participants
with ADHD, all children (19 boys, mean age 10.11) on long-term methylphenidate
medication, who were given 20 CBT sessions with 10 weeks of TE introduced as of
session 5. Their ten most acute problem behaviors were selected and written
records kept. On weekdays, parents recorded each inappropriate behavior and
provided a suitable model for their actions. At weekly sessions, problem
behaviors were counted and incident-free participants rewarded with a token. To
analyze improvement (less frequent problem behavior), a list of 11 behavioral
categories was rated: inattention, impulsivity, hyperactivity, disorganization,
disobeying rules and routines, poor self-care, verbal/physical aggression, low
frustration tolerance, compulsive behavior, antisocial behavior, lacking in
initiative and distraction. Two CBT specialists categorized behaviors and an ADHD
specialist ruled on discrepancies. Statistical analyses used were Generalized
Estimating Equations with Poisson distribution and autoregressive order
correlation structure. In the course of the sessions, problematic behaviors
decreased significantly in seven categories: impulsiveness, hyperactivity,
disorganization, disobeying rules and routine, poor self-care, low frustration
tolerance, compulsive behaviors, and antisocial behaviors. Caregiver attitudes to
children's inappropriate behavior were discussed and reshaped. As functional
improvement was observed on applying TE for 10 weeks, this type of intervention
may be useful as an auxiliary strategy combined with medication.
DOI: 10.3389/fpsyt.2015.00167
PMCID: PMC4659172
PMID: 26635642
1385. J Diabetes Res. 2016;2016:2129838. Epub 2016 Sep 6.
Effects of a Patient-Provider, Collaborative, Medication-Planning Tool: A

Randomized, Controlled Trial.
Graumlich JF(1), Wang H(2), Madison A(3), Wolf MS(4), Kaiser D(5), Dahal K(6),
Morrow DG(7).
Author information:
(1)Department of Medicine, University of Illinois College of Medicine at Peoria,
530 Northeast Glen Oak Avenue, Peoria, IL 61637, USA.
(2)Department of Medicine, Division of Research Services, University of Illinois
College of Medicine at Peoria, One Illini Drive, Peoria, IL 61605, USA.
(3)Department of Psychology, University of Illinois at Urbana-Champaign, 603 E.
Daniel, Champaign, IL 61820, USA.
Northwestern University Feinberg School of Medicine, 750 North Lake Shore Drive,
10th Floor, Chicago, IL 60611, USA.
(5)Northwestern Medical Faculty Foundation, 675 North Saint Clair Street,
Chicago, IL 60611, USA.
(6)Department of Medicine, University of Illinois College of Medicine at Peoria,
One Illini Drive, Peoria, IL 61605, USA.
(7)Department of Educational Psychology, University of Illinois at
Urbana-Champaign, Education Building, 1310 South 6th Street, Champaign, IL 61820,
USA.
Among patients with various levels of health literacy, the effects of

collaborative, patient-provider, medication-planning tools on outcomes relevant
to self-management are uncertain. Objective. Among adult patients with type II
diabetes mellitus, we tested the effectiveness of a medication-planning tool
(Medtable™) implemented via an electronic medical record to improve patients'
medication knowledge, adherence, and glycemic control compared to usual care.
Design. A multicenter, randomized controlled trial in outpatient primary care
clinics. 674 patients received either the Medtable tool or usual care and were
followed up for up to 12 months. Results. Patients who received Medtable had
greater knowledge about indications for medications in their regimens and were
more satisfied with the information about their medications. Patients' knowledge
of drug indication improved with Medtable regardless of their literacy status.
However, Medtable did not improve patients' demonstrated medication use, regimen
adherence, or glycemic control (HbA1c). Conclusion. The Medtable tool supported
provider/patient collaboration related to medication use, as reflected in patient
satisfaction with communication, but had limited impact on patient medication
knowledge, adherence, and HbA1c outcomes. This trial is registered with
ClinicalTrials.gov NCT01296633.
DOI: 10.1155/2016/2129838
PMCID: PMC5028848
1386. Clin Exp Gastroenterol. 2016 Aug 23;9:259-67. doi: 10.2147/CEG.S106302.

eCollection 2016.
Self-management in patients with inflammatory bowel disease: strategies,

outcomes, and integration into clinical care.
Plevinsky JM(1), Greenley RN(1), Fishman LN(2).
Author information:
(1)Department of Psychology, Rosalind Franklin University of Medicine and
Science, North Chicago, IL.
(2)Department of Gastroenterology, Boston Children's Hospital, Harvard Medical
School, Boston, MA, USA.
Self-management, including medication adherence, is associated with improved

health and outcomes for patients with inflammatory bowel disease. The concept of
self-management is complex, but can be divided into those aspects that involve
the individual patient, those that involve the provider-patient relationship, and
those that encompass the social environment. At the individual level, enhancing
problem-solving skills and self-efficacy have both been shown to improve
self-management tasks, particularly adherence to treatment. However, it is
critical to consider these domains from a lifespan perspective because these
processes by which self-management can be improved are distinct for children,
adolescents, young adults, and adults. A particular emphasis is placed on
strategies to improve self-management of older adolescents and young adults as
they transition from pediatric to adult providers. The review concludes with
recommendations for providers, including rationale and techniques for assessing
and promoting patient self-efficacy, encouraging the development of
problem-solving skills, improving the patient-provider relationship, and
enhancing social support. Providers are encouraged to utilize elements of
problem-solving skills training, engage in collaborative relationships with their
patients, and offer their patients recommendations for how to increase the
quality of their social support networks as ways of increasing overall
self-management.
DOI: 10.2147/CEG.S106302
PMCID: PMC5003515
PMID: 27601930
1387. J Immigr Minor Health. 2016 Oct;18(5):1247-52. doi: 10.1007/s10903-015-0254-

5.
Migration, Health Care Behaviors, and Primary Care for Rural Latinos with
Diabetes.
Moreno G(1), Morales LS(2), Batts F(3), Noguera C(4), Isiordia M(5), Mangione
CM(6)(7).
Author information:
(1)Department of Family Medicine, David Geffen School of Medicine at UCLA, 10880
Wilshire Blvd, Suite 1800, Los Angeles, CA, 90024, USA. gemoreno@mednet.ucla.edu.
(2)School of Medicine, University of Washington, Seattle, WA, USA.
(3)Livingston Health Centers, Inc., Livingston, CA, USA.
(4)Community Health Centers, Inc., Stockton, CA, USA.
(5)University of California Davis, Davis, CA, USA.
(6)Division of Health Services Research and General Internal Medicine, David
Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
(7)Department of Health Policy and Management, UCLA Fielding School of Public
Many US Latinos migrate or travel between the US and Mexico on a regular basis,
defined as circular migration. Latinos with diabetes (n = 250) were surveyed
about circular migration and their ability to use medications and perform
recommended diabetes self-care activities. A review of medical charts was
performed. Twenty-eight percent (n = 70) of patients traveled to Mexico during
the last 12 months. Older Latinos were more likely to report traveling to Mexico
and back into the US. Among those that traveled, 29 % reported use of less
medication than they wanted to or were prescribed because of travel and 20 % ran
out of medications. The rate of reported problem areas while traveling were 39 %
(27/70) for following a diabetic diet, 31 % (21/70) for taking medication, and
37 % (26/70) for glucose self-monitoring. The results suggest that the structure
of primary care and care coordination are important for this population to fully
engage in diabetes self-care.
DOI: 10.1007/s10903-015-0254-5
PMCID: PMC4721941
1388. Chron Respir Dis. 2018 May;15(2):103-113. doi: 10.1177/1479972317723237. Epub

2017 Jul 27.
The Quebec Respiratory Health Education Network: Integrating a model of

self-management education in COPD primary care.
Bourbeau J(1)(2), Farias R(1), Li PZ(1), Gauthier G(2), Battisti L(2)(3), Chabot
V(2), Beauchesne MF(4), Villeneuve D(2), Côté P(2), Boulet LP(5).
Author information:
(1)1 Respiratory Epidemiology and Clinical Research Unit (RECRU), Research
Institute of the McGill University Health Centre (RI-MUHC), Montreal, Québec,
Canada.
(2)2 Quebec Respiratory Health Education Network/Réseau Québécois d'Éducation en
Santé Respiratoire (QRHEN/RQESR), Québec, Canada.
(3)3 Hôpital St-François d'Assise, Québec, Canada.
(4)4 Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
(5)5 Institut Universitaire de Cardiologie et de Pneumologie de Québec,
Université Laval, Québec, Canada.
The objective of this study is to evaluate whether a chronic obstructive

pulmonary disease (COPD) self-management education program with coaching of a
case manager improves patient-related outcomes and leads to practice changes in
primary care. COPD patients from six family medicine clinics (FMCs) participated
in a 1-year educational program offered by trained case managers who focused on
treatment adherence, inhaler techniques, smoking cessation, and the use of an
action plan for exacerbations. Health-care utilization, health-related quality of
life (HRQL), treatment adherence, inhaler technique, and COPD knowledge were
assessed at each visit with validated questionnaires. We also evaluated whether
the use of spirometry and the assessment of individual patient needs led to a
more COPD-targeted treatment by primary care physicians, based on changes in
prescriptions for COPD (medication, immunization, and written action plan).
Fifty-four patients completed the follow-up visits and were included in the
analysis. The number of unscheduled physician visits went from 40 the year before
intervention to 17 after 1 year of educational intervention ( p = 0.033).
Emergency room visits went from five to two and hospitalizations from two to
three (NS). Significant improvements were observed in HRQL ( p = 0.0001),
treatment adherence ( p = 0.025), adequate inhaler technique ( p < 0.0001), and
COPD knowledge ( p < 0.001). Primary care physicians increased their
prescriptions for long-acting bronchodilators with/without inhaled
corticosteroid, flu immunizations, and COPD action plans in the event patient had
an exacerbation. The COPD self-management educational intervention in FMCs
reduced unscheduled visits to the clinic and improved patients' quality of life,
self-management skills, and knowledge. The program had a positive impact on
COPD-related practices by primary care physicians in the FMCs.
DOI: 10.1177/1479972317723237
PMCID: PMC5958467
1389. J Affect Disord. 2016 Jun;197:182-8. doi: 10.1016/j.jad.2016.03.013. Epub

2016
Mar 8.
Clinical management following self-harm in a UK-wide primary care cohort.
Carr MJ(1), Ashcroft DM(2), Kontopantelis E(3), While D(4), Awenat Y(5), Cooper
J(4), Chew-Graham C(6), Kapur N(7), Webb RT(4).
Author information:
(1)Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental
Health, University of Manchester, UK. Electronic address:
matthew.carr@manchester.ac.uk.
(2)Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School,
University of Manchester, UK; NIHR Greater Manchester Primary Care Patient Safety
Translational Research Centre, UK.
(3)Centre for Health Informatics, Institute of Population Health, University of
Manchester, UK; NIHR School for Primary Care Research, University of Manchester,
UK.
Health, University of Manchester, UK.
(5)School of Psychological Sciences, University of Manchester, UK.
(6)Research Institute of Primary Care and Health Sciences, Keele University, UK.
Health, University of Manchester, UK; Manchester Mental Health and Social Care
Trust, UK.
BACKGROUND: Little is known about the clinical management of patients in primary

care following self-harm.
METHODS: A descriptive cohort study using data from 684 UK general practices that
contributed to the Clinical Practice Research Datalink (CPRD) during 2001-2013.
We identified 49,970 patients with a self-harm episode, 41,500 of whom had one
complete year of follow-up.
RESULTS: Among those with complete follow-up, 26,065 (62.8%, 62.3-63.3) were
prescribed psychotropic medication and 6318 (15.2%, 14.9-15.6) were referred to
mental health services; 4105 (9.9%, CI 9.6-10.2) were medicated without an
antecedent psychiatric diagnosis or referral, and 4,506 (10.9%, CI 10.6-11.2) had
a diagnosis but were not subsequently medicated or referred. Patients registered
at practices in the most deprived localities were 27.1% (CI 21.5-32.2) less
likely to be referred than those in the least deprived. Despite a specifically
flagged NICE 'Do not do' recommendation in 2011 against prescribing tricyclic
antidepressants following self-harm because of their potentially lethal toxicity
in overdose, 8.8% (CI 7.8-9.8) of individuals were issued a prescription in the
subsequent year. The percentage prescribed Citalopram, an SSRI antidepressant
with higher toxicity in overdose, fell sharply during 2012/2013 in the aftermath
of a Medicines and Healthcare products Regulatory Agency (MHRA) safety alert
issued in 2011.
CONCLUSIONS: A relatively small percentage of these vulnerable patients are
referred to mental health services, and reduced likelihood of referral in more
deprived localities reflects a marked health inequality. National clinical
guidelines have not yet been effective in reducing rates of tricyclic
antidepressant prescribing for this high-risk group.
DOI: 10.1016/j.jad.2016.03.013
PMCID: PMC4870375
1390. NPJ Prim Care Respir Med. 2017 Nov 14;27(1):61. doi: 10.1038/s41533-017-0061-
7.
Modelling the effect of beliefs about asthma medication and treatment

intrusiveness on adherence and preference for once-daily vs. twice-daily
medication.
Chapman S(1), Dale P(2)(3), Svedsater H(2), Stynes G(2)(4), Vyas N(5), Price
D(6), Horne R(7).
Author information:
(1)University of Bath, Bath, UK.
(2)GSK, Brentford, UK.
(3)Peter Dale, HEOR Solutions Ltd, Marlow, UK.
(4)Gillian Stynes, Bristol-Myers Squibb, Uxbridge, UK.
(5)Healthcare Research Worldwide, Wallingford Oxon, UK.
(6)Observational and Pragmatic Research Institute, Singapore, Singapore.
(7)University College London, London, UK. r.horne@ucl.ac.uk.
People with asthma who do not adhere to their maintenance medication may
experience poorer asthma control and need more healthcare support than those who
adhere. People (N = 1010) aged 18-55 years with self-reported asthma, taking one
or more asthma maintenance medication(s), from five European countries,
participated in a survey using validated scales (Medication Adherence Report
Scale [MARS], Asthma Control Test™ [ACT], Beliefs about Medicine Questionnaire
[BMQ] and the Asthma Treatment Intrusiveness Questionnaire [ATIQ]). We performed
a post hoc evaluation of adherence to maintenance medication, asthma control,
beliefs about medication, preferences for once-daily vs. twice-daily asthma
maintenance medication and treatment intrusiveness, using structural equation
modelling to investigate the relationships between these factors. Most
participants reported potential problems with asthma control (ACT < 19: 76.8%
[n = 776]), low adherence (median MARS = 3.40) and preferred once-daily
medication (73.5% [n = 742/1010]). Non-adherence was associated with worse asthma
control (r = 0.262 [P < 0.001]) and a expressed preference for once-daily
medication over a "twice daily medication that works slightly better" (test
statistic [T] = 2.970 [P = 0.003]). Participants reporting
non-adherence/preferring once-daily medication had negative beliefs about their
treatment (BMQ necessity-concerns differential: r = 0.437 [P < 0.001]/T = 6.886
[P < 0.001]) and found medication intrusive (ATIQ: r = -0.422
[P < 0.001]/T = 2.689[P = 0.007]). Structural equation modelling showed complex
relationships between variables, including: (1) high concerns about treatment
associated with increased perceived treatment intrusiveness and reduced
adherence, which influenced asthma control; (2) high concerns about treatment and
healthcare seeking behaviour, which were predictive of preferring twice-daily
asthma medication. Concerns about medication and perceived treatment
intrusiveness were predictive of poor adherence, and were associated with
preference for once-daily asthma medication. Confirm the utility of the PAPA
model and NCF in explaining nonadherence linked to poor asthma control.
DOI: 10.1038/s41533-017-0061-7
PMCID: PMC5686129
1391. Health Technol Assess. 2018 Apr;22(21):1-142. doi: 10.3310/hta22210.
Self-Management education for adults with poorly controlled epILEpsy [SMILE

(UK)]: a randomised controlled trial.
Ridsdale L(1), McKinlay A(1), Wojewodka G(1), Robinson EJ(2), Mosweu I(3), Feehan
SJ(1), Noble AJ(4), Morgan M(5), Taylor SJ(6), McCrone P(3), Landau S(2),
Richardson M(1), Baker G(7), Goldstein LH(8).
Author information:
(1)Department of Basic and Clinical Neurosciences, Institute of Psychiatry,
Psychology and Neuroscience, King's College London, London, UK.
(2)Department of Biostatistics and Health Informatics, Institute of Psychiatry,
Psychology and Neuroscience, King's College London, London, UK.
(3)King's Health Economics, Institute of Psychiatry, Psychology and Neuroscience,
King's College London, London, UK.
(4)Department of Psychological Sciences, Institute of Psychology, Health and
Society, University of Liverpool, Liverpool, UK.
(5)Institute of Pharmaceutical Science, King's College London, London, UK.
(6)Barts and The London School of Medicine and Dentistry, Queen Mary University
of London, Centre for Primary Care and Public Health, London, UK.
(7)Department of Molecular and Clinical Pharmacology, University of Liverpool,
Liverpool, UK.
(8)Department of Psychology, Institute of Psychiatry, Psychology and
BACKGROUND: Epilepsy is a common neurological condition resulting in recurrent

seizures. Research evidence in long-term conditions suggests that patients
benefit from self-management education and that this may improve quality of life
(QoL). Epilepsy self-management education has yet to be tested in a UK setting.
OBJECTIVES: To determine the effectiveness and cost-effectiveness of
Self-Management education for people with poorly controlled epILEpsy [SMILE
(UK)].
DESIGN: A parallel pragmatic randomised controlled trial.
SETTING: Participants were recruited from eight hospitals in London and
south-east England.
PARTICIPANTS: Adults aged ≥ 16 years with epilepsy and two or more epileptic
seizures in the past year, who were currently being prescribed antiepileptic
drugs.
INTERVENTION: A 2-day group self-management course alongside treatment as usual
(TAU). The control group received TAU.
MAIN OUTCOME MEASURES: The primary outcome is QoL in people with epilepsy at
12-month follow-up using the Quality Of Life In Epilepsy 31-P (QOLIE-31-P) scale.
Other outcomes were seizure control, impact of epilepsy, medication adverse
effects, psychological distress, perceived stigma, self-mastery and medication
adherence. Cost-effectiveness analyses and a process evaluation were undertaken.
RANDOMISATION: A 1 : 1 ratio between trial arms using fixed block sizes of two.
BLINDING: Participants were not blinded to their group allocation because of the
nature of the study. Researchers involved in data collection and analysis
remained blinded throughout.
RESULTS: The trial completed successfully. A total of 404 participants were
enrolled in the study [SMILE (UK), n = 205; TAU, n = 199] with 331 completing the
final follow-up at 12 months [SMILE (UK), n = 163; TAU, n = 168]. In the
intervention group, 61.5% completed all sessions of the course. No adverse events
were found to be related to the intervention. At baseline, participants had a
mean age of 41.7 years [standard deviation (SD) 14.1 years], and had epilepsy for
a median of 18 years. The mean QOLIE-31-P score for the whole group at baseline
was 66.0 out of 100.0 (SD 14.2). Clinically relevant levels of anxiety symptoms
were reported in 53.6% of the group and depression symptoms in 28.0%. The results
following an intention-to-treat analysis showed no change in any measures at the
12-month follow-up [QOLIE-31-P: SMILE (UK) mean: 67.4, SD 13.5; TAU mean: 69.5,
SD 14.8]. The cost-effectiveness study showed that SMILE (UK) was possibly
cost-effective but was also associated with lower QoL. The process evaluation
with 20 participants revealed that a group course increased confidence by sharing
with others and improved self-management behaviours.
CONCLUSIONS: For people with epilepsy and persistent seizures, a 2-day
self-management education course is cost-saving, but does not improve QoL after
12-months or reduce anxiety or depression symptoms. A psychological intervention
may help with anxiety and depression. Interviewed participants reported attending
a group course increased their confidence and helped them improve their
self-management.
FUTURE WORK: More research is needed on self-management courses, with
psychological components and integration with routine monitoring.
TRIAL REGISTRATION: Current Controlled Trials ISRCTN57937389.
FUNDING: This project was funded by the National Institute for Health Research
(NIHR) Health Technology Assessment programme and will be published in full in
Health Technology Assessment; Vol. 22, No. 21. See the NIHR Journals Library
website for further project information.
DOI: 10.3310/hta22210
PMCID: PMC5949577
Conflict of interest statement: Leone Ridsdale secured funding from the

Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and
King’s College London. Laura H Goldstein reports that her independent research
also receives support from the National Institute for Health Research (NIHR)
Maudsley Biomedical Research Unit at the South London and Maudsley NHS Foundation
Trust and King’s College London. She receives royalties from Goldstein LH and
McNeil JE (editors) Clinical Neuropsychology. A Practical Guide to Assessment and
Management for Clinicians. 2nd edn. Chichester: Wiley-Blackwell, 2013; and from
Cull C and Goldstein LH (editors) The Clinical Psychologist’s Handbook of
Epilepsy: Assessment and Management. Abingdon-on-Thames: Routledge; 1997. Sabine
Landau reports grants from NIHR Maudsley Biomedical Research Unit at the South
London and Maudsley NHS Foundation Trust and King’s College London during the
conduct of the study and received a grant from NIHR Health Technology Assessment.
Stephanie JC Taylor is on the Health Technology Assessment Clinical Trials Board
and reports grants from the NIHR Collaboration for Leadership in Applied Health
Research and Care North Thames at Barts Health NHS Trust. The authors received a
contribution from Sanofi UK to enable printing of the patient workbooks.
1392. Int J Circumpolar Health. 2015 May 21;74:26290. doi: 10.3402/ijch.v74.26290.

eCollection 2015.
Healthcare use for acute gastrointestinal illness in two Inuit communities:

Rigolet and Iqaluit, Canada.
Harper SL(1), Edge VL(2)(3), Ford J(4), Thomas MK(2)(5), Pearl D(2), Shirley
J(6); IHACC; RICG, McEwen SA(2).
Author information:
(1)Department of Population Medicine, University of Guelph, Guelph, Ontario,
Canada; harpers@uoguelph.ca.
(2)Department of Population Medicine, University of Guelph, Guelph, Ontario,
Canada.
(3)Office of Public Health Practice, Public Health Agency of Canada, Guelph,
Ontario, Canada.
(4)Department of Geography, McGill University, Montreal, Quebec, Canada.
(5)Centre for Food-borne, Environmental & Zoonotic Infectious Diseases, Public
Health Agency of Canada, Guelph, Ontario, Canada.
(6)Nunavut Research Institute, Iqaluit, Nunavut, Canada.
BACKGROUND: The incidence of self-reported acute gastrointestinal illness (AGI)

in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere
in Canada; as such, understanding AGI-related healthcare use is important for
healthcare provision, public health practice and surveillance of AGI.
OBJECTIVES: This study described symptoms, severity and duration of self-reported
AGI in the general population and examined the incidence and factors associated
with healthcare utilization for AGI in these 2 Inuit communities.
DESIGN: Cross-sectional survey data were analysed using multivariable exact
logistic regression to examine factors associated with individuals' self-reported
healthcare and over-the-counter (OTC) medication utilization related to AGI
symptoms.
RESULTS: In Rigolet, few AGI cases used healthcare services [4.8% (95%
CI=1.5-14.4%)]; in Iqaluit, some cases used healthcare services [16.9% (95%
CI=11.2-24.7%)]. Missing traditional activities due to AGI (OR=3.8; 95%
CI=1.18-12.4) and taking OTC medication for AGI symptoms (OR=3.8; 95%
CI=1.2-15.1) were associated with increased odds of using healthcare services in
Iqaluit. In both communities, AGI severity and secondary symptoms (extreme
tiredness, headache, muscle pains, chills) were significantly associated with
increased odds of taking OTC medication.
CONCLUSIONS: While rates of self-reported AGI were higher in Inuit communities
compared to non-Inuit communities in Canada, there were lower rates of
AGI-related healthcare use in Inuit communities compared to other regions in
Canada. As such, the rates of healthcare use for a given disease can differ
between Inuit and non-Inuit communities, and caution should be exercised in
making comparisons between Inuit and non-Inuit health outcomes based solely on
clinic records and healthcare use.
DOI: 10.3402/ijch.v74.26290
PMCID: PMC4441732
1393. J Gen Intern Med. 2015 Jun;30(6):797-803. doi: 10.1007/s11606-015-3208-7.
Potential Impact of Incorporating a Patient-Selected Support Person into mHealth

for Depression.
Aikens JE(1), Trivedi R, Heapy A, Pfeiffer PN, Piette JD.
Author information:
(1)Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann
Arbor, MI, 48104-1213, USA, aikensj@umich.edu.
BACKGROUND: Although telephone care management improves depression outcomes, its

implementation as a standalone strategy is often not feasible in
resource-constrained settings. Moreover, little research has examined the
potential role of self-management support from patients' trusted confidants.
OBJECTIVE: To investigate the potential benefits of integrating a
patient-selected support person into automated mobile health (mHealth) for
depression.
DESIGN: Patient preference trial.
PARTICIPANTS: Depressed primary care patients who were at risk for antidepressant
nonadherence (i.e., Morisky Medication Adherence Scale total score > 1).
INTERVENTION: Patients received weekly interactive voice response (IVR) telephone
calls for depression that included self-management guidance. They could opt to
designate a lay support person from outside their home to receive guidance on
supporting their self-management. Patients' clinicians were automatically
notified of urgent patient issues.
MAIN MEASURES: Each week over a period of 6 months, we used IVR calls to monitor
depression with the Patient Health Questionnaire-9 (PHQ-9; with total < 5
classified as remission), adherence (single item reflecting perfect adherence
over the past week), and functional impairment (any bed days due to mental
health).
KEY RESULTS: Of 221 at-risk patients, 61% participated with a support person.
Analyses were adjusted for race, medical comorbidity, and baseline levels of
symptom severity and adherence. Significant interaction effects indicated that
during the initial phase of the program, only patients who participated with a
support person improved significantly in their likelihood of either adhering to
antidepressant medication (AOR = 1.31, 95% CI: 1.16-1.47, p < 0.001) or achieving
remission of depression symptoms (AOR = 1.24, 95% CI: 1.14-1.34, p < 0.001).
These benefits were maintained throughout the 6-month observation period.
CONCLUSIONS: Incorporating the "human factor" of a patient-selected support
person into automated mHealth for depression self-management may yield sustained
improvements in antidepressant adherence and depression symptom remission.
However, this needs to be confirmed in a subsequent randomized controlled trial.
DOI: 10.1007/s11606-015-3208-7
PMCID: PMC4441673
1394. Psychiatry Clin Neurosci. 2015 Apr;69(4):220-7. doi: 10.1111/pcn.12232. Epub

2014
Sep 23.
Clinical behavior of Japanese community pharmacists for preventing prescription

drug overdose.
Shimane T(1), Matsumoto T, Wada K.
Author information:
(1)Department of Drug Dependence Research, National Center of Neurology and
Psychiatry, Tokyo, Japan.
AIM: Prescription drug abuse, including benzodiazepines, is a growing health

problem in Japan. This study examined the community pharmacist's clinical
behavior regarding patients who overdose on prescribed drugs, and explored the
possibility of overdose prevention by community pharmacists.
METHODS: We surveyed all registered community pharmacies with dispensing
functions (n = 1867) in the Saitama Pharmaceutical Association. An anonymous
self-administered questionnaire was mailed to each pharmacy. Respondents were
asked about clinical behavior such as medication counseling and referral to the
prescriber if prescription drug overdose was identified.
RESULTS: Among respondents, 26% of community pharmacists reported clinical
experience of working with patients who overdosed on prescribed drugs in the
previous year. Half of respondents evaluated their practice such as medication
counseling and referral to the prescriber as 'good'. On multivariate analysis, a
'poor' self-evaluation of referral to the prescriber was significantly associated
with the following perceptions: 'insufficient confidence in communication with
prescribers' (odds ratio [OR], 2.7; 95% confidence interval [95%CI]: 1.4-5.3),
and 'to avoid trouble with prescribers' (OR, 1.7; 95%CI: 1.0-2.7).
CONCLUSION: Japanese community pharmacists could prevent prescription drug abuse
in their practice, but the pharmacists who have insufficient confidence in
communication with prescribers and who are afraid of trouble with a prescriber,
reported poor self-evaluation for referral to the prescribers. All prescribers
should understand the importance of referral by community pharmacists, to assist
community pharmacists in playing a critical role in prevention of prescription
drug abuse.
© 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society
of Psychiatry and Neurology.
DOI: 10.1111/pcn.12232
1395. Public Health Res Pract. 2015 Mar 30;25(2):e2521518. doi:
10.17061/phrp2521518.
Manual versus automated coding of free-text self-reported medication data in the

45 and Up Study: a validation study.
Gnjidic D(1), Pearson SA(2), Hilmer SN(3), Basilakis J(4), Schaffer AL(5), Blyth
FM(6), Banks E(7); High Risk Prescribing Investigators.
Author information:
(1)Faculty of Pharmacy, University of Sydney, NSW, Australia; Sydney Medical
School, University of Sydney, NSW, Australia danijela.gnjidic@sydney.edu.au.
(2)Faculty of Pharmacy, University of Sydney, NSW, Australia; Sydney School of
Public Health, University of Sydney, NSW, Australia.
(3)Sydney Medical School, University of Sydney, NSW, Australia; Royal North Shore
Hospital and Kolling Institute of Medical Research, Sydney, NSW, Australia.
(4)School of Computing, Engineering and Mathematics, University of Western
(5)Faculty of Pharmacy, University of Sydney, NSW, Australia.
(6)Sydney Medical School, University of Sydney, NSW, Australia; Centre for
Education and Research on Ageing (CERA), Concord Hospital, Sydney, NSW,
Australia; Sax Institute, Sydney, NSW, Australia.
(7)Sax Institute, Sydney, NSW, Australia; National Centre for Epidemiology and
Population Health, Australian National University, Canberra, ACT, on behalf of
the High Risk Prescribing Investigators.
BACKGROUND: Increasingly, automated methods are being used to code free-text

medication data, but evidence on the validity of these methods is limited.
AIM: To examine the accuracy of automated coding of previously keyed in free-text
medication data compared with manual coding of original handwritten free-text
responses (the 'gold standard').
METHODS: A random sample of 500 participants (475 with and 25 without medication
data in the free-text box) enrolled in the 45 and Up Study was selected. Manual
coding involved medication experts keying in free-text responses and coding using
Anatomical Therapeutic Chemical (ATC) codes (i.e. chemical substance 7-digit
level; chemical subgroup 5-digit; pharmacological subgroup 4-digit; therapeutic
subgroup 3-digit). Using keyed-in free-text responses entered by non-experts, the
automated approach coded entries using the Australian Medicines Terminology
database and assigned corresponding ATC codes.
RESULTS: Based on manual coding, 1377 free-text entries were recorded and, of
these, 1282 medications were coded to ATCs manually. The sensitivity of automated
coding compared with manual coding was 79% (n = 1014) for entries coded at the
exact ATC level, and 81.6% (n = 1046), 83.0% (n = 1064) and 83.8% (n = 1074) at
the 5, 4 and 3-digit ATC levels, respectively. The sensitivity of automated
coding for blank responses was 100% compared with manual coding. Sensitivity of
automated coding was highest for prescription medications and lowest for vitamins
and supplements, compared with the manual approach. Positive predictive values
for automated coding were above 95% for 34 of the 38 individual prescription
medications examined.
CONCLUSIONS: Automated coding for free-text prescription medication data shows
very high to excellent sensitivity and positive predictive values, indicating
that automated methods can potentially be useful for large-scale,
medication-related research.
DOI: 10.17061/phrp2521518
1396. BMC Public Health. 2015 Oct 3;15:1006. doi: 10.1186/s12889-015-2346-5.

Joint association of physical activity and overweight with subsequent
psychotropic medication: a register-linked follow-up study among employees.
Loponen T(1), Lallukka T(2)(3), Holstila A(4), Lahti J(5).
Author information:
(1)Department of Public Health, University of Helsinki, Helsinki, Finland.
tiina.loponen@helsinki.fi.
tea.lallukka@ttl.fi.
(3)Centre of Expertise for Health and Work Ability & Disability Prevention
Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland.
tea.lallukka@ttl.fi.
ansku.holstila@helsinki.fi.
jouni.mm.lahti@helsinki.fi.
BACKGROUND: Physical activity level and overweight have shown associations with
mental health problems but it is not known whether the risk of mental health
problems due to overweight varies by physical activity. We examined joint
association of physical activity and overweight with subsequent psychotropic
medication among 40-60-year-old employees.
METHODS: The questionnaire survey data were derived from Helsinki Health Study
baseline postal questionnaires in 2000-02 among employees of the City of Helsinki
aged 40-60 years (n = 8960, response rate 67%). Baseline survey data were linked
with prospective register data on prescribed psychotropic medication (ATC-codes
N05 and N06, except N06D) among those with written consent (74%) for such
linkage. The analyses included 6169 responders (78% women, corresponding to the
target population). We divided participants into six groups according to their
baseline self-reported body mass index and leisure-time physical activity using
physically highly active normal-weight participants as a reference group. We used
Cox regression analysis adjusted for age, gender, psychotropic medication prior
to baseline, and socioeconomic position, marital status, working conditions,
limiting long-standing illness, alcohol use, and smoking.
RESULTS: At baseline, 49% were overweight and 23% were physically inactive. After
adjusting for age and gender, inactive normal-weight (hazard ratio (HR) 1.3, 95%
CI 1.1-1.5), moderately active overweight (HR 1.3, 95% CI 1.1-1.5) and inactive
overweight (HR 1.4, 95% CI 1.2-1.6) had higher risk for any psychotropic
medication compared with group of highly active normal-weight. After adjusting
for prior medication, only the inactive overweight group had higher risk (HR 1.4,
95% CI 1.2-1.6). Other covariates made but a minor contribution to the examined
associations. For antidepressants the associations were somewhat stronger than
for sedatives.
CONCLUSIONS: Both normal-weight and physical activity help prevent psychotropic
medication but physical activity dominates the association over normal-weight.
DOI: 10.1186/s12889-015-2346-5
PMCID: PMC4592569
1397. Curr Rheumatol Rep. 2018 Mar 8;20(3):12. doi: 10.1007/s11926-018-0720-x.
How Can We Improve Disease Education in People with Gout?
Fields TR(1)(2), Batterman A(3).

Author information:
(1)Division of Rheumatology, Hospital for Special Surgery, 535 East 70th St.,
Suite 848-West, New York, NY, 10021, USA. fieldst@hss.edu.
(2)Weill Cornell College of Medicine, New York, NY, USA. fieldst@hss.edu.
(3)Department of Social Work Programs, Hospital for Special Surgery, New York,
NY, USA.
PURPOSE OF REVIEW: Gout management is currently suboptimal despite excellent

available therapy. Gout patient education has been shown to enhance medication
adherence and self-management, but needs improvement. We explored the literature
on gout patient education including gaps in gout patient knowledge; use of
written materials; in-person individual and group sessions; education via nurses,
pharmacists, or multi-disciplinary groups; and use of phone, web-based, mobile
health app, and text messaging educational efforts.
RECENT FINDINGS: Nurse-led interventions have shown significant improvement in
reaching urate goals. Pharmacist-led programs have likewise succeeded, but to a
lesser degree. A multi-disciplinary approach has shown feasibility.
Needs-assessments, patient questionnaires, and psychosocial evaluations can
enhance targeted education. An interactive and patient-centered approach can
enhance gout educational interventions. Optimal programs will assess for and
address educational needs related to knowledge gaps, health literacy, race,
gender, socio-economic status, and level of social support.
DOI: 10.1007/s11926-018-0720-x
PMCID: PMC5842278
1398. Transl Androl Urol. 2018 May;7(Suppl 2):S198-S204. doi:

10.21037/tau.2018.05.05.
Medication patterns and fertility rates in a cohort of anabolic steroid users.
Avant RA(1), Charchenko CM(1), Alom M(1), Westerman ME(1), Maldonado F(1), Miest
T(1), Trost L(1).
Author information:
(1)Department of Urology, Mayo Clinic, Rochester, MN, USA.
Background: To describe self-reported medication patterns and fertility rates in

a population of anabolic steroid (AS) users.
Methods: We reviewed data from an online survey of AS users and identified a
sub-group who had attempted to achieve a pregnancy with their partners while
using AS. The online survey consisted of questions addressing demographics, AS
use, ancillary medications, and fertility outcomes.
Results: A total of 97 men (of 231 total respondents) had attempted to achieve a
pregnancy while taking AS and comprise the current cohort. The majority of men
were 25-44 years old (63.9%), married (75.5%) and Caucasian (88.7%). Ancillary
drug use was common with only 5.2% denying drug use other than ASs. The most
common reported ancillary drugs were antiestrogens (89.7%) and sexual enhancement
medications (SEMs) (68%). The fertility rate was 92.8%, with 82.4% achieving
pregnancy within one year. Interestingly, only 13.5% sought fertility evaluation
with treatment required in 8.3%. Age at initiation of AS use, maximum dosage
utilized, yearly duration of supplementation, and number of years using steroids
were not associated with a prolonged duration to pregnancy or decreased rate of
pregnancy.
Conclusions: Despite continued use of ASs, this cohort's self-reported fertility
rates are unexpectedly high. This is presumably related to cycling of therapy and
concomitant use of fertility preserving medications.
DOI: 10.21037/tau.2018.05.05
PMCID: PMC5989110
PMID: 29928618
Conflict of interest statement: Conflicts of Interest: The authors have no

conflicts of interest to declare.
1399. Adolesc Health Med Ther. 2016 Oct 21;7:117-124. eCollection 2016.
Strategies to optimize treatment adherence in adolescent patients with cystic

fibrosis.
Bishay LC(1), Sawicki GS(1).
Author information:
(1)Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA.
While development of new treatments for cystic fibrosis (CF) has led to a
significant improvement in survival age, routine daily treatment for CF is
complex, burdensome, and time intensive. Adolescence is a period of decline in
pulmonary function in CF, and is also a time when adherence to prescribed
treatment plans for CF tends to decrease. Challenges to adherence in adolescents
with CF include decreased parental involvement, time management and significant
treatment burden, and adolescent perceptions of the necessity and value of the
treatments prescribed. Studies of interventions to improve adherence are limited
and focus on education, without significant evidence of success. Smaller studies
on behavioral techniques do not focus on adolescents. Other challenges for
improving adherence in adolescents with CF include infection control practices
limiting in-person interactions. This review focuses on the existing evidence
base on adherence intervention in adolescents with CF. Future directions for
efforts to optimize treatment adherence in adolescents with CF include reducing
treatment burden, developing patient-driven technology to improve tracking,
communication, and online support, and rethinking the CF health services model to
include assessment of individualized adherence barriers.
DOI: 10.2147/AHMT.S95637
PMCID: PMC5085292
PMID: 27799838
Conflict of interest statement: Dr. Gregory Sawicki has served on advisory boards
for Genentech, Novartis, and Vertex Pharmaceuticals and receives research funding
from the Cystic Fibrosis Foundation. Dr. Lara Bishay has received unrelated
research funding from Vertex Pharmaceuticals. The authors report no other
conflicts of interest in this work.
1400. AIDS Behav. 2015 Jan;19(1):27-33. doi: 10.1007/s10461-014-0796-x.
The factor structure and presentation of depression among HIV-positive adults in

Uganda.
Psaros C(1), Haberer JE, Boum Y 2nd, Tsai AC, Martin JN, Hunt PW, Bangsberg DR,
Safren SA.
Author information:
(1)Department of Psychiatry, Behavioral Medicine Service, Massachusetts General
Hospital, One Bowdoin Square, 7th Floor, Boston, MA, 02114, USA,
cpsaros@partners.org.
Depression is one of the most prevalent psychiatric comorbidities of HIV and one
of the greatest barriers to HIV self-care and adherence. Despite this, little
consensus exists on how to best measure depression among people living with
HIV/AIDS (PLWHA) in African settings. Measurement of depression among PLWHA may
be confounded by somatic symptoms. Some research recommends excluding these items
to enhance measurement validity; sensitivity may be lost with this approach. We
sought to characterize depression among a cohort (N = 453) of PLWHA initiating
antiretroviral therapy in Uganda via factor analysis of a widely used measure of
depression, the Hopkins Symptom Checklist (HSCLD). Common factor analysis was
performed, associations between HSCLD and the Mental Health subscale of the
Medical Outcomes Study HIV (MOS-HIV) estimated, and a Cronbach's alpha calculated
to examine validity. Factor analysis yielded two factors: (1) somatic-cognitive
symptoms and (2) behavioral disengagement. Persons with more versus less advanced
disease (CD4 cell count of ≤200 cells/mm(3)) showed no statistically significant
differences in depression scores (1.7 vs. 1.7, P ≥ 0.5). Both factors were
significantly associated with the MOS-HIV (P < .01). Factor one was highly
reliable (α = .81); factor two had only modest reliability (α = .65).
Somatic-cognitive symptoms of depression and disengagement from life's activities
appear to be distinct components of depression in this sample. Consideration of
somatic items may be valuable in identifying depression in this setting.
DOI: 10.1007/s10461-014-0796-x
PMCID: PMC4360967
1401. Diabetes Technol Ther. 2016 Jun;18(6):341-2. doi: 10.1089/dia.2016.0142. Epub

2016 May 20.
Frequency of Missed Insulin Boluses in Type 1 Diabetes and Its Impact on Diabetes
Control.
Jaser SS(1), Datye KA(1).
Author information:
(1)Department of Pediatrics, Vanderbilt University Medical Center , Nashville,
Tennessee.
DOI: 10.1089/dia.2016.0142
PMCID: PMC4932778
1402. BMC Cancer. 2017 Feb 10;17(1):122. doi: 10.1186/s12885-017-3110-2.
Supporting adherence to oral anticancer agents: clinical practice and clues to

improve care provided by physicians, nurse practitioners, nurses and pharmacists.
Timmers L(1), Boons CC(2), Verbrugghe M(3), van den Bemt BJ(4)(5), Van Hecke
A(3), Hugtenburg JG(2)(6).
Author information:
Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
l.timmers@vumc.nl.
Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
(3)University Centre of Nursing and Midwifery, Department of Public Health, Ghent
(4)Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.
(5)Department of Pharmacy, Radboud University Medical Center, Nijmegen, The
Netherlands.
(6)The EMGO Institute for Health and Care Research, VU University Medical Center,
BACKGROUND: Healthcare provider (HCP) activities and attitudes towards patients

strongly influence medication adherence. The aim of this study was to assess
current clinical practices to support patients in adhering to treatment with oral
anticancer agents (OACA) and to explore clues to improve the management of
METHODS: A cross-sectional, observational study among HCPs in (haemato-)oncology
settings in Belgium and the Netherlands was conducted in 2014 using a composite
questionnaire. A total of 47 care activities were listed and categorised into
eight domains. HCPs were also asked about their perceptions of adherence
management on the items: insight into adherence, patients' communication,
capability to influence, knowledge of consequences and insight into causes.
Validated questionnaires were used to assess beliefs about medication (BMQ) and
shared decision making (SDM-Q-doc).
RESULTS: In total, 208 HCPs (29% male) participated; 107 from 51 Dutch and 101
from 26 Belgian hospitals. Though a wide range of activities were reported,
certain domains concerning medication adherence management received less
attention. Activities related to patient knowledge and adverse event management
were reported most frequently, whereas activities aimed at patient's
self-efficacy and medication adherence during ongoing use were frequently missed.
The care provided differed between professions and by country. Belgian physicians
reported more activities than Dutch physicians, whereas Dutch nurses and
pharmacists reported more activities than Belgian colleagues. The perceptions of
medication adherence management were related to the level of care provided by
HCPs. SDM and BMQ outcomes were not related to the care provided.
CONCLUSIONS: Enhancing the awareness and perceptions of medication adherence
management of HCPs is likely to have a positive effect on care quality. Care can
be improved by addressing medication adherence more directly e.g., by questioning
patients about (expected) barriers and discussing strategies to overcome them, by
asking for missed doses and offering (electronic) reminders to support long-term
medication adherence. A multidisciplinary approach is recommended in which the
role of the pharmacist could be expanded.
DOI: 10.1186/s12885-017-3110-2
PMCID: PMC5303208
1403. J Pak Med Assoc. 2017 Jan;67(1):146-147.
Refractory diabetes: Focus on the obvious.
Kalra S(1), Talwar V(2).
Author information:
(1)Department of Endocrinology, Bharti Hospital, Karnal, India.
(2)Department of Endocrinology, Golden Hospital, Jalandhar, India.
Refractory diabetes, characterized by poor glycaemic control despite adequate

treatment, is an important entity. In this condition, even the best therapeutic
regimes tailored for rapid symptomatic relief and attainment of glycaemic goals
may not work. The need is to revive the clinical angle of endocrinology,
including a detailed history, thorough examination, judicious use of
investigations and patient specific management plan, along with quality control
by self and peer assessment.
1404. Healthcare (Basel). 2015 Dec 4;3(4):1228-42. doi: 10.3390/healthcare3041228.
A Theory-Based Approach for Developing Interventions to Change Patient

Behaviours: A Medication Adherence Example from Paediatric Secondary Care.
Heath G(1), Cooke R(2), Cameron E(3).
Author information:
(1)Department of Psychology, School of Life and Health Sciences, Aston
University, Birmingham B4 7ET, UK. g.heath1@aston.ac.uk.
(2)Department of Psychology, School of Life and Health Sciences, Aston
University, Birmingham B4 7ET, UK. r.cooke@aston.ac.uk.
(3)Manchester Centre for Health Psychology, University of Manchester, Coupland 1
Building, Coupland Street, Manchester M13 9PL, UK.
elaine.cameron@manchester.ac.uk.
In this article we introduce a Health Psychology approach to changing patient

behaviour, in order to demonstrate the value of Health Psychology professional
practice as applied within healthcare settings. Health Psychologists are experts
in understanding, predicting and changing health-related behaviours at the
individual, group and population level. They combine psychological theory,
research evidence and service-user views to design interventions to solve
clinically relevant behavioural problems and improve health outcomes. We provide
a pragmatic overview of a theory and evidence-based Intervention Mapping approach
for developing, implementing and evaluating interventions to change
health-related behaviour. An example of a real behaviour change intervention
designed to improve medication adherence in an adolescent patient with poorly
controlled asthma is described to illustrate the main stages of the intervention
development process.
DOI: 10.3390/healthcare3041228
PMCID: PMC4934641
PMID: 27417822
1405. J Am Board Fam Med. 2017 May-Jun;30(3):331-336. doi:

10.3122/jabfm.2017.03.160129.
Patient Beliefs Have a Greater Impact Than Barriers on Medication Adherence in a

Community Health Center.
Gagnon MD(1), Waltermaurer E(2), Martin A(2), Friedenson C(2), Gayle E(2), Hauser
DL(2).
Author information:
(1)From the Institute for Family Health, New York, NY (MDG, EG, DLH); the
Benjamin Center, State University of New York, New Paltz (EW); the Institute for
Advanced Medicine, Mount Sinai Health System, New York (AM); and the University
of Pennsylvania School of Veterinary Medicine, Philadelphia (CF).
mgagnon@institute.org.
(2)From the Institute for Family Health, New York, NY (MDG, EG, DLH); the
Benjamin Center, State University of New York, New Paltz (EW); the Institute for
Advanced Medicine, Mount Sinai Health System, New York (AM); and the University
of Pennsylvania School of Veterinary Medicine, Philadelphia (CF).
Comment in
J Am Board Fam Med. 2017 Nov-Dec;30(6):848.
PURPOSE: Nonadherence to medicines contributes to poor health outcomes,

especially for patients with complicated medicine regimens. We examined adherence
among patients at a family health center and the impact that barriers to getting
medicines and negative beliefs about medicines have on adherence.
METHODS: A survey was administered incorporating the 8-item Morisky Medication
Adherence Scale, questions from the Beliefs about Medicine Questionnaire, and
questions about patients' external barriers to getting medicines. Low adherence
was examined by any external barrier and by higher negative beliefs, adjusting
for patient characteristics.
RESULTS: The convenience sample of 343 participants is demographically
representative of the larger population. Among these patients, 54% report low
adherence, 51% have at least 1 barrier to adherence, and 52% report more negative
than positive beliefs about medicines. When beliefs and barriers are examined
together, patients with negative beliefs are 49% less likely to adhere than those
with more positive beliefs, whereas barriers show no significant impact on
adherence.
CONCLUSIONS: Negative beliefs about medicines are as prevalent in this population
as external barriers to accessing medicines, but negative beliefs were more
significantly associated with adherence than external barriers. Physicians should
identify and address patients' negative beliefs about medicines to improve
adherence rates.
DOI: 10.3122/jabfm.2017.03.160129
1406. Am J Lifestyle Med. 2017 Mar 20;11(5):397-403. doi: 10.1177/1559827617697922.

eCollection 2017 Sep-Oct.
Medication Adherence, When Lifestyle Is the Medicine.
Faries MD(1)(2), Abreu A(1)(2).
Author information:
(1)Texas A&M AgriLife Extension Service and Texas A&M University, College of
Medicine, College Station, Texas (MDF).
(2)Department of Kinesiology and Health Science, Stephen F. Austin State
University, Nacogdoches, Texas (AA).
Giving patients insight, knowledge, and skills, although important, may not alone
be enough for behavior change maintenance. Rather, the health care provider (HCP)
has an important role in fostering behavior change and maintenance by asking,
"Why do people change?" and "What can I do to help?" This review highlights 4
evidence-based factors related to medication adherence, when lifestyle is the
medicine. (1) Autonomy is the belief that one is the origin of his or her own
actions, and must be supported by the HCP (eg, "My HCP listens to how I would
like to do things regarding my health"). (2) Competence and confidence ensure
that patients believe they can succeed. These are gained through mastery
experience, vicarious experience, and through positive and constructive feedback
on past performance (eg, "My HCP conveys confidence in my ability to make changes
regarding my health"). (3) Coping planning is being able to formulate a plan of
intention, with the awareness of barriers and emotional regulation that can
inhibit patient behavior (eg, "I feel able to share my feelings with my HCP").
(4) Personal values of the patients are used to understand how and why they cope
when there is a threat to these values (eg, "My HCP tries to understand how I see
my health before suggesting any changes").
DOI: 10.1177/1559827617697922
PMCID: PMC6124947
PMID: 30202361

1407. J Med Internet Res. 2019 Jun 18;21(6):e12505. doi: 10.2196/12505.
Mobile Apps for Increasing Treatment Adherence: Systematic Review.
Pérez-Jover V(#)(1), Sala-González M(#)(1), Guilabert M(#)(1), Mira JJ(#)(1).
Author information:
(1)Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche,
Spain.
BACKGROUND: It is estimated that 20% to 50% of patients do not take their

medication correctly, and this leads to increased morbidity and inefficacy of
therapeutic approaches. Fostering treatment adherence is a priority objective for
all health systems. The growth of mobile apps to facilitate therapeutic adherence
has significantly increased in recent years. However, the effectiveness of the
apps for this purpose has not been evaluated.
OBJECTIVE: This study aimed to analyze whether mobile apps are perceived as
useful for managing medication at home and if they actually contribute to
increasing treatment adherence in patients.
METHODS: We carried out a systematic review of research published using Scopus,
Cochrane Library, ProQuest, and MEDLINE databases and analyzed the information
about their contribution to increasing therapeutic adherence and the perceived
usefulness of mobile apps. This review examined studies published between 2000
and 2017.
RESULTS: Overall, 11 studies fulfilled the inclusion criteria. The sample sizes
of these studies varied between 16 and 99 participants. In addition, 7 studies
confirmed that the mobile app increased treatment adherence. In 5 of them, the
before and after adherence measures suggested significant statistical
improvements, when comparing self-reported adherence and missed dose with a
percentage increase ranging between 7% and 40%. The users found mobile apps easy
to use and useful for managing their medication. The patients were mostly
satisfied with their use, with an average score of 8.1 out of 10.
CONCLUSIONS: The use of mobile apps helps increase treatment adherence, and they
are an appropriate method for managing medication at home.
©Virtudes Pérez-Jover, Marina Sala-González, Mercedes Guilabert, José Joaquín

Mira. Originally published in the Journal of Medical Internet Research
(http://www.jmir.org), 18.06.2019.
DOI: 10.2196/12505
PMCID: PMC6604503
PMID: 31215517
1408. J Nurs Educ Pract. 2015;5(3):22-27.
Factors associated with medication adherence among heart failure patients and
their caregivers.
Aggarwal B(1), Pender A(1), Mosca L(1), Mochari-Greenberger H(1).
Author information:
(1)Department of Medicine, Columbia University Medical Center/New
York-Presbyterian Hospital, New York, United States.
BACKGROUND: Reducing the rate of rehospitalization among heart failure patients

is a major public health challenge; medication non-adherence is a crucial factor
shown to trigger rehospitalizations. Objective: To collect pilot data to inform
the design of educational interventions targeted to heart failure patients and
their caregivers to improve medication adherence.
METHODS: Heart failure patients with an implantable cardioverter defibrillator
and their family caregivers were recruited from an outpatient electrophysiology
clinic at an urban university medical center (N = 10 caregiver and patient dyads,
70% race/ethnic minority, mean patient age = 63 years). Quantitative and
qualitative research methods were utilized. Semi-structured individual interviews
were conducted to assess patients' and caregivers' individual interest in, and
access to, new medication adherence technologies. Patient adherence to
medications, medication self-efficacy, and depression were assessed by validated
questionnaires. Medication adherence and hospitalization rates were assessed
among patients at 30-days post-clinic visit by mailed survey.
RESULTS: At baseline, 60% of patients reported sometimes forgetting to take their
medications. The most common factors associated with non-adherence included
forgetfulness (50%), having other medications to take (20%), and being
symptom-free (20%). At 30-day follow-up, half of patients reported non-adherence
to their medications, and 1 in 10 reported being hospitalized within the past
month. Dyads reported widespread access to technology, with the majority of dyads
showing interest in mobile applications and text messaging. There was less
acceptance of medication-dispensing technologies; caregivers and patients were
concerned about added burden.
CONCLUSIONS: The majority of etiologies of medication non-adherence were subject
to intervention. Enthusiasm from patients and caregivers in new technologies to
aid in adherence was tempered by potential burden, and should be considered when
designing interventions to promote adherence.
DOI: 10.5430/jnep.v5n3p22
PMCID: PMC4307014
PMID: 25635204
1409. J Allergy Clin Immunol Pract. 2016 Sep-Oct;4(5):868-76. doi:

10.1016/j.jaip.2016.04.020. Epub 2016 Jun 7.
Mapping the Asthma Care Process: Implications for Research and Practice.
Dima AL(1), de Bruin M(2), Van Ganse E(3); ASTRO-LAB group.
Author information:
(1)Amsterdam School of Communication Research ASCoR, University of Amsterdam,
Amsterdam, the Netherlands. Electronic address: a.dima@uva.nl.
(2)Amsterdam School of Communication Research ASCoR, University of Amsterdam,
Amsterdam, the Netherlands; Institute of Applied Health Sciences, University of
Aberdeen, Foresterhill, Aberdeen, Scotland.
(3)Lyon Pharmaco-Epidemiology Unit, Faculte d'Odontologie, Universite Claude
Bernard Lyon 1, Lyon, France; Respiratory Medicine, Croix-Rousse University
Hospital, Lyon, France.
BACKGROUND: Whether people with asthma gain and maintain control over their
condition depends not only on the availability of effective drugs, but also on
multiple patient and health care professional (HCP) behaviors. Research in asthma
rarely considers how these behaviors interact with each other and drug
effectiveness to determine health outcomes, which may limit real-life
applicability of findings.
OBJECTIVE: The objective of this study was to develop a logic process model
(Asthma Care Model; ACM) that explains how patient and HCP behaviors impact on
the asthma care process.
METHODS: Within a European research project on asthma (ASTRO-LAB), we reviewed
asthma care guidelines and empirical literature, and conducted qualitative
interviews with patients and HCPs. Findings were discussed with the project team
and respiratory care experts and integrated in a causal model.
RESULTS: The model outlines a causal sequence of treatment events, from diagnosis
and assessment to treatment prescription, drug exposure, and health outcomes. The
relationships between these components are moderated by patient behaviors
(medication adherence, symptom monitoring, managing triggers, and exacerbations)
and HCP behaviors (medical care and self-management support). Modifiable and
nonmodifiable behavioral determinants influence the behaviors of patients and
HCPs. The model is dynamic as it includes feedback loops of behavioral and
clinical outcomes, which influence future patient and HCP decision making. Key
evidence for each relationship is summarized to derive research priorities and
clinical recommendations.
CONCLUSIONS: The ACM model is of interest to both researchers and practitioners,
and intended as a first version (ACM-v1) of a common framework for generating and
translating research evidence in asthma care.
DOI: 10.1016/j.jaip.2016.04.020
1410. Neurol Med Chir (Tokyo). 2015;55(2):149-54. doi: 10.2176/nmc.oa.2014-0105.

Epub
2015 Jan 23.
Evaluation and management of plaque protrusion or thrombus following carotid

artery stenting.
Hashimura N(1), Mutoh T, Matsuda K, Matsumoto K.
Author information:
(1)Department of Neurosurgery, JCHO Kobe Central Hospital.
Carotid artery stenting (CAS) has become a common treatment for carotid artery
stenosis. However, complications, such as an ischemic event, can occur with CAS
during intra- and post-operative periods. Among these ischemic complications,
plaque protrusion into the stent and thrombus on the stent have occurred after
CAS. We retrospectively evaluated the temporal profile and treatment options for
these complications in 32 consecutive cases who underwent CAS at our hospital
between April 2009 and December 2011. The cases were evaluated pre-operatively
for risk factors, as well as the plaque morphology and characteristics using
computed tomographic angiography (CTA), ultrasound (US), and magnetic resonance
imaging (MRI). Post-operatively, lesions were examined by CTA and/or US within 1
week of CAS. As a result, among the 32 cases, 8 experienced plaque protrusions or
thrombus, which were treated with medication (anti-platelet and/or
anti-coagulation reinforcement). In 7 of these 8 cases, the plaque protrusion or
thrombus was stabilized with medication alone. However, the remaining case showed
growth and migration of the plaque protrusion or thrombus when treated with
medication alone, and therefore, required further endovascular treatment. We
identified that a history of symptomatic cerebral infarction and plaques with
ulceration were risk factors for plaque protrusion or thrombus formation after
CAS, and pre dilatation can decrease the risk of these complications. Medication
was effective in most cases of plaque protrusion or thrombus; however, further
endovascular treatment was required when medication alone was unsuccessful.
DOI: 10.2176/nmc.oa.2014-0105
PMCID: PMC4533408
1411. J Am Heart Assoc. 2016 Jun 17;5(6). pii: e002606. doi:

10.1161/JAHA.115.002606.
Medication Adherence Interventions Improve Heart Failure Mortality and

Readmission Rates: Systematic Review and Meta-Analysis of Controlled Trials.
Ruppar TM(1), Cooper PS(2), Mehr DR(3), Delgado JM(2), Dunbar-Jacob JM(4).
Author information:
(1)Sinclair School of Nursing, University of Missouri, Columbia, MO
ruppart@missouri.edu.
(2)Sinclair School of Nursing, University of Missouri, Columbia, MO.
(3)Department of Family and Community Medicine, University of Missouri, Columbia,
MO.
(4)School of Nursing, University of Pittsburgh, PA.
Comment in
J Am Heart Assoc. 2016 Jun 17;5(6):.
BACKGROUND: Poor adherence to medications is a common problem among heart failure

(HF) patients. Inadequate adherence leads to increased HF exacerbations, reduced
physical function, and higher risk for hospital admission and death. Many
interventions have been tested to improve adherence to HF medications, but the
overall impact of such interventions on readmissions and mortality is unknown.
METHODS AND RESULTS: We conducted a comprehensive search and systematic review of
intervention studies testing interventions to improve adherence to HF
medications. Mortality and readmission outcome effect sizes (ESs) were calculated
from the reported data. ESs were combined using random-effects model
meta-analysis methods, because differences in true between-study effects were
expected from variation in study populations and interventions. ES differences
attributed to study design, sample, and intervention characteristics were
assessed using moderator analyses when sufficient data were available. We
assessed publication bias using funnel plots. Comprehensive searches yielded 6665
individual citations, which ultimately yielded 57 eligible studies. Overall,
medication adherence interventions were found to significantly reduce mortality
risk among HF patients (relative risk, 0.89; 95% CI, 0.81, 0.99), and decrease
the odds for hospital readmission (odds ratio, 0.79; 95% CI, 0.71, 0.89).
Heterogeneity was low. Moderator analyses did not detect differences in ES from
common sources of potential study bias.
CONCLUSIONS: Interventions to improve medication adherence among HF patients have
significant effects on reducing readmissions and decreasing mortality. Medication
adherence should be addressed in regular follow-up visits with HF patients, and
interventions to improve adherence should be a key part of HF self-care programs.
by Wiley Blackwell.
DOI: 10.1161/JAHA.115.002606
PMCID: PMC4937243
1412. Cien Saude Colet. 2015 Feb;20(2):557-64. doi: 10.1590/1413-

81232015202.02112014.
Coverage by the public health services of medication and vaccines for the
population with diabetes mellitus.
Monteiro CN(1), Gianini RJ(1), Goldbaum M(1), Cesar CL(2), Barros MB(3).
Author information:
(1)Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de
São Paulo, São Paulo, SP, Brasil, camilamonteiro02@usp.br.
(2)Faculdade de Saúde Pública, USP.
(3)Faculdade de Ciências Médicas, Universidade de Campinas.
This study analyzed the coverage by the public health service of expenses with
medication and vaccines for the adult population of São Paulo with self-reported
diabetes mellitus in 2003 and the implications for access to medicines and
vaccination campaigns programs. Data were collected by the Multicenter Health
Survey of São Paulo. The Unified Health System (SUS) was widely used by the
population for vaccination against influenza and pneumonia and there was
significant private sector participation for coverage of expenses with
medication, with an estimated coverage of 38% by SUS. There were no significant
differences in the prevalence of use of public services for vaccination among the
categories of variables studied, suggesting a universal distribution of
vaccination by the public health service. Unlike vaccinations, in 2003 the
coverage of medication expenses by the public health service was recent in
Brazil, which may explain the low level of coverage. An analysis of coverage of
vaccination and medication expenses in diabetes mellitus population since 2003
may contribute to be the basis for policies to broaden access of the population
to health services.
DOI: 10.1590/1413-81232015202.02112014
1413. BMC Psychiatry. 2016 Jun 6;16:185. doi: 10.1186/s12888-016-0889-3.
Obesity and psychotropic medication: a prospective register linkage study among

midlife women and men.
Svärd A(1), Lahti J(2), Rahkonen O(2), Lahelma E(2), Lallukka T(2)(3).
Author information:
(1)Department of Public Health, Faculty of Medicine, University of Helsinki,
Tukholmankatu 8B, P.O. Box 20, 00014, Helsinki, Finland. anna.svard@helsinki.fi.
(2)Department of Public Health, Faculty of Medicine, University of Helsinki,
Tukholmankatu 8B, P.O. Box 20, 00014, Helsinki, Finland.
(3)Finnish Institute of Occupational Health, Helsinki, Finland.
BACKGROUND: Both obesity and mental health are major public health issues. This
study aimed to examine whether overweight and obesity among midlife employees are
associated with subsequent psychotropic medication. A further aim was to examine
the potential effect of key covariates on the association.
METHODS: The Helsinki Health Study baseline survey was conducted in 2000-2002
among 40-60-year-old employees of the City of Helsinki, Finland (n = 8960). The
participants were classified as of normal weight (18.5-24.9 kg/m(2)), overweight
(25-29.9 kg/m(2)), obese (30-34.9 kg/m(2)) or severely obese (≥35 kg/m(2)) based
on self-reported body mass index. Data on psychotropic medication purchases from
baseline to 2009 were derived from registers of the Social Insurance Institution
of Finland. The final analysis included 4760 women and 1338 men. Antidepressants
and sedatives were examined separately. Covariates included socio-demographic
factors, workload, health behaviours, physical functioning, somatic ill-health
and psychotropic medication prior to baseline. Hazard ratios (HR) for the first
psychotropic medication purchase were calculated using Cox regression analysis.
RESULTS: Third of women and quarter of men made at least one psychotropic
medication purchase during the follow-up. Adjusting for age, obese (HR = 1.57;
95 % CI = 1.10-2.24) and severely obese (HR = 2.15; 95 % CI = 1.29-3.56) men were
at risk of having psychotropic medication compared to men of normal weight. These
associations disappeared after further adjustment. Severe obesity remained
associated with subsequent sedative medication among the men even after full
adjustment (HR = 2.12; 95 % CI = 1.17-3.84). No associations were found among the
women.
CONCLUSIONS: Obese and severely obese men, but not women, were at risk of
psychotropic medication. Further studies are needed to deepen understanding of
the relationship between obesity and mental ill-health, and the possible
protecting effects of age, employment, and living environment.
DOI: 10.1186/s12888-016-0889-3
PMCID: PMC4896028
1414. AIDS Care. 2016 Aug;28(8):963-70. doi: 10.1080/09540121.2016.1154134. Epub

2016
Mar 10.
Alcohol-antiretroviral therapy interactive toxicity beliefs and daily medication

adherence and alcohol use among people living with HIV.
Pellowski JA(1), Kalichman SC(2), Kalichman MO(2), Cherry C(2).
Author information:
(1)a Department of Psychiatry and Human Behavior , The Warren Alpert Medical
School of Brown University , Providence , RI , USA.
(2)b Department of Psychology , University of Connecticut , Storrs , CT , USA.
Alcohol-antiretroviral therapy (ART) interactive toxicity beliefs reflect

perceived adverse outcomes of mixing alcohol and ART. Previous research has shown
a significant relationship between alcohol-ART interactive toxicity beliefs and
ART non-adherence, over and above other correlates of non-adherence such as human
immunodeficiency virus (HIV)symptoms and frequency of alcohol use. Most past
studies have collected data over extended periods and have not determined if
alcohol use and missed medications occur at the day-level among people holding
interactive toxicity beliefs. Previous daily analyses, however, have been limited
by self-reported adherence and relatively short periods of observation. To
address these gaps in the literature, men and women living with HIV in Atlanta,
GA, were enrolled in a 45-day observational cohort study. Daily alcohol use was
collected using two-way interactive text message surveys and daily adherence was
collected via the Wisepill device. Fifty-seven participants completed a measure
of alcohol-ART interactive toxicity beliefs and contributed 2565 days of daily
data. Participants who endorsed high levels of interactive toxicity beliefs had
significantly more days when they missed doses of medication.
Alcohol-antiretroviral toxicity beliefs predicted missing doses of medication on
days when participants were drinking and on days when they were not drinking.
Multilevel multivariate regressions showed that these toxicity beliefs predicted
daily missed doses of medication over and above quantity of alcohol consumed,
depression and general medication concerns. This study replicates and extends
previous literature and indicates the necessity of addressing alcohol-ART
toxicity beliefs within adherence interventions.
DOI: 10.1080/09540121.2016.1154134
PMCID: PMC4963817
1415. Trends Psychiatry Psychother. 2018 Apr-Jun;40(2):85-92. doi:

10.1590/2237-6089-2017-0077. Epub 2018 May 14.
Reliability and validity of the Medication Adherence Rating Scale in a cohort of

patients with schizophrenia from Nigeria.
Owie GO(1), Olotu SO(1), James BO(1).
Author information:
(1)Department of Clinical Services, Federal Neuro-Psychiatric Hospital, Benin
City, Nigeria.
INTRODUCTION: Assessing adherence in schizophrenia facilitates interventions that

optimize outcomes. Adherence rating questionnaires are feasible and
non-intrusive; however, no validated measure exists in sub-Saharan Africa. We
aimed to assess the psychometric properties of the 10-item Medication Adherence
Rating Scale (MARS).
METHODS: This was a cross-sectional study of a cohort of patients with
schizophrenia (n=230). A sociodemographic questionnaire, the Mini International
Neuropsychiatric Interview (MINI), Positive and Negative Syndrome Scale (PANSS),
Scale for the Unawareness of Mental Disorder (SUMD) and the MARS were all
administered by an interviewer.
RESULTS: The MARS demonstrated good reliability (Cronbach's alpha: 0.76). The
scale was reducible to a 3-factor construct (1 - medication adherence behavior, 2
- attitude to taking medications, and 3 - negative side effects and attitude to
psychotropics), with significant though weak external validity in relation to
psychopathology (p<0.001) and insight (p<0.001). The first factor showed good
internal consistency (α=0.80), comprising six items that could serve as a
reliable proxy measure of adherence in place of the MARS.
CONCLUSION: The MARS demonstrated fair psychometric characteristics in assessing
adherence in patients with schizophrenia in this cohort. The scale may be useful
in the dimensional assessment of medication adherence for schizophrenia in
sub-Saharan African settings.
DOI: 10.1590/2237-6089-2017-0077
1416. J Cardiovasc Nurs. 2017 Jul/Aug;32(4):E9-E23. doi:
10.1097/JCN.0000000000000392.
Internet-Delivered Self-management Support for Improving Coronary Heart Disease

and Self-management-Related Outcomes: A Systematic Review.
Palacios J(1), Lee GA, Duaso M, Clifton A, Norman IJ, Richards D, Barley EA.
Author information:
(1)Jorge Palacios, MD, MSc PhD Student, Florence Nightingale Faculty of Nursing &
Midwifery, King's College London, London, UK. Geraldine A. Lee, PhD Senior
Lecturer, Florence Nightingale Faculty of Nursing & Midwifery, King's College
London, London, UK. Maria Duaso, PhD Lecturer, Florence Nightingale Faculty of
Nursing & Midwifery, King's College London, London, UK. Abigail Clifton, BSc
Research Assistant, Florence Nightingale Faculty of Nursing & Midwifery, King's
College London, London, UK. Ian J. Norman, PhD Executive Dean, Florence
Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
Derek Richards, PhD Director of Clinical Research and Innovation, Silvercloud
Health, and School of Psychology, Trinity College Dublin, Ireland. Elizabeth
Alexandra Barley, PhD, CPsychol Professor in Health and Wellbeing, College of
Nursing, Midwifery and Healthcare, University of West London, UK.
INTRODUCTION: Coronary heart disease (CHD) is associated with significant

morbidity and mortality, including mental health comorbidity, which is associated
with poor outcomes. Self-management is key, but there is limited access to
self-management support. Internet-delivered interventions may increase access.
OBJECTIVE: The aim of this study was to conduct a systematic review to (1)
determine the effectiveness of Internet-delivered CHD self-management support for
improving CHD, mood, and self-management related outcomes and (2) identify and
describe essential components for effectiveness.
METHOD: Randomized controlled trials that met prespecified eligibility criteria
were identified using a systematic search of 3 healthcare databases (Medline,
PsychINFO, and Embase).
RESULTS: Seven trials, which included 1321 CHD patients, were eligible for
inclusion. There was considerable heterogeneity between studies in terms of the
intervention content, outcomes measured, and study quality. All 7 of the studies
reported significant positive between-group effects, in particular for
lifestyle-related outcomes. Personalization of interventions and provision of
support to promote engagement may be associated with improved outcomes, although
more data are required to confirm this. The theoretical basis of interventions
was poorly developed though evidence-based behavior change interventions were
used.
CONCLUSION: More well-designed randomized controlled trials are needed. These
should also explore how interventions work and how to improve participant
retention and satisfaction and examine the role of personalization and support
within interventions.
DOI: 10.1097/JCN.0000000000000392
PMCID: PMC5469565
1417. J Manag Care Spec Pharm. 2016 Dec;22(12):1394-1401.
Adherence to Disease-Modifying Therapies for Multiple Sclerosis.
Higuera L(1), Carlin CS(1), Anderson S(2).

Author information:
(1)1 Medica Research Institute, Minnetonka, Minnesota.
(2)2 Medica Health Plans, Minnetonka, Minnesota.
BACKGROUND: Multiple sclerosis (MS) is a neurological degenerative chronic

condition without cure. However, long-term disease-modifying therapies (DMTs)
help reduce the severity of MS symptoms. Adherence to DMTs is key to their
success. Several studies have analyzed what makes patients adherent to their
DMTs. As new DMTs have entered the market, few studies have analyzed factors of
adherence using all currently available DMTs.
OBJECTIVE: To analyze different factors of adherence to DMTs for MS, in
particular how the type of DMT affects adherence.
METHODS: This retrospective cohort study used enrollment and claims data from an
upper Midwest health plan in the United States between 2011 and 2013. Patients
entered the study if they had any medical claim with an MS diagnosis and used
only 1 DMT during the study time frame. Medication possession ratios (MPRs) were
computed as the fraction of days with medication supplied during the year;
patients with MPRs of 0.8 or higher were considered adherent. Multivariate probit
models with patient-specific random effects were estimated, with controls for
demographic characteristics, type of DMT, health plan type, and measures of
health status.
RESULTS: Patients aged over 45 years were between 13.7 to 18.6 percentage points
more likely to be adherent than younger patients. Women had a 5.5
percentage-point lower probability of being adherent than men. Patients using
self-injectable DMTs with injection site reactions as the most likely side effect
were 9.1 percentage points less likely to be adherent than patients using oral,
infusible, and other self-injectable DMTs. Patients with depression had a 5.5
percentage-point lower probability of being adherent. These results were robust
to changes in controls for type of plan and neighborhood socioeconomic
characteristics.
CONCLUSIONS: This study found statistically significant differences in adherence
to DMTs by age, sex, type of DMT, and a depression diagnosis.
DISCLOSURES: TEVA provided funding for this study and had the option to review
the manuscript. The authors retained autonomy in the determination of the final
content of this work. Study concept and design were contributed by Carlin,
Anderson, and Higuera. Data interpretation was primarily performed by Higuera and
Carlin, along with Anderson. The manuscript was written and revised by Higuera,
Carlin, and Anderson.
DOI: 10.18553/jmcp.2016.22.12.1394
1418. Epilepsy Behav. 2018 Feb;79:58-67. doi: 10.1016/j.yebeh.2017.11.015. Epub

2017
Dec 15.
A discrete-choice experiment to elicit preferences of patients with epilepsy for

self-management programs.
Atkinson-Clark E(1), Charokopou M(2), Van Osselaer N(3), Hiligsmann M(4).
Author information:
(1)Department of Health Services Research, CAPHRI Care and Public Health Research
Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The
Netherlands. Electronic address: Edward@atkinsonclark.com.
(2)UCB Pharma, 60 Allée de la Recherche, Brussels, Belgium. Electronic address:
Mata.Charokopou@ucb.com.
(3)UCB Pharma, 60 Allée de la Recherche, Brussels, Belgium.
(4)Department of Health Services Research, CAPHRI Care and Public Health Research
Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The
Netherlands. Electronic address: m.hiligsmann@maastrichtuniversity.nl.
BACKGROUND: There is an increasing number of self-management programs developed

for patients with epilepsy, with the goal of supporting treatment management and
improving their quality of life. With the aim of increasing medication adherence
and effectiveness of self-management programs, it is important to design programs
that are engaging to, and align with the preferences of patients with epilepsy.
This study aimed to evaluate and compare the preferences of patients with
epilepsy for self-management programs in three European countries. This is the
first cross-border evaluation of the preferences of patients with epilepsy in
Europe for such programs.
METHODS: Using a discrete-choice experiment, patients with epilepsy from Germany,
France, and the Netherlands were surveyed, and chose repetitively between two
hypothetical self-management programs. These differed in the following six
characteristics: i) the thematic area which would be the main focus of the
program, ii) the method of interaction, iii) the source of information or
provider of the program, iv) the amount of time spent on the program per week, v)
the cost, and vi) whether the program would start immediately, or if there would
be a delay of 3weeks before its initiation. A Bayesian efficient design was used
to construct 15 choice sets, and a mixed panel logit model was used to estimate
patients' preferences. Subgroup analyses were conducted according to
socioeconomic status, burden of disease, and previous activation in
self-management.
RESULTS: A total of 299 people with epilepsy were included in the study, with a
mean age of 45.5years. Only 15% had previously made use of a self-management
program, although 44.5% reported having previously heard of them. In all three
countries, all attributes barring the content were significant at 10%. The cost
attribute - i.e., an out-of-pocket expenditure for a program - was reported as
the most important feature in each country and across subgroups (significant at
1%). This was followed by the length of program sessions per week, which ranged
from 20 to 90min per week. Although there was some heterogeneity between
countries and subgroups, the patients, overall, had a preference for a
face-to-face meeting with a doctor. In the Netherlands, a preference for online
programs and physician assistants was observed when compared with the other
countries. Other attributes, including the information source - whether a program
was led by a physician, another patient with epilepsy, or another combination -
was also important to patients, who appear willing to trade preferences in order
to gain their favored attribute level. However, 20% of the population chose
consistently to not participate in any self-management program.
CONCLUSION: Given the heterogeneity of the epilepsies, preferences, and
dispreferences across subgroups, our study highlights that if full account is not
taken of different segmentation strategies when designing a self-management
program, a large proportion of the population may not be attracted to it.
DOI: 10.1016/j.yebeh.2017.11.015
1419. Cannabis Cannabinoid Res. 2017 Jun 1;2(1):160-166. doi:

10.1089/can.2017.0012.
eCollection 2017.
Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report.
Reiman A(1), Welty M(2), Solomon P(3).

Author information:
(1)School of Social Welfare, University of California, Berkeley, Berkeley,
California.
(2)School of Lifespan Development and Educational Services, Kent State
University, Kent, Ohio.
(3)Chief Medical Officer, HelloMD, San Francisco, California.
Introduction: Prescription drug overdoses are the leading cause of accidental

death in the United States. Alternatives to opioids for the treatment of pain are
necessary to address this issue. Cannabis can be an effective treatment for pain,
greatly reduces the chance of dependence, and eliminates the risk of fatal
overdose compared to opioid-based medications. Medical cannabis patients report
that cannabis is just as effective, if not more, than opioid-based medications
for pain. Materials and Methods: The current study examined the use of cannabis
as a substitute for opioid-based pain medication by collecting survey data from
2897 medical cannabis patients. Discussion: Thirty-four percent of the sample
reported using opioid-based pain medication in the past 6 months. Respondents
overwhelmingly reported that cannabis provided relief on par with their other
medications, but without the unwanted side effects. Ninety-seven percent of the
sample "strongly agreed/agreed" that they are able to decrease the amount of
opiates they consume when they also use cannabis, and 81% "strongly
agreed/agreed" that taking cannabis by itself was more effective at treating
their condition than taking cannabis with opioids. Results were similar for those
using cannabis with nonopioid-based pain medications. Conclusion: Future research
should track clinical outcomes where cannabis is offered as a viable substitute
for pain treatment and examine the outcomes of using cannabis as a medication
assisted treatment for opioid dependence.
DOI: 10.1089/can.2017.0012
PMCID: PMC5569620
PMID: 28861516
Conflict of interest statement: No competing financial interests exist.
1420. Eur J Cardiovasc Nurs. 2016 Aug;15(5):317-27. doi: 10.1177/1474515115572047.

Epub
2015 Feb 11.
Family partner intervention influences self-care confidence and treatment

self-regulation in patients with heart failure.
Stamp KD(1), Dunbar SB(2), Clark PC(3), Reilly CM(2), Gary RA(2), Higgins M(2),
Ryan RM(4).
Author information:
(1)Boston College, USA stampk@bc.edu.
(2)Nell Hodgson Woodruff School of Nursing, Emory University, USA.
(3)Byrdine F. Lewis School of Nursing, Georgia State University, USA.
(4)Institute for Positive Psychology and Education Australian Catholic
University, Australia.
BACKGROUND: Heart failure self-care requires confidence in one's ability and

motivation to perform a recommended behavior. Most self-care occurs within a
family context, yet little is known about the influence of family on heart
failure self-care or motivating factors.
AIMS: To examine the association of family functioning and the self-care
antecedents of confidence and motivation among heart failure participants and
determine if a family partnership intervention would promote higher levels of
perceived confidence and treatment self-regulation (motivation) at four and eight
months compared to patient-family education or usual care groups.
METHODS: Heart failure patients (N=117) and a family member were randomized to a
family partnership intervention, patient-family education or usual care groups.
Measures of patient's perceived family functioning, confidence, motivation for
medications and following a low-sodium diet were analyzed. Data were collected at
baseline, four and eight months.
RESULTS: Family functioning was related to self-care confidence for diet (p=0.02)
and autonomous motivation for adhering to their medications (p=0.05) and diet
(p=0.2). The family partnership intervention group significantly improved
confidence (p=0.05) and motivation (medications (p=0.004; diet p=0.012) at four
months, whereas patient-family education group and usual care did not change.
CONCLUSION: Perceived confidence and motivation for self-care was enhanced by
family partnership intervention, regardless of family functioning. Poor family
functioning at baseline contributed to lower confidence. Family functioning
should be assessed to guide tailored family-patient interventions for better
outcomes.
© The European Society of Cardiology 2015.
DOI: 10.1177/1474515115572047
PMCID: PMC4532663
1421. J Int Assoc Provid AIDS Care. 2017 Nov/Dec;16(6):595-602. doi:

10.1177/2325957417729753. Epub 2017 Sep 7.
Is the Newest Vital Sign a Useful Measure of Health Literacy in HIV Disease?
Kordovski VM(1), Woods SP(1)(2), Avci G(1), Verduzco M(2), Morgan EE(2).
Author information:
(1)1 Department of Psychology, University of Houston, Houston, TX, USA.
(2)2 Department of Psychiatry, University of California-San Diego, San Diego, CA,
USA.
BACKGROUND: Limited health literacy is common among persons infected with HIV and
has been linked to poor mental and physical health outcomes, but there are no
well-validated screening measures of health literacy in this vulnerable clinical
population. The present study evaluates the usefulness of the Newest Vital Sign
(NVS) as a brief measure of health literacy in HIV disease.
METHODS: Seventy-eight HIV+ adults were administered the NVS, Rapid Estimate of
Adult Literacy in Medicine (REALM), and Single Item Literacy Screener (SILS).
Main criterion variables included plasma HIV viral load, medication management
capacity, self-efficacy for medication management, and perceived relationships
with healthcare providers.
RESULTS: The NVS showed good internal consistency and moderate correlations with
the REALM and SILS. Rates of limited health literacy were highest on the NVS
(30.3%) as compared to SILS (6.6%) and REALM (9.2%). A series of regressions
controlling for education showed that the NVS was incrementally predictive of
viral load, medication management capacity and self-efficacy, and relationships
with healthcare providers, above and beyond the REALM and SILS.
CONCLUSION: The NVS shows evidence of reliability, convergent validity, and
incremental criterion-related validity and thus may serve as useful screening
tool for assessing health literacy in HIV disease.
DOI: 10.1177/2325957417729753
PMCID: PMC5698171
1422. Ghana Med J. 2016 Jun;50(2):90-102.
Do diabetes-specialty clinics differ in management approach and outcome? A

cross-sectional assessment of ambulatory type 2 diabetes patients in two teaching
hospitals in Nigeria.
Adisa R(1), Fakeye TO(1).
Author information:
(1)Department of Clinical Pharmacy & Pharmacy Administration, Faculty of
Pharmacy, University of Ibadan, Ibadan, Oyo State, Nigeria.
OBJECTIVES: To evaluate management approach and outcome in two

endocrinologist-managed clinics using data on treatment adherence,
diabetes-specific parameters, prescribed medications and self-management
practices among ambulatory type 2 diabetes patients. Opinion on cause(s) and
perceived fear about diabetes were also explored.
DESIGN: A cross-sectional prospective study using semi-structured interview among
consented patients for eightweek, and a review of participants' case notes at
3-month post-interactive contact for details of diabetes-specific parameters and
antidiabetes medications.
SETTINGS: The University College Hospital (UCH) and Obafemi Awolowo University
Teaching Hospitals Complex (OAUTHC) in southwestern Nigeria.
PARTICIPANTS: Adult patients with type 2 diabetes, on therapies for >3-month and
who had average fasting blood glucose (FBG)>6.0mmol/L were enrolled. All patients
with type 1 diabetes, and type 2 diabetes who decline participation were
excluded. Out of 185 participants who were approached, 176(95.1%) consented and
completed the study including 113(64.2%) from UCH and 63(35.8%) in OAUTHC.
RESULTS: Mean FBG for patients were 9.6mmol/L in UCH and 11.0mmol/L in OAUTHC
(p=0.03). Medication adherence among patients was 47(46.5%) in UCH and 31(52.5%)
in OAUTHC (p=0.46). Prescribed antidiabetes medications between the clinics
significantly differ. Practice of self-monitoring of blood glucose among
participants was 26(23.0%) in UCH and 13(20.6%) in OAUTHC (p=0.72). Thirty-two
participants (29.4%) in UCH and 33(43.4%) from OAUTHC (p=0.02) mentioned
complications as perceived fear about type 2 diabetes.
CONCLUSION: There are differences and similarities between the diabetes-specialty
clinics with respect to diabetes management and outcome. This underscores the
necessity for a protocol-driven treatment approach in ensuring improved diabetes
care and outcome.
FUNDING: None declared.
PMCID: PMC5012141
Conflict of interest statement: Conflicts of Interest: None declared

eCollection 2016.
Increase in Self-Injury as a Method of Self-Harm in Ghent, Belgium: 1987-2013.
Vancayseele N(1), Portzky G(1), van Heeringen K(1).

Author information:
(1)Department of psychiatry and medical psychology, Ghent University, Ghent,
Belgium.
BACKGROUND: Self-harm is a major health care problem and changes in its

prevalence and characteristics can have important implications for suicide
prevention. The objective was to describe trends in the epidemiology of self-harm
based on emergency department (A&E departments) visits over a 26-year period in
Ghent, Belgium.
METHODS: We analyzed data on all self-harm presentations from the three large
general hospitals in Ghent between 1987 and 2013. We investigated trends in
prevalence (events by year per 100.000), methods and alcohol use.
RESULTS: Rates of self-harm steadily decreased during the 26-year study period.
In general female rates of self-harm were higher than male rates. The mean
patient age was 35 years. The most commonly used method of self-harm was
self-poisoning by means of an overdose of medication (80.8%), followed by cutting
(10.2%) and hanging (4.2%). Psychotropics (including antidepressants,
benzodiazepines, barbiturates and other tranquilizers) were the most frequently
used drugs (74.5%). A proportional increase in the use of self-injurious methods
in self-harm was highly significant, more specifically in the use of hanging,
jumping from heights and the use of other violent methods such as the use of
firearms, jumping before a moving object or other traffic related injury.
CONCLUSION: This epidemiological study showed an increase in the use of
high-lethality methods in self-harm which has important implications for suicide
prevention. As restrictions in the availability of these methods are difficult or
impossible to achieve, prevention programmes will have to emphasize the role of
thorough psychosocial assessment and adequate follow-up care of self-harm
patients.
PMCID: PMC4889035
1424. Am J Alzheimers Dis Other Demen. 2017 Nov;32(7):373-381. doi:

10.1177/1533317517711247. Epub 2017 May 30.
Development and Testing of a Measure of Caregiver Confidence in Medical

Sign/Symptom Management.
Piggott CA(1)(2), Zimmerman S(3)(4), Reed D(4), Sloane PD(4)(5).
Author information:
(1)1 Department of Medicine, School of Medicine, University of North Carolina at
Chapel Hill, NC, USA.
(2)2 Department of Family Medicine, School of Medicine, University of Colorado,
Aurora, CO, USA.
(3)3 School of Social Work, University of North Carolina at Chapel Hill, NC, USA.
(4)4 Cecil G. Sheps Center for Health Services Research, University of North
(5)5 Department of Family Medicine, School of Medicine, University of North
Evaluation of efforts to support family caregivers of people with dementia in

their daily medical management responsibilities requires a measure of caregiver
self-efficacy (confidence). This article describes the development and
psychometric properties of the Caregiver Confidence in Sign/Symptom Management
(CCSM) scale, the only available instrument in this area. Measurement development
included literature and expert panel review, cognitive testing, and field
testing. The CCSM is a 25-item measure (α = .92) composed of confidence in
relation to 4 subscales: knowledge of signs/symptoms (α = .83), management of
cognitive signs/symptoms (α = .85), management of medical signs/symptoms (α =
.87), and general medication management/responsiveness (α = .85), all of which
relate to caregiver role strain. The CCSM is a reliable and valid instrument to
assess caregiver confidence in sign/symptom management and is useful to determine
caregiver needs and outcomes of related interventions. Additionally, it furthers
understanding of the role of self-efficacy in caregiver quality of life.
DOI: 10.1177/1533317517711247
PMCID: PMC5529254

eCollection 2017.
Does cognitive impairment impact adherence? A systematic review and meta-analysis

of the association between cognitive impairment and medication non-adherence in
stroke.
Rohde D(1), Merriman NA(1), Doyle F(1), Bennett K(1), Williams D(2), Hickey A(1).
Author information:
(1)Division of Population Health Sciences, Royal College of Surgeons in Ireland,
Dublin, Ireland.
(2)Department of Geriatric and Stroke Medicine, Beaumont Hospital and Royal
College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
BACKGROUND: While medication adherence is essential for the secondary prevention

of stroke, it is often sub-optimal, and can be compromised by cognitive
impairment. This study aimed to systematically review and meta-analyse the
association between cognitive impairment and medication non-adherence in stroke.
METHODS: A systematic literature search of longitudinal and cross-sectional
studies of adults with any stroke type, which reported on the association between
any measure of non-adherence and cognitive impairment, was carried out according
to PRISMA guidelines. Odds ratios and 95% confidence intervals were the primary
measure of effect. Risk of bias was assessed using the Cochrane Bias Methods
Group's Tool to Assess Risk of Bias in Cohort Studies, with evidence quality
assessed according to the GRADE approach. We conducted sensitivity analyses
according to measure of cognitive impairment, measure of medication adherence,
population, risk of bias and adjustment for covariates. The protocol was
registered with PROSPERO.
RESULTS: From 1,760 titles and abstracts, we identified 9 studies for inclusion.
Measures of cognitive impairment varied from dementia diagnosis to standardised
cognitive assessments. Medication adherence was assessed through self-report or
administrative databases. The majority of studies were of medium risk of bias (n
= 6); two studies had low risk of bias. Findings were mixed; when all studies
were pooled, there was no evidence of an association between cognitive impairment
and medication non-adherence post-stroke [OR (95% CI): 0.85 (0.66, 1.03)].
However, heterogeneity was substantial [I2 = 90.9%, p < .001], and the overall
evidence quality was low.
CONCLUSIONS: Few studies have explored associations between cognitive impairment
and medication adherence post-stroke, with substantial heterogeneity in study
populations, and definitions and assessments of non-adherence and cognitive
impairment. Further research using clear, standardised and objective assessments
is needed to clarify the association between cognitive impairment and medication
non-adherence in stroke.
PMCID: PMC5722379
1426. J Family Med Prim Care. 2017 Jan-Mar;6(1):78-82. doi: 10.4103/2249-

4863.214962.
Medication discrepancies and potentially inadequate prescriptions in elderly

adults with polypharmacy in ambulatory care.
Franco JVA(1)(2)(3)(4), Terrasa SA(1)(2), Kopitowski KS(1)(3).
Author information:
(1)Research Area, Family and Community Medicine Division, Hospital Italiano de
Buenos Aires, Buenos Aires, Argentina.
(2)Department of Public Health, Instituto Universitario Hospital Italiano and
Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
(3)Department of Research, Instituto Universitario Hospital Italiano, Buenos
Aires, Argentina.
(4)Department of Toxicology and Pharmacology, Universidad de, Buenos Aires,
Argentina.
OBJECTIVES: The objective of this study is to describe the frequency and type of
medication discrepancies (MD) through medication reconciliation and to describe
the frequency of potentially inadequate prescription (PIP) medications using
screening tool of older persons' prescriptions criteria.
DESIGN: Cross-sectional comparison of electronic medical record (EMR) medication
lists and patient's self-report of their comprehensive medication histories
obtained through telephone interviews.
INCLUSION CRITERIA: Elderly individuals (>65 years old) with more than ten
medications recorded in their EMR, who had not been hospitalized in the past year
and were not under domiciliary care, affiliated to a private community hospital.
OUTCOME MEASURES: The primary outcomes were the proportion of patients with MD
and PIP. Secondary outcomes were the proportion of types of discrepancies and
PIP. We analyzed possible associations between these variables and other
demographic and clinical variables.
RESULTS: Out of 214 randomly selected individuals, 150 accepted to participate
(70%). The mean number of medications referred to be consumed by patients was 9.1
(95% confidence interval [CI] =8.6-9.6), and the mean number of prescribed
medications in their EMR was 13.9 (95% CI = 13.3-14.5). Ninety-nine percent had
at least one discrepancy (total 1252 discrepancies); 46% consumed at least one
prescription not documented in their EMR and 93% did not consume at least one of
the prescriptions documented in their EMR. In 77% of the patients, a PIP was
detected (total 186), 87% of them were at least within one of the following
categories: Prolonged used of benzodiazepines or proton pump inhibitors and the
use of aspirin for the primary prevention of cardiovascular disease.
CONCLUSIONS: There was a high prevalence of MD and PIP within the community of
elderly adults affiliated to a Private University Hospital. Future interventions
should be aimed at reducing the number of PIP to prevent adverse drug events and
improve EMR accuracy by lowering medications discrepancies.
DOI: 10.4103/2249-4863.214962
PMCID: PMC5629905
PMID: 29026754

10.1002/14651858.CD012042.pub2.
Providing physicians with feedback on medication adherence for people with

chronic diseases taking long-term medication.
Zaugg V(1), Korb-Savoldelli V, Durieux P, Sabatier B.
Author information:
(1)Clinical Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20
rue Leblanc, Paris, France, 75015.
BACKGROUND: Poor medication adherence decreases treatment efficacy and worsens

clinical outcomes, but average rates of adherence to long-term pharmacological
treatments for chronic illnesses are only about 50%. Interventions for improving
medication adherence largely focus on patients rather than on physicians;
however, the strategies shown to be effective are complex and difficult to
implement in clinical practice. There is a need for new care models addressing
the problem of medication adherence, integrating this problem into the patient
care process. Physicians tend to overestimate how well patients take their
medication as prescribed. This can lead to missed opportunities to change
medications, solve adverse effects, or propose the use of reminders in order to
improve patients' adherence. Thus, providing physicians with feedback on
medication adherence has the potential to prompt changes that improve their
patients' adherence to prescribed medications.
OBJECTIVES: To assess the effects of providing physicians with feedback about
their patients' medication adherence for improving adherence. We also assessed
the effects of the intervention on patient outcomes, health resource use, and
processes of care.
SEARCH METHODS: We conducted a systematic search of the Cochrane Central Register
of Controlled Trials (CENTRAL), MEDLINE, and Embase, all from database inception
to December 2016 and without any language restriction. We also searched ISI Web
of Science, two trials registers, and grey literature.
SELECTION CRITERIA: We included randomised trials, controlled before-after
studies, and interrupted time series studies that compared the effects of
providing feedback to physicians about their patients' adherence to prescribed
long-term medications for chronic diseases versus usual care. We included
published or unpublished studies in any language. Participants included any
physician and any patient prescribed with long-term medication for chronic
disease. We included interventions providing the prescribing physician with
information about patient adherence to medication. Only studies in which feedback
to the physician was the sole intervention or the essential component of a
multifaceted intervention were eligible. In the comparison groups, the physicians
should not have had access to information about their patients' adherence to
medication. We considered the following outcomes: medication adherence, patient
outcomes, health resource use, processes of care, and adverse events.
DATA COLLECTION AND ANALYSIS: Two independent review authors extracted and
analysed all data using standard methodological procedures expected by Cochrane
and the Effective Practice and Organisation of Care group. Due to heterogeneity
in study methodology, comparison groups, intervention settings, and measurements
of outcomes, we did not carry out meta-analysis. We describe the impact of
interventions on outcomes in tabular form and make a qualitative assessment of
the effects of studies.
MAIN RESULTS: We included nine studies (23,255 patient participants): eight
randomised trials and one interrupted time series analysis. The studies took
place in primary care and other outpatient settings in the USA and Canada. Seven
interventions involved the systematic provision of feedback to physicians
concerning all their patients' adherence to medication, and two interventions
involved issuing an alert for non-adherent patients only. Seven studies used
pharmacy refill data to assess medication adherence, and two used an electronic
device or self-reporting. The definition of adherence differed across studies,
making comparisons difficult. Eight studies were at high risk of bias, and one
study was at unclear risk of bias. The most frequent source of bias was lack of
protection against contamination.Providing physicians with feedback may lead to
little or no difference in medication adherence (seven studies, 22,924 patients),
patient outcomes (two studies, 1292 patients), or health resource use (two
studies, 4181 patients). Providing physicians with feedback on medication
adherence may improve processes of care (e.g. more medication changes, dialogue
with patient, management of uncontrolled hypertension) compared to usual care
(four studies, 2780 patients). None of the studies reported an adverse event due
to the intervention. The certainty of evidence was low for all outcomes, mainly
due to high risk of bias, high heterogeneity across studies, and indirectness of
evidence.
AUTHORS' CONCLUSIONS: Across nine studies, we observed little or no evidence that
provision of feedback to physicians regarding their patients adherence to
prescribed medication improved medication adherence, patient outcomes, or health
resource use. Feedback about medication adherence may improve processes of care,
but due to the small number of studies assessing this outcome and high risk of
bias, we cannot draw firm conclusions on the effect of feedback on this outcome.
Future research should use a clear, standardised definition of medication
adherence and cluster-randomisation to avoid the risk of contamination.
DOI: 10.1002/14651858.CD012042.pub2
PMCID: PMC6491069
1428. Drugs Aging. 2017 Feb;34(2):97-113. doi: 10.1007/s40266-016-0426-6.
Theory-Based Interventions to Improve Medication Adherence in Older Adults

Prescribed Polypharmacy: A Systematic Review.
Patton DE(1), Hughes CM(1), Cadogan CA(1)(2), Ryan CA(3)(4).
Author information:
(1)School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast,
United Kingdom.
(2)School of Pharmacy, Royal College of Surgeons in Ireland, 111 St. Stephens
Green, Dublin 2, Ireland.
(3)School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast,
United Kingdom. cristinryan@rcsi.ie.
(4)School of Pharmacy, Royal College of Surgeons in Ireland, 111 St. Stephens
Green, Dublin 2, Ireland. cristinryan@rcsi.ie.
BACKGROUND: Previous interventions have shown limited success in improving

medication adherence in older adults, and this may be due to the lack of a
theoretical underpinning.
OBJECTIVE: This review sought to determine the effectiveness of theory-based
interventions aimed at improving medication adherence in older adults prescribed
polypharmacy and to explore the extent to which psychological theory informed
their development.
DATA SOURCES: Eight electronic databases were searched from inception to March
2015, and extensive hand-searching was conducted.
ELIGIBILITY CRITERIA: Interventions delivered to older adults (populations with a
mean/median age of ≥65 years) prescribed polypharmacy (four or more regular
oral/non-oral medicines) were eligible. Studies had to report an underpinning
theory and measure at least one adherence and one clinical/humanistic outcome.
REVIEW METHODS: Data were extracted independently by two reviewers and included
details of intervention content, delivery, providers, participants, outcomes and
theories used. The theory coding scheme (TCS) was used to assess the extent of
theory use.
RESULTS: Five studies cited theory as the basis for intervention development
(social cognitive theory, health belief model, transtheoretical model,
self-regulation model). The extent of theory use and intervention effectiveness
in terms of adherence and clinical/humanistic outcomes varied across studies. No
study made optimal use of theory as recommended in the TCS.
CONCLUSIONS: The heterogeneity observed and inclusion of pilot designs mean
conclusions regarding effectiveness of theory-based interventions targeting older
adults prescribed polypharmacy could not be drawn. Further primary research
involving theory as a central component of intervention development is required.
The review findings will help inform the design of future theory-based adherence
interventions.
DOI: 10.1007/s40266-016-0426-6
PMCID: PMC5290062
Conflict of interest statement: Compliance with Ethical StandardsFundingThis work

was supported by The Dunhill Medical Trust (Grant Number: R298/0513). The funding
body was not involved in the design of the review, data collection, analysis and
interpretation of findings or in writing the manuscript.Conflict of
interestDeborah Patton, Carmel Hughes, Cathal Cadogan and Cristín Ryan have no
conflicts of interest relevant to the content of this review.
1429. Oncol Nurs Forum. 2016 Sep 1;43(5):576-82. doi: 10.1188/16.ONF.576-582.
The Association Between Patient-Reported and Objective Oral Anticancer Medication

Adherence Measures: A Systematic Review.
Atkinson TM(1), Rodríguez VM(1), Gordon M(1), Avildsen IK(1), Emanu JC(1), Jewell
ST(2), Anselmi KA(1), Ginex PK(1).
Author information:
(1)Memorial Sloan Kettering Cancer Center.
(2)Rutgers University.
PROBLEM IDENTIFICATION: Oral anticancer medication (OAM) use has been steadily
increasing, leading to several patient benefits. A notable challenge for nurses
is accurate monitoring of patient OAM regimens because nonadherence is associated
with poor health outcomes and decreased survival. Currently, no gold standard
measure of OAM adherence exists. The authors conducted a systematic review of the
association between objective and patient-reported measures of OAM adherence..
LITERATURE SEARCH: A systematic electronic literature search was conducted using
PubMed, EMBASE, Scopus, PsycINFO®, Cochrane Library, Web of Science, and CINAHL®
databases through November 2014. .
DATA EVALUATION: Articles were independently reviewed to determine whether they
included an original characterization of the level of association between
objective and patient-reported measures of OAM adherence..
SYNTHESIS: From a total of 11,135 articles retrieved, eight studies met inclusion
criteria. Objective adherence was primarily assessed using pill counts or
Medication Event Monitoring System (MEMSCap™). Patient-reported adherence was
most commonly assessed using study-specific questionnaires. Significant positive
correlations were observed between objective and patient-reported adherence
across most studies, with three studies reporting higher rates of adherence via
patient reporting..
CONCLUSIONS: Despite variation in the OAMs and measures used, patient-reported
adherence rates were equal to or higher than objective adherence measures across
studies. Social desirability bias may be a concern; however, given the
significant concordance observed, using patient-reported methods in future
studies of OAM adherence may be justified. .
IMPLICATIONS FOR NURSING: This review provides evidence to support nursing use of
patient-reported measures to accurately monitor OAM adherence and potentially
improve the quality of patient-provider communication.
DOI: 10.1188/16.ONF.576-582
PMCID: PMC5008846
1430. BMJ Open Diabetes Res Care. 2017 May 8;5(1):e000349. doi:
Discovering successful strategies for diabetic self-management: a qualitative

comparative study.
Weller SC(1)(1), Baer R(2), Nash A(3), Perez N(3).
Author information:
(1)Department of Family Medicine, University of Texas Medical Branch, Galveston,
Texas, USA.
(2)Department of Anthropology, University of South Florida, Tampa, Florida, USA.
(3)Department of Preventive Medicine and Community Health, University of Texas
Medical Branch, Galveston, Texas, USA.
OBJECTIVE: This project explored lifestyles of patients in good and poor control
to identify naturally occurring practices and strategies that result in
successful diabetes management.
RESEARCH DESIGN AND METHODS: Semistructured interviews with adult patients with
type 2 diabetes explored diet, food preparation, physical activity, medication
use and glucose monitoring. Patients (n=56) were classified into good (A1C
<7.0%), fair (7.0%<A1C<8.0%) or poor (A1C >8.0%) control groups and matched
across groups on diabetes duration (±5 years) and medication modality (none,
oral, insulin±oral) to control for non-lifestyle factors. A qualitative
comparative analysis identified practices that distinguished glycemic groups.
RESULTS: Good control patients were more likely to test their glucose two or more
times a day and reduce their sodium intake, as well as increase fruits and
vegetables and limit portion sizes, some attaining good control without exercise.
Fair control patients discussed several dietary strategies including limiting
sweets, drinking non-caloric beverages, reducing carbs, 'cheating' (eating only a
few sweets/limiting carbs in one meal to have more in another meal) and tested
their glucose once a day. Poor control patients were more likely to skip
antidiabetic medications and not test their glucose.
CONCLUSIONS: Although clinical trials indicate most self-management practices
have limited effectiveness over time, increased glucose monitoring is a valuable
component in daily management. Research is needed on effectiveness of dietary
strategies that emphasize sodium monitoring and allow some degree of cheating.
Reoffering diabetes education classes and providing pill boxes as memory aids may
help improve poor control.
DOI: 10.1136/bmjdrc-2016-000349
PMCID: PMC5530238
PMID: 28761649

1431. J Pediatr Health Care. 2014 Nov-Dec;28(6):478-85. doi:
10.1016/j.pedhc.2014.02.008. Epub 2014 Apr 27.
Development of a positive psychology intervention to improve adherence in

adolescents with type 1 diabetes.
Jaser SS, Patel N, Linsky R, Whittemore R.
INTRODUCTION: Novel interventions are needed to improve adherence to treatment in

adolescents with type 1 diabetes. In this article, we describe the development,
feasibility, and acceptability of a positive psychology intervention for this
population.
METHOD: Adolescents and their parents (n = 39) were randomly assigned to either a
positive psychology intervention or an attention control group. Quantitative and
qualitative data were collected on feasibility and acceptability. Descriptive and
content analysis methods were used.
RESULTS: Recruitment was successful, participation and satisfaction were high in
both groups, and retention was excellent over 6 months. In the positive
psychology group, adolescents and their parents noted benefits related to
increased positive communication and thinking more about diabetes care. We also
identified challenges to implementation.
DISCUSSION: Although more research is indicated, a positive psychology framework
emphasizing positive emotions and strengths, rather than problems, may be
beneficial to adolescents living with a complex chronic illness.

DOI: 10.1016/j.pedhc.2014.02.008
PMCID: PMC4273905
1432. Qual Health Res. 2018 Oct;28(12):1839-1857. doi: 10.1177/1049732318784883.

Epub
2018 Jul 21.
"Patients Are Not Following the [Adherence] Club Rules Anymore": A Realist Case
Study of the Antiretroviral Treatment Adherence Club, South Africa.
Mukumbang FC(1)(2), Marchal B(1)(2), Van Belle S(2), van Wyk B(1).
Author information:
(1)1 University of the Western Cape, Bellville, South Africa.
(2)2 The Institute of Tropical Medicine, Antwerp, Belgium.
There is growing evidence that differentiated care models employed to manage

treatment-experienced patients on antiretroviral therapy could improve adherence
to medication and retention in care. We conducted a realist evaluation to
determine how, why, for whom, and under what health system context the adherence
club intervention works (or not) in real-life implementation. In the first phase,
we developed an initial program theory of the adherence club intervention. In
this study, we report on an explanatory theory-testing case study to test the
initial theory. We conducted a retrospective cohort analysis and an explanatory
qualitative study to gain insights into the important mechanisms activated by the
adherence club intervention and the relevant context conditions that trigger the
different mechanisms to achieve the observed outcomes. This study identified
potential mitigating circumstances under which the adherence club program could
be implemented, which could inform the rollout and implementation of the
adherence club intervention.
DOI: 10.1177/1049732318784883
PMCID: PMC6154254
1433. Heart Lung. 2016 Jan-Feb;45(1):70-8. doi: 10.1016/j.hrtlng.2015.11.002.
Changes in clinical conversations when providers are informed of asthma patients'

beliefs about medication use and integrative medical therapies.
George M(1), Abboud S(2), Pantalon MV(3), Sommers ML(2), Mao J(4), Rand C(5).
Author information:
(1)Columbia University School of Nursing, USA. Electronic address:
mg3656@cumc.columbia.edu.
(2)University of Pennsylvania School of Nursing, USA.
(3)Department of Psychiatry, School of Medicine, Yale University, USA; Department
of Emergency Medicine, School of Medicine, Yale University, USA.
(4)University of Pennsylvania, Perelman School of Medicine, USA.
(5)Johns Hopkins University School of Medicine, USA.
OBJECTIVES: To explore whether patient's personal beliefs about inhaled

corticosteroid (ICS) and integrative medicine (IM) are discussed at routine
primary care visits for asthma.
BACKGROUND: Negative medication beliefs and preferences for IM can be salient
barriers to effective asthma self-management.
METHOD: A qualitative analysis of transcripts from 33 audio-recorded primary care
visits using conventional content analysis techniques.
RESULTS: Four themes emerged when providers had knowledge of patient's beliefs:
negative ICS beliefs, IM use for asthma, decision-making and healthy lifestyles.
Two themes were identified when providers did not have this knowledge: asthma
self-management and healthy lifestyles.
CONCLUSION: When providers had knowledge of their patient's IM endorsement or
negative ICS beliefs, they initiated conversations about these modifiable
beliefs. Without training in IM and in effective communication techniques, it is
unlikely that providers will be able to effectively engage in shared
decision-making aimed at improving asthma self-management.
DOI: 10.1016/j.hrtlng.2015.11.002
PMCID: PMC4691278
1434. BMC Psychiatry. 2014 Sep 24;14:273. doi: 10.1186/s12888-014-0273-0.
Clinical predictors associated with full remission versus episode of major

depressive disorder outpatients: the experience at a teaching hospital in Taiwan.
Yeh MY, Lee Y, Sung SC, Tung TH.
BACKGROUND: When depressed patients are in remission, the clinical

characteristics indicate that they are able to participate in social activities
more regularly, and their impairment in daily functioning is improved. The
present study examines the clinical characteristics associated with one- and two
month clinical response in outpatients with Major Depressive Disorder (MDD) in
Taiwan.
METHODS: A total of 160 outpatients were initially recruited from the medical
centre in Taiwan. Of these participants, 151 MDD patients completed the
baseline-assessment interview, 111 were interviewed and assessed again 4 weeks
later, and 78 completed the final interview and assessment 8 weeks later. In the
present study, asymptomatic was defined as scoring ≤ 7 on the Hamilton Depression
Rating Scale (HAM-D); partially symptomatic was defined as scoring 8-14; fully
symptomatic was defined as scoring ≥15. Finally, asymptomatic, partially
symptomatic, and fully symptomatic were defined in patients with MDD respectively
as in full remission, in persistent depressive symptom, and in episode.
RESULTS: Of the remaining 78 patients, a total of 21 (26.9%) were in full
remission, 35 (44.9%) were in persistent depressive symptom, and 22 (28.2%) were
in episode. Patients in full remission were older (p = 0.03), exhibited greater
psychosocial functioning, (p < 0.001), held more-positive beliefs regarding
antidepressant medication (p = 0.03), had higher self-efficacy (p = 0.001), and
scored lower for neuroticism (p = 0.003), as compared to patients in episode.
Younger patients were more prevalent in persistent depression. Repeated-measures
ANOVA revealed that differences in four factors (psychosocial functioning,
beliefs regarding antidepressant medication, self-efficacy in managing and
preventing depression, and neuroticism) were significantly different between full
remission and episode. Episode was significantly associated with
psychosocial-functioning impairment (OR = 1.12, 95% CI: 1.00-1.26) and poorer
self-efficacy (OR = 0.91, 95% CI: 0.82-1.00).
CONCLUSIONS: Our findings identify significant factors of full remission,
persistent depressive symptom, and episode. We highlight the importance of
enhancing patients' psychosocial functioning and self-efficacy until achieving
full remission. Suggestions are provided for clinical health-care management
services in Taiwan.
DOI: 10.1186/s12888-014-0273-0
PMCID: PMC4189597
1435. AIDS Behav. 2015 May;19(5):758-69. doi: 10.1007/s10461-014-0891-z.
Factors Associated with Adherence and Concordance Between Measurement Strategies

in an HIV Daily Oral Tenofovir/Emtricitibine as Pre-exposure Prophylaxis (Prep)
Clinical Trial, Botswana, 2007-2010.
Kebaabetswe PM(1), Stirratt MJ, McLellan-Lemal E, Henderson FL, Gray SC, Rose CE,
Williams T, Paxton LA.
Author information:
(1)HIV Prevention Research Unit, CDC Botswana, Gaborone, Botswana,
poloko.kebaabetswe@mopipi.ub.bw.
This study examined study product adherence and its determinants in the Botswana
oral pre-exposure prophylaxis efficacy trial. Among the 1,219 participants, the
mean adherence by pill count and 3-day self-report was 94 % for each. In
multivariable models, pill count adherence was significantly associated with
adverse events (nausea, dizziness, vomiting) (RR 0.98 95 % CI 0.98-1.00; p =
0.03) and side effect concerns (RR 0.98 95 % CI 0.96-0.99; p = 0.01).
Self-reported adherence was significantly associated with having an HIV-positive
partner (RR 1.02 95 % CI 1.00-1.04; p = 0.02) and Francistown residence (RR 0.98
95 % CI 0.96, 0.99; p = 0.0001). Detectable drug concentrations showed modest
associations with self-report and pill count adherence, and drug levels were
higher among those self-reporting 100 % adherence than those reporting <100 %.
Most common adherence barriers involved refill delays and other logistic
challenges; cellphone alarm reminder use was the most common facilitator.
DOI: 10.1007/s10461-014-0891-z
PMCID: PMC4586059
1436. J Asthma. 2019 Feb;56(2):218-226. doi: 10.1080/02770903.2018.1443467. Epub

2018
Mar 15.
Evaluating the implementation of a multicomponent asthma education program for

Head Start staff.
Ruvalcaba E(1), Chung SE(1), Rand C(1), Riekert KA(1), Eakin M(1).
Author information:
(1)a Division of Pulmonary and Critical Care Medicine , Johns Hopkins School of
Medicine , Baltimore , MD , USA.
OBJECTIVE: Asthma disproportionately affects minority groups, low income

populations, and young children under 5. Head Start (HS) programs predominantly
serve this high-risk population, yet staff are not trained on asthma management.
The objective of this study was to assess a 5-year, multicomponent HS staff
asthma education program in Baltimore City HS programs.
METHODS: All HS programs were offered annual staff asthma education by a medical
research team that included didactic lectures and hands-on training. Attendees
received continuing education credits. HS staff were anonymously surveyed on
asthma knowledge and skills and asthma medication management practices in Year 1
(preimplementation) and Year 5.
RESULTS: There was an estimated response rate of 94% for Year 1 and 82% for Year
5. Compared to staff in Year 1, Year 5 staff were significantly more likely to
report they had very good knowledge and skills related to asthma [odds ratio (OR)
1.63; p < 0.05] and were engaged in asthma care activities (OR 2.02; p < 0.05).
Self-reported presence of asthma action plans for all children with asthma was
82% at Year 1 and increased to 89% in Year 5 (p = 0.064).
CONCLUSIONS: Year 5 HS staff reported higher self-assessed knowledge and skills,
self-reports of asthma medication management practices, and self-reports of
asthma activities compared to Year 1 staff. HS serves high-risk children with
asthma, and a multicomponent program can adequately prepare staff to manage
asthma in the child care setting. Our results indicate the feasibility of
providing efficacious health skill education into child care provider training to
reduce asthma knowledge gaps.
DOI: 10.1080/02770903.2018.1443467
PMCID: PMC6139065
PMID: 29543493
1437. BMC Res Notes. 2019 Aug 6;12(1):489. doi: 10.1186/s13104-019-4502-y.
Self-care practices and associated factors among adult hypertensive patients in

Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, 2018.
Gebremichael GB(1), Berhe KK(2), Beyene BG(2), Gebrekidan KB(2).
Author information:
(1)School of Nursing College of Health Science, Mekelle Univesity, Mekelle,
Tigray, Ethiopia. Neverimpossible12@yahoo.com.
(2)School of Nursing College of Health Science, Mekelle Univesity, Mekelle,
Tigray, Ethiopia.
OBJECTIVES: To assess self-care practices and associated factors among

hypertensive patients in Ayder Comprehensive Specialized Hospital 2017/2018.
RESULT: Good self-care practice was found only among 20.3% of respondents.
Adherence to not smoking, anti-hypertensive medication, alcohol abstinence,
dietary management, physical exercise and weight management was found to be
99.1%, 74.10%, 67.20%, 63.10%, 49.4% and 40.6% respectively. Sex (AOR = 2.254,
95% CI 1.092-4.653), age (AOR = 3.265, 95% CI 1.030-10.355), educational status
(AOR = 4.205, 95% CI 1.304-13.559), disease duration (AOR = 3.124, 95% CI
1.204-8.105), BP status (AOR = 2.728, 95% CI 1.256-5.926) and knowledge
(AOR = 6.196, 95% CI 2.906-13.214) showed significant statistical association
with self-care practice.
DOI: 10.1186/s13104-019-4502-y
PMCID: PMC6685278
PMID: 31387617
1438. Am J Prev Med. 2015 Dec;49(6):832-41. doi: 10.1016/j.amepre.2015.04.016. Epub

2015 Jul 29.
Telephone Intervention to Improve Diabetes Control: A Randomized Trial in the New

York City A1c Registry.
Chamany S(1), Walker EA(2), Schechter CB(3), Gonzalez JS(4), Davis NJ(5), Ortega
FM(1), Carrasco J(6), Basch CE(7), Silver LD(8).
Author information:
(1)New York City Department of Health and Mental Hygiene, New York, New York.
(2)Albert Einstein College of Medicine, Bronx, New York. Electronic address:
Elizabeth.Walker@einstein.yu.edu.
(3)Albert Einstein College of Medicine, Bronx, New York.
(4)Albert Einstein College of Medicine, Bronx, New York; Ferkauf Graduate School
of Psychology, Yeshiva University, Bronx, New York.
(5)Albert Einstein College of Medicine, Bronx, New York; North Bronx Healthcare
Network, Bronx, New York.
(6)Montefiore Medical Center, Bronx, New York.
(7)Teachers College, Columbia University, New York, New York;
(8)Public Health Institute, Oakland, California.
INTRODUCTION: Scalable self-management interventions are necessary to address

suboptimal diabetes control, especially among minority populations. The study
tested the effectiveness of a telephone behavioral intervention in improving
glycemic control among adults with diabetes in the New York City A1c Registry.
DESIGN: RCT comparing a telephone intervention to print-only intervention in the
context of the A1c Registry program.
SETTING/PARTICIPANTS: Nine hundred forty-one adults with diabetes and hemoglobin
A1c (A1c) >7% from a low-income, predominantly Latino population in the South
Bronx were recruited from the A1c Registry.
INTERVENTION: All study participants were mailed print diabetes self-management
materials at baseline and modest lifestyle incentives quarterly. Only the
telephone participants received four calls from health educators evenly spaced
over 1 year if baseline A1c was >7%-9%, or eight calls if baseline A1c was >9%.
Medication adherence was the main behavioral focus and, secondarily, nutrition
and exercise.
MAIN OUTCOME MEASURES: Primary outcome was difference between two study arms in
change in A1c from baseline to 1 year. Secondary outcomes included diabetes
self-care activities, including self-reported medication adherence. Data were
collected in 2008-2012 and analyzed in 2012-2014.
RESULTS: Participants were predominantly Latino (67.7%) or non-Latino black
(28%), with 69.7% foreign-born and 55.1% Spanish-speaking. Among 694 (74%)
participants with follow-up A1c, mean A1c decreased by 0.9 (SD=0.1) among the
telephone group compared with 0.5 (SD=0.1) among the print-only group, a
difference of 0.4 (95% CI=0.09, 0.74, p=0.01). The intervention had significant
effect when baseline A1c was >9%. Both groups experienced similar improvements in
self-care activities, medication adherence, and intensification.
CONCLUSIONS: A telephone intervention delivered by health educators can be a
clinically effective tool to improve diabetes control in diverse populations,
specifically for those with worse metabolic control identified using a registry.
This public health approach could be adopted by health systems supported by
electronic record capabilities. CLINICALTRIALS.
GOV REGISTRATION: NCT00797888.
Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier

Inc. All rights reserved.
DOI: 10.1016/j.amepre.2015.04.016
PMCID: PMC4656092
1439. Eur J Ageing. 2016 Apr 2;13(2):185-193. doi: 10.1007/s10433-016-0369-0.

How aging affects self-reports.
Knäuper B(1), Carrière K(1), Chamandy M(2), Xu Z(1), Schwarz N(3), Rosen NO(4).
Author information:
(1)Department of Psychology, McGill University, Montreal, Canada.
(2)School of Psychology, University of Ottawa, Ottawa, Canada.
(3)Department of Psychology, University of Southern California, Los Angeles, CA
USA.
(4)Department of Psychology and Neuroscience, Dalhousie University, Halifax,
Canada.
A lot of information used in aging research relies on self-reports. Surveys or

questionnaires are used to assess quality of life, attitudes toward aging,
experiences of aging, subjective well-being, symptomatology, health behaviors,
financial information, medication adherence, etc. Growing evidence suggests that
older and younger respondents are differentially affected by questionnaire
features and the cognitive tasks that question answering pose. This research has
shown that age-related changes in cognitive and communicative functioning can
lead to age-related differences in self-reports that are erroneously interpreted
as real age differences in attitudes and behaviors. The current review highlights
how the processes underlying respondents' self-report change as a function of
respondents' age; it updates our previous reviews of this literature.
DOI: 10.1007/s10433-016-0369-0
PMCID: PMC5550601
PMID: 28804377
1440. Arthritis Res Ther. 2018 Jul 11;20(1):143. doi: 10.1186/s13075-018-1633-9.

Gout prevalence and predictors of urate-lowering therapy use: results from a
Pisaniello HL(1), Lester S(2)(3), Gonzalez-Chica D(4), Stocks N(4), Longo M(5),
Sharplin GR(6), Dal Grande E(3), Gill TK(3), Whittle SL(2)(3), Hill CL(2)(3).
Author information:
(1)Department of Rheumatology, The Queen Elizabeth Hospital, Woodville South,
Australia. huaileng@gmail.com.
(2)Department of Rheumatology, The Queen Elizabeth Hospital, Woodville South,
Australia.
(3)Discipline of Medicine, Faculty of Health and Medical Sciences, The University
of Adelaide, Adelaide, Australia.
(4)Discipline of General Practice, Adelaide Medical School, The University of
Adelaide, Adelaide, Australia.
(5)Drug and Alcohol Services South Australia, Stepney, Australia.
(6)Behavioural Research and Evaluation Unit, Cancer Council South Australia,
Eastwood, Australia.
BACKGROUND: Gout has an increasing global prevalence. Underutilization of

urate-lowering therapy (ULT) is thought to be common, via both suboptimal dosing
and poor medication adherence. The aims of this study were to determine the
prevalence of self-reported gout and the key predictors of ULT use in those with
gout in a representative population survey in South Australia.
METHODS: Data were obtained from the Spring 2015 South Australian Health Omnibus
Survey, a multilevel, systematic, survey in a representative population sample
involving face-to-face interviews (n = 3005). This study analyzed responses from
respondents aged ≥ 25 years (n = 2531) about self-reported gout, ULT use,
sociodemographic factors, lifestyle factors, and comorbidities, using survey
weighting. Univariate and subsequent adjusted logistic regression analyses on
self-reported gout were performed. ULT use was divided into three categories
(never use, prior use, and current use) and these data were analyzed using a
multinomial logistic regression model.
RESULTS: Self-reported gout prevalence was 6.8% (95% CI 5.8, 7.9). The mean age
of respondents with gout was 64 years (standard deviation 16) and 82% were male.
As expected, older age, male gender, lower socioeconomic status (SES), and higher
body mass index (BMI) were associated with gout, as were high alcohol
consumption, current smoking, other forms of arthritis, and hypertension or
hypercholesterolemia medication, after adjustment for sociodemographic variables.
Two thirds of respondents with gout reported ULT use (36% current; 29% previous)
with only 55% continuing treatment. Predictors of ULT use included male gender,
low SES, and concomitant cholesterol-lowering therapy. Respondents with gout with
a higher BMI were more likely to remain on ULT.
CONCLUSIONS: Despite gout being a common, potentially disabling joint disease,
only 55% of respondents with gout in this study adhered to ULT. Identification of
key predictors of ULT use will provide guidance on prescribing strategy in
clinical practice and on the quality of gout care in the community.
DOI: 10.1186/s13075-018-1633-9
PMCID: PMC6042461
1441. AIDS Patient Care STDS. 2016 Jun;30(6):261-73. doi: 10.1089/apc.2016.0031.

Epub
2016 May 23.
Life Lessons from Women with HIV: Mutuality, Self-Awareness, and Self-Efficacy.
Brody LR(1), Jack DC(2), Bruck-Segal DL(1), Ruffing EG(1), Firpo-Perretti YM(1),
Dale SK(3), Weber KM(4), Cohen MH(5).
Author information:
(1)1 Department of Psychological and Brain Sciences, Boston University , Boston,
Massachusetts.
(2)2 Fairhaven College of Interdisciplinary Studies, Western Washington
University , Bellingham, Washington.
(3)3 Behavioral Medicine Service, Massachusetts General Hospital , Boston,
Massachusetts.
(4)4 Cook County Health and Hospitals System, Hektoen Institute of Medicine ,
Chicago, Illinois.
(5)5 Department of Medicine, Stroger Hospital , Cook County Health & Hospitals
System, and Rush University, Chicago, Illinois.
Women with HIV in the United States cope with multiple traumas that influence
adherence to antiretroviral therapy (ART) and well-being. Narrative themes from
three life turning points and a projective story task were compared for two
groups of women with HIV (HIV well-managed vs. HIV not well-managed, matched on
demographics and narrative word count) to understand predictors of successful
outcomes. The well-managed group (n = 10) was virally suppressed and reported
≥95% ART adherence; the not well-managed group (n = 10) had detectable viral load
and reported <95% ART adherence. Women were predominantly African American with
low socioeconomic status and averaged 46.51 years. A three-stage coding process
(with coders blind to group status in stages 1 and 2) involved (1) line by line
thematic analyses that generated 155 subthemes reflecting six content areas
(interpersonal relationships; culture and community; sense of self; relationship
to past, present, and future experiences; self-care; and motivators for change);
(2) absence/presence of the 155 subthemes was compared for the two groups; the
frequency of 37 subthemes was found to significantly differ; and (3) the 37
differentiating subthemes were conceptually integrated, revealing that the
well-managed group's narratives more frequently reflected (a) mutuality
(growth-fostering relationships involving reciprocal care and empathy); (b)
self-awareness (recognition of personal strengths and weaknesses and multiple
factors contributing to life choices and trajectories); and (c) self-efficacy
(active coping, self-advocacy, and utilizing resources). Implications for
treatment and interconnections among themes are discussed, emphasizing the
factors that enable women to care for themselves and others.
DOI: 10.1089/apc.2016.0031
PMCID: PMC4913488
1442. Ethn Dis. 2016 Jan 21;26(1):51-60. doi: 10.18865/ed.26.1.51.
Results from the Trial Using Motivational Interviewing, Positive Affect, and
Self-Affirmation in African Americans with Hypertension (TRIUMPH).
Boutin-Foster C(1), Offidani E(1), Kanna B(2), Ogedegbe G(2), Ravenell J(3),
Scott E(4), Rodriguez A(1), Ramos R(1), Michelen W(2), Gerber LM(5), Charlson
M(1).
Author information:
(1)Weill Cornell Medical College, Department of Medicine.
(2)Lincoln Medical Center, Department of Administration.
(3)New York University School of Medicine, Department of Population Health.
(4)New York University Langone Medical Center.
(5)Weill Cornell Medical College, Department of Healthcare Policy and Research.
OBJECTIVE: Our objective was to determine the effectiveness of combining positive
affect and self-affirmation strategies with motivational interviewing in
achieving blood pressure control among hypertensive African Americans (AA)
compared with AA hypertensives in an education-only control group.
DESIGN: Randomized trial.
SETTING: Ambulatory practices in the South Bronx and Harlem, New York City.
PARTICIPANTS: African American adults with uncontrolled hypertension.
INTERVENTIONS: Participants were randomized to a positive affect and
self-affirmation intervention or an education control group. The positive affect
and self-affirmation intervention involved having participants think about things
that made them happy and that reminded them of their core values on a daily
basis. These strategies were reinforced every two months through motivational
interviewing. The control arm received a workbook of strategies on blood pressure
control. All participants were called every two months for one year.
MAIN OUTCOMES: Blood pressure control rate.
RESULTS: A total of 238 participants were randomized. The average age was 56 ± 11
years, approximately 70% were female, 80% were not married, and up to 70% had
completed high school. There was no difference in control rates between the
intervention and the control group. However, at one year, female participants
were more likely to be controlled. Participants with high depressive symptoms or
high perceived stress at baseline were less likely to be controlled.
CONCLUSIONS: While this study did not demonstrate an intervention effect, it does
provide important insight into the psychosocial factors that may underlie blood
pressure control in African Americans. Implications for future behavioral
intervention trials are discussed.
DOI: 10.18865/ed.26.1.51
PMCID: PMC4738855
1443. Int J Environ Res Public Health. 2018 Oct 29;15(11). pii: E2403. doi:
10.3390/ijerph15112403.
Smartphone Applications for Encouraging Asthma Self-Management in Adolescents: A

Systematic Review.
Alquran A(1), Lambert KA(2), Farouque A(3), Holland A(4), Davies J(5), Lampugnani
ER(6), Erbas B(7).
Author information:
(1)School of Public Health, College of Science Health and Engineering, La Trobe
University, Bundoora 3083, Victoria, Australia. alaalmahmoud7@gmail.com.
University, Bundoora 3083, Victoria, Australia. k.lambert@latrobe.edu.au.
University, Bundoora 3083, Victoria, Australia. amber.farouque@gmail.com.
(4)Alfred Health Clinical School, Department of Rehabilitation, Nutrition and
Sport, School of Allied Health, College of Science Health and Engineering, La
Trobe University, Bundoora 3083, Victoria, Australia. A.Holland@latrobe.edu.au.
(5)Faculty of Health, School-Biomedical Sciences, Queensland University of
Technology, Brisbane 4000, Queensland, Australia. j36.davies@qut.edu.au.
(6)School of Biosciences, the University of Melbourne, Melbourne 3010, Australia.
edwin.lampugnani@unimelb.edu.au.
University, Bundoora 3083, Victoria, Australia. b.erbas@latrobe.edu.au.
Adolescent asthma is still a major problem with poor adherence to treatment.

Globally, adolescents are devoted users of smartphone technologies and app use in
asthma self-management may improve adherence. The objective of this systematic
review is to assess the feasibility and efficacy of mobile technology in
improving asthma outcomes in adolescents. We conducted an extensive review of the
peer-review literature of studies with populations consisting of children and
adolescents under 18 years in seven bibliographic databases and Google Scholar.
All study designs were considered. Quality assessment of included studies were
independently assessed and reported. The search identified 291 articles; of the
16 eligible full-text papers, 8 met the review criteria, reporting two
interventional, two qualitative and four observational studies. Samples ranged
from 12 to 21 participants. Heterogeneity related to study design and the methods
of the included studies prevented meta-analysis. Nevertheless, the intervention
studies reported a positive effect of smartphone apps on asthma control,
medication adherence and self-efficacy. Smartphone apps may be an effective
asthma control tool especially among adolescents who are major users of
smartphones; however, conclusions are limited by a lack of controlled trials and
adequate sample sizes.
DOI: 10.3390/ijerph15112403
PMCID: PMC6266660
1444. Eur J Hosp Pharm. 2017 Jan;24(1):58-62. doi: 10.1136/ejhpharm-2016-001008.

Epub
2016 Aug 19.
Deprescribing and managing polypharmacy in frail older people: a patient-centred

approach in the real world.
Oboh L(1), Qadir MS(1).
Author information:
(1)Department of Pharmacy, Guys and St Thomas NHS Foundation Trust, London, UK.
Polypharmacy is common in people with multiple long-term conditions (LTC) to

relieve symptoms and improve quality of life. However, it is also associated with
poor outcomes and increased risk of adverse drug events in older people. Older
people are seldom involved in therapeutic research, and when the results are
applied to those with multiple LTCs, it can increase pill burden and adverse
events without necessarily replicating the expected positive outcomes. This
article describes a pharmacist-led, patient-centred approach to deprescribing in
a 73-year-old diabetic man taking multiple medication, with gastrointestinal (GI)
and pain symptoms as well as poor adherence to medicines. The approach considered
his perspective and experience of taking his many medicines into account while
using the best available research evidence and the clinician's experience. After
six visits over 8 weeks, the patient was more involved with self-managing his
diabetes, his pain and GI symptoms improved and overall pill burden was reduced.
DOI: 10.1136/ejhpharm-2016-001008
PMCID: PMC6451457
PMID: 31156900
1445. J Adv Pract Oncol. 2017 Sep-Oct;8(6):575-580. Epub 2017 Sep 1.
Assessing the Plain Language Planner for Communication About Common Palliative
Care Medications.
Wittenberg E(1), Ferrell B(2), Goldsmith J(3).
Author information:
(1)Communication Studies, California State University, Los Angeles, California.
(2)City of Hope National Medical Center, Division of Nursing Research and
Education, Duarte, California.
(3)Department of Communication, University of Memphis, Memphis, Tennessee.
Using plain language to communicate about oncology and palliative care

medications and symptoms is recommended as a communication strategy to address
patient/family health literacy demands. This study tested the Plain Language
Planner©, a provider tool for communicating about medication and symptoms using
plain language. Prior to and immediately following an oncology and palliative
care nurse educational session, participants (n = 87) role-played about a symptom
and medication. Common symptoms (nausea, constipation, and anxiety) and
medications were selected. Self-evaluation and peer evaluation addressing the
extent of plain language used during the role-play were rated. Plain language
characteristics improved post educational role-play sessions for nurses. The
largest improvement in plain language was the inclusion of the brand and generic
names of medication in relating the drug to the symptom. The pocket guide
provided during the educational session was consulted by 86% of nurses during the
postsession role-play. Brief training with the Plain Language Planner may improve
provider communication and meet patient/family health literacy needs. This
resource may be a valuable asset to other health-care disciplines working in
oncology and palliative care contexts.
PMCID: PMC6167079
PMID: 30310720
1446. J Med Syst. 2015 Oct;39(10):116. doi: 10.1007/s10916-015-0298-z. Epub 2015

Aug
19.
An Ambient Intelligence Framework for End-User Service Provisioning in a Hospital

Pharmacy: a Case Study.
Martín D(1), Alcarria R, Sánchez-Picot Á, Robles T.
Author information:
(1)Technical University of Madrid, Av. Complutense 30, 28040, Madrid, Spain,
diego.martin.de.andres@upm.es.
End-user development is a new trend to provide tailored services to dynamic

environments such as hospitals. These services not only facilitate daily work for
pharmacy personnel but also improve self-care in elder people that are still
related to hospital, such as discharged patients. This paper presents an ambient
intelligence (AmI) environment for End-user service provisioning in the pharmacy
department of Gregorio Marañón Hospital in Madrid, composed of a drug
traceability infrastructure (DP-TraIN) and a ubiquitous application for enabling
the pharmacy staff to create and execute their own services for facilitating drug
management and dispensing. The authors carried out a case study with various
experiments where different roles from the pharmacy department of Gregorio
Marañón Hospital were involved in activities such as drug identification,
dispensing and medication administering. The authors analyzed the effort required
to create services by pharmacy staff, the discharged patients' perception of the
AmI environment and the quantifiable benefits in reducing patient waiting time
for drug dispensing.
DOI: 10.1007/s10916-015-0298-z
PMCID: PMC4540754
1447. J Dev Behav Pediatr. 2018 Feb/Mar;39(2):93-100. doi:

10.1097/DBP.0000000000000530.
Caregivers' Priorities and Observed Outcomes of Attention-Deficit Hyperactivity

Disorder Medication for Their Children.
Ross M(1), Nguyen V(1), Bridges JFP(2), Ng X(1), Reeves G(3), Frosch E(4),
dosReis S(1).
Author information:
(1)Department of Pharmaceutical Health Services Research, University of Maryland
School of Pharmacy, Baltimore, MD.
(2)Department of Health Policy and Management, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD.
(3)Department of Psychiatry, Division of Child and Adolescent Psychiatry,
University of Maryland School of Medicine, Baltimore, MD.
(4)Department of Psychiatry, Division of Child and Adolescent Psychiatry, Johns
Hopkins University School of Medicine, Baltimore, MD.
OBJECTIVE: To document variability among caregivers' priorities when considering

medication to treat their Children's attention-deficit hyperactivity disorder
(ADHD) and explore associations between these priorities and medication-related
improvements.
METHODS: Caregivers of children, ages 4 to 14 years, diagnosed with ADHD were
recruited from outpatient clinics and support groups across Maryland. A survey
gathered data on caregiver-reported concerns when considering ADHD medication,
demographic characteristics, and observed and desired improvements in their
child's ADHD. A validated Best-Worst Scaling instrument assessed priorities among
16 concerns when considering ADHD medication. Latent class analysis identified
subgroups with similar ADHD medication concerns. Differences in self-reported
medication-related improvements were examined across subgroups.
RESULTS: The 184 participants (mean = 42 yrs) were primarily the biological
mother, 68% white and 25% black. Their children were mostly male (73%) and using
medication (81%). Overall, the most important ADHD medication concerns were the
child becoming a successful adult (p < 0.0001), school behavior improvements (p <
0.0001), and better grades (p < 0.0001). Others thinking badly of the child was a
significantly less important concern (p < 0.0001). Three subgroups were
identified: short-term outcomes-oriented group (39%), long-term outcomes-oriented
group (37%), and side effects/safety-oriented group (27%). Relative to the other
2 groups, a smaller proportion of the side effects/safety-oriented group desired
these improvements (p < 0.2618).
CONCLUSION: Most caregivers prioritize short- and long-term outcomes when
considering ADHD medication. However, those most concerned with long- or
short-term outcomes tended to desire additional improvements in their child's
ADHD.
DOI: 10.1097/DBP.0000000000000530
PMCID: PMC5863279
eCollection 2018.
Attitudes toward concordance and self-efficacy in decision making: a

cross-sectional study on pharmacist-patient consultations.
Ng YK(1), Shah NM(1), Loong LS(2), Pee LT(3), Hidzir SAM(4), Chong WW(1).
Author information:
(1)Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
(2)Department of Pharmacy, Universiti Kebangsaan Malaysia Medical Centre, Kuala
Lumpur, Malaysia.
(3)Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
(4)Department of Pharmacy, Hospital Sungai Buloh, Selangor, Malaysia.
Purpose: This study investigated patients' and pharmacists' attitudes toward

concordance in a pharmacist-patient consultation and how patients' attitudes
toward concordance relate to their involvement and self-efficacy in decision
making associated with medication use.
Subjects and methods: A cross-sectional study was conducted among patients with
chronic diseases and pharmacists from three public hospitals in Malaysia. The
Revised United States Leeds Attitudes toward Concordance (RUS-LATCon) was used to
measure attitudes toward concordance in both patients and pharmacists. Patients
also rated their perceived level of involvement in decision making and completed
the Decision Self-Efficacy scale. One-way analysis of variance (ANOVA) and
independent t-test were used to determine significant differences between
different subgroups on attitudes toward concordance, and multiple linear
regression was performed to find the predictors of patients' self-efficacy in
decision making.
Results: A total of 389 patients and 93 pharmacists participated in the study.
Pharmacists and patients scored M=3.92 (SD=0.37) and M=3.84 (SD=0.46) on the
RUS-LATCon scale, respectively. Seven items were found to be significantly
different between pharmacists and patients on the subscale level. Patients who
felt fully involved in decision making (M=3.94, SD=0.462) scored significantly
higher on attitudes toward concordance than those who felt partially involved
(M=3.82, SD=0.478) and not involved at all (M=3.68, SD=0.471; p<0.001). Patients
had an average score of 76.7% (SD=14.73%) on the Decision Self-Efficacy scale. In
multiple linear regression analysis, ethnicity, number of medications taken by
patients, patients' perceived level of involvement, and attitudes toward
concordance are significant predictors of patients' self-efficacy in decision
making (p<0.05).
Conclusion: Patients who felt involved in their consultations had more positive
attitudes toward concordance and higher confidence in making an informed
decision. Further study is recommended on interventions involving pharmacists in
supporting patients' involvement in medication-related decision making.
DOI: 10.2147/PPA.S159113
PMCID: PMC5923248
PMID: 29731609

1449. J Diabetes Sci Technol. 2017 Sep;11(5):970-974. doi:

10.1177/1932296817713025.
Epub 2017 Jun 12.
Bolus Insulin Dose Error Distributions Based on Results From Two Clinical Trials
Comparing Blood Glucose Monitoring Systems.
Pardo S(1), Dunne N(1), Simmons DA(1).
Author information:
(1)1 Ascensia Diabetes Care, Parsippany, NJ.
BACKGROUND: In 2 previous clinical trials, fingertip capillary blood samples were

evaluated using prespecified blood glucose monitoring systems (BGMSs) and a
reference YSI glucose analyzer. In post hoc analyses, hypothetical insulin doses
were calculated using these blood glucose measurements; dosing errors were
compared for each trial.
METHOD: For each blood glucose measurement, premeal bolus insulin dosing was
determined for a hypothetical person, assuming a 60-g carbohydrate meal and
100-mg/dL target blood glucose level (adjusting 1/25 insulin sensitivity and 1/15
insulin:carbohydrate ratio inputs to account for BGMS measurement error). Dosing
error was the difference between doses calculated using the BGMS and YSI results.
RESULTS: In Clinical Trial 1, 95% dose error ranges (in units of insulin) were:
CONTOUR®NEXT EZ BGMS (EZ), -0.9 to 0.5; Accu-Chek® Aviva BGMS (ACA), -0.5 to 1.8;
FreeStyle Freedom Lite® BGMS (FFL), -3.2 to -0.3; OneTouch® Ultra®2 BGMS (OTU2),
-4.1 to 0.3; and Truetrack® BGMS (TT), -3.9 to 2.2. In Clinical Trial 2, these
ranges were: CONTOUR®NEXT BGMS (CN), -0.7 to 1.7; Accu-Chek® Aviva Nano BGMS
(ACAN), -1.3 to 1.8; FreeStyle Lite® BGMS (FSL), -5.1 to 0.2; OTU2, -1.9 to 1.2;
OneTouch® Verio® Pro BGMS (OTVP), -1.0 to 1.9; and TT, -5.1 to 1.7. Within each
trial, EZ and CN had statistically significantly smaller insulin dose error
ranges than other BGMSs ( P <0.0001).
CONCLUSIONS: The ranges of insulin dose errors were statistically significantly
smaller with EZ and CN than with all other BGMSs in this post hoc analysis.
Differences in BGMS accuracy could result in clinically important differences in
insulin dosing.
DOI: 10.1177/1932296817713025
PMCID: PMC5950998
1450. J Glaucoma. 2016 Oct;25(10):815-821.
User-centered Design of the eyeGuide: A Tailored Glaucoma Behavior Change

Program.
Killeen OJ(1), MacKenzie C, Heisler M, Resnicow K, Lee PP, Newman-Casey PA.
Author information:
(1)Departments of *Ophthalmology & Visual Sciences §Internal Medicine, University
of Michigan Medical School †School of Public Health ‡School of Social Work,
University of Michigan, Ann Arbor, MI.
PURPOSE: We employed user-centered design to refine a prototype of the eyeGuide,

a novel, tailored behavior change program intended to improve medication
adherence among glaucoma patients.
PATIENTS: Glaucoma patients age 40 years and above prescribed ≥1 glaucoma
medication were included.
METHODS: The eyeGuide consists of tailored educational content and tailored
testimonials in which patients share how they were able to overcome barriers to
improve their medication adherence. A hybrid of semistructured diagnostic and
pretesting interviews were used to refine the content of the eyeGuide. Purposeful
sampling was used to recruit a study population representative of the glaucoma
patient population. Interviews were conducted until thematic saturation was
reached. Interviews were audiorecorded and transcribed verbatim. Three
researchers analyzed the transcripts, generated a codebook, and identified key
themes using NVivo 10.0 to further refine the eyeGuide.
RESULTS: Twenty-one glaucoma patients were interviewed; mean age 72±12.4 years, 5
(24%) African Americans, 9 (43%) with poor self-reported adherence, 10 (47.6%)
age 75 years and above, 10 (47.6%) with poor vision, and 9 (42.9%) women.
Qualitative analysis identified 5 important themes for improving glaucoma
self-management: social support, patient-provider relationship, medication
routine, patients' beliefs about disease and treatment, and eye drop
instillation. All participants expressed satisfaction with in-person delivery of
the eyeGuide and preferred this to a Web-based module. Participant feedback
resulted in revised content.
CONCLUSIONS: User-centered design generated improvements in the eyeGuide that
would not have been possible without patient input. Participants expressed
satisfaction with the tailored content.
DOI: 10.1097/IJG.0000000000000431
PMCID: PMC5067955
1451. J Geriatr Psychiatry Neurol. 2015 Dec;28(4):281-7. doi:

10.1177/0891988715598227.
Epub 2015 Aug 12.
The Association Between Benzodiazepine Use and Depression Outcomes in Older

Veterans.
Leggett A(1), Kavanagh J(2), Zivin K(3), Chiang C(4), Kim HM(5), Kales HC(4).
Author information:
(1)Department of Psychiatry, University of Michigan Medical School, Ann Arbor,
MI, USA leggetta@med.umich.edu.
MI, USA.
MI, USA Department of Veterans Affairs, Center for Clinical Management Research,
Ann Arbor, MI, USA Department of Health Management and Policy, University of
Michigan School of Public Health, Ann Arbor, MI, USA Institute for Social
Research, University of Michigan, Ann Arbor, MI, USA.
MI, USA Department of Veterans Affairs, Center for Clinical Management Research,
Ann Arbor, MI, USA.
(5)Center for Statistical Consultation & Research, University of Michigan, Ann
Arbor, MI, USA Department of Biostatistics, University of Michigan, Ann Arbor,
MI, USA.
Benzodiazepines (BZDs) are commonly prescribed to older adults with depression,

but it is unknown whether they improve antidepressant (AD) adherence or
depressive symptoms. We followed 297 older veterans diagnosed with depression and
provided a new AD medication prospectively for 4 months. Data include validated
self-report measures and VA pharmacy records. At initial assessment, 20.5% of
participants were prescribed a BZD. Those with a BZD prescription at baseline
were significantly more likely than those without to have a personality disorder,
schizophrenia spectrum disorder, or other anxiety disorder, and higher depressive
symptom and anxiety symptom scale scores on average. In adjusted regressions, BZD
use was not significantly associated with AD adherence, any improvement in
depressive symptoms, or a 50% reduction in depressive symptoms. Our results
suggest BZD use concurrent with AD treatment does not significantly improve
depressive outcomes in older veterans.
DOI: 10.1177/0891988715598227
PMCID: PMC4927262
1452. J Am Heart Assoc. 2015 Jan 7;4(1):e001575. doi: 10.1161/JAHA.114.001575.
Self-controlled case-series study to verify the effect of adherence to

Beta-blockers in secondary prevention of myocardial infarction.
Di Bartolomeo S(1), Marino M(1), Guastaroba P(1), Valent F(2), De Palma R(1).
Author information:
(1)Regional Agency for Health and Social Care of Emilia-Romagna/Azienda
Ospedaliero-Universitaria di Udine, Bologna/Udine, Italy (S.D.B., M.M., P.G.,
R.D.P.).
(2)Servizio di Epidemiologia, Direzione Centrale Salute, Integrazione
Sociosanitaria e Politiche Sociali, Regione Autonoma Friuli Venezia Giulia,
Udine, Italy (F.V.).
BACKGROUND: Beta-blockers (BB) are recommended in secondary prevention of acute

myocardial infarction (AMI), but adherence to prescription medication is a
recognized problem. Most literature on the consequences of poor adherence to
prescribed BB is limited by the possibility of "healthy adherer bias" and
better-designed studies have been advocated.
METHODS AND RESULTS: We investigated the association between adherence to BB
prescription and risk of subsequent AMIs using the self-controlled case series
design, which allows improved control of interpersonal confounding, being based
on intrapersonal comparisons. From all the 30 089 patients hospitalized for AMI
in the years 2009-2011 in an Italian region we selected those that suffered
subsequent AMIs at days 31 to 365 from discharge (1328), and then the 1207 that
had at least one BB prescription collected at any of the regional pharmacies.
Using information on prescriptions, each individual's observation time was then
divided into periods exposed or unexposed to BB and the relative AMI incidence
rate ratios (IRR) of BB exposure were estimated by conditional Poisson
regression. The IRR (rate of recurrent AMI in exposed versus unexposed periods)
was 0.79 (95% CI 0.69 to 0.90, P=0.001). Various sensitivity analyses confirmed
the robustness to possible failure of assumptions, ie, considering only first
recurrences (IRR 0.76, 95% CI 0.66 to 0.88, P<0.001), excluding cardiovascular
fatalities (IRR 0.76, 95% CI 0.65 to 0.89, P<0.001), and excluding individuals
with long hospital admissions (IRR 0.60, 95% CI 0.43 to 0.83, P=0.002).
CONCLUSIONS: Adherence to recommended BB therapy was associated with a 20%
reduction of recurrent AMIs, consistently with previous research, but with
decreased concerns about healthy-adherer bias.
by Wiley Blackwell.
DOI: 10.1161/JAHA.114.001575
PMCID: PMC4330079
1453. Addiction. 2017 Apr;112(4):673-682. doi: 10.1111/add.13685. Epub 2016 Dec 12.
How do text-messaging smoking cessation interventions confer benefit? A multiple
mediation analysis of Text2Quit.
Hoeppner BB(1), Hoeppner SS(1), Abroms LC(2).
Author information:
(1)Department of Psychiatry, Massachusetts General Hospital, Harvard Medical
School, Boston, MA, USA.
(2)Department of Prevention and Community Health, Milken Institute School of
Public Health, George Washington University, Washington, DC, USA.
Comment in
Addiction. 2017 Apr;112(4):683-684.
AIMS: To determine the degree to which the observed benefit of Text2Quit was
accounted for by psychosocial mechanisms derived from its quit smoking messaging
versus from the use of extra-programmatic smoking cessation treatments and
services.
DESIGN: Prospective, multiple mediation model of a randomized controlled trial
(RCT).
SETTING: United States nation-wide.
PARTICIPANTS: A total of 409 adult daily smokers participated. Participants were,
on average, 35 years of age, predominantly female (68%), white (79%), lacked a
college degree (70%), had medium nicotine dependence (average Fagerström Nicotine
Dependence Score score of 5.2) and more than half (62%) had made a previous quit
attempt.
INTERVENTION: Adult daily smokers browsing the web for smoking cessation support
(n = 409; recruited 19 May2011-10 July 2012) were randomized to receive smoking
cessation support via Text2Quit versus a smoking cessation material.
MEASUREMENTS: Mediators (i.e. changes in psychosocial constructs of health
behavior change, use of extra-programmatic treatment) were assessed at 1 month
using single-item measures and outcome (i.e. self-reported 7-day point prevalence
abstinence) at 6-month follow-up.
FINDINGS: Mediators accounted for 35% of the effect of Text2Quit on smoking
cessation. Only psychosocial mechanisms had complete mediational paths, with
increases in self-efficacy [b = 0.10 (0.06-0.15)], quitting know-how [b = 0.07
(0.03-0.11)] and the sense that someone cared [b = 0.06 (0.01-0.11)], partially
explaining the conferred benefit of Text2Quit. Use of outside resources,
including treatments promoted explicitly by Text2Quit, i.e. medication [b = 0.001
(-0.01 to 0.01), quitline [b = -0.002 (-0.01 to 0.04)], treatments and resources
not promoted by Text2Quit, i.e. online forums [b = 0.01 (-0.01 to 0.04)] and
self-help materials [b = -0.01 (-0.04 to 0.02)], did not have complete
mediational paths. An interaction effect existed for medication use that
suggested that for participants not using medication, Text2Quit conferred
substantial benefit, but not for participants using medication.
CONCLUSIONS: Text-messaging programs for smoking cessation appear primarily to
confer benefit by promoting improvements in the psychosocial processes related to
quitting rather than through the use of extra-programmatic smoking cessation
treatments and services.
DOI: 10.1111/add.13685
PMCID: PMC6067921
1454. J Smok Cessat. 2018 Sep;13(3):145-153. doi: 10.1017/jsc.2017.18. Epub 2017

Sep
25.
Triple Smoking Cessation Therapy with Varenicline, Nicotine Patch and Nicotine
Lozenge: A Pilot Study to Assess Tolerability, Satisfaction, and End-of-Treatment
Quit Rates.
Berg KM(1)(2)(3), Jorenby DE(2), Baker TB(2), Fiore MC(2).
Author information:
(1)Division of General Internal Medicine, Department of Medicine, University of
Wisconsin School of Medicine and Public Health, 2828 Marshall Ct, Suite 100,
Madison, WI USA 53705.
(2)Center for Tobacco Research and Intervention, University of Wisconsin School
of Medicine and Public Health, 1930 Monroe St, Suite 200, Madison, WI USA 53711.
(3)Primary Care Research Fellowship, Department of Family Medicine and Community
Health, University of Wisconsin School of Medicine and Public Health, 1100
Delaplaine Ct, Madison, WI USA 53715.
Introduction: The majority of attempts to stop smoking end in failure. One way to
improve success may be to explore different combinations of existing cessation
medications.
Aims: This observational study examined "triple therapy" (varenicline + nicotine
patch + nicotine lozenge) in 36 smokers trying to quit.
Methods: A 12-week, observational study exploring tolerability, via adverse
events (AEs) elicited at each of 9 phone assessments. Secondary outcomes included
satisfaction rates, medication changes, and self-reported quit rates at week 12.
Results: 35 of 36 participants reported at least one AE. Insomnia (75%), abnormal
dreams (72%) and nausea (64%) were most common. Most were mild to moderate. No
deaths, hospitalizations, cardiovascular events, or suicidality were reported.
Six participants (17%) decreased the dose of at least one medication, 5 (14%)
decreased the dose then discontinued at least one medication, and 13 (36%)
discontinued at least one medication without trying a lesser dose. Participants
were highly satisfied with their medications, and 58% reported quitting at 12
weeks, with 38% reporting prolonged abstinence.
Conclusion: Despite high rates of AEs and medication changes, high rates of
satisfaction and self-reported quitting, with no serious AEs, were observed with
triple therapy. Additional data on tolerability and efficacy are needed.
Trial Registration: clinicaltrials.gov number NCT02681510.
DOI: 10.1017/jsc.2017.18
PMCID: PMC6277035
PMID: 30524509
Conflict of interest statement: Conflict of Interest Author KMB has no conflicts

of interest, authors DEJ, TBB, and MCF have no conflicts of interest although
have received federal grants in the past 3 years.
1455. J Acquir Immune Defic Syndr. 2018 Jan 1;77(1):64-71. doi:

10.1097/QAI.0000000000001569.
Dating Violence Against HIV-Infected Youth in South Africa: Associations With

Sexual Risk Behavior, Medication Adherence, and Mental Health.
Kidman R(1), Violari A(2).
Author information:
(1)Program in Public Health and Department of Family, Population and Preventative
Medicine, Stony Brook University, Health Sciences Center, Stony Brook, NY.
(2)Perinatal HIV Research Unit, Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, South Africa.
BACKGROUND: As perinatal HIV-infected youth become sexually active, the potential

for onward transmission becomes an increasing concern. In other populations,
intimate partner violence (IPV) is a risk factor for HIV acquisition. We build on
this critical work by studying the role of IPV in facilitating onward
transmission among HIV-infected youth-an important step toward effective
intervention.
SETTING: Soweto, South Africa.
METHODS: Self-report surveys were completed by 129 perinatal HIV-infected female
youth (aged 13-24 years). We calculated the IPV prevalence and used logistic
models to capture the association between IPV and health outcomes known to
facilitate onward HIV transmission (eg, risky sex, poor medication adherence,
depression, and substance abuse).
RESULTS: A fifth of perinatal HIV-infected participants reported physical and/or
sexual IPV in the past year; one-third reported lifetime IPV. Childhood adversity
was common and positively associated with IPV. Past-year physical and/or sexual
IPV was positively correlated with high-risk sex [odds ratio (OR) = 8.96; 95%
confidence interval (CI): 2.78 to 28.90], pregnancy (OR = 6.56; 95% CI: 1.91 to
22.54), poor medication adherence to antiretroviral therapy (OR = 5.37; 95% CI:
1.37 to 21.08), depression (OR = 4.25; 95% CI: 1.64 to 11.00), and substance
abuse (OR = 4.11; 95% CI: 1.42 to 11.86). Neither past-year nor lifetime IPV was
associated with viral load or HIV status disclosure to a partner.
CONCLUSIONS: We find that IPV may increase risk for onward HIV transmission in
perinatal HIV-infected youth by both increasing engagement in risky sexual
behaviors and lowering medication adherence. HIV clinics should consider
integrating primary IPV prevention interventions, instituting routine IPV
screening, and collocating services for victims of violence.
DOI: 10.1097/QAI.0000000000001569
PMCID: PMC5720896
1456. Glob J Health Sci. 2015 Feb 24;7(5):33-42. doi: 10.5539/gjhs.v7n5p33.
Determinants of Self-Care in Diabetic Patients Based on Health Belief Model.
Dehghani-Tafti A, Mazloomy Mahmoodabad SS, Morowatisharifabad MA, Afkhami

Ardakani M, Rezaeipandari H(1), Lotfi MH.
Author information:
(1)Msc in health education, Elderly Health Research Center, Shahid Sadoughi
University of Medical Sciences,Yazd , Iran. hrezaeipandari@yahoo.com.
INTRODUCTION: The aim of this study was to determine self-care predictors in

diabetic patients based on health belief model.
MATERIALS & METHODS: The cross-sectional study was conducted on 110 diabetic
patients referred to health service centers in Ardakan city, Yazd, Iran. The data
was collected by a questionnaire including perceived benefits, barriers,
severity, susceptibility, self-efficacy, social support, self-care behaviors and
demographic variables.
RESULTS: Regularly medicine use (mean=6.48 times per week) and shoes checking
(mean=1.17 times per week) were reported as the highest and the lowest self-care
behaviors respectively. Health belief model constructs including perceived
benefits, barriers, severity, susceptibility, self-efficacy and social support
predicted 33.5% of the observed variance of self-care behaviors. Perceived
susceptibility and self-efficacy had positive effect on self-care behavior;
whereas perceived barrier's has negative effect. Self-efficacy, perceived
susceptibility and barriers were most powerful predictor respectively.
CONCLUSION: The findings approved the efficiency of health belief model in
prediction of self-care behaviors among diabetic patients. The findings realized
the health belief model structure; therefore, it can be used as a framework for
designing and implementing educational interventions in diabetes control plans.
DOI: 10.5539/gjhs.v7n5p33
PMCID: PMC4803867
1457. Glob Adv Health Med. 2019 Jun 13;8:2164956119858034. doi:

10.1177/2164956119858034. eCollection 2019.
Nonpharmacological Self-Management of Migraine Across Social Locations: An

Equity-Oriented, Qualitative Analysis.
Befus DR(1), Hull S(2), Strand de Oliveira J(2), Schmidler GS(3), Weinberger
M(4), Coeytaux RR(5).
Author information:
(1)Arthur Labatt Family School of Nursing, Western University Faculty of Health
Sciences, London, Ontario, Canada.
(2)Department of Community and Family Medicine, Duke University School of
Medicine, Durham, North Carolina.
(3)Department of Population Health Sciences, Duke University School of Medicine,
Durham, North Carolina.
(4)Gillings School of Global Public Health, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina.
(5)Department of Family and Community Medicine, Wake Forest University School of
Medicine, Winston-Salem, North Carolina.
Background: Migraine is a disabling neurological disorder and the sixth biggest

cause of disability worldwide. The World Health Organization has declared
migraine a major public health problem due to a paucity of knowledge about cause
and effective treatment options. Both in incidence and severity, migraine
disproportionately affects people occupying marginalized social locations (SL).
Managed pharmacologically, migraine is treated with daily preventive and
as-needed abortive medications. Both come with high literal and figurative costs:
intolerable side effects, medication interactions, and prohibitive prices. Cost
prohibitive, ineffective, and unsustainable pharmacological treatment options
have contributed to high levels of interest in complementary approaches by people
with migraine, but little is known about their motivations, patterns of use or
access, or how these may vary by SL.
Method: We conducted focus groups with 30 people with migraine to explore their
desires and recommendations for migraine clinicians and researchers. We used
qualitative content analysis to identify themes.Outcomes: We identified 4 themes:
a more holistic, collaborative, long-term treatment approach; medication as a
short-term solution; high personal and economic costs of medication; and desire
for more information and access to natural approaches. Across SL, participants
expressed keen interest in integrative approaches and wanted better access to
complementary modalities. Participants in marginalized SL described reliance on
traditional/folk remedies, including engagement with family and community
healers, who they described as more affordable and culturally accessible.
Conclusions: Holistic and integrative approaches were preferred over medication
as long-term migraine management strategies. However, people in marginalized SL,
while disproportionately disabled by migraine, did not feel as comfortable
accessing integrative approaches through currently available channels. Engaging
with these communities and using a critical lens to explore barriers to access
can develop options to make complementary modalities more approachable, while
also attending to systemic blind spots that may unintentionally alienate socially
marginalized groups.
DOI: 10.1177/2164956119858034
PMCID: PMC6566474
PMID: 31223518

eCollection 2017.
Adherence to Prophylaxis in Adolescents and Young Adults with Severe Haemophilia:

A Quantitative Study with Patients.
van Os SB(1), Troop NA(1), Sullivan KR(1), Hart DP(2)(3).
Author information:
(1)Psychology and Sport Sciences Department, School of Life and Medical Sciences,
University of Hertfordshire, Hatfield, United Kingdom.
(2)The Royal London Hospital Haemophilia Centre, Barts Health NHS Trust, London,
United Kingdom.
(3)Barts and The London School of Medicine and Dentistry, QMUL, London, United
Kingdom.
INTRODUCTION: haemophilia is an inherited bleeding disorder caused by a

deficiency in one of the blood coagulation factors. For people affected by severe
haemophilia, the deficiency can cause spontaneous internal bleeding. Most young
people with severe haemophilia in the UK follow a preventative treatment regimen
(prophylaxis) consisting of several intravenous injections of factor concentrate
each week. There is good evidence that prophylaxis reduces bleeds whilst also
improving quality of life. However, levels of adherence among young people with
haemophilia reported in the existing literature vary widely and are predominately
based on estimations made by healthcare professionals and parents. Additionally,
drivers of (non)adherence among young people specifically have not been
evidenced.
AIM: to assess self-reported adherence among young people with haemophilia,
provide evidence of psychosocial predictors of adherence, and to establish the
associations between non-adherence and number of bleeds and hospital visits.
METHODS: 91 participants were recruited during outpatient appointments in 13
haemophilia centres across England and Wales, and invited to complete a
questionnaire assessing self-reported adherence (VERITAS-Pro),
Haemophilia-related pain and impact of pain, Illness Perceptions, Beliefs about
Medications, Self-efficacy, Outcome expectations, Positive and Negative Affect,
and Social support. Number of hospital visits and bleeds during the previous six
months were collected from medical files.
RESULTS: Of 78 participants with complete data, just 18% had scores indicating
non-adherence. Psychosocial predictors differed between intentional (skipping)
and un-intentional (forgetting) non-adherence. Overall, however, better adherence
was reported where participants perceived the need for prophylaxis was greater
than their concern over taking it as well as having a positive expectancy of its
effectiveness, good social support and a stronger emotional reaction to having
haemophilia.
CONCLUSION: The findings indicate that adherence is generally good, and that
assessing illness and treatment beliefs, social support and outcome expectations
may play a valuable role in identifying which individuals are at risk of
non-adherence. Interventions aimed at improving adherence should particularly
consider improving social support, reducing patients' concerns about prophylaxis,
increasing their belief in the necessity of prophylaxis, and increasing positive
outcome expectations.
PMCID: PMC5245860
Conflict of interest statement: Dr Hart, Dr Troop and Dr van Os are currently

involved in research funded by Baxalta (part of Shire). Dr Hart has received
research support from Bayer (Early Career Investigator Award) and Octapharma;
travel support from Octapharma and honoraria from Baxter, Bayer, Novo Nordisk and
Pfizer. Dr van Os has received travel support and honoraria from Bayer.
1459. AIDS Care. 2015;27(5):649-54. doi: 10.1080/09540121.2014.991269. Epub 2014

Dec
15.
Smoking, internalized heterosexism, and HIV disease management among male

couples.
Gamarel KE(1), Neilands TB, Dilworth SE, Taylor JM, Johnson MO.
Author information:
(1)a Department of Psychiatry and Human Behavior , Alpert Medical School of Brown
University , Providence , RI , USA.
High rates of cigarette smoking have been observed among HIV-positive

individuals. Smoking has been linked to HIV-related medical complications and
non-AIDS defining cancers and negatively impacts on immune function and virologic
control. Although internalized heterosexism has been related to smoking
behaviors, little is known about associations between partners' reports of
smoking, internalized heterosexism, and HIV medication management in male couples
with HIV. A sample of 266 male couples completed baseline assessments for a
cohort study examining relationship factors and HIV treatment. A computer-based
survey assessed self-reported smoking behaviors, alcohol use, internalized
heterosexism, and antiretroviral therapy (ART) adherence. HIV-positive men also
provided blood samples to assess viral load. Approximately 30% of the sample
reported that they are currently smoking cigarettes. After adjusting for
demographic characteristics, men in a primary relationship with a partner who
reported currently smoking had more than five-fold greater odds of reporting
smoking. Higher levels of internalized heterosexism and financial hardship were
each independently associated with greater odds of reporting smoking. Among
HIV-positive men on ART (n = 371), having a partner who reported smoking was
associated with almost three-fold greater odds of having a detectable viral load.
Our findings add new support to the evidence of romantic partners influencing
each other's health behaviors, and demonstrate an association between smoking and
disease management within male couples. Future research should explore the
interpersonal and social contexts of smoking in order to develop interventions
that meet the unique needs of male couples.
DOI: 10.1080/09540121.2014.991269
PMCID: PMC4336592
1460. J Manag Care Spec Pharm. 2017 May 30:1-11. doi: 10.18553/jmcp.2017.17100.
[Epub
ahead of print]
Optimization of Medication Use at Accountable Care Organizations.
Wilks C(1), Krisle E(1), Westrich K(2), Lunner K(1), Muhlestein D(1), Dubois
R(2).
Author information:
(1)1 Leavitt Partners, Salt Lake City, Utah.
(2)2 National Pharmaceutical Council, Washington, DC.
BACKGROUND: Optimized medication use involves the effective use of medications

for better outcomes, improved patient experience, and lower costs. Few studies
systematically gather data on the actions accountable care organizations (ACOs)
have taken to optimize medication use.
OBJECTIVES: To (a) assess how ACOs optimize medication use; (b) establish an
association between efforts to optimize medication use and achievement on
financial and quality metrics; (c) identify organizational factors that correlate
with optimized medication use; and (d) identify barriers to optimized medication
use.
METHODS: This cross-sectional study consisted of a survey and interviews that
gathered information on the perceptions of ACO leadership. The survey contained a
medication practices inventory (MPI) composed of 38 capabilities across 6
functional domains related to optimizing medication use. ACOs completed
self-assessments that included rating each component of the MPI on a scale of 1
to 10. Fisher's exact tests, 2-proportions tests, t-tests, and logistic
regression were used to test for associations between ACO scores on the MPI and
performance on financial and quality metrics, and on ACO descriptive
characteristics.
RESULTS: Of the 847 ACOs that were contacted, 49 provided usable survey data.
These ACOs rated their own system's ability to manage the quality and costs of
optimizing medication use, providing a 64% and 31% affirmative response,
respectively. Three ACOs achieved an overall MPI score of 8 or higher, 45 scored
between 4 and 7.9, and 1 scored between 0 and 3.9. Using the 3 score groups, the
study did not identify a relationship between MPI scores and achievement on
financial or quality benchmarks, ACO provider type, member volume, date of ACO
creation, or the presence of a pharmacist in a leadership position. Barriers to
optimizing medication use relate to reimbursement for pharmacist integration,
lack of health information technology interoperability, lack of data, feasibility
issues, and physician buy-in.
CONCLUSIONS: Compared with 2012 data, data on ACOs that participated in this
study show that they continue to build effective strategies to optimize
medication use. These ACOs struggle with both notification related to
prescription use and measurement of the influence optimized medication use has on
costs and quality outcomes. Compared with the earlier study, these data find that
more ACOs are involving pharmacists directly in care, expanding the use of
generics, electronically transmitting prescriptions, identifying gaps in care and
potential adverse events, and educating patients on therapeutic alternatives.
ACO-level policies that facilitate practices to optimize medication use are
needed. Integrating pharmacists into care, giving both pharmacists and physicians
access to clinical data, obtaining physician buy-in, and measuring the impact of
practices to optimize medication use may improve these practices.
DISCLOSURES: This research was sponsored and funded by the National
Pharmaceutical Council (NPC), an industry funded health policy research group
that is not involved in lobbying or advocacy. Employees of the sponsor
contributed to the research questions, determination of the relevance of the
research questions, and the research design. Specifically, there was involvement
in the survey and interview instruments. They also contributed to some data
interpretation and revision of the manuscript. Leavitt Partners was hired by NPC
to conduct research for this study and also serves a number of health care
clients, including life sciences companies, provider organizations, accountable
care organizations, and payers. Westrich and Dubois are employed by the NPC.
Wilks, Krisle, Lunner, and Muhlestein are employed by Leavitt Partners and did
not receive separate compensation. Study concept and design were contributed by
Krisle, Dubois, and Muhlestein, along with Lunner and Westrich. Krisle and
Muhlestein collected the data, and data interpretation was performed by Wilks,
Krisle, Muhlestein, along with Dubois and Westrich. The manuscript was written
primarily by Wilks, along with Krisle and Muhlestein, and revised by Wilks,
Westrich, Lunner, and Krisle. Preliminary versions of this work were presented at
the following: National Council for Prescription Drug Programs Educational
Summit, November 1, 2016; Academy Health 2016 Annual Research Meeting, June 27,
2016; Accountable Care Learning Collaborative Webinar, June 16, 2016; the 21st
Annual PBMI Drug Benefit Conference, February 29, 2016; National Value-Based
Payment and Pay for Performance Summit, February 17, 2016; National Accountable
Care Congress, November 17, 2015; and American Journal of Managed Care's ACO
Emerging Healthcare Delivery Coalition, Fall 2015 Live Meeting, October 15, 2015.
DOI: 10.18553/jmcp.2017.17100
PMID: 29406837
1461. J Invest Dermatol. 2018 Apr;138(4):785-794. doi: 10.1016/j.jid.2017.11.015.

Epub
2017 Nov 26.
Intentional and Unintentional Medication Non-Adherence in Psoriasis: The Role of

Patients' Medication Beliefs and Habit Strength.
Thorneloe RJ(1), Griffiths CEM(2), Emsley R(3), Ashcroft DM(4), Cordingley L(5);
British Association of Dermatologists Biologic Interventions Register; Psoriasis
Stratification to Optimise Relevant Therapy Study Groups.
Collaborators: Barker J, Benham M, Burden D, Evans I, Griffiths C, Hussain S,

Kirby B, Lawson L, Mason K, McElhone K, Murphy R, Ormerod A, Owen C, Reynolds N,
Smith C, Warren R, Barker J, Barnes M, Burden D, Emsley R, Griffiths C, Payne K,
Reynolds N, Ryder S, Smith C, Stocken D, Warren R.
Author information:
Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre
for Dermatology Research, Manchester Academic Health Science Centre and NIHR
Manchester Biomedical Research Centre, University of Manchester, Manchester, UK.
Electronic address: Rachael.Thorneloe@manchester.ac.uk.
(2)Centre for Dermatology Research, Manchester Academic Health Science Centre and
NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester,
UK; Salford Royal Hospital NHS Foundation Trust, Salford, UK; Division of
Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science
Centre and NIHR Manchester Biomedical Research Centre, University of Manchester,
Manchester, UK.
(3)Centre for Biostatistics, School of Health Sciences, University of Manchester,
Manchester Academic Health Science Centre, Manchester, UK.
Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre
for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science
Centre, University of Manchester, Manchester, UK.
(5)Division of Musculoskeletal and Dermatological Sciences, Manchester Academic
Health Science Centre and NIHR Manchester Biomedical Research Centre, University
of Manchester, Manchester, UK.
Medication non-adherence is a missed opportunity for therapeutic benefit. We
assessed "real-world" levels of self-reported non-adherence to conventional and
biologic systemic therapies used for psoriasis and evaluated psychological and
biomedical factors associated with non-adherence using multivariable analyses.
Latent profile analysis was used to investigate whether patients can be
categorized into groups with similar medication beliefs. Latent profile analysis
categorizes individuals with similar profiles on a set of continuous variables
into discrete groups represented by a categorical latent variable. Eight hundred
and eleven patients enrolled in the British Association of Dermatologists
Biologic Interventions Register were included. Six hundred and seventeen patients
were using a self-administered systemic therapy; 22.4% were classified as
"non-adherent" (12% intentionally and 10.9% unintentionally). Patients using an
oral conventional systemic agent were more likely to be non-adherent compared to
those using etanercept or adalimumab (29.2% vs. 16.4%; P ≤ 0.001). Latent profile
analysis supported a three-group model; all groups held strong beliefs about
their need for systemic therapy but differed in levels of medication concerns.
Group 1 (26.4% of the sample) reported the strongest concerns, followed by Group
2 (61%), with Group 3 (12.6%) reporting the weakest concerns. Group 1 membership
was associated with intentional non-adherence (odds ratio = 2.27, 95% confidence
interval = 1.16-4.47) and weaker medication-taking routine or habit strength was
associated with unintentional non-adherence (odds ratio = 0.92, 95% confidence
interval = 0.89-0.96). Medication beliefs and habit strength are modifiable
targets for strategies to improve adherence in psoriasis.
DOI: 10.1016/j.jid.2017.11.015
PMCID: PMC5869950
1462. J Diabetes. 2015 Nov;7(6):800-8. doi: 10.1111/1753-0407.12238. Epub 2015 Feb

19.
Depression in Chinese patients with type 2 diabetes: associations with

hyperglycemia, hypoglycemia, and poor treatment adherence.
Zhang Y(1)(2), Ting RZ(1)(3), Yang W(4), Jia W(5), Li W(6), Ji L(7), Guo X(8),
Kong AP(1)(3), Wing YK(9), Luk AO(1)(2)(3), Sartorius N(10), Morisky DE(11),
Oldenburg B(12), Weng J(13), Chan JC(1)(2)(3); China Depression in Chinese
Patients with Type 2 Diabetes (DD2) Study Group.
Collaborators: Chan J, Yang W, Jia W, Li W, Ji L, Guo X, Weng J, Xing X, Wing YK,

Sartorius N, Luk A, Zhang Y, Ting R, Ma R, So WY, Kong A, Ozaki R, Nan H, Lam M,
Lam J, Yu M, Zhu Y, Li M, Hou X, Hong J, Zhang J, Zhu Y.
Author information:
(1)Department of Medicine and Therapeutics, The Chinese University of Hong Kong,
The Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
(2)Asia Diabetes Foundation, The Chinese University of Hong Kong, The Prince of
Wales Hospital, Shatin, Hong Kong SAR, China.
(3)Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong
Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
(4)Department of Endocrinology and Metabolism, China-Japan Friendship Hospital,
Beijing, China.
(5)Department of Endocrinology and Metabolism, Shanghai Jiao Tong University
Affiliated Sixth People's Hospital, Shanghai, China.
(6)Department of Endocrinology and Metabolism, Peking Union Medical College
Hospital, Beijing, China.
(7)Department of Endocrinology and Metabolism, Peking University People's
Hospital, Beijing, China.
(8)Department of Endocrinology and Metabolism, Peking University First Hospital,
Beijing, China.
(9)Department of Psychiatry, The Chinese University of Hong Kong, Shatin
Hospital, Shatin, Hong Kong SAR, China.
(10)Association for the Improvement of Mental Health Programmes, Geneva,
Switzerland.
(11)University of California Los Angeles Fielding School of Public Health, Los
Angeles, CA, USA.
(12)School of Population and Global Health, The University of Melbourne,
Melbourne, VIC, Australia.
(13)Department of Endocrinology and Metabolism, The Third Affiliated Hospital of
Sun Yat-Sen University, Guangzhou, China.
Comment in
J Diabetes. 2015 Nov;7(6):777-8.
BACKGROUND: We hypothesize that depression in type 2 diabetes might be associated

with poor glycemic control, in part due to suboptimal self-care. We tested this
hypothesis by examining the associations of depression with clinical and
laboratory findings in a multicenter survey of Chinese type 2 diabetic patients.
METHOD: 2538 patients aged 18-75 years attending hospital-based clinics in four
cities in China underwent detailed clinical-psychological-behavioral assessment
during a 12-month period between 2011 and 2012. Depression was diagnosed if
Patient Health Questionnaire-9 (PHQ-9) score ≥10. Diabetes self-care and
medication adherence were assessed using the Summary of Diabetes Self-care
Activities and the 4-item Morisky medication adherence scale respectively.
RESULTS: In this cross-sectional study (mean age: 56.4 ± 10.5[SD] years, 53%
men), 6.1% (n = 155) had depression. After controlling for study sites, patients
with depression had higher HbA(1c) (7.9 ± 2.0 vs. 7.7 ± 2.0%, P = 0.008) and were
less likely to achieve HbA(1c) goal of <7.0% (36.2% vs 45.6%, P = 0.004) than
those without depression. They were more likely to report hypoglycemia and to
have fewer days of being adherent to their recommended diet, exercise, foot care
and medication. In logistic regression, apart from young age, poor education,
long disease duration, tobacco use, high body mass index, use of insulin,
depression was independently associated with failure to attain HbA(1c) target
(Odds Ratio [OR] = 1.56, 95%CI:1.05-2.32, P = 0.028). The association between
depression and glycemic control became non-significant after inclusion of
adherence to diet, exercise and medication (OR = 1.48, 95% CI 0.99-2.21,
P = 0.058).
CONCLUSION: Depression in type 2 diabetes was closely associated with
hyperglycemia and hypoglycemia, which might be partly mediated through poor
treatment adherence.
© 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley
Publishing Asia Pty Ltd.
DOI: 10.1111/1753-0407.12238
PMCID: PMC4964948
1463. BMC Cancer. 2015 May 19;15:416. doi: 10.1186/s12885-015-1428-1.
Self-management support intervention to control cancer pain in the outpatient

setting: a randomized controlled trial study protocol.
Hochstenbach LM(1), Courtens AM(2), Zwakhalen SM(3)(4), van Kleef M(5)(6), de

Witte LP(7)(8).
Author information:
(1)School for Public Health and Primary Care (CAPHRI), Department of Health
Services Research, Maastricht University, P.O. Box 616, 6200, Maastricht, MD, The
Netherlands. l.hochstenbach@maastrichtuniversity.nl.
(2)Department of Patient and Care, Maastricht University Medical Center, P.O. Box
5800, 6202, Maastricht, AZ, The Netherlands. a.courtens@mumc.nl.
Netherlands. s.zwakhalen@maastrichtuniversity.nl.
(4)School of Health and Social Care, Dept. of Social Work and Health Development,
University of Greenwich, Avery Hill Rd, London, SE9 2UG, UK.
s.zwakhalen@maastrichtuniversity.nl.
(5)Department of Anesthesiology, School for Mental Health and Neuroscience
(MHeNS), Maastricht University Medical Center, P.O. Box 5800, 6202, Maastricht,
AZ, The Netherlands. maarten.van.kleef@mumc.nl.
(6)Department of Anesthesiology, VU University Medical Center, P.O. Box 7057,
1007, Amsterdam, MB, The Netherlands. maarten.van.kleef@mumc.nl.
Netherlands. l.dewitte@maastrichtuniversity.nl.
(8)Research Centre Technology in Care, Zuyd University of Applied Sciences, P.O.
Box 550, 6400, Heerlen, AN, The Netherlands. l.dewitte@maastrichtuniversity.nl.
BACKGROUND: Pain is a prevalent and distressing symptom in patients with cancer,

having an enormous impact on functioning and quality of life. Fragmentation of
care, inadequate pain communication, and reluctance towards pain medication
contribute to difficulties in optimizing outcomes. Integration of patient
self-management and professional care by means of healthcare technology provides
new opportunities in the outpatient setting.
METHODS/DESIGN: This study protocol outlines a two-armed multicenter randomized
controlled trial that compares a technology based multicomponent self-management
support intervention with care as usual and includes an effect, economic and
process evaluation. Patients will be recruited consecutively via the outpatient
oncology clinics and inpatient oncology wards of one academic hospital and one
regional hospital in the south of the Netherlands. Irrespective of the stage of
disease, patients are eligible when they are diagnosed with cancer and have
uncontrolled moderate to severe cancer (treatment) related pain defined as NRS≥4
for more than two weeks. Randomization (1:1) will assign patients to either the
intervention or control group; patients in the intervention group receive
self-management support and patients in the control group receive care as usual.
The intervention will be delivered by registered nurses specialized in pain and
palliative care. Important components include monitoring of pain, adverse effects
and medication as well as graphical feedback, education, and nurse support.
Effect measurements for both groups will be carried out with questionnaires at
baseline (T0), after 4 weeks (T1) and after 12 weeks (T2). Pain intensity and
quality of life are the primary outcomes. Secondary outcomes include
self-efficacy, knowledge, anxiety, depression and pain medication use. The final
questionnaire contains also questions for the economic evaluation that includes
both cost-effectiveness and cost-utility analysis. Data for the process
evaluation will be gathered continuously over the study period and focus on
recruitment, reach, dose delivered and dose received.
DISCUSSION: The proposed study will provide insight into the effectiveness of the
self-management support intervention delivered by nurses to outpatients with
uncontrolled cancer pain. Study findings will be used to empower patients and
health professionals to improve cancer pain control.
TRIAL REGISTRATION: NCT02333968 December 29, 2014.
DOI: 10.1186/s12885-015-1428-1
PMCID: PMC4451734
1464. J Behav Educ. 2014 Dec 1;23(4):421-434. Epub 2014 Sep 6.
Implementation of a self-monitoring application to improve on-task behavior: A

high school pilot study.
Wills HP(1), Mason BA(1).
Author information:
(1)Juniper Gardens Children's Project, University of Kansas, 444 Minnesota Ave,
Kansas City, KS 66101.
Technological innovations offer promise for improving intervention implementation

in secondary, inclusive classrooms. A withdrawal design was employed with two
high school students in order to assess the effectiveness of a
technologically-delivered, self-monitoring intervention in improving on-task
behavior in a science classroom. Two students ages 14 and 15 with diagnoses of
specific learning disability (student 1) and attention deficit hyperactivity
disorder (ADHD: student 2) were selected by case manager referral due to
difficulties with on-task behavior despite long-term administration of
psychostimulant medication. After baseline data were collected, both students
were trained in the use of a self-monitoring application (I-Connect) delivered
via a handheld tablet. On-task prompts were delivered at five min intervals in an
ABAB withdrawal design. The intervention resulted in positive, stable
improvements in the primary dependent variable of on-task behavior for both
students and less clear improvement in the generalization variable of disruptive
behavior.
DOI: 10.1007/s10864-014-9204-x
PMCID: PMC4662407
PMID: 26617453
1465. Prim Care Companion CNS Disord. 2016 Feb 25;18(1). doi: 10.4088/PCC.15m01879.
eCollection 2016.
A Randomized Survey of the Public's Expectancies and Willingness to Participate

in Clinical Trials of Antidepressants Versus Psychotherapy for Depression.
Gaudiano BA(1), Ellenberg SR(1), Schofield CA(2), Rifkin LS(3).
Author information:
(1)Butler Hospital, Providence, Rhode Island; Alpert Medical School of Brown
University, Providence, Rhode Island.
(2)Department of Psychology, Skidmore College, Saratoga Springs, New York.
(3)McLean Hospital/Harvard Medical School, Belmont, Massachusetts.
BACKGROUND: Expectancies and treatment preferences are known to affect the

outcomes of patients enrolled in clinical trials for depression, but there is
little research on their influence when the public is considering participation
in these trials.
METHOD: We conducted an online survey (May 2013) in which participants (N = 615)
were randomly assigned to read hypothetical descriptions of clinical trials for
depression based on 1 of the following study designs: medication versus placebo,
medication versus medication, psychotherapy versus placebo, or psychotherapy
versus psychotherapy. Afterward, individuals rated willingness to participate in
the trial, logic and credibility of the treatments, and expected success and
improvement in symptoms.
RESULTS: There were no differences in expectancies for ratings of credibility and
logic or success and improvement among clinical trial designs. However,
self-reported willingness to participate in the study was rated significantly
higher in the 2 psychotherapy trial designs (active-comparator and
placebo-controlled) compared with the active-comparator medication design (P <
.05). Psychiatric treatment history, general treatment preferences, and
depression severity were positively correlated with willingness to participate
primarily in the active-comparator medication design.
CONCLUSIONS: Consistent with the broader treatment preference literature,
individuals reported a greater willingness to participate in psychotherapy
compared with antidepressant studies. Thus, people's perceptions of different
treatments are likely to influence not only the outcomes of clinical trials for
depression but also decisions to participate in these trials in the first place.
DOI: 10.4088/PCC.15m01879
PMCID: PMC4874763
1466. Indian J Community Med. 2015 Jan-Mar;40(1):33-7. doi: 10.4103/0970-

0218.149267.
Determinants of Patient's Adherence to Hypertension Medications in a Rural

Population of Kancheepuram District in Tamil Nadu, South India.
Venkatachalam J(1), Abrahm SB(1), Singh Z(1), Stalin P(1), Sathya GR(2).
Author information:
(1)Department of Community Medicine, Pondicherry Institute of Medical Sciences,
Kalapet, Pondicherry, India.
(2)Department of Physiology, Pondicherry Institute of Medical Sciences, Kalapet,
Pondicherry, India.
CONTEXT: Non-communicable diseases, no longer a disease of the rich, impose a

great threat in the developing nations due to demographic and epidemiological
transition. This increasing burden of non-communicable diseases and their risk
factors is worrisome. Adherence to hypertension (HT) medication is very important
for improving the quality of life and preventing complications of HT.
AIM: To study the factors determining adherence to HT medication.
SETTINGS AND DESIGN: A community-based cross-sectional study was conducted in a
rural area of Kancheepuram district, Tamil Nadu, with a total population of
around 16,005.
MATERIALS AND METHODS: This study was carried out over a period of 6 months
(February-July) using a pre-structured and validated questionnaire. All eligible
participants were selected by house-to-house survey and individuals not available
on three consecutive visits were excluded from the study. The questionnaire
included information on demographic characteristics, lifestyle habits, adherence
to HT medication, blood pressure, and body mass index (BMI). Caste was classified
based on Tamil Nadu Public Service commission.
STATISTICAL ANALYSIS: Data were entered in MS Excel and analyzed in SPSS version
16. P value <0.05 was considered statistically significant. Ethical
Consideration: Informed verbal consent was obtained prior to data collection. The
patient's adherence to HT medication was assessed using the Morisky 4-Item
Self-Report Measure of Medication-taking Behavior [MMAS-4].
RESULTS: We studied 473 hypertensive patients of which 226 were males and 247
were females. The prevalence of adherence was 24.1% (n = 114) in the study
population. Respondents with regular physical activity, non-smokers and
non-alcoholics were more adherent to HT medication as compared with respondents
with sedentary lifestyle, smoking and alcohol intake (P < 0.005). Based on health
belief model, the respondents who perceived high susceptibility, severity,
benefit had better adherence compared with moderate and low susceptibility,
severity, benefit.
DOI: 10.4103/0970-0218.149267
PMCID: PMC4317978
PMID: 25657510
Prevalence and severity of asthmatic symptoms in Grenadian school children: the

Grenada National Asthma Survey.
Thongkham D(1), Tran J(1), Clunes MT(2), Brahim F(1).
Author information:
(1)Department of Anatomical Sciences, School of Medicine, St. George's
University, Grenada, West Indies.
(2)Department of Physiology and Neuroscience, School of Medicine, St. George's
University, Grenada, West Indies.
OBJECTIVE: The goal of this study was to determine the prevalence of asthma in
school children in the tri-island Caribbean nation of Grenada.
SETTING, PARTICIPANTS AND OUTCOMES: This was a self-report study provided to the
guardians of all primary school children between ages 6 and 7 throughout Grenada,
Carriacou and Petite Martinique in 2013. Of the 2362 surveys provided, 1374 were
returned, resulting in a response rate of 58.2%. Only responders listing
birthdays between 1 January 2006 and 31 December 2007 were included in the
analysis, resulting in 1165 qualifying responders. Asthma diagnosis was based on
previous physician diagnosed asthma and/or self-reported presence of wheeze in
the past 12 months (current wheeze). Severity of asthma, medication usage,
environmental exposures, physician and emergency department visits were compared
among respondents.
RESULTS: The prevalence of wheezing in the past year was 30.5±1.8%, and of these
68.4% were previously diagnosed with asthma. Of the current wheeze participants,
39.9±9.2% reported moderate to severe asthma symptoms and increased exposure to
cigarette smoke, excessive dust, burning brush and landfills. Carriacou and
Petite Martinique, the two smaller islands, had a lower incidence of current
wheeze (14.1±7.7%) and exposure rates to cigarette smoke and burning brush as
compared to the larger, denser island of Grenada. Although 65.7% of respondents
diagnosed with asthma reported taking medication, the number of annual doctor and
emergency department visits were high (2.82 and 0.86, respectively). Respondents
with the most severe asthma symptoms reported the most emergency department
visits with an average of 1.05 visits annually, whereas respondents with moderate
asthma symptoms had the most doctor visits with an average of 3.33 visits
annually.
CONCLUSIONS: This study indicates that the prevalence of childhood asthma in
Grenada is very high and warrants policy consideration in public health and
education to decrease its morbidity.
DOI: 10.1136/bmjopen-2015-008557
PMCID: PMC4611493
1468. J Clin Psychopharmacol. 2015 Apr;35(2):120-7. doi:

10.1097/JCP.0000000000000276.
Offering financial incentives to increase adherence to antipsychotic medication:

the clinician experience.
Highton-Williamson E(1), Barnicot K, Kareem T, Priebe S.
Author information:
(1)From the *Unit of Social and Community Psychiatry, Queen Mary University of
London; †Institute of Psychiatry, Psychology and Neuroscience, King's College
London; and ‡Centre for Mental Health, Imperial College London, London, UK.
Financial incentives for medication adherence in patients with psychotic

disorders are controversial. It is not yet known whether fears expressed by
clinicians are borne out in reality. We aimed to explore community mental health
clinicians' experiences of the consequences of giving patients with psychotic
disorders a financial incentive to take their depot medication. We implemented
descriptive and thematic analyses of semistructured interviews with the
clinicians of patients assigned to receive incentives within a randomized
controlled trial. Fifty-nine clinicians were interviewed with regard to the
effect of the incentives on 73 of the 78 patients allocated to receive incentives
in the trial. Most commonly, the clinicians reported benefits for clinical
management including improved adherence, contact, patient monitoring,
communication, and trust (n = 52). Positive effects on symptoms, insight, or
social functioning were reported for some (n = 33). Less commonly, problems for
patient management were reported (n = 19) such as monetarization of the
therapeutic relationship or negative consequences for the patient (n = 15) such
as increased drug and alcohol use. Where requests for increased money occurred,
they were rapidly resolved. It seems that, in most cases, the clinicians found
that using incentives led to benefits for patient management and for patient
health. However, in 33% of cases, some adverse effects were reported. It remains
unclear whether certain clinical characteristics are associated with increased
risk for adverse effects of financial incentives. The likelihood of benefit
versus the smaller risk for adverse effects should be weighed up when deciding
whether to offer incentives to individual patients.
DOI: 10.1097/JCP.0000000000000276
PMCID: PMC4352071
1469. J Med Educ Curric Dev. 2019 Mar 12;6:2382120519834325. doi:

Expanding Pharmacist and Student Pharmacist Access to

Genetics/Genomics/Pharmacogenomics Competency Education.
Kisor DF(1), Farrell CL(2).
Author information:
(1)Pharmacy and Pharmacogenomics Programs, Manchester University, Fort Wayne, IN,
USA.
(2)Pharmaceutical and Administrative Sciences, Presbyterian College, Clinton, SC,
USA.
Background: As pharmacogenomics (PGx), a component of genetics/genomics and
precision medicine, gains traction in the clinical setting, education of health
care providers and health professions students must be made broadly available to
improve accessibility of such services to patients. As medication experts with
education in pharmacology, pharmacokinetics, and pharmacodynamics, pharmacists
must further their education to include pharmacogenomics. Currently, few
opportunities exist to gain this type of education, and therefore, these services
are not yet broadly available to the public.
Objective: The specific goal of this study was to evaluate pharmacists' and
student pharmacists' self-assessed perception of competence related to genetics,
genomics, and pharmacogenomics as presented via an online "pharmacogenomics
certification program" (PGx program).
Design: The PGx program was delivered online with the content consisting of 3
background lessons and 8 specific drug-gene lessons presented in the context of
pharmacist competency statements. In addition, 11 "video modules" with
competency-related PGx content were included to provide a comprehensive program.
A pre- and post-course survey instrument was used to evaluate the participants'
self-assessed perception of competence related to each of 16 statements.
Results: One hundred thirty-seven (137) individuals enrolled in and completed the
pharmacogenomics certification program. Overall, participants reported
self-perceived improved competency as evidenced by the pre-course survey as
compared with the post-course survey for each of the 16 competency statements
related to genetics/genomics, including pharmacogenomics. Similar results were
observed for the subgroups of student pharmacists (n = 63) and pharmacists
(n = 74).
Future direction: This study showed that dissemination of
genetics/genomics/pharmacogenomics competency statements education can be
accomplished via online delivery. This delivery approach can expand
genetics/genomics/pharmacogenomics content dissemination. The intent is to reach
a broader population of pharmacy students, pharmacists, and other health care
providers and health professions students to potentially advance the availability
of such services, which can improve the safety and efficacy of medication use for
patients.
DOI: 10.1177/2382120519834325
PMCID: PMC6415470
PMID: 30886894
Conflict of interest statement: Declaration of conflicting interests:The

1470. J Assoc Nurses AIDS Care. 2015 Jul-Aug;26(4):308-15. doi:

10.1016/j.jana.2015.01.005. Epub 2015 Jan 30.
Initial Validation of the HIV Treatment Regimen Fatigue Scale for Adults
Prescribed Antiretroviral Therapy.
Claborn KR, Miller MB, Meier E.
Clinical observations have linked antiretroviral nonadherence to treatment

regimen fatigue in persons living with HIV (PLWH). Although nonadherence appears
to be a consequence of treatment regimen fatigue, little is known about the
onset, course, and duration of this construct. Our study developed and evaluated
psychometric properties of a measure of treatment regimen fatigue for PLWH. Based
on a recent review, the concept was hypothesized to reflect decreased motivation,
treatment cynicism, and low self-efficacy to adhere to treatment. Items
comprising these factors were generated based on measures of similar constructs
in the literature. Exploratory factor analyses suggested that a two-factor
solution best fit the data and accounted for 35.8% of the variance. Our study
supported a two-factor model of treatment regimen fatigue consisting of Treatment
Cynicism and Self-Efficacy. The scale provides a new tool to assess treatment
regimen fatigue in PLWH and can be used to inform and improve treatment of HIV.
Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc.

DOI: 10.1016/j.jana.2015.01.005
PMCID: PMC4465914
1471. Health Serv Res. 2017 Aug;52(4):1511-1533. doi: 10.1111/1475-6773.12547. Epub

2016 Aug 25.
Medication Nonadherence: The Role of Cost, Community, and Individual Factors.
Abbass I(1), Revere L(1), Mitchell J(2), Appari A(1).
Author information:
(1)School of Public Health, The University of Texas Health Science Center at
Houston, Houston, TX.
(2)School of Business, University of Houston Clear Lake, League City, TX.
OBJECTIVE: To explain the association of out-of-pocket (OOP) cost,

community-level factors, and individual characteristics on statin therapy
nonadherence.
DATA SOURCES: BlueCross BlueShield of Texas claims data for the period of
2008-2011.
STUDY DESIGN: A retrospective cohort of 49,176 insured patients, aged
18-64 years, with at least one statin refill during 2008-2011 was analyzed. Using
a weighted proportion of days covered ratio, differences between adherent and
nonadherent groups are assessed using chi-squared tests, t-tests, and a clustered
generalized linear model with logit link function.
PRINCIPAL FINDINGS: Statin therapy adherence, measured at 48 percent, is
associated with neighborhood-level socioeconomic factors, including
race/ethnicity, educational attainment, and poverty level. Individual
characteristics influencing adherence include OOP medication cost, gender, age,
comorbid conditions, and total health care utilization.
CONCLUSIONS: This study signifies the importance of OOP costs as a determinant of
adherence to medications, but more interestingly, the results suggest that other
socioeconomic factors, as measured by neighborhood-level variables, have a
greater association on the likelihood of adherence. The results may be of
interest to policy makers, benefit designers, self-insured employers, and
provider organizations.
© Health Research and Educational Trust.
DOI: 10.1111/1475-6773.12547
PMCID: PMC5517674
1472. Prev Med Rep. 2016 Mar 12;3:264-9. doi: 10.1016/j.pmedr.2016.03.009.

eCollection
2016 Jun.
The effects of antihypertensive medications on physical function.
Loprinzi PD(1), Loenneke JP(2).
Author information:
(1)Physical Activity Epidemiology Laboratory, Department of Health, Exercise
Science, and Recreation Management, The University of Mississippi, MS, United
States.
(2)Kevser Ermin Applied Physiology Laboratory, Department of Health, Exercise
Science, and Recreation Management, The University of Mississippi, MS, United
States.
OBJECTIVE: Limited research has examined the effects of antihypertensive

medication use and physical function. These studies provided mixed findings while
employing a convenience sample and limiting their examination to few indices of
physical function and few classes of antihypertensive medications. The purpose of
this study was to examine whether several antihypertensive medication classes
were associated with several measures of physical function in a national sample
of U.S. middle-to-older age adults.
METHODS: Data from the 1999-2002 and 2011-2012 NHANES were used. Antihypertensive
medication use was assessed from an interviewer, and included angiotensin
converting enzyme (ACE) inhibitors, peripherally-acting antiadrenergic agents and
centrally-acting antiadrenergic agents. Physical function-related parameters
included objectively-measured lower extremity isokinetic knee extensor strength
(IKES), objectively-measured grip strength, laboratory-assessed walking
performance (8 and 20 ft walk tests) and self-reported physical activity
engagement.
RESULTS: Those on ACE inhibitors had a 37% reduced odds (OR = 0.63, 95% CI:
0.48-0.83, P = .002) of engaging in moderate-to-vigorous physical activity, had
reduced knee extensor strength (β = - 15.4, 95% CI: - 27.2 to - 3.4, P = .01) and
took longer to complete the 20 ft (β = .42, 95% CI: 0.02-0.81, P = .04) and 8 ft
walking tests (β = .22, 95% CI: 0.05-0.39, P = .01). Those on peripherally-acting
antiadrenergic agents had reduced grip strength (β = - 4.8, 95% CI: - 9.1 to
- 0.5, P = .02).
CONCLUSIONS: Antihypertensive medication use, particularly ACE inhibitors, is
associated with various measures of reduced physical function. Clinicians are
encouraged to monitor the long-term mobility function of their patients on
antihypertensive medications.
DOI: 10.1016/j.pmedr.2016.03.009
PMCID: PMC4929186
PMID: 27419024
1473. GMS J Med Educ. 2019 Mar 15;36(2):Doc17. doi: 10.3205/zma001225. eCollection
2019.
"Hopefully, I will never forget that again" - sensitizing medical students for
drug safety by working on cases and simulating doctor-patient communication.
Kirsch V(1), Johannsen W(1), Thrien C(2), Herzig S(1)(3), Matthes J(1).
Author information:
(1)Universität zu Köln, Zentrum für Pharmakologie, Köln, Germany.
(2)Universität zu Köln, Medizinische Fakultät, Studiendekanat, Kölner
Interprofessionelles Skills Lab und Simulationszentrum (KISS), Köln, Germany.
(3)Technische Hochschule Köln, Köln, Germany.
Objective: This project is part of the "PJ-STArT-Block", a one-week course
preparing 10th semester medical students for their final practical year. The
focus is on sensitizing students to aspects of medication safety by becoming
aware of their skills and their deficits in terms of application and
communication of pharmacological knowledge. The modules were evaluated regarding
feasibility, acceptance and possible effects. Furthermore, the areas in which
students see their pharmacological deficits or learning successes were gathered.
Methods: In simulated physician-patient conversations, the students are to
identify drug-related problems such as medication errors, adverse drug events or
interactions. Together with their fellow students and under medical or
pharmaceutical moderation, they then have to find solutions for the identified
problems and communicate these solutions to the patients. Based on paper cases,
students practice, reflect, and discuss the research of reliable information
about drugs and medication therapy. The written evaluation included the
evaluation by school grades and the possibility of comments in free text. A
content analysis of interviews with students at the beginning of the project
aimed to identify areas of pharmacology in which they see their own deficits.
Results: Evaluation results including the free text comments indicate students'
acceptance of our pharmacology modules. According to this, the students realize
the importance of aspects relevant for medication safety. The areas mentioned in
35 interviews in which students localize deficits, correspond to the topics that
were intended when conceiving the modules and which are important for medication
safety (e.g. interactions, adverse drug effects, dosages). Conclusion:
Implementation of context-based, application-oriented teaching formats as
recently claimed for pharmacological education to improve the quality of
prescriptions, is possible, as the Cologne example shows. The student evaluation
turns out positively and indicates a critical self-reflection. The students
identified various pharmacological deficits in themselves, which have since been
confirmed and quantified in another study.
Publisher: Zielsetzung: Das Projekt ist Teil des PJ-STArT-Blocks, einer

einwöchigen Vorbereitung Medizinstudierender des 10. Semesters auf das Praktische
Jahr. Im Vordergrund steht, Studierende für Aspekte der Arzneitherapiesicherheit
zu sensibilisieren, indem sie sich ihrer Fähigkeiten bzw. Defizite bezüglich der
Anwendung und Kommunikation pharmakologischer Kenntnisse bewusst werden. Die
Module wurden mit Blick auf Durchführbarkeit, Akzeptanz und mögliche Effekte
evaluiert. Des Weiteren wurde erhoben, in welchen Bereichen die Studierenden
grundsätzlich pharmakologische Defizite bzw. Lernerfolge bei sich sehen.Methodik:
In simulierten Arzt-Patient-Gesprächen sollen die Studierenden
arzneimittelbezogene Probleme wie Medikationsfehler, unerwünschte
Arzneimittelwirkungen oder Interaktionen erkennen, gemeinsam mit
Kommiliton/inn/en unter ärztlicher bzw. pharmazeutischer Moderation Lösungen für
die vorliegenden Probleme finden und diese den Patient/inn/en kommunizieren.
Anhand von Papierfällen üben, reflektieren und diskutieren die Studierenden die
Recherche zuverlässiger Informationen zu Arzneimitteln und Arzneitherapie. Die
Evaluation der Module erfolgte schriftlich anhand von Schulnoten und
Freitextkommentaren. Eine inhaltsanalytische Auswertung von Interviews mit
Studierenden zu Beginn des Projekts galt der Identifizierung von Bereichen der
Pharmakologie, in denen sie eigene Defizite sehen.Ergebnisse: Die Akzeptanz der
Pharmakologie-Module kann angesichts der Evaluationsergebnisse inkl.
Freitextkommentaren als gegeben angesehen werden. Die Studierenden erkennen
demnach die Bedeutung von für die Arzneitherapiesicherheit relevanten Aspekten.
Die in 35 Interviews genannten Bereiche, in denen Studierende Defizite
lokalisieren, entsprechen den bei der Konzeption der Module intendierten, für die
Patient/inn/ensicherheit bedeutsamen Themen (z.B. Interaktionen, unerwünschte
Wirkungen, Dosierungen).Schlussfolgerung: Das Kölner Beispiel zeigt, dass die
erfolgreiche Umsetzung kontextbasierter, anwendungsorientierter
Unterrichtsformate wie sie aktuell mit dem Ziel einer verbesserten
Verordnungsqualität für die pharmakologische Ausbildung gefordert werden, möglich
ist. Die studentische Evaluation fällt positiv aus und lässt eine kritische
Selbstreflexion erkennen. Die Studierenden sehen verschiedene pharmakologische
Defizite bei sich, die in einer weitergehenden Untersuchung bestätigt und
quantifiziert wurden.
DOI: 10.3205/zma001225
PMCID: PMC6446464
PMID: 30993175
interests.
1474. World Psychiatry. 2017 Feb;16(1):50-61. doi: 10.1002/wps.20383.
Public attitudes towards psychiatry and psychiatric treatment at the beginning of

the 21st century: a systematic review and meta-analysis of population surveys.
Angermeyer MC(1)(2), van der Auwera S(3), Carta MG(2), Schomerus G(3).
Author information:
(1)Center for Public Mental Health, Gösing am Wagram, Austria.
(2)Department of Public Health, Clinical and Molecular Medicine, University of
Cagliari, Cagliari, Italy.
(3)Department of Psychiatry and Psychotherapy, University of Greifswald,
Greifswald, Germany.
Public attitudes towards psychiatry are crucial determinants of help-seeking for

mental illness. It has been argued that psychiatry as a discipline enjoys low
esteem among the public, and a "crisis" of psychiatry has been noted. We
conducted a systematic review and meta-analysis of population studies examining
public attitudes towards various aspects of psychiatric care. Our search in
PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on
population surveys conducted since 2000 and published no later than 2015. We
found that professional help for mental disorders generally enjoys high esteem.
While general practitioners are the preferred source of help for depression,
mental health professionals are the most trusted helpers for schizophrenia. If
respondents have to rank sources of help, they tend to favor mental health
professionals, while open questions yield results more favorable to general
practitioners. Psychiatrists and psychologists/psychotherapists are equally
recommended for the treatment of schizophrenia, while for depression
psychologists/psychotherapists are more recommended, at least in Europe and
America. Psychotherapy is consistently preferred over medication. Attitudes
towards seeking help from psychiatrists or psychologists/psychotherapists as well
as towards medication and psychotherapy have markedly improved over the last
twenty-five years. Biological concepts of mental illness are associated with
stronger approval of psychiatric help, particularly medication. Self-stigma and
negative attitudes towards persons with mental illness decrease the likelihood of
personally considering psychiatric help. In conclusion, the public readily
recommends psychiatric help for the treatment of mental disorders. Psychotherapy
is the most popular method of psychiatric treatment. A useful strategy to further
improve the public image of psychiatry could be to stress that listening and
understanding are at the core of psychiatric care.
© 2017 World Psychiatric Association.
DOI: 10.1002/wps.20383
PMCID: PMC5269489
PMID: 28127931
1475. Obstet Gynecol Sci. 2015 Nov;58(6):507-13. doi: 10.5468/ogs.2015.58.6.507.
Epub
2015 Nov 16.
Factors affecting medication discontinuation in patients with overactive bladder

symptoms.
Shim EJ(1), Yoo EH(2), Kim YM(2), Kim D(3).
Author information:
(1)Department of Obstetrics and Gynecology, Kyung Hee University Hospital, Seoul,
Korea.
(2)Department of Obstetrics and Gynecology, Kyung Hee University Hospital at
Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
(3)Department of Statistics, Sungkyunkwan University, Seoul, Korea.
OBJECTIVE: To find out the factors affecting medication discontinuation in

patients with overactive bladder (OAB) symptoms.
METHODS: The clinical data of 125 patients with OAB symptoms who had taken
antimuscarinics and behavioral therapy were retrospectively reviewed.
Antimuscarinics related outcomes were evaluated by an independent observer with
telephone interview. All patients were asked about duration of medication and
reason of continuation or discontinuation of antimuscarinics. To determine
pre-treatment factors predicting self-report discontinuation of antimuscarinics,
variables of only those with P-values <0.25 on the univariate analysis were
included in the Cox proportional hazard modeling.
RESULTS: Mean follow-up was 39.6 months and the proportion of discontinuation of
antimuscarinics was 60.0% (75/125). The mean duration of medication was 21.2
months in the continuation group and 3.3 months in the discontinuation group. The
reasons of discontinuation of antimuscarinics were improved OAB symptoms (46.7%),
tolerable OAB symptoms (33.3%), no change of OAB symptoms (1.3%), side-effects
(8.0%) and no desire to take long-term medication (10.7%). The variables
affecting remaining cumulative probability of antimuscarinics were age, history
of anti-incontinence surgery or vaginal surgery, and having stress predominant
urinary incontinence on urodynamic study.
CONCLUSION: The lower rate of cumulative continuation of antimuscarinics
encourages us to give a more detailed counseling and education to the patients
with OAB symptoms before prescription. And explorations about newer agent and
non-pharmacologic treatment with good efficacy and lower side-effects are needed.
DOI: 10.5468/ogs.2015.58.6.507
PMCID: PMC4663230
PMID: 26623416
1476. Arch Womens Ment Health. 2016 Oct;19(5):909-15. doi: 10.1007/s00737-016-0636-

2.
Epub 2016 May 13.
The prevalence and correlates of self-harm in pregnant women with psychotic

disorder and bipolar disorder.
Taylor CL(1)(2), van Ravesteyn LM(3), van denBerg MP(3)(4), Stewart RJ(5), Howard
LM(6).
Author information:
(1)Department of Health Services and Population Research, Institute of
Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
clare.l.taylor@kcl.ac.uk.
(2)Section of Women's Mental Health, PO31 Institute of Psychiatry, Psychology &
Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK.
clare.l.taylor@kcl.ac.uk.
(3)Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The
Netherlands.
(4)Department of Child & Adolescent Psychiatry, Erasmus University Medical
Center, Rotterdam, The Netherlands.
(5)Department of Psychological Medicine, Institute of Psychiatry, Psychology and
(6)Department of Health Services and Population Research, Institute of
Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Women with severe mental illness are at increased risk of suicide in the
perinatal period, and these suicides are often preceded by self-harm, but little
is known about self-harm and its correlates in this population. This study aimed
to investigate the prevalence of suicidal ideation and self-harm, and its
correlates, in women with psychotic disorders and bipolar disorder during
pregnancy. Historical cohort study using de-identified secondary mental
healthcare records linked with national maternity data. Women pregnant from 2007
to 2011, with ICD-10 diagnoses of schizophrenia and related disorders, bipolar
disorder or other affective psychoses were identified. Data were extracted from
structured fields, natural language processing applications and free text.
Logistic regression was used to examine the correlates of self-harm in pregnancy.
Of 420 women, 103 (24.5 %) had a record of suicidal ideation during the first
index pregnancy, with self-harm recorded in 33 (7.9 %). Self-harm was
independently associated with younger age (adjusted odds ratio (aOR) 0.91, 95 %
CI 0.85-0.98), self-harm in the previous 2 years (aOR 2.55; 1.05-6.50) and
smoking (aOR 3.64; 1.30-10.19). A higher prevalence of self-harm was observed in
women with non-affective psychosis, those who discontinued or switched medication
and in women on no medication at the start of pregnancy, but these findings were
not statistically significant in multivariable analyses. Suicidal thoughts and
self-harm occur in a significant proportion of pregnant women with severe mental
illness, particularly younger women and those with a history of self-harm; these
women need particularly close monitoring for suicidality.
DOI: 10.1007/s00737-016-0636-2
PMCID: PMC5021774
Conflict of interest statement: This study has been part-funded by the Johnson &
Johnson CSR Citizenship Trust. Johnson & Johnson had no involvement in the design
of the study or access to any data throughout the project. RS and MB have
received research funding from the Pfizer, J&J, Lundbeck and Roche. Funding This
report was independent research, part funded by Tommy’s Charity through Johnson &
Johnson CSR Citizenship Trust. Johnson & Johnson had no involvement in the design
of the study or access to any data. Part funding was also obtained from the NIHR
Biomedical Research Centre informatics facility at South London and Maudsley NHS
Foundation Trust, London, UK, a National Institute for Health Research
Professorship for Louise Howard (NIHR-RP-R3-12-011); RS is part-funded by the
National Institute for Health Research (NIHR) Biomedical Research Centre at South
London and Maudsley NHS Foundation Trust and King’s College London and LvR is
part-funded by Erasmus University Medical Center (MRACE) and the Coolsingel
Foundation. The views expressed in this publication are those of the author(s)
and not necessarily those of the NHS, the National Institute for Health Research
or the Department of Health.
1477. Ann Afr Med. 2015 Jul-Sep;14(3):159-60. doi: 10.4103/1596-3519.149879.

Barriers to HIV treatment adherence: Perspectives from the nonadherent at a
treatment center in South-South, Nigeria.
Maduka O(1), Tobin-West CI.
Author information:
(1)Department of Preventive and Social Medicine, University of Port Harcourt,
Port Harcourt, Nigeria.
DOI: 10.4103/1596-3519.149879
1478. Ther Adv Psychopharmacol. 2015 Apr;5(2):76-87. doi: 10.1177/2045125314566807.
Use of automated medication adherence monitoring in bipolar disorder research:

pitfalls, pragmatics, and possibilities.
Levin JB(1), Sams J(2), Tatsuoka C(3), Cassidy KA(2), Sajatovic M(2).
Author information:
10524 Euclid Avenue, Cleveland, OH, 44106 USA.
Cleveland, OH, USA.
(3)Neurological and Behavioral Outcomes Center, University Hospitals Case Medical
Center, Cleveland, OH, USA.
OBJECTIVES: Medication nonadherence occurs in 20-60% of persons with bipolar

disorder (BD) and is associated with serious negative outcomes, including
relapse, hospitalization, incarceration, suicide and high healthcare costs.
Various strategies have been developed to measure adherence in BD. This
descriptive paper summarizes challenges and workable strategies using electronic
medication monitoring in a randomized clinical trial (RCT) in patients with BD.
METHODS: Descriptive data from 57 nonadherent individuals with BD enrolled in a
prospective RCT evaluating a novel customized adherence intervention versus
control were analyzed. Analyses focused on whole group data and did not assess
intervention effects. Adherence was assessed with the self-reported Tablets
Routine Questionnaire and the Medication Event Monitoring System (MEMS).
RESULTS: The majority of participants were women (74%), African American (69%),
with type I BD (77%). Practical limitations of MEMS included misuse in
conjunction with pill minders, polypharmacy, cost, failure to bring to research
visits, losing the device, and the device impacting baseline measurement. The
advantages were more precise measurement, less biased recall, and collecting data
from past time periods for missed interim visits.
CONCLUSIONS: Automated devices such as MEMS can assist investigators in
evaluating adherence in patients with BD. Knowing the anticipated pitfalls allows
study teams to implement preemptive procedures for successful implementation in
BD adherence studies and can help pave the way for future refinements as
automated adherence assessment technologies become more sophisticated and readily
available.
DOI: 10.1177/2045125314566807
PMCID: PMC4521443
PMID: 26240747
1479. Pan Afr Med J. 2017 Nov 15;28:231. doi: 10.11604/pamj.2017.28.231.12385.

eCollection 2017.
Barriers to self-care in women of reproductive age with HIV/AIDS in Iran: a

qualitative study.
Oskouie F(1)(2), Kashefi F(1)(2), Rafii F(1)(2), Gouya MM(2)(3)(4).
Author information:
(1)Nursing Care Research Center, School of Nursing and Midwifery,Iran.
(2)Iran University of Medical Sciences, Tehran, Iran.
(3)Iranian Centres for Communicable Disease Control (CDC).
(4)Ministry of Health and Medical Education (MOHME), Iran.
Introduction: Although increasing attention is paid to HIV/AIDS, patients with

HIV still experience several barriers to self-care. These barriers have been
previously identified in small quantitative studies on women with HIV, but
qualitative studies are required to clarify barriers to self-care.
Methods: We conducted our study using the grounded theory methodological
approach. A total of 28 women with HIV and their family members, were
interviewed. The data were analyzed with the Corbin and Strauss method (1998).
Results: The key barriers to self-care in women with HIV/AIDS included social
stigma, addiction, psychological problems, medication side-effects and financial
problems.
Conclusion: Women with HIV/AIDS face several barriers to self-care. Therefore,
when designing self-care models for these women, social and financial barriers
should be identified. Mental health treatment should also be incorporated into
such models and patients' access to health care services should be facilitated.
DOI: 10.11604/pamj.2017.28.231.12385
PMCID: PMC5882209
1480. Eur Child Adolesc Psychiatry. 2016 Jun;25(6):649-58. doi:

10.1007/s00787-015-0780-7. Epub 2015 Oct 15.
Clinical predictors of antipsychotic use in children and adolescents with autism

spectrum disorders: a historical open cohort study using electronic health
records.
Downs J(1), Hotopf M(2), Ford T(2)(3), Simonoff E(2), Jackson RG(2)(4), Shetty
H(4), Stewart R(2)(4), Hayes RD(2).
Author information:
(1)Institute of Psychiatry, Psychology and Neuroscience, King's College London,
De Crespigny Park, Box 63, SE5 8AF, London, UK. johnny.downs@kcl.ac.uk.
(2)Institute of Psychiatry, Psychology and Neuroscience, King's College London,
De Crespigny Park, Box 63, SE5 8AF, London, UK.
(3)University of Exeter Medical School, Exeter, UK.
(4)South London and Maudsley NHS Foundation Trust, London, UK.
Children with autism spectrum disorders (ASD) are more likely to receive
antipsychotics than any other psychopharmacological medication, yet the
psychiatric disorders and symptoms associated with treatment are unclear. We
aimed to determine the predictors of antipsychotic use in children with ASD
receiving psychiatric care. The sample consisted of 3482 children aged 3-17 with
an ICD-10 diagnosis of ASD referred to mental health services between 2008 and
2013. Antipsychotic use outcome, comorbid diagnoses, and other clinical
covariates, including challenging behaviours were extracted from anonymised
patient records. Of the 3482 children (79 % male) with ASD, 348 (10 %) received
antipsychotic medication. The fully adjusted model indicated that comorbid
diagnoses including hyperkinetic (OR 1.44, 95 %CI 1.01-2.06), psychotic (5.71,
3.3-10.6), depressive (2.36, 1.37-4.09), obsessive-compulsive (2.31, 1.16-4.61)
and tic disorders (2.76, 1.09-6.95) were associated with antipsychotic use. In
addition, clinician-rated levels of aggression, self-injurious behaviours,
reduced adaptive function, and overall parental concern for their child's
presenting symptoms were significant risk factors for later antipsychotic use. In
ASD, a number of comorbid psychiatric disorders are independent predictors for
antipsychotic treatment, even after adjustment for familial, socio-demographic
and individual factors. As current trial evidence excludes children with
comorbidity, more pragmatic randomised controlled trials with long-term drug
monitoring are needed.
DOI: 10.1007/s00787-015-0780-7
PMCID: PMC4889626
1481. J Subst Abuse Treat. 2019 Apr;99:44-51. doi: 10.1016/j.jsat.2019.01.005. Epub

2019 Jan 9.
A new brief opioid stigma scale to assess perceived public attitudes and
internalized stigma: Evidence for construct validity.
Yang LH(1), Grivel MM(2), Anderson B(3), Bailey GL(4), Opler M(5), Wong LY(6),
Stein MD(7).
Author information:
(1)Department of Social and Behavioral Sciences, College of Global Public Health,
New York University, NY, USA; Department of Epidemiology, Mailman School of
Public Health, Columbia University, NY, USA. Electronic address: Ly1067@nyu.edu.
(2)Department of Social and Behavioral Sciences, College of Global Public Health,
New York University, NY, USA.
(3)Butler Hospital, Providence, RI, USA.
Brown University, Providence, RI, USA; Stanley Street Treatment & Resources,
Inc., Fall River, MA, USA.
(5)MedAvante-ProPhase Inc., USA.
(6)City College of New York, NY, USA.
(7)Butler Hospital, Providence, RI, USA; Boston University School of Public
Health, Boston, MA, USA.
One key strategy to improve treatment access for persons with opioid use disorder
(OUD) is overcoming stigma that is internalized by such individuals. Because few
theoretically-derived, multidimensional measures of substance abuse stigma exist,
we contribute a brief, theoretically-based measure of opioid-related stigma
(adapted from Corrigan's Self-Stigma of Mental Illness Scale) to assess perceived
stigma and internalized stigma among individuals with OUD. This study presents
initial validation of the newly-developed Brief Opioid Stigma Scale among 387
adults who entered an inpatient opioid managed-withdrawal program. The scale
assesses: (1) Stereotype awareness ("Aware"), or the extent to which individuals
who use opioids perceive community members to believe OUD-related stereotypes;
(2) Stereotype agreement ("Agree"), or the endorsement of stigmatizing beliefs by
individuals who use opioids; (3) Self-esteem decrement ("Harm"), or the
diminution of self-esteem due to these negative stereotypes' impacts on
self-worth. Psychosocial measures including self-esteem, depressive symptoms,
mental and physical functioning, and desire for aftercare OUD medication
treatment, were administered to assess construct validity. Results showed that
greater endorsement of the "harm" stigma subscale was associated with greater
depressive symptoms, lower self-esteem, and poorer mental and physical
functioning. The "aware" stigma subscale displayed similar overall patterns of
associations with self-esteem and depression but to a lesser magnitude. The
"aware" stigma subscale was positively associated with desire for aftercare
methadone and naltrexone treatment, and the "harm" subscale was positively
associated with desire for aftercare buprenorphine treatment. Results indicated
good initial construct validity. Tailored stigma interventions are recommended
for specific aftercare OUD medication treatments.
DOI: 10.1016/j.jsat.2019.01.005
PMCID: PMC6716158
PMID: 30797393
1482. Breathe (Sheff). 2015 Jun;11(2):98-109. doi: 10.1183/20734735.015614.
Supported self-management for asthma.
Pinnock H(1).
Author information:
(1)Asthma UK Centre for Applied Research, Usher Institute of Population Health
Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
KEY POINTS: Self-management education in asthma is not an optional extra.

Healthcare professionals have a responsibility to ensure that everyone with
asthma has personalised advice to enable them to optimise how they self-manage
their condition.Overviews of the extensive evidence-base conclude that asthma
self-management supported by regular professional review, improves asthma
control, reduces exacerbations and admissions, and improves quality of
life.Self-management education should be reinforced by a written personalised
asthma action plan which provides a summary of the regular management strategy,
how to recognise deterioration and the action to take.Successful implementation
combines education for patients, skills training for professionals in the context
of an organisation committed to both the concept and the practice of supported
self-management.
EDUCATIONAL AIMS: To summarise the evidence base underpinning supported
self-management for asthmaTo provide clinicians with a practical approach to
providing supported self-management for asthmaTo suggest an appropriate strategy
for implementing supported self-management.
SUMMARY: The evidence in favour of supported self-management for asthma is
overwhelming. Self-management including provision of a written asthma action plan
and supported by regular medical review, almost halves the risk of
hospitalisation, significantly reduces emergency department attendances and
unscheduled consultations, and improves markers of asthma control and quality of
life. Demographic and cultural tailoring enables effective programmes to be
implemented in deprived and/or ethnic communities or within schools. A crucial
component of effective asthma self-management interventions is the provision of
an agreed, written personalised action plan which advises on using regular
medication, recognising deterioration and appropriate action to take. Monitoring
can be based on symptoms or on peak flows and should specify thresholds for
action including increasing inhaled steroids, commencing oral steroids, and when
(and how) to seek professional help. Plans should be personalised to reflect
asthma severity and treatment regimes, avoidance of triggers, co-morbid rhinitis
and the individual's preferences. Implementation is a challenge. Systematic
review evidence suggests that it is possible to implement asthma self-management
in routine care, but that to be effective this requires a whole systems approach
which considers implementation from the perspective of patient education and
resources, professional skills and motivation and organisation priorities and
routines.
DOI: 10.1183/20734735.015614
PMCID: PMC4487370
PMID: 26306110
1483. Cochrane Database Syst Rev. 2016 Aug 22;(8):CD010442. doi:

10.1002/14651858.CD010442.pub2.
Self management programmes for quality of life in people with stroke.
Fryer CE(1), Luker JA, McDonnell MN, Hillier SL.
Author information:
(1)International Centre for Allied Health Evidence, Sansom Institute for Health
Research, University of South Australia (City East), North Tce, Adelaide, SA,
Australia, 5000.
Comment in
Int J Nurs Pract. 2018 Apr;24(2):e12612.
BACKGROUND: Stroke results from an acute lack of blood supply to the brain and
becomes a chronic health condition for millions of survivors around the world.
Self management can offer stroke survivors a pathway to promote their recovery.
Self management programmes for people with stroke can include specific education
about the stroke and likely effects but essentially, also focusses on skills
training to encourage people to take an active part in their management. Such
skills training can include problem-solving, goal-setting, decision-making, and
coping skills.
OBJECTIVES: To assess the effects of self management interventions on the quality
of life of adults with stroke who are living in the community, compared with
inactive or active (usual care) control interventions.
SEARCH METHODS: We searched the following databases from inception to April 2016:
the Cochrane Stroke Group Trials Register, Cochrane Central Register of
Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS, Web of
Science, OTSeeker, OT Search, PEDro, REHABDATA, and DARE. We also searched the
following trial registries: ClinicalTrials.gov, Stroke Trials Registry, Current
Controlled Trials, World Health Organization, and Australian New Zealand Clinical
Trials Registry.
SELECTION CRITERIA: We included randomised controlled trials of adults with
stroke living in the community who received self management interventions. These
interventions included more than one component of self management or targeted
more than a single domain of change, or both. Interventions were compared with
either an inactive control (waiting list or usual care) or active control
(alternate intervention such as education only). Measured outcomes included
changes in quality of life, self efficacy, activity or participation levels,
impairments, health service usage, health behaviours (such as medication
adherence or lifestyle behaviours), cost, participant satisfaction, or adverse
events.
DATA COLLECTION AND ANALYSIS: Two review authors independently extracted
prespecified data from all included studies and assessed trial quality and risk
of bias. We performed meta-analyses where possible to pool results.
MAIN RESULTS: We included 14 trials with 1863 participants. Evidence from six
studies showed that self management programmes improved quality of life in people
with stroke (standardised mean difference (SMD) random effects 0.34, 95%
confidence interval (CI) 0.05 to 0.62, P = 0.02; moderate quality evidence) and
improved self efficacy (SMD, random effects 0.33, 95% CI 0.04 to 0.61, P = 0.03;
low quality evidence) compared with usual care. Individual studies reported
benefits for health-related behaviours such as reduced use of health services,
smoking, and alcohol intake, as well as improved diet and attitude. However,
there was no superior effect for such programmes in the domains of locus of
control, activities of daily living, medication adherence, participation, or
mood. Statistical heterogeneity was mostly low; however, there was much variation
in the types and delivery of programmes. Risk of bias was relatively low for
complex intervention clinical trials where participants and personnel could not
be blinded.
AUTHORS' CONCLUSIONS: The current evidence indicates that self management
programmes may benefit people with stroke who are living in the community. The
benefits of such programmes lie in improved quality of life and self efficacy.
These are all well-recognised goals for people after stroke. There is evidence
for many modes of delivery and examples of tailoring content to the target group.
Leaders were usually professionals but peers (stroke survivors and carers) were
also reported - the commonality is being trained and expert in stroke and its
consequences. It would be beneficial for further research to be focused on
identifying key features of effective self management programmes and assessing
their cost-effectiveness.
DOI: 10.1002/14651858.CD010442.pub2
PMCID: PMC6450423
1484. Psychopharmacology (Berl). 2016 Jul;233(13):2469-78. doi:

10.1007/s00213-016-4298-6. Epub 2016 Apr 16.
Effects of zolpidem alone and in combination with nabilone on cannabis withdrawal

and a laboratory model of relapse in cannabis users.
Herrmann ES(1), Cooper ZD(2), Bedi G(2), Ramesh D(2), Reed SC(2), Comer SD(2),
Foltin RW(2), Haney M(2).
Author information:
(1)Division on Substance Abuse, New York State Psychiatric Institute, Department
of Psychiatry, Columbia University Medical Center, New York, NY, USA.
herrman@nyspi.columbia.edu.
(2)Division on Substance Abuse, New York State Psychiatric Institute, Department
of Psychiatry, Columbia University Medical Center, New York, NY, USA.
RATIONALE: Each year, over 300,000 individuals in the USA enter treatment for
cannabis use disorder (CUD). The development of effective pharmacotherapy for CUD
is a priority.
OBJECTIVE: This placebo-controlled study examined the effects of zolpidem alone
and in combination with nabilone on cannabis withdrawal and a laboratory measure
of relapse.
METHODS: Eleven daily, non-treatment-seeking cannabis users completed three,
8-day inpatient phases; each phase tested a different medication condition in
counter-balanced order. On the first day of each phase, participants were
administered placebo capsules t.i.d. and smoked experimenter-administered active
cannabis (5.6 % Δ(9)-tetrahydrocannabinol (THC)). On days 2-8, the participants
were administered capsules containing either placebo (0 mg at 0900, 1800, and
2300 hours), zolpidem (0 mg at 0900 and 1800, and 12.5 mg at 2300), or zolpidem
(12.5 mg at 2300) and nabilone (3 mg at 0900 and 1800). Cannabis withdrawal,
subjective capsule effects, and cognitive performance were examined on days 3-4,
when only inactive cannabis (0.0 % THC) was available for self-administration.
"Relapse" was measured on days 5-8, when participants could self-administer
active cannabis.
RESULTS: Both medication conditions decreased withdrawal-related disruptions in
sleep, but only zolpidem in combination with nabilone decreased
withdrawal-related disruptions in mood and food intake relative to placebo.
Zolpidem in combination with nabilone, but not zolpidem alone, decreased
self-administration of active cannabis. Zolpidem in combination with nabilone
also produced small increases in certain abuse-related subjective capsule
ratings, while zolpidem alone did not. Neither medication condition altered
cognitive performance.
CONCLUSIONS: Clinical testing of nabilone, either alone, or in combination with
zolpidem is warranted.
DOI: 10.1007/s00213-016-4298-6
PMCID: PMC5302052
1485. West J Nurs Res. 2014 Oct;36(9):1272-98. doi: 10.1177/0193945914521696. Epub

2014
Feb 7.
Diabetes self-care and the older adult.
Weinger K(1), Beverly EA(2), Smaldone A(3).
Author information:
(1)Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
katie.weinger@joslin.harvard.edu.
(2)Ohio University Heritage College of Osteopathic Medicine, Athens, USA.
(3)Columbia University School of Nursing, New York, NY, USA.
The prevalence of diabetes is highest in older adults, a population that is

increasing. Diabetes self-care is complex with important recommendations for
nutrition, physical activity, checking glucose levels, and taking medication.
Older adults with diabetes have unique issues that impact self-care. As people
age, their health status, support systems, physical and mental abilities, and
nutritional requirements change. Furthermore, comorbidities, complications, and
polypharmacy complicate diabetes self-care. Depression is also more common among
the elderly and may lead to deterioration in self-care behaviors. Because of
concerns about cognitive deficits and multiple comorbidities, adults older than
65 years are often excluded from research trials. Thus, little clinical evidence
is available and the most appropriate treatment approaches and how to best
support older patients' self-care efforts are unclear. This review summarizes the
current literature, research findings, and expert and consensus recommendations
with their rationales.
DOI: 10.1177/0193945914521696
PMCID: PMC4125543
1486. J Clin Med Res. 2019 Aug;11(8):583-592. doi: 10.14740/jocmr3894. Epub 2019
Jul
27.
Adherence to Medication, Physical Activity and Diet in Older Adults With

Diabetes: Its Association With Cognition, Anxiety and Depression.
Mendes R(1)(2), Martins S(2)(3), Fernandes L(2)(3)(4).
Author information:
(1)Department of Internal Medicine, Centro Hospitalar Universitario S. Joao
(CHUSJ), Porto, Portugal.
(2)Center for Health Technology and Services Research (CINTESIS), Faculty of
Medicine, University of Porto (FMUP), Portugal.
(3)Department of Clinical Neurosciences and Mental Health, Faculty of Medicine,
University of Porto (FMUP), Portugal.
(4)Clinic of Psychiatry and Mental Health, Centro Hospitalar Universitario S.
Joao (CHUSJ), Porto, Portugal.
Background: Adherence to medication, physical activity (PA) and diet in diabetes

mellitus (DM) patients is crucial for its good management, avoiding acute and
chronic complications. There are several risk factors associated with
non-adherence, including cognitive impairment, depression and anxiety.
Nevertheless, studies on therapeutic adherence in older patients with DM are
scarce. In this context, the present study aimed to analyze whether adherence to
medication, PA and diet are associated with cognitive impairment, anxiety and
depression. It also aimed to identity predictors of medication non-adherence.
Methods: A cross-sectional study of older patients (≥ 65 years old) with DM was
carried out in the Outpatient Department of Internal Medicine Service of
CHUSJ-Porto, Portugal. Those unable to communicate were excluded. Cognition
(mini-mental state examination), anxiety and depression (hospital anxiety and
depression scale) were assessed. Adherence to medication, PA and diet was
measured, based on self-reporting patient/family, questionnaires, physician
clinical opinion, hemoglobin test and pharmacy records. Patient groups were
compared, using the Mann-Whitney or the Kruskal-Wallis test for continuous
variables and the Chi-square test for paired categorical variables (significance
level of 0.05). The odds ratio (OR) was calculated to identify independent
predictors of non-adherence to medication.
Results: The final sample (n = 94) had a mean age of 75.2 years (standard
deviation: 6.7) and mostly were female (53.2%), married (63.8%) and with a low
education level (61.7%). Also, 22.3% with cognitive impairment, 16% with
depression and 23.4% with anxiety were found. Patients non-adherent to medication
had higher depression (P = 0.048) and anxiety (P = 0.010), compared to
adherents/partial adherents. Patients non-adherent to PA showed higher anxiety (P
= 0.035) and depression (P = 0.004), compared to adherents. Non-adherents to PA
had more cognitive impairment than adherents (26.3% vs. 0%; P = 0.034). Patients
who had insulin prescribed presented a higher risk of non-adherence to medication
(OR: 4.041, 95% confidence interval (CI): 1.404 - 11.628; P = 0.010). Also, the
risk of non-adherence to medication is higher by an increase of one unit in
anxiety (OR: 1.252, 95% CI: 1.046 - 1.499; P = 0.014).
Conclusions: Higher anxiety and depression were associated with non-adherence to
medication and to PA. Insulin prescribed and high anxiety scores were predictors
of medication non-adherence. This study appears to contribute to the knowledge
about the influence of cognitive and psychological factors in therapeutic
adherence in these older diabetic patients.
DOI: 10.14740/jocmr3894
PMCID: PMC6681861
PMID: 31413770
1487. Int J Equity Health. 2019 Jan 15;18(1):9. doi: 10.1186/s12939-018-0906-x.

Assessing the relationship between out-of-pocket spending on blood pressure and
diabetes medication and household catastrophic health expenditure: evidence from
Pakistan.
Datta BK(1), Husain MJ(2), Asma S(3).
Author information:
(1)Global Noncommunicable Diseases Branch, Division of Global Health Protection,
Center for Global Health, Centers for Disease Control and Prevention, Atlanta,
GA, USA. BDatta@cdc.gov.
(2)Global Noncommunicable Diseases Branch, Division of Global Health Protection,
Center for Global Health, Centers for Disease Control and Prevention, Atlanta,
GA, USA.
(3)Health Metrics and Measurement Cluster, World Health Organization, Geneva,
Switzerland.
BACKGROUND: Treatment of non-communicable diseases (NCDs) in

low-and-middle-income countries (LMICs) is costly and could expose households to
financial hardship and vulnerability. This paper examines the association between
medication costs of two major NCDs - hypertension (blood pressure) and diabetes,
and household-level incidences of catastrophic health expenditure (CHE) in a
South Asian LMIC, Pakistan.
METHODS: The study analyzes self-reported blood pressure and diabetes (BPD)
medication expenditure from the latest version (2015-16) of the Household
Integrated Economic Survey (HIES) of Pakistan, a nationally representative survey
of 24,238 households. The incidence of CHE is defined as households'
out-of-pocket (OOP) medical expenditure exceeding 10% of the total household
expenditure. Using a linear probability model, we estimate the adjusted
differences in CHE incidence between households that are spending and 'not'
spending on BPD medication. We also analyze several hypothetical scenarios of BPD
medication cost coverage, and compare the estimated CHE incidences of respective
scenarios with the status quo.
RESULTS: We find that the average monthly medical expenditure, and average
medical expenditure share are significantly higher for households spending on BPD
medication, compared to households 'not' spending. The incidence of CHE is found
6.7 percentage point higher for the households consuming BPD medication, after
controlling for relevant socioeconomic attributes. If 25, 50, and 100% of the BPD
medication OOP cost is covered, then the CHE incidence would reduce respectively
by 5.9, 12.7, and 21.4% compared to the status quo.
CONCLUSION: Medication cost for managing two major NCDs and household
catastrophic health expenditure have strong associations. The findings inform
policies toward ensuring access to necessary healthcare services, and protecting
households from NCD treatment related financial hardship.
DOI: 10.1186/s12939-018-0906-x
PMCID: PMC6334430
1488. J Am Geriatr Soc. 2016 Jun;64(6):1195-202. doi: 10.1111/jgs.14166.
A New Method of Identifying Characteristics of Needing Help to Take Medications

in an Older Representative Community-Dwelling Population: The Older Adults
Medication Assist Scale.
Jamerson BD(1)(2)(3)(4), Fillenbaum GG(1)(2), Sloane R(1)(5)(4), Morey

MC(1)(5)(4).
Author information:
(1)Claude D. Pepper Older Americans Independence Center, Duke University, Durham,
North Carolina.
(2)Center on Biobehavioral Health Disparities Research, Duke University, Durham,
North Carolina.
(3)Department of Psychiatry and Behavioral Sciences, Duke University, Durham,
North Carolina.
(4)Geriatric Research Education and Clinical Center, Veterans Administration
Medical Center, Durham, North Carolina.
(5)Center for the Study of Aging and Human Development, Duke University, Durham,
North Carolina.
OBJECTIVES: To determine the sociodemographic characteristics, health conditions,

and cognitive and functional status associated with baseline prevalence and new
need for help taking medication 3 years later and to construct a brief scale
indicative of need for help taking medications.
DESIGN: Retrospective cross-sectional and 3-year longitudinal study.
SETTING: Five-county area in north-central Piedmont, North Carolina.
PARTICIPANTS: Representative community-dwelling sample of black and white
individuals aged 65 and older (N = 4,136).
MEASUREMENTS: Information was obtained in person in participants' homes using
structured questionnaires. Health conditions included sensory impairment and
self-report of physician-diagnosed conditions. Cognitive status was assessed
using the 10-item Short Portable Mental Status Questionnaire. Functional status
was assessed using the three-item Rosow-Breslau scale, the five-item Katz
activity of daily living scale, and a modified six-item Older Americans Resources
and Services instrumental activities of daily living scale.
RESULTS: Characteristics associated with need for help taking medications were
aged 80 and older, being male, living with others, having four or more chronic
conditions, and impaired cognitive or functional status (c-statistic 0.94, 77.1%
sensitivity, 87.9% specificity). Predictors of new need for help with medications
3 years later included aged 75 and older at baseline, being male, and impaired
cognitive and functional status (c-statistic 0.75).
CONCLUSION: This brief scale can help identify persons needing help with
medications and could be useful in assisting clinicians with medication
management.
Society.
DOI: 10.1111/jgs.14166
PMCID: PMC5295838
Conflict of interest statement: The editor in chief has reviewed the conflict of
interest checklist provided by the authors and has determined that the authors
have no financial or any other kind of personal conflicts with this paper.
1489. Contemp Clin Trials Commun. 2019 Jan 14;14:100326. doi:

10.1016/j.conctc.2019.100326. eCollection 2019 Jun.
Design and rationale of a mixed methods randomized control trial: ADdressing

Health literacy, bEliefs, adheRence and self-Efficacy (ADHERE) program to improve
diabetes outcomes.
Shiyanbola OO(1), Walbrandt Pigarelli DL(2), Unni EJ(3), Smith PD(4), Maurer
MA(5), Huang YM(1).
Author information:
of Wisconsin-Madison, WI, USA.
(2)Division of Pharmacy Practice, School of Pharmacy, University of
Wisconsin-Madison, WI, USA.
(3)Department of Pharmaceutical Sciences, College of Pharmacy, Roseman University
of Health Sciences, Utah, USA.
(4)Department of Family Medicine and Community Health, School of Medicine and
Public Health, University of Wisconsin-Madison, WI, USA.
(5)Sonderegger Research Center, School of Pharmacy, University of
Wisconsin-Madison, WI, USA.
Background: Improving medication adherence is one of the most effective

approaches to improving the health outcomes of patients with diabetes. To date,
enhancing diabetes medication adherence has occurred by improving
diabetes-related knowledge. Unfortunately, behavior change often does not follow
knowledge change. Enhancing communication between patients and healthcare
professionals through addressing health literacy-related psychosocial attributes
is critical.
Objective: Examine whether a patient-centered intervention augmenting usual care
with a health literacy-psychosocial support intervention will improve medication
adherence for patients with diabetes, compared to usual care.
Methods: This study is a randomized controlled trial with an intervention mixed
methods design. Fifty participants being enrolled are English-speaking, 18-80
years old with diagnosed diabetes, take at least one diabetes medication, have
low diabetes medication adherence (proportion of days covered less than 80% or
based on clinical notes), and have poor diabetes control (hemoglobin A1c of ≥8%).
Participants will be allocated to either a control group receiving usual care
(n = 25) or an intervention group (n = 25) receiving usual care and a 6-session
intervention focusing on the modifiable psychosocial factors that may influence
medication adherence. A questionnaire will be administered at baseline and at the
end of the intervention to all participants to assess the effectiveness of the
intervention. Fifteen participants from the intervention group will be
interviewed to explore participants' experiences and perceptions of the
intervention processes and outcomes.
Conclusions: The trial will examine if a patient-centered intervention that
addresses patients' health literacy and focuses on modifiable psychosocial
factors will improve medication adherence among patients with diabetes.
DOI: 10.1016/j.conctc.2019.100326
PMCID: PMC6348197
PMID: 30705995
Barriers to HIV Medication Adherence as a Function of Regimen Simplification.
Chen Y(1), Chen K(2), Kalichman SC(3).
Author information:
(1)Psychological Sciences, University of Connecticut, Storrs, CT, 06268, USA.
(2)Department of Statistics, University of Connecticut, Storrs, CT, USA.
(3)Psychological Sciences, University of Connecticut, Storrs, CT, 06268, USA.
seth.k@uconn.edu.
BACKGROUND: Barriers to HIV medication adherence may differ by levels of dosing

schedules.
PURPOSE: The current study examined adherence barriers associated with medication
regimen complexity and simplification.
METHODS: A total of 755 people living with HIV currently taking anti-retroviral
therapy were recruited from community services in Atlanta, Georgia. Participants
completed audio-computer-assisted self-interviews that assessed demographic and
behavioral characteristics, provided their HIV viral load obtained from their
health care provider, and completed unannounced phone-based pill counts to
monitor medication adherence over 1 month.
RESULTS: Participants taking a single-tablet regimen (STR) were more likely to be
adherent than those taking multi-tablets in a single-dose regimen (single-dose
MTR) and those taking multi-tablets in a multi-dose regimen (multi-dose MTR),
with no difference between the latter two. Regarding barriers to adherence,
individuals taking STR were least likely to report scheduling issues and
confusion as reasons for missing doses, but they were equally likely to report
multiple lifestyle and logistical barriers to adherence.
CONCLUSIONS: Adherence interventions may need tailoring to address barriers that
are specific to dosing regimens.
DOI: 10.1007/s12160-016-9827-3
PMCID: PMC5253105
Conflict of interest statement: and Ethical Adherence The authors claim no

conflict of interests or competing interests. All research procedures were
approved by the University of Connecticut Institutional Review Board and adhered
to the ethical guidelines for human participants research set forth by the
American Psychological Association.
1491. J Prim Care Community Health. 2016 Jan;7(1):44-55. doi:

10.1177/2150131915601794.
Epub 2015 Aug 24.
Peers as Facilitators of Medication Adherence Interventions: A Review.
Enriquez M(1), Conn VS(2).
Author information:
(1)University of Missouri, Columbia, MO, USA enriquezm@missouri.edu.
(2)University of Missouri, Columbia, MO, USA.
BACKGROUND: Difficulty taking essential medications as prescribed is a prevalent

problem among people living with chronic diseases. Numerous interventions to
enhance medication adherence have been developed; the majority facilitated by
health care professionals.
OBJECTIVE: This review examined medication adherence interventions delivered by
peers (ie, lay individuals living with the same chronic disease) and reports what
is known about the impact of peer-facilitated interventions.
DATA SOURCES: PubMed, CINAHL, Google Scholar, Google, and PsychInfo, and ancestry
searches.
STUDY SELECTION: Solely peers delivered the intervention and follow-up occurred
for at least 24 weeks postintervention. Electronic databases were searched from
their start date to December 31, 2014.
RESULTS: Eleven studies were located that reported 10 different interventions
focused on 6 chronic disease conditions. Most interventions were delivered in
clinical settings and grounded in a theoretical framework. Formats were evenly
split between individual and group level, with one intervention using both.
Length of training for the interventionists and the number of intervention
sessions that subjects received varied across studies.
LIMITATIONS: Self-report was frequently used as a measure of adherence.
Biomarkers were sometimes used to assess medication adherence; however, lifestyle
modification may have also affected biomarker levels.
CONCLUSIONS: Overall, the interventions had positive effects and attrition was
quite low. Peer-facilitated interventions appear to enhance medication adherence
as well as other healthful behaviors, such as exercise.
DOI: 10.1177/2150131915601794
PMCID: PMC5695224
1492. J Behav Med. 2015 Jun;38(3):397-406. doi: 10.1007/s10865-014-9612-3. Epub

2014
Dec 23.
Synergistic effects of food insecurity and drug use on medication adherence among
people living with HIV infection.
Chen Y(1), Kalichman SC.
Author information:
(1)Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit
1020, Storrs, CT, 06269, USA, star.chen@uconn.edu.
Food insecurity and drug use are closely connected in the context of poverty, and
both have been suggested to interfere with HIV medication adherence among people
living with HIV/AIDS (PLWH). Yet the potential interaction between the two
factors on adherence has not been examined. For this study we collected
longitudinal data on HIV medication adherence among PLWH in Atlanta, GA, to
assess a possible synergistic effect between the two factors on HIV medication
adherence. People informed about the study came to the research site and
completed an audio computer-assisted self-interview and instructions for pill
counting. Over the next 5 weeks participants received three unscheduled follow-up
phone assessments conducted 2 weeks apart to collect pill counts of their HIV
medication. The prevalence of food insecurity was 60 % (488) and that of drug use
was 33 % (274) in the sample of 809 participants. Among 770 participants who
completed follow-up phone assessments, both food insecurity and drug use were
associated with HIV medication adherence after adjusting for socio-demographic
characteristics. The negative association between drug use and adherence
persisted after further adjusting for health-related characteristics. Moreover,
drug use appeared to moderate the effect of food insufficiency on adherence, with
drug users who were food insufficient being the least likely to achieve 85 %
adherence. Results from the current study demonstrate a synergism between food
insecurity and drug use that may impede adherence among PLWH. The findings imply
that the disruptive effects of food insecurity and drug use on adherence are
likely to be intensified with the presence of each other, and encourage
interventions to address the problem of HIV medication adherence from a
multi-faceted perspective that takes into account detrimental combination of
problem factors.
DOI: 10.1007/s10865-014-9612-3
PMCID: PMC4425576
1493. Med Care. 2019 Mar;57(3):230-236. doi: 10.1097/MLR.0000000000001064.

Effect of Home Medication Titration on Blood Pressure Control in Patients With
Hypertension: A Meta-Analysis of Randomized Controlled Trials.
Chen TY(1)(2), Kao CW(3)(4), Cheng SM(5)(6), Chang YC(7).
Author information:
(1)Graduate Institute of Medical Sciences, National Defense Medical Center,
Taipei.
(2)Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi.
(3)Department of Nursing, Tri-Service General Hospital.
(4)School of Nursing, National Defense Medical Center.
(5)Department of Internal Medicine, Division of Cardiology, Tri-Service General
Hospital.
(6)School of Medicine, National Defense Medical Center.
(7)Department of Mathematics, Tamkang University, Taipei, Taiwan.
BACKGROUND: Medication titration has been used in home blood pressure (BP)
control, with the expectation of enabling patients with hypertension to better
manage their BP.
OBJECTIVE: The study goal was to estimate the effects of medication titration
intervention in lowering the systolic blood pressure and diastolic blood pressure
of patients with hypertension.
METHODS: The meta-analysis included randomized controlled trials on adults
diagnosed with hypertension and BP≧130/80 mm Hg, having a medication-titration
intervention, and using a home BP measurement. We systematically searched PubMed,
CINAHL, Ovid-Medline, and the Cochrane Library, for studies published from 1997
to 2017. The quality of the studies was evaluated by the Modified Jadad scale.
Statistical heterogeneity among the trials was evaluated using Q statistics and
I. Publication bias was assessed with the funnel plot and Rosenthal's fail-safe
N.
RESULTS: The meta-analysis included 4 studies randomizing 1335 participants.
Medication-titration intervention significantly assisted hypertensive patients to
improve BP control; systolic blood pressure was reduced by 6.86 mm Hg [95%
confidence interval (CI), 4.80-8.93, P<0.0001] and diastolic blood pressure by
3.03 mm Hg (95% CI, 2.07-3.99, P<0.0001), did not significantly affect EQ-5D
scores (mean difference, 0.02; 95% CI, -0.01 to 0.04, P=0.13).
CONCLUSIONS: Our findings suggest home medication titration of antihypertensive
medication for hypertensive patients significantly improved home BP control.
However, the strategy did not enhance quality of life in patients with
hypertension.
DOI: 10.1097/MLR.0000000000001064
PMCID: PMC6410972
1494. Einstein (Sao Paulo). 2018 Nov 8;16(4):eAO4212. doi:

10.31744/einstein_journal/2018AO4212.
Medications used in pediatric cystic fibrosis population.
Alves SP(1), Frank MA(2), Bueno D(1).
Author information:
(1)Programa de Pós-Graduação em Assistência Farmacêutica, Faculdade de Farmácia,
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
(2)Serviço de Farmácia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS,
Brazil.
OBJECTIVE: To describe the drug utilization profile used by pediatric cystic

fibrosis patients.
METHODS: A transversal study comprising the analysis of records and interviews
with caregivers of pediatric patient in a reference center of Southern Brazil. We
collected information about patients' clinical condition, medication used and
household therapy.
RESULTS: Out of 78 patients participating in the study, prevailing
characteristics were: female, self-declared white color, mutation F508del and
countryside resident. Forty-three patients had health monitoring exclusively in
the hospital's outpatient division. We analyzed 509 prescribed medication (6.5
medication/patient). The caregiver acknowledged the correct indication in 83% of
cases. Patients with pulmonary complications and diseases and/or comorbities
related to the cystic fibrosis had an increased quantity of prescribed
medication. Vitamins, pancreatic enzymes, hypertonic saline solution, dornase
alpha, acid ursodesoxicolic and inhalation antibiotics were most commonly
prescribed. Out of the sum of medication, 265 (52.1%) were registered in the
Relação Nacional de Medicamentos Essenciais , 26.7% were registered in the basic
component and 25.4% were registered in the specialized component of
pharmaceutical assistance. Seventy-four interviewees informed difficulty in the
acquisition of at least one prescribed medication. Most of the reports
acknowledge the State Health Department as the place to find and receive
medication for cystic fibrosis.
CONCLUSION: This study allowed reaching a deeper understanding about therapy,
caring needed with patients with cystic fibrosis, highlighting to implement
strategies that might contribute to enhance life quality and to execute the
patients' therapy plan.
DOI: 10.31744/einstein_journal/2018AO4212
PMCID: PMC6223948
Impact of self-funding on patient experience of oral anticoagulation

self-monitoring: a qualitative study.
Tompson A(1), Heneghan C(1), Sutton S(2), Fitzmaurice D(3), Ward A(1).
Author information:
Oxford, UK.
(2)Institute of Public Health, University of Cambridge, Cambridge, UK.
(3)Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
OBJECTIVE: To explore the impact self-funding has on patient experience of oral

anticoagulation therapy self-monitoring.
DESIGN: Semistructured, qualitative interviews were conducted. Transcripts were
analysed thematically using constant comparison.
SETTING: England.
PARTICIPANTS: Interviewees were participants of the Cohort Study of
Anticoagulation Self-Monitoring (CASM). Cohort members were recruited as they
bought a monitor from the major manufacturer in the UK. A purposive sample was
invited to be interviewed on completion of the 12-month cohort follow-up.
DATA: Patient narratives on their experiences of self-monitoring their oral
anticoagulation therapy in non-trial conditions.
RESULTS: 26 interviews were completed. Interviewees viewed purchasing the
monitoring device as a long-term commitment balancing the limitations of
clinic-based monitoring against the cost. They were unable to try out the monitor
prior to purchase and therefore had to be confident in their own ability to use
it. The variable provision of self-monitoring equipment caused resentment, and
interviewees were uncomfortable negotiating with healthcare professionals. High
test strip usage while learning how to use the monitor caused anxiety that was
exacerbated by worries about their cost. However, self-funding did mean that
interviewees felt a sense of ownership and were determined to persevere to
overcome problems.
CONCLUSIONS: Self-funding has negative implications in terms of equity of access;
however, the money invested acts as a barrier to discontinuation. If oral
anticoagulation therapy self-monitoring devices and consumables were provided
free of charge in routine care, the training and support available in England may
need to be reviewed to prevent discontinuation rates rising to those observed in
clinical trials.
DOI: 10.1136/bmjopen-2016-013123
PMCID: PMC5223672
eCollection 2019.
Knowledge, attitude and practice of pharmacists on medication therapy management:

a survey in Hospital Pulau Pinang, Penang, Malaysia.
Al-Tameemi NK(1), Sarriff A(1).
Author information:
(1)Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti
Sains Malaysia, Pinang, Malaysia.
Background: Medication therapy management (MTM) service provides set of clinical

activities to optimize therapeutic outcomes for patients. It requires the
collaboration between patient, pharmacist and other healthcare providers to
ensure safe and effective use of medicines. The objective of the current study
was to assess Hospital Pulau Pinang pharmacists' knowledge, attitude and practice
on MTM service.
Methods: A self-administrated validated survey was carried out among all
pharmacists working at Hospital Pulau Pinang.
Results: A total of 93 pharmacists out of 130 (71.5%) were included in the study
(61.3% between the age of 20-30 years old, 74.2% female, 68.8% Chinese, 88.2%
holding bachelor's degree and 48.4% working in medication therapy adherence
clinic and outpatient pharmacy). Majority of pharmacists had a high level of
knowledge and positive attitudes regarding MTM service. All pharmacists agreed
that MTM service could improve the quality of health services and most
pharmacists were interested in providing MTM service (92.5%). Moreover, 95.7%
were interested in acquiring more information about MTM service. About the
barriers that might affect MTM service implementation, the most common barriers
identified by pharmacists were lack of training (88.2%), need of high budget to
implement MTM service (51.6%) and lack of time (46.2%).
Conclusions: Overall, the research findings provide some insights about the
Hospital Pulau Pinang pharmacists' knowledge, attitude and practice regarding MTM
service. Majority of pharmacists agreed and showed their interest towards the
implementation of MTM service.
DOI: 10.1186/s40780-019-0131-9
PMCID: PMC6327512
PMID: 30652009
Conflict of interest statement: Approval for distributing the questionnaires at

Hospital Pulau Pinang was obtained from Medical Research and Ethics Committee
(MREC), Malaysia (NMRR-17-3186-39,237).Not applicable.The authors declare that
they have no conflicts of interest in this work.Springer Nature remains neutral
with regard to jurisdictional claims in published maps and institutional
affiliations.
1497. J Pediatr Oncol Nurs. 2018 Mar/Apr;35(2):86-93. doi:

10.1177/1043454217741877.
Epub 2017 Nov 30.
Adherence to Oral Medications During Maintenance Therapy Among Children and

Adolescents With Acute Lymphoblastic Leukemia: A Medication Refill Analysis.
Wu YP(1), Stenehjem DD(1)(2), Linder LA(1)(3), Yu B(1), Parsons BG(1), Mooney

R(1), Fluchel MN(1).
Author information:
(1)1 University of Utah, Salt Lake City, UT, USA.
(2)3 Department of Pharmacy Practice and Pharmaceutical Sciences, University of
Minnesota, College of Pharmacy, Duluth, MN, USA.
(3)2 Primary Children's Hospital, Salt Lake City, UT, USA.
Adherence to oral medications during maintenance therapy is essential for

pediatric patients with acute lymphoblastic leukemia. Self-reported or electronic
monitoring of adherence indicate suboptimal adherence, particularly among
particular sociodemographic groups. This study used medication refill records to
examine adherence among a national sample of pediatric patients with acute
lymphoblastic leukemia. Patients in a national claims database, aged 0 to 21
years with a diagnosis of acute lymphoblastic leukemia and in the maintenance
phase of treatment, were included. Medication possession ratios were used as
measures of adherence. Overall adherence and adherence by sociodemographic groups
were examined. Adherence rates were 85% for 6-mercaptopurine and 81% for
methotrexate. Adherence was poorer among patients 12 years and older. Oral
medication adherence rates were suboptimal and similar to or lower than
previously documented rates using other methods of assessing adherence. Refill
records offer a promising avenue for monitoring adherence. Additional work to
identify groups most at-risk for poor adherence is needed. Nurses are well
positioned to routinely monitor for medication adherence and to collaborate with
the multidisciplinary team to address barriers to adherence.
DOI: 10.1177/1043454217741877
PMCID: PMC5935503
PMID: 29188741
1498. Implement Sci. 2017 Jan 13;12(1):8. doi: 10.1186/s13012-016-0535-y.
Impact of a tailored program on the implementation of evidence-based

recommendations for multimorbid patients with polypharmacy in primary care
practices-results of a cluster-randomized controlled trial.
Jäger C(1), Freund T(2), Steinhäuser J(3), Stock C(4), Krisam J(4),
Kaufmann-Kolle P(5), Wensing M(2), Szecsenyi J(2).
Author information:
Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 4.OG, 69120,
Heidelberg, Germany. cornelia.jaeger@med.uni-heidelberg.de.
Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 4.OG, 69120,
(3)Institute of Family Medicine, UniversityHospital Schleswig-Holstein, Campus
Lübeck, Ratzburger Allee 160, Haus 50, 23538, Lübeck, Germany.
(4)Department of Medical Biometry, Institute of Medical Biometry and Informatics,
University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Turm West, 12.OG,
69120, Heidelberg, Germany.
(5)Institute for Applied Quality Improvement and Research in Health Care GmbH,
(AQUA-Institute), Maschmühlenweg 8-10, 37073, Göttingen, Germany.
BACKGROUND: Multimorbid patients receiving polypharmacy represent a growing

population at high risk for negative health outcomes. Tailoring is an approach of
systematic intervention development taking account of previously identified
determinants of practice. The aim of this study was to assess the effect of a
tailored program to improve the implementation of three important processes of
care for this patient group: (a) structured medication counseling including brown
bag reviews, (b) the use of medication lists, and (c) structured medication
reviews to reduce potentially inappropriate medication.
METHODS: We conducted a cluster-randomized controlled trial with a follow-up time
of 9 months. Participants were general practitioners (GPs) organized in quality
circles and participating in a GP-centered care contract of a German health
insurance. Patients aged >50 years, suffering from at least 3 chronic diseases,
receiving more than 4 drugs, and being at high risk for medication-related events
according to the assessment of the treating GP were enrolled. The tailored
program consisted of a workshop for GPs and health care assistants, educational
materials and reminders for patients, and the elaboration of implementation
action plans. The primary outcome was the change in the degree of implementation
between baseline and follow-up, measured by a summary score of 10 indicators. The
indicators were based on structured surveys with patients and GPs.
RESULTS: We analyzed the data of 21 GPs (10 - intervention group, 11 - control
group) and 273 patients (130 - intervention group, 143 - control group). The
increase in the degree of implementation was 4.2 percentage points (95%
confidence interval: -0.3, 8.6) higher in the intervention group compared to the
control group (p = 0.1). Two of the 10 indicators were significantly improved in
the intervention group: medication counseling (p = 0.017) and brown bag review
(p = 0.012). Secondary outcomes showed an effect on patients' self-reported use
of medication lists when buying drugs in the pharmacy (p = 0.03).
CONCLUSIONS: The tailored program may improve implementation of medication
counseling and brown bag review whereas the use of medication lists and
medication reviews did not improve. No effect of the tailored program on the
combined primary outcome could be substantiated. Due to limitations of the study,
results have to be interpreted carefully. The factors facilitating and hindering
successful implementation will be examined in a comprehensive process evaluation.
TRIAL REGISTRATION NUMBER: ISRCTN34664024 , assigned 14/08/2013.
DOI: 10.1186/s13012-016-0535-y
PMCID: PMC5237147
1499. Int J Environ Res Public Health. 2017 Aug 12;14(8). pii: E910. doi:
10.3390/ijerph14080910.
Study on the Status of Health Service Utilization among Caregivers of Left-Behind

Children in Poor Rural Areas of Hunan Province: A Baseline Survey.
Ji M(1), Zhang Y(2), Zou J(3), Yuan T(4), Tang A(5), Deng J(6), Yang L(7), Li
M(8), Chen J(9), Qin H(10), Lin Q(11).
Author information:
(1)Department of Nutrition Science and Food Hygiene, Xiangya School of Public
Health, Central South University, 110 Xiangya Road, Changsha 410078, Hunan,
China. jimeimei1024@foxmail.com.
China. yefuzhang@foxmail.com.
China. zjj170605@foxmail.com.
China. yuantong168@foxmali.com.
(5)Department of Molecular, Cellular and Developmental Biology, Yale University,
219 Prospect St, New Haven, CT 06511, USA. amber.tang@yale.edu.
(6)Department of Epidemiology and Statistical Science, Xiangya School of Public
China. dengjing2@126.com.
China. ylnly1997@csu.edu.cn.
China. lmz1976@126.com.
China. chenjh@csu.edu.cn.
China. qinhong@csu.edu.cn.
China. linqian@csu.edu.cn.
BACKGROUND: The caregivers of left-behind children (CLBC) in China's poor, rural

areas are mostly elderly and women. Their health status and access to health
services have not been previously characterized. This study aims to explore the
status of CLBC in terms of their health service utilization and to provide a
scientific basis for guiding effective implementation of health policy in rural
Hunan.
METHODS: Random cluster sampling was used to survey CLBC in two rural counties.
Face-to-face interviews and questionnaires were used to collect data, including
socioeconomic status and health service utilization. The two-week prevalence rate
was used to reflect health service needs, while the two-week visiting rate,
annual hospitalization rate and participation in basic public health services
were used to evaluate health service utilization.
RESULTS: Of the 518 respondents in the study, 95.9% were farmers and 88.4% were
over 40 years old. The two-week prevalence rate was 36.1%. Furthermore, 40.1% of
ill caregivers' activities were partly restricted by illness and 3.7% needed to
be on bed rest. The two-week visiting rate was 21.0%. The main reasons for not
seeing a doctor were "self-medication" (39.1%) or "financial difficulties"
(32.6%). The annual hospitalization rate of the CLBC was 22.6% and the
non-hospitalization rate of those who needed hospitalization was 41.5%. "Lack of
time" (22.3%) and "financial difficulties" (50.5%) were the major factors
affecting the utilization of hospitalization services. In terms of participation
in basic public health services, only 35.1% CLBC clearly knew that township
hospitals have established health records for them. Only 50.6% of caregivers
received free health examinations in village clinics or township hospitals and
81.3% of the caregivers did not participate in health education or lectures
organized by local health institutions in 2014.
CONCLUSIONS: The utilization rate of health services was extremely low, which may
affect the quality of care for left-behind children. Better public health
education through multi-sector cooperation is urgently needed to improve health
cognition among CLBC in rural China.
DOI: 10.3390/ijerph14080910
PMCID: PMC5580613
1500. Clin Ophthalmol. 2015 Oct 22;9:1931-43. doi: 10.2147/OPTH.S92935. eCollection

2015.
Health coaching for glaucoma care: a pilot study using mixed methods.
Vin A(1), Schneider S(2), Muir KW(3), Rosdahl JA(1).
Author information:
(1)Department of Ophthalmology, Duke University, Durham, NC, USA.
(2)Department of Health Philosophy and Promotion, Maryland University of
Integrative Health, Laurel, MD, USA.
(3)Department of Ophthalmology, Duke University, Durham, NC, USA ; Durham VA
Medical Center, Durham, NC, USA.
INTRODUCTION: Adherence to glaucoma medications is essential for successful

treatment of the disease but is complex and difficult for many of our patients.
Health coaching has been used successfully in the treatment of other chronic
diseases. This pilot study explores the use of health coaching for glaucoma care.
METHODS: A mixed methods study design was used to assess the health coaching
intervention for glaucoma patients. The health coaching intervention consisted of
four to six health coaching sessions with a certified health coach via telephone.
Quantitative measures included demographic and health information, adherence to
glaucoma medications (using the visual analog adherence scale and medication
event monitoring system), and an exit survey rating the experience. Qualitative
measures included a precoaching health questionnaire, notes made by the coach
during the intervention, and an exit interview with the subjects at the end of
the study.
RESULTS: Four glaucoma patients participated in the study; all derived benefits
from the health coaching. Study subjects demonstrated increased glaucoma drop
adherence in response to the coaching intervention, in both visual analog scale
and medication event monitoring system. Study subjects' qualitative feedback
reflected a perceived improvement in both eye and general health self-care. The
subjects stated that they would recommend health coaching to friends or family
members.
CONCLUSION: Health coaching was helpful to the glaucoma patients in this study;
it has the potential to improve glaucoma care and overall health.
DOI: 10.2147/OPTH.S92935
PMCID: PMC4629983
PMID: 26604666
1501. World J Diabetes. 2014 Dec 15;5(6):945-50. doi: 10.4239/wjd.v5.i6.945.
Risk factors for cost-related medication non-adherence among older patients with
diabetes.
Zhang JX(1), Lee JU(1), Meltzer DO(1).
Author information:
(1)James X Zhang, Jhee U Lee, David O Meltzer, Section of Hospital Medicine,
Department of Medicine, the University of Chicago, Chicago, IL 60637, United
States.
AIM: To assess the risk factors for cost-related medication non-adherence (CRN)
among older patients with diabetes in the United States.
METHODS: We used data from the 2010 Health and Retirement Study to assess risk
factors for CRN including age, drug insurance coverage, nursing home residence,
functional limitations, and frequency of hospitalization. CRN was self-reported.
We conducted multivariate regression analysis to assess the effect of each risk
factor.
RESULTS: Eight hundred and seventy-five (18%) of 4880 diabetes patients reported
CRN. Age less than 65 years, lack of drug insurance coverage, and frequent
hospitalization significantly increased risk for CRN. Limitation in both
activities of daily living and instrumental activities of daily living were also
generally associated with increased risk of CRN. Residence in a nursing home and
Medicaid coverage significantly reduced risk.
CONCLUSION: These results suggest that expanding prescription coverage to
uninsured, sicker, and community-dwelling individuals is likely to produce the
largest decreases in CRN.
DOI: 10.4239/wjd.v5.i6.945
PMCID: PMC4265885
PMID: 25512801
1502. Afr J AIDS Res. 2017 Jul;16(2):91-99. doi: 10.2989/16085906.2017.1308386.

Epub
2017 Jun 22.
Barriers and facilitators of antiretroviral therapy adherence in rural Eastern

province, Zambia: the role of household economic status.
Masa R(1)(2), Chowa G(1)(2), Nyirenda V(2).
Author information:
(1)a School of Social Work , University of North Carolina at Chapel Hill , Chapel
Hill , North Carolina , USA.
(2)b Global Social Development Innovations , University of North Carolina at
Chapel Hill , Chapel Hill , North Carolina , USA.
In Zambia, more people living with HIV now have access to lifesaving
antiretroviral therapy than ever before. However, progress in HIV treatment and
care has not always resulted in lower mortality. Adherence remains a critical
barrier to treatment success. The objective of this study was to examine the
barriers and facilitators of antiretroviral therapy adherence, particularly the
role of household economic status. The study included a cross-sectional sample of
101 people living with HIV (PLHIV) in two rural communities in eastern Zambia.
Adherence was measured using patient self-assessment and pharmacy information.
Household economic status included components such as occupation, income, assets,
food security, and debt. Multivariable logistic regression was conducted to
examine the associations between household economic factors and adherence. Our
findings suggest that the role of economic status on adherence appears to be a
function of the economic component. Debt and non-farming-related occupation were
consistently associated with non-adherence. The association between assets and
adherence depends on the type of asset. Owning more transportation-related assets
was consistently associated with non-adherence, whereas owning more livestock was
associated with self-reported adherence. Additionally, living in a community with
fewer economic opportunities was associated with non-adherence. The associations
between place of residence and pharmacy refill adherence and between
transportation assets and self-reported adherence were statistically significant.
Improving adherence requires a multifaceted strategy that addresses the role of
economic status as a potential barrier and facilitator. Programmes that provide
economic opportunities and life-skills training may help PLHIV to overcome
economic, social, and psychological barriers.
DOI: 10.2989/16085906.2017.1308386
PMCID: PMC5963730
1503. J Investig Allergol Clin Immunol. 2015;25(6):408-15.
Self-Management of Anaphylaxis Is Not Optimal.
Múgica-García MV, Tejedor-Alonso MA, Moro-Moro M, Esteban-Hernández J,

Rojas-Perez-Ezquerra PE, Vila-Albelda C, Rosado-Ingelmo A.
BACKGROUND: Our objective was to ascertain the degree of adherence to

recommendations made to patients with anaphylaxis, most of whom were attended in
our allergy outpatient clinic.
METHODS: A questionnaire was sent to 1512 patients who had experienced
anaphylaxis and completed by 887. The chosen definition of anaphylaxis was that
of the National Institute of Allergy and Infectious Diseases and the Food Allergy
and Anaphylaxis Network Symposium. We evaluated the prescription, purchase, and
use of epinephrine auto-injectors and oral drugs, as well as the avoidance of
allergens involved in previous anaphylaxis episodes.
RESULTS: Most patients (94.53%) reported that they had received advice on
avoidance of responsible allergens after their allergy workup. Epinephrine
auto-injectors and oral drugs were prescribed according to the subtype of
anaphylaxis. Only 30.74% of patients used the epinephrine auto-injector; 54.26%
took oral medication. Most patients (88.3%) avoided the allergen.
CONCLUSIONS: Despite general agreement that anaphylaxis occurring in the
community should be treated with epinephrine auto-injectors, use of these devices
to treat recurrences was low in our patients. Oral medication intake was more
common than the epinephrine auto-injector in all subtypes. In order to increase
adherence to epinephrine auto-injectors, it is necessary to think beyond the
measures recommended during regular visits to allergy outpatient clinics.
1504. Sleep Disord. 2015;2015:607148. doi: 10.1155/2015/607148. Epub 2015 Dec 9.

Residual Effects of Sleep Medications Are Commonly Reported and Associated with
Impaired Patient-Reported Outcomes among Insomnia Patients in the United States.
Fitzgerald T(1), Vietri J(2).
Author information:
(1)Merck & Co., Whitehouse Station, NJ 08889, USA.
(2)Kantar Health, 20121 Milan, Italy.
Study Objective. To measure the association of symptoms attributed to residual

effects of sleep medication (e.g., drowsiness, difficulty concentrating, and
impaired memory) on self-reported functioning and satisfaction with these
medications. Methods. Individuals using prescription medications for insomnia
were invited to complete an Internet-based survey. Respondents were compared
according to the presence of self-reported residual effects; relationships
between severity of these effects and outcomes were modeled using regression.
Measures included the Brief Insomnia Questionnaire, Work Productivity and
Activity Impairment Questionnaire, and SATMED-Q. Subgroup analyses were conducted
with patients aged ≥65 years. Approximately 80% reported experiencing ≥1 residual
effect. The severity of residual effects was associated with increased residual
effect-related work impairment, including absenteeism (RR = 1.46, p < 0.001),
presenteeism (RR = 1.12, p < 0.001), overall work impairment (RR = 1.13, p <
0.001), and nonwork activity impairment (RR = 1.11, p < 0.001). More severe
residual symptoms were also associated with increased difficulty in home
management (Beta = .31, p < 0.001), ability to work (Beta = .31, p < 0.001),
social relationships, (Beta = .32, p < 0.001), close personal relationships (Beta
= .30, p < 0.001), and lower medication satisfaction (Beta = -.37, p < 0.001).
Conclusions. Individuals using medications for insomnia commonly experience
symptoms considered as residual effects, and these symptoms are associated with
greater interference of sleep-related problems at work, at home, and with social
relationships.
DOI: 10.1155/2015/607148
PMCID: PMC4689974
PMID: 26783470
1505. BMC Public Health. 2018 Oct 4;18(1):1157. doi: 10.1186/s12889-018-6070-9.
Relation between health literacy, self-care and adherence to treatment with oral
anticoagulants in adults: a narrative systematic review.
Cabellos-García AC(1), Martínez-Sabater A(2), Castro-Sánchez E(3), Kangasniemi

M(4), Juárez-Vela R(5), Gea-Caballero V(6)(7).
Author information:
(1)Unidad de cuidados intensivos, Hospital Universitario y politécnico La Fe,
Valencia, Spain.
(2)Nursing Department, University of Valencia, Valencia, Spain.
(3)NIHR Health Protection Research Unit in Healthcare Associated Infection and
Antimicrobial Resistance at Imperial College London, Du Cane Road, W12 0NN,
London, UK. e.castro-sanchez@imperial.ac.uk.
(4)Department of Nursing Science, Faculty of Health Sciences, University of
Eastern Finland, Kuopio, Finland.
(5)Universidad San Jorge de Zaragoza, Villanueva de Gállego, Zaragoza, Spain.
(6)Escuela de Enfermería La Fe, centro adscrito Universidad de Valencia,
Valencia, Spain.
(7)Instituto de Investigación La Fe. Grupo de investigación GREIACC, Valencia,
Spain.
BACKGROUND: Oral anticoagulants (OAC) are widely used in patients with

cardiovascular diseases. However, for optimal OAC self-care patients must have
skills, among which health literacy (HL) is highlighted. We aimed to describe the
relation between HL and self-care in cardiovascular patients on OAC treatment.
METHODS: Electronic searches were carried out in the PubMed, Scopus, Embase,
CINAHL, Web of Science, Cochrane Library, SciELO, IME-Biomedicina, CUIDEN Plus
and LILACS databases, limited to Spanish and English language and between January
2000-December 2016. Papers reported on adults older than 18 years, taking OAC by
themselves for at least three months. PRISMA guidelines were used for paper
selection.
RESULTS: We identified 142 articles and finally included 10; almost all of them
about warfarin. Our results suggest that in patients taking OAC treatments there
is a positive relationship between HL and the level of knowledge. In addition, a
small percentage of participants on the selected papers recognized the side
effects and complications associated with OAC treatment. Lower HL level was
associated with greater knowledge deficits and less adherence to treatment.
CONCLUSION: There is a paucity of research evaluating the effect of HL on diverse
aspects of OAC treatments. There is a need to expand the evidence base regarding
appropriate HL screening tools, determinants of adequate knowledge and optimal
behaviours related to OAC self-management.
DOI: 10.1186/s12889-018-6070-9
PMCID: PMC6172776
1506. BMC Public Health. 2019 Mar 4;19(1):262. doi: 10.1186/s12889-019-6550-6.
DTEXT - text messaging intervention to improve outcomes of people with type 2

diabetes: protocol for randomised controlled trial and cost-effectiveness
analysis.
Waller K(1), Furber S(2), Bauman A(3), Allman-Farinelli M(3), van den Dolder
P(2), Hayes A(3), Facci F(2), Franco L(2), Webb A(2), Moses R(2), Colagiuri S(3).
Author information:
(1)Illawarra Shoalhaven Local Health District, Warrawong, Australia.
karen.waller@health.nsw.gov.au.
(2)Illawarra Shoalhaven Local Health District, Warrawong, Australia.
(3)University of Sydney, Sydney, Australia.
BACKGROUND: Diabetes prevalence is rapidly increasing, with type 2 diabetes

predicted to be the leading contributor of non-communicable disease in Australia
by 2020. It is anticipated that rates of type 2 diabetes will continue to
increase if factors such as overweight and obesity, low physical activity and
poor nutrition are not addressed. The majority of Australians with type 2
diabetes do not meet the guidelines for optimal diabetes management, and access
to diabetes education is limited. This highlights the need for new interventions
that can reduce existing barriers to diabetes education, attain greater
population reach and support self-management strategies for people with type 2
diabetes. Mobile phone text messages have shown promising results as an
intervention for people with chronic disease. They have the ability to achieve
high levels of engagement and broad population reach, whilst requiring minimal
resources. There is however, no evidence on the effect of text messaging to
improve the health of people with type 2 diabetes in Australia.
METHODS/DESIGN: This randomised controlled trial aims to investigate if a 6 month
text message intervention (DTEXT) can lead to improvements in glycated
haemoglobin (HbA1c) and diabetes self-management among Australian residents in
New South Wales (NSW) with type 2 diabetes. Community dwelling adults (n = 340)
will be recruited with the primary outcome being change in HbA1c at 6 months.
Secondary outcomes include behaviour change for diabetes self-management,
self-efficacy, quality of life and intervention acceptability. An economic
evaluation will be conducted using a funder plus patient perspective.
DISCUSSION: This study will provide evidence on the effectiveness and cost
effectiveness of a text message intervention to reduce HbA1c and enhance
self-management of type 2 diabetes in the Australian population. If successful,
this intervention could be used as a model to complement and extend existing
diabetes care in the Australian health care system.
TRIAL REGISTRATION: The study has been registered with the Australian New Zealand
Clinical Trials Registry, Trial ID: ACTRN12617000416392 . Registered: 23 March
2017.
DOI: 10.1186/s12889-019-6550-6
PMCID: PMC6399841
1507. Patient Educ Couns. 2016 Jun;99(6):988-94. doi: 10.1016/j.pec.2015.12.001.

Epub
2015 Dec 29.
Gist and verbatim communication concerning medication risks/benefits.
Blalock SJ(1), DeVellis RF(2), Chewning B(3), Sleath BL(4), Reyna VF(5).
Author information:
(1)Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of
North Carolina at Chapel Hill, USA. Electronic address: s_blalock@unc.edu.
(2)Health Behavior, Gillings Global School of Public Health, University of North
Carolina at Chapel Hill, USA.
(3)Social and Administrative Sciences Division, School of Pharmacy, University of
Wisconsin-Madison, USA.
(4)Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of
North Carolina at Chapel Hill, USA.
(5)Human Neuroscience Institute, Cornell University, Ithaca, NY 14853, USA.
OBJECTIVES: To describe the information about medication risks/benefits that

rheumatologists provide during patient office visits, the gist that patients with
rheumatoid arthritis (RA) extract from the information provided, and the
relationship between communication and medication satisfaction.
METHODS: Data from 169 RA patients were analyzed. Each participant had up to
three visits audiotaped. Four RA patients coded the audiotapes using a Gist
Coding Scheme and research assistants coded the audiotapes using a Verbatim
Coding Scheme.
RESULTS: When extracting gist from the information discussed during visits,
patient coders distinguished between discussion concerning the possibility of
medication side effects versus expression of significant safety concerns. Among
patients in the best health, nearly 80% reported being totally satisfied with
their medications when the physician communicated the gist that the medication
was effective, compared to approximately 50% when this gist was not communicated.
CONCLUSION: Study findings underscore the multidimensional nature of medication
risk communication and the importance of communication concerning medication
effectiveness/need.
PRACTICE IMPLICATIONS: Health care providers should ensure that patients
understand that medication self-management practices can minimize potential
risks. Communicating simple gist messages may increase patient satisfaction,
especially messages about benefits for well-managed patients. Optimal
communication also requires shared understanding of desired therapeutic outcomes.
DOI: 10.1016/j.pec.2015.12.001
PMCID: PMC5511622
1508. Neuropsychiatr Dis Treat. 2015 May 8;11:1161-7. doi: 10.2147/NDT.S72367.

eCollection 2015.
High relapse rate and poor medication adherence in the Chinese population with
schizophrenia: results from an observational survey in the People's Republic of
China.
Xiao J(1), Mi W(1), Li L(1), Shi Y(1), Zhang H(1).
Author information:
(1)Department of Psychiatry, Peking University Sixth Hospital, Peking University
Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health,
Peking University, Beijing, People's Republic of China.
BACKGROUND: Relapse is common in schizophrenia, and seriously impacts patients'

quality of life and social functioning. Many factors have been identified that
may potentially increase the risk of relapse. This study was designed to
investigate the relapse rate in the year following hospital discharge among
Chinese patients with schizophrenia in the naturalistic condition, and to explore
possible risk factors related to relapse.
METHODS: We conducted a large, multicenter, retrospective, observational study in
ten psychiatric hospitals throughout the People's Republic of China. Nine hundred
and ninety-two schizophrenic outpatients aged 18-65 years discharged from these
hospitals between September 2011 and February 2012 with recovery/improvement of
their condition were included in the study. Information about relapse and
correlative factors during the year after discharge was collected by telephone
interview using a questionnaire.
RESULTS: Eight hundred and seventy-six of 992 eligible patients completed the
telephone survey. Of these patients, 293 (33.4%) had at least one relapse within
1 year after discharge, and 165 (18.8%) were rehospitalized. In respondents'
view, the most important factor contributing to relapse was poor medication
adherence (50.7%). Approximately 30% of the respondents had a negative attitude
toward medication, with the impression that there was no need to take drugs at
all or for a long time. Nonadherent patients (37.9%) had a relapse rate that was
2.5-fold higher than adherent patients (54.5% versus 20.7%, P<0.001). The top
five risk factors associated with relapse were nonadherence to medication (odds
ratio [OR] 4.602, 95% confidence interval [CI] 3.410-6.211), being without work
(OR 3.275, 95% CI 2.291-4.681), poor self-care ability (OR 2.996, 95% CI
2.129-4.214), poor interpersonal skills (OR 2.635, 95% CI 1.951-3.558), and
hospitalization on more than three occasions (OR 2.299, 95% CI 1.691-3.126).
CONCLUSION: The 1-year relapse rate after discharge in patients with
schizophrenia was 33.5% in our study. The most important risk factor related to
relapse was poor medication adherence, which was mainly due to patients having a
negative attitude toward their medication. Lack of psychosocial support and a
complicated disease history also increased the risk of relapse.
DOI: 10.2147/NDT.S72367
PMCID: PMC4431492
PMID: 26056450
1509. AMIA Annu Symp Proc. 2018 Apr 16;2017:1893-1902. eCollection 2017.
Towards Supporting Patient Decision-making In Online Diabetes Communities.
Zhang J(1), Marmor R(1), Huh J(1).
Author information:
(1)University of California San Diego, San Diego, CA.
As of 2014, 29.1 million people in the US have diabetes. Patients with diabetes
have evolving information needs around complex lifestyle and medical decisions.
As their conditions progress, patients need to sporadically make decisions by
understanding alternatives and comparing options. These moments along the
decision-making process present a valuable opportunity to support their
information needs. An increasing number of patients visit online diabetes
communities to fulfill their information needs. To understand how patients
attempt to fulfill the information needs around decision-making in online
communities, we reviewed 801 posts from an online diabetes community and included
79 posts for in-depth content analysis. The findings revealed motivations for
posters' inquiries related to decision-making including the changes in disease
state, increased self-awareness, and conflict of information received. Medication
and food were the among the most popular topics discussed as part of their
decision-making inquiries. Additionally, We present insights for automatically
identifying those decision-making inquiries to efficiently support information
needs presented in online health communities.
PMCID: PMC5977569
1510. Br J Clin Pharmacol. 2018 Mar;84(3):553-567. doi: 10.1111/bcp.13479. Epub

2018
Jan 5.
Drug burden index to define the burden of medicines in older adults with
intellectual disabilities: An observational cross-sectional study.
O'Connell J(1)(2), Burke É(2), Mulryan N(2), O'Dwyer C(2), Donegan C(1)(2),
McCallion P(3), McCarron M(4), Henman MC(1), O'Dwyer M(1).
Author information:
(1)School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin,
Ireland.
(2)IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland.
(3)College of Public Health, Temple University, Philadelphia, USA.
(4)Dean of Health Sciences, Trinity College, Dublin, Ireland.
AIMS: The drug burden index (DBI) is a dose-related measure of anticholinergic

and sedative drug exposure. This cross-sectional study described DBI in older
adults with intellectual disabilities (ID) and the most frequently reported
therapeutic classes contributing to DBI and examined associations between higher
DBI scores and potential adverse effects as well as physical function.
METHODS: This study analysed data from Wave 2 (2013/2014) of the Intellectual
Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA), a
representative study on the ageing of people with ID in Ireland. Self- and
objectively-reported data were collected on medication use and physical health,
including health conditions. The Barthel index was the physical function measure.
RESULTS: The study examined 677 individuals with ID, of whom 644 (95.1%) reported
taking medication and 78.6% (n = 532) were exposed to medication with
anticholinergic and/or sedative activity. 54.2% (n = 367) were exposed to high
DBI score (≥1). Adjusted multivariate regression analysis revealed no significant
association between DBI score and daytime dozing, constipation or falls. After
adjusting for confounders (sex, age, level of ID, comorbidities, behaviours that
challenge, history of falls), DBI was associated with significantly higher
dependence in the Barthel index (P = 0.002).
CONCLUSIONS: This is the first time DBI has been described in older adults with
ID. Scores were much higher than those observed in the general population and
higher scores were associated with higher dependence in Barthel index activities
of daily living.
DOI: 10.1111/bcp.13479
PMCID: PMC5809360

eCollection 2018.
Integrating factors associated with hypertensive patients' self-management using

structural equation modeling: a cross-sectional study in Guangdong, China.
Ding W(1), Li T(1), Su Q(2), Yuan M(2), Lin A(1).
Author information:
(1)Department of Epidemiology and Health Statistics, School of Public Health, Sun
Yat-sen University, Guangzhou, Guangdong, China, linaihua@mail.sysu.edu.cn.
(2)Department of Chronic Disease Management, Dadong Community Healthcare Center,
Guangzhou, Guangdong, China.
Purpose: Hypertension is considered a major public health issue worldwide because

of its high frequency and concomitant risk of cardiovascular disease (CVD).
Chronic-disease self-management has been proven to be cost-effective, but
influencing factors and pathways remain complex and unclear. The purpose of this
study was to integrate factors associated with hypertension self-management to
provide a theoretical reference for community hypertension management.
Methods: A total of 268 community-dwelling hypertensive patients were enrolled in
a cross-sectional study conducted from July to September in 2017. A questionnaire
on demographic-disease characteristics, disease knowledge, social support,
self-efficacy, and self-management was completed by patients. Structural equation
modeling was performed to verify multiple factors in self-management based on the
self-efficacy theory.
Results: The final model showed a good fit to sample data, ie, younger patients
with lower CVD risk, shorter disease course, and less disease knowledge and
social support predicted less self-efficacy, less hypertension self-management,
and less controlled hypertension. Furthermore, social support was negatively
correlated with age, CVD risk, and disease course and positively with disease
knowledge.
Conclusion: Medication adherence is the lowest dimension in self-management, and
self-efficacy is vital to consider in the development of self-management
interventions. Self-management education and mutual-help groups may be potential
solutions with the power of technology. Younger patients with lower CVD risk and
shorter disease course are vulnerable and need more attention.
DOI: 10.2147/PPA.S180314
PMCID: PMC6198889
PMID: 30410312

1512. BMC Health Serv Res. 2018 Mar 1;18(1):149. doi: 10.1186/s12913-018-2950-z.
Delays in seeking and receiving health care services for pneumonia in children
under five in the Peruvian Amazon: a mixed-methods study on caregivers'
perceptions.
Pajuelo MJ(1)(2), Anticona Huaynate C(3)(4), Correa M(3)(4), Mayta Malpartida

H(3)(4), Ramal Asayag C(5)(6), Seminario JR(5), Gilman RH(7), Murphy L(3)(8),
Oberhelman RA(3)(8), Paz-Soldan VA(3)(8).
Author information:
(1)Office of Global Health, Tulane University School of Public Health and
Tropical Medicine, 1140 Canal Street, Suite 2210, New Orleans, LA, 70112, USA.
Monica.pajuelo.t@upch.pe.
(2)Department of Cellular and Molecular Science. School of Science and
Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.
Monica.pajuelo.t@upch.pe.
(3)Office of Global Health, Tulane University School of Public Health and
Tropical Medicine, 1140 Canal Street, Suite 2210, New Orleans, LA, 70112, USA.
(4)Department of Cellular and Molecular Science. School of Science and
Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.
(5)Hospital Regional de Loreto, Iquitos, Peru.
(6)Universidad Nacional de la Amazonia Peruana, Iquitos, Peru.
(7)Department of International Health, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA.
(8)Department of Global Community Health & Behavioral Sciences, Tulane University
School of Public Health and Tropical Medicine, New Orleans, LA, USA.
BACKGROUND: Delays in receiving adequate care for children suffering from

pneumonia can be life threatening and have been described associated with
parents' limited education and their difficulties in recognizing the severity of
the illness. The "three delays" was a model originally proposed to describe the
most common determinants of maternal mortality, but has been adapted to describe
delays in the health seeking process for caregivers of children under five. This
study aims to explore the caregivers' perceived barriers for seeking and
receiving health care services in children under five years old admitted to a
referral hospital for community-acquired pneumonia in the Peruvian Amazon Region
using the three-delays model framework.
METHODS: There were two parts to this mixed-method, cross-sectional,
hospital-based study. First, medical charts of 61 children (1 to 60 months old)
admitted for pneumonia were reviewed, and clinical characteristics were noted.
Second, to examine health care-seeking decisions and actions, as well as
associated delays in the process of obtaining health care services, we
interviewed 10 of the children's caregivers.
RESULTS: Half of the children in our study were 9 months old or less. Main
reasons for seeking care at the hospital were cough (93%) and fever (92%).
Difficulty breathing and fast breathing were also reported in more than 60% of
cases. In the interviews, caregivers reported delays of 1 to 14 days to go to the
closest health facility. Factors perceived as causes for delays in deciding to
seek care were apparent lack of skills to recognize signs and symptoms and of
confidence in the health system, and practicing self-medication. No delays in
reaching a health facility were reported. Once the caregivers reached a health
facility, they perceived lack of competence of medical staff and inadequate
treatment provided by the primary care physicians.
CONCLUSION: According to caregivers, the main delays to get health care services
for pneumonia among young children were identified in the initial decision of
caregivers to seek healthcare and in the health system to provide it. Specific
interventions targeted to main barriers may be useful for reducing delays in
providing appropriate health care for children with pneumonia.
DOI: 10.1186/s12913-018-2950-z
PMCID: PMC5831863

eCollection 2017.
What strategies do ulcerative colitis patients employ to facilitate adherence?
Kawakami A(1), Tanaka M(2), Naganuma M(3), Maeda S(4), Kunisaki R(5),
Yamamoto-Mitani N(6).
Author information:
Minami-ku, Yokohama, Japan; Department of Gerontological Home Care and Long-term
Care Nursing, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo,
Japan.
(2)Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital,
Mahidol University, Ratchathewi, Bangkok, Thailand.
(3)Division of Gastroenterology and Hepatology, Keio University, Shinjuku-ku,
Tokyo, Japan.
Medicine, Kanazawa-ku, Yokohama, Japan.
Minami-ku, Yokohama, Japan.
(6)Department of Gerontological Home Care and Long-term Care Nursing, Graduate
School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
BACKGROUND: Overall, 30%-45% of patients with ulcerative colitis (UC) are

non-adherent and have difficulties taking their medications; this non-adherence
increases the risk of clinical relapse 1.4- to 5.5-fold. This study aimed to
clarify the strategies patients employ to facilitate adherence and determine
whether the strategies had an impact on good adherence.
METHODS: This was a cross-sectional survey using a self-administered
questionnaire and review of medical records. Patients diagnosed as having UC and
attending one of the outpatient clinics of four urban hospitals from June 2009 to
December 2012 were enrolled. A questionnaire was developed to identify the
strategies patients employ to facilitate adherence and then administered to
patients with UC. Adherence to 5-aminosalicylic acid was calculated, and
univariate and multiple logistic regression analyses were performed to determine
the strategies that were associated with good adherence.
RESULTS: The final analyses included 671 participants (mean age 40.2 years; 54.3%
males). The valid response rate was 96.9%; 186 (27.7%) participants were
classified as non-adherent, the mean adherence rate being 86.1% (standard
deviation [SD] 17.9). Seven strategies that patients employ to facilitate
adherence were identified, the following two being significantly associated with
good adherence: "I keep my medicines where I eat meals" and "I keep each day's
medicine in a pill case or something similar to make sure I have taken them".
CONCLUSION: The identified strategies might be used to develop a program to
improve medication adherence in patients with UC.
DOI: 10.2147/PPA.S117841
PMCID: PMC5293502
PMID: 28203059

1514. Exp Hematol Oncol. 2015 Jun 11;4:15. doi: 10.1186/s40164-015-0011-4.

eCollection
2015.
Are Australian clinicians monitoring medication adherence in hematological cancer

survivors? Two cross-sectional studies.
Lynagh MC(1), Clinton-McHarg T(2), Hall A(1), Sanson-Fisher R(1), Stevenson W(3),
Tiley C(1), Bisquera A(4).
Author information:
(1)School of Medicine and Public Health, Faculty of Health and Medicine,
University of Newcastle, Level 4, West, HMRI Building, Callaghan, NSW 2308
Australia.
(2)School of Medicine and Public Health, Faculty of Health and Medicine, The
University of Newcastle, 1127 Booth Building, Wallsend Campus, NSW 2308
Australia.
(3)Department of Haematology Royal North Shore Hospital Pathology North, The
University of Sydney, Sydney, NSW 2006 Australia.
(4)The Clinical Research Design Information Technology and Statistical Support
Unit (CReDITSS), The University of Newcastle, HMRI Building, Callaghan, Sydney,
NSW 2308 Australia.
BACKGROUND: Hematological cancer survivors are growing in number and increasingly

rely on oral therapy. Given known poor outcomes associated with non-adherence and
previous evidence that many patients do not fully adhere to their treatment
regimen, this study aimed to determine the degree to which clinicians monitor
adherence to oral medication in hematological cancer survivors.
METHODS: Data was combined from two cross-sectional surveys of a heterogeneous
sample of 431 hematological cancer survivors recruited from three outpatient
hematology clinics in three different states (n = 215) and one state cancer
registry (n = 216) in Australia. Participants completed a self-administered
survey that included demographic characteristics and a 7-item measure of
medication adherence developed by the researchers specifically for the purpose of
the studies.
RESULTS: Of the 431 participants, 37 % (n = 160) reported currently taking daily
cancer-related medication. Of these, 14 % (n = 23) were found to be non-adherent
with 'missing a dose' being the most commonly reported non-adherent behaviour.
Only 41 % of survivors indicated that their hematologist or cancer clinician had
'always' asked about their cancer-related medication during their last six
visits.
CONCLUSIONS: Non-adherence to oral therapy remains a problem in hematological
cancer survivors, yet clinicians in Australia do not appear to be regularly
monitoring adherence in their patients. Given an increasing dependence on oral
therapy in clinical hematology and medical oncology and the importance of
medication adherence to optimising health outcomes, greater effort should be
invested in developing effective interventions to improve support and adherence
monitoring by cancer clinicians and GPs.
DOI: 10.1186/s40164-015-0011-4
PMCID: PMC4469244
PMID: 26082857

eCollection 2015.
The influence of cultural and religious orientations on social support and its
potential impact on medication adherence.
Hatah E(1), Lim KP(2), Ali AM(1), Mohamed Shah N(1), Islahudin F(1).
Author information:
Aziz, Jalan Pahang, Kuala Lumpur, Malaysia.
Aziz, Jalan Pahang, Kuala Lumpur, Malaysia ; Pharmacy Department, Kuala Lumpur
General Hospital, Jalan Pahang, Kuala Lumpur, Malaysia.
PURPOSE: Social support can positively influence patients' health outcomes

through a number of mechanisms, such as increases in patients' adherence to
medication. Although there have been studies on the influence of social support
on medication adherence, these studies were conducted in Western settings, not in
Asian settings where cultural and religious orientations may be different. The
objective of this study was to assess the effects of cultural orientation and
religiosity on social support and its relation to patients' medication adherence.
METHODS: This was a cross-sectional study of patients with chronic diseases in
two tertiary hospitals in Selangor, Malaysia. Patients who agreed to participate
in the study were asked to answer questions in the following areas: 1) perceived
group and higher authority cultural orientations; 2) religiosity: organizational
and non-organizational religious activities, and intrinsic religiosity; 3)
perceived social support; and 4) self-reported medication adherence. Patients'
medication adherence was modeled using multiple logistic regressions, and only
variables with a P-value of <0.25 were included in the analysis.
RESULTS: A total of 300 patients completed the questionnaire, with the exception
of 40 participants who did not complete the cultural orientation question. The
mean age of the patients was 57.6±13.5. Group cultural orientation,
organizational religious activity, non-organizational religious activity, and
intrinsic religiosity demonstrated significant associations with patients'
perceived social support (r=0.181, P=0.003; r=0.230, P<0.001; r=0.135, P=0.019;
and r=0.156, P=0.007, respectively). In the medication adherence model, only age,
duration of treatment, organizational religious activity, and disease type (human
immunodeficiency virus) were found to significantly influence patients' adherence
to medications (adjusted odds ratio [OR] 1.05, P=0.002; OR 0.99, P=0.025; OR
1.19, P=0.038; and OR 9.08, P<0.05, respectively).
CONCLUSION: When examining religious practice and cultural orientation, social
support was not found to have significant influence on patients' medication
adherence. Only age, duration of treatment, organizational religious activity,
and disease type (human immunodeficiency virus) had significant influence on
patients' adherence.
DOI: 10.2147/PPA.S79477
PMCID: PMC4423506
PMID: 25960641
1516. Front Aging Neurosci. 2015 Apr 21;7:56. doi: 10.3389/fnagi.2015.00056.

eCollection 2015.
Determinants of frailty: the added value of assessing medication.
Coelho T(1), Paúl C(2), Gobbens RJ(3), Fernandes L(4).
Author information:
(1)Department of Occupational Therapy, School of Allied Health Technologies,
Polytechnic Institute of Porto, Vila Nova de Gaia Portugal ; The Research and
Education Unit on Ageing, Institute of Biomedical Sciences Abel Salazar,
University of Porto, Porto Portugal.
(2)The Research and Education Unit on Ageing, Institute of Biomedical Sciences
Abel Salazar, University of Porto, Porto Portugal.
(3)Faculty of Health, Sports and Social Work, Inholland University of Applied
Sciences, Amsterdam Netherlands ; Zonnehuisgroep Amstelland, Amstelveen
Netherlands.
(4)Center for Health Technology and Services Research (CINTESIS), Faculty of
Medicine, University of Porto, Porto Portugal.
This study aims to analyze which determinants predict frailty in general and each
frailty domain (physical, psychological, and social), considering the integral
conceptual model of frailty, and particularly to examine the contribution of
medication in this prediction. A cross-sectional study was designed using a
non-probabilistic sample of 252 community-dwelling elderly from three Portuguese
cities. Frailty and determinants of frailty were assessed with the Tilburg
Frailty Indicator. The amount and type of different daily-consumed medication
were also examined. Hierarchical regression analysis were conducted. The mean age
of the participants was 79.2 years (±7.3), and most of them were women (75.8%),
widowed (55.6%) and with a low educational level (0-4 years: 63.9%). In this
study, determinants explained 46% of the variance of total frailty, and 39.8,
25.3, and 27.7% of physical, psychological, and social frailty respectively. Age,
gender, income, death of a loved one in the past year, lifestyle, satisfaction
with living environment and self-reported comorbidity predicted total frailty,
while each frailty domain was associated with a different set of determinants.
The number of daily-consumed drugs was independently associated with physical
frailty, and the consumption of medication for the cardiovascular system and for
the blood and blood-forming organs explained part of the variance of total and
physical frailty. The adverse effects of polymedication and its direct link with
the level of comorbidities could explain the independent contribution of the
amount of prescribed drugs to frailty prediction. On the other hand, findings in
regard to medication type provide further evidence of the association of frailty
with cardiovascular risk. In the present study, a significant part of frailty was
predicted, and the different contributions of each determinant to frailty domains
highlight the relevance of the integral model of frailty. The added value of a
simple assessment of medication was considerable, and it should be taken into
account for effective identification of frailty.
DOI: 10.3389/fnagi.2015.00056
PMCID: PMC4404866
PMID: 25954195
1517. Int J Chron Obstruct Pulmon Dis. 2016 Aug 3;11:1811-22. doi:
Assessing the effect of culturally specific audiovisual educational interventions

on attaining self-management skills for chronic obstructive pulmonary disease in
Mandarin- and Cantonese-speaking patients: a randomized controlled trial.
Poureslami I(1), Kwan S(2), Lam S(3), Khan NA(4), FitzGerald JM(5).
Author information:
(1)Respiratory Division, Department of Medicine, Faculty of Medicine, University
of British Columbia, Vancouver, Canada; Department of Graduate Studies, Centre
for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research
Institute, Vancouver, Canada.
(2)Respiratory Department, Burnaby Hospital, University of British Columbia,
Burnaby, Canada.
(3)Respiratory Division, University of British Columbia, Vancouver, Canada;
Department of Integrative Oncology, BC Cancer Research Centre, Vancouver, Canada.
(4)Department of Internal Medicine, Faculty of Medicine, University of British
Columbia, Vancouver, Canada; Department of Internal Medicine, Providence Health
Care Authority, Vancouver, Canada.
(5)VGH Divisions of Respiratory Medicine, University of British Columbia,
Vancouver, Canada; Respiratory Medicine, Vancouver Coastal Health Authority,
Vancouver Coastal Health Research Institute, Institute for Heart and Lung Health,
The Lung Centre, Gordon and Leslie Diamond Health Care Centre, Vancouver, Canada.
BACKGROUND: Patient education is a key component in the management of chronic

obstructive pulmonary disease (COPD). Delivering effective education to ethnic
groups with COPD is a challenge. The objective of this study was to develop and
assess the effectiveness of culturally and linguistically specific audiovisual
educational materials in supporting self-management practices in Mandarin- and
Cantonese-speaking patients.
METHODS: Educational materials were developed using participatory approach
(patients involved in the development and pilot test of educational materials),
followed by a randomized controlled trial that assigned 91 patients to three
intervention groups with audiovisual educational interventions and one control
group (pamphlet). The patients were recruited from outpatient clinics. The
primary outcomes were improved inhaler technique and perceived self-efficacy to
manage COPD. The secondary outcome was improved patient understanding of
pulmonary rehabilitation procedures.
RESULTS: Subjects in all three intervention groups, compared with control
subjects, demonstrated postintervention improvements in inhaler technique
(P<0.001), preparedness to manage a COPD exacerbation (P<0.01), ability to
achieve goals in managing COPD (P<0.01), and understanding pulmonary
rehabilitation procedures (P<0.05).
CONCLUSION: Culturally appropriate educational interventions designed
specifically to meet the needs of Mandarin and Cantonese COPD patients are
associated with significantly better understanding of self-management practices.
Self-management education led to improved proper use of medications, ability to
manage COPD exacerbations, and ability to achieve goals in managing COPD.
CLINICAL IMPLICATION: A relatively simple culturally appropriate disease
management education intervention improved inhaler techniques and self-management
practices. Further research is needed to assess the effectiveness of
self-management education on behavioral change and patient empowerment
strategies.
DOI: 10.2147/COPD.S105408
PMCID: PMC4976815
1518. Eur J Clin Pharmacol. 2018 Oct;74(10):1343-1349. doi: 10.1007/s00228-018-

2508-3.
Epub 2018 Jun 28.
Developing confidence in basic prescribing skills during medical school: a

longitudinal questionnaire study investigating the effects of a modified clinical
pharmacology course.
Eriksson AL(1)(2), Wallerstedt SM(3)(4).
Author information:
(1)Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy,
University of Gothenburg, 413 45, Gothenburg, Sweden. anna.eriksson@pharm.gu.se.
(2)Department of Clinical Pharmacology, Sahlgrenska University Hospital,
Gothenburg, Sweden. anna.eriksson@pharm.gu.se.
(3)Department of Clinical Pharmacology, Sahlgrenska University Hospital,
Gothenburg, Sweden.
(4)Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden.
PURPOSE: To investigate if increased focus on pharmacotherapy during medical

school can increase students' confidence in basic prescribing skills, that is,
performing medication reviews and writing medication discharge summaries.
METHODS: In 2016, the clinical pharmacology course in medical school in
Gothenburg, Sweden, was modified to facilitate the students' acquisition of
prescribing skills, with (i) clarified learning outcomes; (ii) supply of a list
of common drugs for self-completion; (iii) instructions to practice medication
reviews/discharge summaries during the ward-based education; and (iv) a
concluding compulsory seminar where the students were to present
prescribing-related experiences from their ward-based attendance. Questionnaires
were administered to students participating in the course before (2016; n = 101)
and after (2017; n = 137) implementation of the modifications. Students were
asked to grade their agreement from 1 (totally disagree) to 5 (totally agree) on
statements related to their perceived confidence in basic prescribing skills.
RESULTS: In all, 195 students returned the questionnaire (response rate 82%;
median age 24 years; 68% female). Confidence was rated higher after the
modifications were implemented, both regarding medication reviews and medication
discharge summaries, after vs. before 3.6 ± 1.2 vs. 3.2 ± 1.0 (P = 0.024), and
4.3 ± 0.9 vs. 3.9 ± 1.1 (P = 0.008), respectively. The adjusted odds for being
confident in performing these tasks were 1.49/1.36 times greater after the course
modifications (P = 0.047/0.019). Perceived confidence in performing medication
reviews/summary reports was positively correlated with numbers performed
(P < 0.0001).
CONCLUSIONS: Modifications of the clinical pharmacology course during medical
school, focusing on students' training in pharmacotherapy, was associated with
increased confidence of this core skill for a physician.
DOI: 10.1007/s00228-018-2508-3
PMCID: PMC6132548
1519. Glob Health Action. 2015 Sep 10;8:28041. doi: 10.3402/gha.v8.28041.

eCollection
2015.
A community-driven hypertension treatment group in rural Honduras.
Reiger S(1)(2)(3), Harris JR(4), Chan KC(5), Oqueli HL(6), Kohn M(4).
Author information:
(1)Department of Medicine, University of Washington School of Medicine, Seattle,
WA, USA.
(2)Department of Epidemiology, University of Washington School of Public Health,
Seattle, WA, USA.
(3)Salud Juntos, Seattle, WA, USA; sreiger@partners.org.
(4)Health Promotion Research Center, Department of Health Services, School of
Public Health, University of Washington, Seattle, WA, USA.
(5)Department of Biostatistics, School of Public Health, University of
Washington, Seattle, WA, USA.
(6)Departmento de Yoro, Morazán, Hector Lopez Oqueli, Secretaría de Salud, Yoro,
Honduras.
BACKGROUND: We formed a self-funded hypertension treatment group in a

resource-poor community in rural Honduras. After training community health
workers and creating protocols for standardized treatment, we used group
membership fees to maintain the group, purchase generic medications in bulk on
the local market, and hire a physician to manage treatment. We then assessed
whether participation in the group improved treatment, medication adherence, and
hypertension control.
DESIGN: This is a program evaluation using quasi-experimental design and no
control group. Using data from the 86 members of the hypertension treatment
group, we analyzed baseline and follow-up surveys of members, along with 30
months of clinical records of treatment, medication adherence, and blood pressure
readings.
RESULTS: Our initial hypertension needs assessment revealed that at baseline,
community hypertensives relied on the local Ministry of Health clinic as their
source of anti-hypertensive medications and reported that irregular supply
interfered with medication adherence. At baseline, hypertension group members
were mainly female, overweight or obese, physically active, non-smoking, and
non-drinking. After 30 months of managing the treatment group, we found a
significant increase in medication adherence, from 54.8 to 76.2% (p<0.01), and
hypertension control (<140/90 mmHg), from 31.4 to 54.7% (p<0.01). We also found a
mean monthly decrease of 0.39 mmHg in systolic blood pressure (p<0.01). At the
end of the 30-month observation period, the local Ministry of Health system had
increased provision of low-cost anti-hypertensive medications and adopted the
hypertension treatment group's treatment protocols.
CONCLUSIONS: Formation of a self-funded, community-based hypertension treatment
group in a rural, resource-poor community is feasible, and group participation
may improve treatment, medication adherence, and hypertension control and can
serve as a political driver for improving hypertension treatment services
provided by the public system.
DOI: 10.3402/gha.v8.28041
PMCID: PMC4567586
1520. J Surg Res. 2018 Feb;222:195-202.e2. doi: 10.1016/j.jss.2017.09.037.
Assessment of risk factors for increased resource utilization in kidney

transplantation.
Vranian SC Jr(1), Covert KL(2), Mardis CR(3), McGillicuddy JW(4), Chavin KD(5),
Dubay D(4), Taber DJ(6).
Author information:
(1)Division of Transplant Surgery, Medical University of South Carolina,
Charleston, South Carolina. Electronic address: vranian@musc.edu.
(2)College of Pharmacy, Bill Gatton College of Pharmacy, Johnson City, Tennessee.
(3)Transplant Service Line, Medical University of South Carolina, Charleston,
South Carolina.
Charleston, South Carolina.
(5)Department of Surgery, School of Medicine, Case Western Reserve University,
Cleveland, Ohio.
Charleston, South Carolina; Department of Pharmacy Services, Ralph H. Johnson
VAMC, Charleston, South Carolina.
BACKGROUND: There are only a limited number of studies that have sought to
identify patients at high risk for medication errors and subsequent adverse
clinical outcomes. This study sought to identify risk factors for increased
health care resource utilization in kidney transplant recipients based on
drug-related problems and self-administered surveys.
METHODS: In this prospective observational study, adult kidney transplant
recipients seen in the transplant clinic between September and November 2015 were
surveyed for self-reported demographics, medication adherence, and health
status/outlook. Subsequently, patients were assessed for associations between
survey results, pharmacist-derived drug-related problems, and health resource
utilization over a minimum 6-mo follow-up period. Based on univariate
associations, two risk cohorts were identified and compared for health care
utilization using multivariable Poisson regression.
RESULTS: A total of 237 patients were included, with a mean follow-up of 8 mo.
From the patient survey data, Medicaid insured or self-rated poor health status
were identified as a significant risk cohort. From pharmacist assessments, those
who received incorrect medication or lacked appropriate follow-up medication
monitoring were identified as a significant risk cohort (pharmacy errors). The
Medicaid insured or self-rated poor health status cohort experienced 43% more
total health care encounters (incident rate ratios [IRR] 1.43, 1.01-2.02) and 35%
more transplant clinic visits (IRR 1.35, 1.03-1.77). The pharmacy errors cohort
experienced 4.2 times the rate of total health care encounters (IRR 4.17,
1.55-11.2), 4.1 times the rate of hospital readmissions (IRR 4.09, 1.58-10.6),
and 2.3 times the rate of transplant clinic visits (IRR 2.31, 1.04-5.11).
CONCLUSIONS: Medicaid insurance, self-rated poor health status, and errors in the
medication regimen or monitoring were significant risk factors for increased
health care utilization in kidney transplant recipients. Further research is
warranted to validate these potential risk factors, determine the long-term
impact on graft/patient survival, and assess the mutability of these risks
through prospective identification and intervention.
DOI: 10.1016/j.jss.2017.09.037
PMCID: PMC5742052
Mobile Diabetes Intervention Study of Patient Engagement and Impact on Blood

Glucose: Mixed Methods Analysis.
Quinn CC(1), Butler EC(2), Swasey KK(1), Shardell MD(3), Terrin MD(1), Barr
EA(1), Gruber-Baldini AL(1).
Author information:
(1)Department of Epidemiology and Public Health, University of Maryland School of
Medicine, Baltimore, MD, United States.
(2)Department of Emergency Medicine, Wellspan York Hospital, York, PA, United
States.
(3)National Institute on Aging, Baltimore, MD, United States.
BACKGROUND: Successful treatment of diabetes includes patient self-management
behaviors to prevent or delay complications and comorbid diseases. On the basis
of findings from large clinical trials and professional guidelines, diabetes
education programs and health providers prescribe daily regimens of glucose
monitoring, healthy eating, stress management, medication adherence, and physical
activity. Consistent, long-term commitment to regimens is challenging. Mobile
health is increasingly being used to assist patients with lifestyle changes and
self-management behaviors between provider visits. The effectiveness of mobile
health to improve diabetes outcomes depends on patient engagement with a
technology, content, or interactions with providers.
OBJECTIVES: In the current analysis, we aimed to identify patient engagement
themes in diabetes messaging with diabetes providers and determine if differences
in engagement in the Mobile Diabetes Intervention Study (MDIS) influenced changes
in glycated hemoglobin A1c (HbA1c) over a 1-year treatment period (1.9% absolute
decrease in the parent study).
METHODS: In the primary MDIS study, 163 patients were enrolled into 1 of 3 mobile
intervention groups or a usual care control group based on their physician
cluster randomization assignment. The control group received care from their
physicians as usual. Participants in each intervention group had access to a
patient portal where they could record monitoring values for blood glucose, blood
pressure, medication changes, or other self-management information while also
assigned to varying levels of physician access to patient data. Intervention
participants could choose to send and receive messages to assigned certified
diabetes educators with questions or updates through the secure Web portal. For
this secondary analysis, patient engagement was measured using qualitative
methods to identify self-care themes in 4109 patient messages. Mixed methods were
used to determine the impact of patient engagement on change in HbA1c over 1
year.
RESULTS: Self-care behavior themes that received the highest engagement for
participants were glucose monitoring (75/107, 70.1%), medication management
(71/107, 66.4%), and reducing risks (71/107, 66.4%). The average number of
messages sent per patient were highest for glucose monitoring (9.2, SD 14.0) and
healthy eating (6.9, SD 13.2). Compared to sending no messages, sending any
messages about glucose monitoring (P=.03) or medication (P=.01) led to a decrease
in HbA1c of 0.62 and 0.72 percentage points, respectively. Sending any messages
about healthy eating, glucose monitoring, or medication combined led to a
decrease in HbA1c of 0.54 percentage points compared to not sending messages in
these themes (P=.045).
CONCLUSIONS: The findings from this study help validate the efficacy of the
mobile diabetes intervention. The next step is to determine differences between
patients who engage in mobile interventions and those who do not engage and
identify methods to enhance patient engagement.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT01107015;
http://www.webcitation.org/6wh4ekP4R).
©Charlene Connolly Quinn, Erin C Butler, Krystal K Swasey, Michelle D Shardell,

Michael D Terrin, Erik A Barr, Ann L Gruber-Baldini. Originally published in JMIR
Mhealth and Uhealth (http://mhealth.jmir.org), 02.02.2018.
PMCID: PMC5816260
PMID: 29396389
1522. Lancet Glob Health. 2018 May;6(5):e568-e578. doi: 10.1016/S2214-

109X(18)30061-5.
Epub 2018 Mar 8.
Effect of self-administration versus provider-administered injection of
subcutaneous depot medroxyprogesterone acetate on continuation rates in Malawi: a
randomised controlled trial.
Burke HM(1), Chen M(2), Buluzi M(3), Fuchs R(2), Wevill S(2), Venkatasubramanian
L(2), Dal Santo L(2), Ngwira B(3).
Author information:
(1)FHI 360, Durham, NC, USA. Electronic address: hburke@fhi360.org.
(2)FHI 360, Durham, NC, USA.
(3)College of Medicine, University of Malawi, Blantyre, Malawi.
Comment in
Lancet Glob Health. 2018 May;6(5):e481-e482.
BACKGROUND: Injectable contraceptives are popular in sub-Saharan Africa but have

high discontinuation rates due partly to the need for provider-administered
re-injection. We compared continuation rates of women who self-injected
subcutaneous depot medroxyprogesterone acetate (DMPA-SC) and women who received
DMPA-SC from a health-care provider, including community health workers (CHWs).
METHODS: We did an open-label randomised controlled trial based at six Ministry
of Health clinics in rural Mangochi District, Malawi. Health-care providers
recruited adult women who presented at the six clinics or to CHWs in rural
communities in the clinic catchment areas. Participants received DMPA-SC and were
randomised (1:1) to receive provider-administered injections or training in how
to self-inject DMPA-SC. Randomisation was done via a computer-generated block
randomisation schedule with block sizes of four, six, and eight and stratified by
study site, generated by an independent statistician. Self-injectors administered
the first injection under observation and were sent home with three doses,
written instructions, and a calendar. The provider-administered group received a
DMPA-SC injection and a calendar, and were asked to return for subsequent
injections. Data collectors contacted participants after the 14-week re-injection
window at 3, 6, and 9 months to collect continuation data. At 12 months after
enrolment or early discontinuation, women had their final interview, which
included pregnancy testing. The primary outcome was discontinuation of DMPA-SC,
as assessed in the intention-to-treat population. We used Kaplan-Meier methods to
estimate the probabilities of continuation and a log-rank test to compare groups.
Safety was assessed in the as-treated population, which consisted only of
participants who successfully received at least one DMPA-SC injection after
randomisation. This trial is registered with ClinicalTrials.gov, number
NCT02293694.
FINDINGS: This study lasted from Sept 17, 2015, to Feb 21, 2017. 731 women
underwent randomisation, with 364 assigned to the self-administered group and 367
to the provider-administered group. One woman in the self-injection group
withdrew at month 0. Treatment was discontinued by 99 women in the
self-administered group and 199 women in the provider-administered group. The 12
month continuation rate was 73% in the self-injection group and 45% in the
provider-administered group, giving an incidence rate ratio of 0·40 (95% CI
0·31-0·51; p<0·0001). Adverse events deemed to potentially be treatment-related
were reported by ten women (20 events) in the self-administered group and 17
women (28 events) in the provider-administered group. Five serious adverse events
were reported during the trial by four women; two events related to DMPA-SC
(menorrhagia and anaemia requiring hospital admission) were reported by the same
woman in the provider-administered group and resolved without sequelae. The other
serious adverse events, including one death, were deemed to be unrelated to
DMPA-SC.
INTERPRETATION: Women who self-injected DMPA-SC had significantly higher rates of
continuation than those receiving provider-injected DMPA-SC. Community-based
provision of injectable contraception for self-injection in low-resource settings
seems to be safe and feasible. Self-administration of DMPA-SC should be made
widely available.
FUNDING: United States Agency for International Development and Children's
Investment Fund Foundation.
article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights
reserved.
DOI: 10.1016/S2214-109X(18)30061-5
1523. Implement Sci. 2017 Mar 27;12(1):42. doi: 10.1186/s13012-017-0572-1.
Applying the Theoretical Domains Framework to identify barriers and targeted

interventions to enhance nurses' use of electronic medication management systems
in two Australian hospitals.
Debono D(1)(2), Taylor N(3), Lipworth W(4), Greenfield D(3)(5), Travaglia J(6),
Black D(7), Braithwaite J(3).
Author information:
(1)Centre for Healthcare Resilience and Implementation Science, Australian
Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
deborah.debono@uts.edu.au.
(2)Faculty of Health, University of Technology, Sydney, NSW, Australia.
deborah.debono@uts.edu.au.
(3)Centre for Healthcare Resilience and Implementation Science, Australian
Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.
(4)Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney,
NSW, Australia.
(5)Australian Institute of Health Services Management, University of Tasmania,
Sydney, Australia.
(6)Faculty of Health, University of Technology, Sydney, NSW, Australia.
(7)Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.
BACKGROUND: Medication errors harm hospitalised patients and increase health care
costs. Electronic Medication Management Systems (EMMS) have been shown to reduce
medication errors. However, nurses do not always use EMMS as intended, largely
because implementation of such patient safety strategies requires clinicians to
change their existing practices, routines and behaviour. This study uses the
Theoretical Domains Framework (TDF) to identify barriers and targeted
interventions to enhance nurses' appropriate use of EMMS in two Australian
hospitals.
METHODS: This qualitative study draws on in-depth interviews with 19 acute care
nurses who used EMMS. A convenience sampling approach was used. Nurses working on
the study units (N = 6) in two hospitals were invited to participate if available
during the data collection period. Interviews inductively explored nurses'
experiences of using EMMS (step 1). Data were analysed using the TDF to identify
theory-derived barriers to nurses' appropriate use of EMMS (step 2). Relevant
behaviour change techniques (BCTs) were identified to overcome key barriers to
using EMMS (step 3) followed by the identification of potential
literature-informed targeted intervention strategies to operationalise the
identified BCTs (step 4).
RESULTS: Barriers to nurses' use of EMMS in acute care were represented by nine
domains of the TDF. Two closely linked domains emerged as major barriers to EMMS
use: Environmental Context and Resources (availability and properties of
computers on wheels (COWs); technology characteristics; specific contexts;
competing demands and time pressure) and Social/Professional Role and Identity
(conflict between using EMMS appropriately and executing behaviours critical to
nurses' professional role and identity). The study identified three potential
BCTs to address the Environmental Context and Resources domain barrier: adding
objects to the environment; restructuring the physical environment; and prompts
and cues. Seven BCTs to address Social/Professional Role and Identity were
identified: social process of encouragement; pressure or support; information
about others' approval; incompatible beliefs; identification of self as role
model; framing/reframing; social comparison; and demonstration of behaviour. It
proposes several targeted interventions to deliver these BCTs.
CONCLUSIONS: The TDF provides a useful approach to identify barriers to nurses'
prescribed use of EMMS, and can inform the design of targeted theory-based
interventions to improve EMMS implementation.
DOI: 10.1186/s13012-017-0572-1
PMCID: PMC5368903
1524. J Diabetes Metab Disord. 2017 Feb 15;16:7. doi: 10.1186/s40200-017-0289-3.

eCollection 2017.
Perceived cognitive deficits are associated with diabetes self-management in a

multiethnic sample.
Cuevas H(1), Stuifbergen A(1).
Author information:
(1)The University of Texas, Austin School of Nursing, 1710 Red River, Austin, TX
78701 USA.
BACKGROUND: People with diabetes have almost twice the risk of developing
cognitive impairment or dementia as do those without diabetes, and about half of
older adults with diabetes will become functionally disabled or cognitively
impaired. But diabetes requires complex self-management: patients must learn
about the implications of their disease; manage their diets, physical activity,
and medication; and monitor their blood glucose. Difficulties with cognition can
hinder these activities.
METHODS: The purpose of this study was to explore perceptions of cognitive
ability in a multiethnic sample of persons with type 2 diabetes (T2DM). One
hundred twenty participants completed surveys assessing perceived memory,
executive function, diabetes self-management, and quality of life. Scores on the
surveys were examined along with hemoglobin A1C levels and demographics.
RESULTS: Scores for executive function were positively associated with
self-reports of dietary adherence and blood glucose monitoring. Perceived memory
ability was a significant predictor of quality of life, and executive function
was a significant predictor of A1C.
CONCLUSIONS: Patients' perceptions of their cognitive difficulties may assist
health care providers in detection of patients' deficiencies in performing
diabetes self-management tasks. The relationships between cognitive difficulties
and self-management found in this descriptive study suggest that research on the
processes leading to cognitive changes in T2DM is needed, as are studies on how
those processes affect diabetes self-management.
DOI: 10.1186/s40200-017-0289-3
PMCID: PMC5312423
PMID: 28239597
10.3390/ijerph16020196.
Adherence to Treatment in Stroke Patients.
Cheiloudaki E(1), Alexopoulos EC(2)(3).
Author information:
(1)School of Social Sciences, Hellenic Open University, 26335 Patra, Greece.
litsachi@hotmail.com.
(2)School of Social Sciences, Hellenic Open University, 26335 Patra, Greece.
ecalexop@med.uoa.gr.
(3)Occupational Health Department, Metropolitan General Hospital, 15562 Athens,
Greece. ecalexop@med.uoa.gr.
Background: Compliance with medication in patients who have suffered stroke is

usually not-optimal. This study aims to measure the level of compliance with the
treatment and to identify socio-demographic, clinical, and subjective factors
related to the long-term compliance of stroke patients with their treatment.
Methods: 140 patients (66.4% males) suffered an ischemic stroke at least six
months old, participated in the survey. Compliance was measured using the
Medication Adherence Report Scale and the quality of life by the Stroke Specific
Quality of Life questionnaire. Furthermore, the Beliefs about Medicines
Questionnaire and the Brief Illness Perception Questionnaire on perceptions about
the disease were assessed. The doctor⁻patient relationship was assessed by the
Common-Sense Model of Self-Regulation questionnaire and the family support was
assessed by the FSS scale. Univariate and multivariate analysis was employed to
identify the significant factors affecting compliance in these stroke patients.
Results: In 68.6% of patients the compliance was classified as optimal, in 25.7%
as partial and as poor in 5.7%; the last two categories were treated as
sub-optimal compliance in multivariate analysis. The high compliance was related
to patient's mental state (OR:3.94 95% CI: 1.84⁻4.46), the perception medication
necessity (OR:1.26 95% CI: 1.01⁻1.56), and the doctor⁻patient communication
(OR:1.76 95% CI: 1.15⁻2.70). Men showed a lower compliance than women, as well as
increased concerns about taking medication (OR: 0.83, 95% CI: 0.69⁻0.99).
Paradoxically, the work /productivity related quality of life was inversely
associated with compliance (OR (95% CI): 0.44 (0.23 to 0.82)). Conclusions: The
perception of medication necessity and the doctor⁻patient communication are
manageable factors associated with compliance in treating patients who have
suffered stroke. In addition, rehabilitation and return to work programs should
consider these factors when providing support to those persons.
DOI: 10.3390/ijerph16020196
PMCID: PMC6351941
1526. Health Psychol. 2017 Sep;36(9):839-847. doi: 10.1037/hea0000529. Epub 2017

Jul
20.
The impact of medication nonadherence on the relationship between mortality risk

and depression in heart failure.
Gathright EC(1), Dolansky MA(2), Gunstad J(1), Redle JD(3), Josephson RA(4),
Moore SM(2), Hughes JW(1).
Author information:
(1)Department of Psychological Sciences, Kent State University.
(2)Frances Payne Bolton School of Nursing, Case Western Reserve University.
(3)Cardiovascular Institute, Summa Health System, Akron City Hospital.
(4)School of Medicine, Case Western Reserve University.
OBJECTIVE: Heart failure affects more than 5 million U.S. adults, and
approximately 20% of individuals with heart failure experience depressive
symptoms. Depression is detrimental to prognosis in heart failure, conferring
approximately a 2-fold increase in mortality risk. Medication nonadherence may
help explain this relationship because depressed patients are less likely to
adhere to the medication regimen.
METHOD: Depression, electronically monitored medication adherence, and mortality
were measured in a sample of 308 patients with heart failure participating in a
study of self-management behavior. Cardiovascular and all-cause mortality data
were obtained from the Centers for Disease Control and Prevention's National
Death Index (median 2.9-year follow-up). Cox proportional hazards regression was
used to assess the relationship between depression and mortality, with and
without adjustment for age, gender, disease severity, and medication
nonadherence.
RESULTS: In adjusted analyses, depression was associated with an increased
all-cause mortality risk (hazard ratio 1.87; 95% confidence interval 1.04-3.37).
Depression was not related to cardiovascular mortality, potentially because of a
low number of cardiac-related deaths. When medication nonadherence was added to
the model, nonadherence (hazard ratio 1.01; 95% confidence interval 1.004-1.02),
but not depression, predicted all-cause mortality risk.
CONCLUSIONS: Depressive symptoms confer increased all-cause mortality risk in
heart failure, and medication nonadherence contributes to this relationship.
Depression and nonadherence represent potentially modifiable risk factors for
poor prognosis. Future research is needed to understand whether interventions
that concomitantly target these factors can improve outcomes. (PsycINFO Database
Record
DOI: 10.1037/hea0000529
PMCID: PMC5573609
1527. AMIA Annu Symp Proc. 2014 Nov 14;2014:1738-47. eCollection 2014.
Could Patient Self-reported Health Data Complement EHR for Phenotyping?
Fort D(1), Wilcox AB(2), Weng C(1).
Author information:
(1)Department of Biomedical Informatics, Columbia University, New York City, NY.
(2)Intermountain Healthcare, Salt Lake City, UT.
Electronic health records (EHRs) have been used as a valuable data source for
phenotyping. However, this method suffers from inherent data quality issues like
data missingness. As patient self-reported health data are increasingly
available, it is useful to know how the two data sources compare with each other
for phenotyping. This study addresses this research question. We used
self-reported diabetes status for 2,249 patients treated at Columbia University
Medical Center and the well-known eMERGE EHR phenotyping algorithm for Type 2
diabetes mellitus (DM2) to conduct the experiment. The eMERGE algorithm achieved
high specificity (.97) but low sensitivity (.32) among this patient cohort. About
87% of the patients with self-reported diabetes had at least one ICD-9 code, one
medication, or one lab result supporting a DM2 diagnosis, implying the remaining
13% may have missing or incorrect self-reports. We discuss the tradeoffs in both
data sources and in combining them for phenotyping.
PMCID: PMC4419899
1528. J Manag Care Spec Pharm. 2017 Oct;23(10):1054-1064. doi:

10.18553/jmcp.2017.23.10.1054.
Optimization of Medication Use at Accountable Care Organizations.
Wilks C(1), Krisle E(1), Westrich K(2), Lunner K(1), Muhlestein D(1), Dubois
R(2).
Author information:
(1)1 Leavitt Partners, Salt Lake City, Utah.
(2)2 National Pharmaceutical Council, Washington, DC.
BACKGROUND: Optimized medication use involves the effective use of medications

for better outcomes, improved patient experience, and lower costs. Few studies
systematically gather data on the actions accountable care organizations (ACOs)
have taken to optimize medication use.
OBJECTIVES: To (a) assess how ACOs optimize medication use; (b) establish an
association between efforts to optimize medication use and achievement on
financial and quality metrics; (c) identify organizational factors that correlate
with optimized medication use; and (d) identify barriers to optimized medication
use.
METHODS: This cross-sectional study consisted of a survey and interviews that
gathered information on the perceptions of ACO leadership. The survey contained a
medication practices inventory (MPI) composed of 38 capabilities across 6
functional domains related to optimizing medication use. ACOs completed
self-assessments that included rating each component of the MPI on a scale of 1
to 10. Fisher's exact tests, 2-proportions tests, t-tests, and logistic
regression were used to test for associations between ACO scores on the MPI and
performance on financial and quality metrics, and on ACO descriptive
characteristics.
RESULTS: Of the 847 ACOs that were contacted, 49 provided usable survey data.
These ACOs rated their own system's ability to manage the quality and costs of
optimizing medication use, providing a 64% and 31% affirmative response,
respectively. Three ACOs achieved an overall MPI score of 8 or higher, 45 scored
between 4 and 7.9, and 1 scored between 0 and 3.9. Using the 3 score groups, the
study did not identify a relationship between MPI scores and achievement on
financial or quality benchmarks, ACO provider type, member volume, date of ACO
creation, or the presence of a pharmacist in a leadership position. Barriers to
optimizing medication use relate to reimbursement for pharmacist integration,
lack of health information technology interoperability, lack of data, feasibility
issues, and physician buy-in.
CONCLUSIONS: Compared with 2012 data, data on ACOs that participated in this
study show that they continue to build effective strategies to optimize
medication use. These ACOs struggle with both notification related to
prescription use and measurement of the influence optimized medication use has on
costs and quality outcomes. Compared with the earlier study, these data find that
more ACOs are involving pharmacists directly in care, expanding the use of
generics, electronically transmitting prescriptions, identifying gaps in care and
potential adverse events, and educating patients on therapeutic alternatives.
ACO-level policies that facilitate practices to optimize medication use are
needed. Integrating pharmacists into care, giving both pharmacists and physicians
access to clinical data, obtaining physician buy-in, and measuring the impact of
practices to optimize medication use may improve these practices.
DISCLOSURES: This research was sponsored and funded by the National
Pharmaceutical Council (NPC), an industry funded health policy research group
that is not involved in lobbying or advocacy. Employees of the sponsor
contributed to the research questions, determination of the relevance of the
research questions, and the research design. Specifically, there was involvement
in the survey and interview instruments. They also contributed to some data
interpretation and revision of the manuscript. Leavitt Partners was hired by NPC
to conduct research for this study and also serves a number of health care
clients, including life sciences companies, provider organizations, accountable
care organizations, and payers. Westrich and Dubois are employed by the NPC.
Wilks, Krisle, Lunner, and Muhlestein are employed by Leavitt Partners and did
not receive separate compensation. Study concept and design were contributed by
Krisle, Dubois, and Muhlestein, along with Lunner and Westrich. Krisle and
Muhlestein collected the data, and data interpretation was performed by Wilks,
Krisle, and Muhlestein, along with Dubois and Westrich. The manuscript was
written primarily by Wilks, along with Krisle and Muhlestein, and revised by
Wilks, Westrich, Lunner, and Krisle. Preliminary versions of this work were
presented at the following: National Council for Prescription Drug Programs
Educational Summit, November 1, 2016; Academy Health 2016 Annual Research
Meeting, June 27, 2016; Accountable Care Learning Collaborative Webinar, June 16,
2016; the 21st Annual PBMI Drug Benefit Conference, February 29, 2016; National
Value-Based Payment and Pay for Performance Summit, February 17, 2016; National
Accountable Care Congress, November 17, 2015; and American Journal of Managed
Care's ACO Emerging Healthcare Delivery Coalition, Fall 2015 Live Meeting,
October 15, 2015.
DOI: 10.18553/jmcp.2017.23.10.1054
1529. Trials. 2017 Jul 18;18(1):334. doi: 10.1186/s13063-017-2063-8.
The effectiveness of daily SMS reminders in pharmaceutical care of older adults

on improving patients' adherence to antihypertensive medication (SPPA): study
protocol for a randomized controlled trial.
Haramiova Z(1), Stasko M(2), Hulin M(3), Tesar T(2), Kuzelova M(4), Morisky
DM(5).
Author information:
(1)Department of Organization and Management of Pharmacy, Faculty of Pharmacy,
Comenius University in Bratislava, Kalinciakova 8, 832 32, Bratislava, Slovak
Republic. haramiova@fpharm.uniba.sk.
(2)Department of Organization and Management of Pharmacy, Faculty of Pharmacy,
Comenius University in Bratislava, Kalinciakova 8, 832 32, Bratislava, Slovak
Republic.
(3)Research Institute for Child Psychology and Pathopsychology, Cyprichova 42,
831 05, Bratislava, Slovak Republic.
(4)Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius
University in Bratislava, Odbojarov 10, 832 32, Bratislava, Slovak Republic.
Health, 650 Charles E. Young Drive South, 46-071 CHS, Los Angeles, CA,
90095-1772, USA.
BACKGROUND: Despite a variety of efficient and cost-effective antihypertensive

medication, hypertension remains a serious health and economic burden. High
consumption of cardiovascular drugs in the Slovak Republic does result neither in
better hypertension control nor in significant decrease in cardiovascular
mortality. At the same time, Slovakia has alarmingly low patients' adherence to
medication intake. Studies have shown the efficiency of short messaging service
(SMS) reminders to improve patients' adherence and health outcomes at low costs.
Since SMS is popular among Slovaks, this approach may be feasible also in
Slovakia. The primary objective is to assess if daily SMS reminders of
antihypertensive medication intake provided by pharmacists in addition to the
standard pharmaceutical care increase the proportion of adherent older
hypertensive ambulatory patients.
METHODS: The SPPA trial is a pragmatic randomized parallel group (1:1) trial in
300 older hypertensive patients carried out in community pharmacies in Slovakia.
Trial pharmacies will be selected from all main regions of Slovakia. Trial
intervention comprises daily personalized SMS reminders of medication intake
embedded into usual pharmaceutical practice. The primary outcome is a combined
adherence endpoint consisting of subjective self-reported medication adherence
via the eight-item Morisky Medication Adherence Scale (MMAS-8) and objective pill
count rate. Secondary outcomes include: change in the MMAS-8; comparison of
adherence rates using pill count; change in systolic blood pressure; and patient
satisfaction. Also, direct treatment costs will be evaluated and a
cost-effectiveness analysis will be carried out.
DISCUSSION: The SPPA trial engages community pharmacists and mobile health
(mHealth) technologies via evidence-based pharmaceutical care to efficiently and
cost-effectively addresses current main healthcare challenges: high prevalence of
hypertension; overconsumption of cardiovascular medicines; low adherence to
medication treatment; and resulting uncontrolled blood pressure. The results may
identify new possibilities and capacities in healthcare with low additional costs
and high value to patients.
TRIAL REGISTRATION: ClinicalTrials.gov, NCT03105687 . Registered on 07 March
2017.
DOI: 10.1186/s13063-017-2063-8
PMCID: PMC5516377
How Does Stigma Affect People Living with HIV? The Mediating Roles of
Internalized and Anticipated HIV Stigma in the Effects of Perceived Community
Stigma on Health and Psychosocial Outcomes.
Turan B(1), Budhwani H(2), Fazeli PL(3), Browning WR(4), Raper JL(5), Mugavero
MJ(5), Turan JM(2).
Author information:
Campbell Hall, Birmingham, AL, 35294-1170, USA. bturanb@uab.edu.
(2)Department of Health Care Organization and Policy, School of Public Health,
University of Alabama at Birmingham, Birmingham, AL, USA.
(3)Department of Family, Community, and Health Systems, School of Nursing, 1720
2nd Avenue South, Birmingham, AL, 35294-1210, USA.
Campbell Hall, Birmingham, AL, 35294-1170, USA.
(5)The Department of Medicine, University of Alabama at Birmingham, Birmingham,
AL, USA.
Few researchers have attempted to examine the mechanisms through which

HIV-related stigma in the community is processed and experienced at an individual
level by people living with HIV. We examined how the effects of perceived HIV
stigma in the community on health outcomes for people living with HIV are
mediated by internalized stigma and anticipated stigma. Participants (N = 203)
from an HIV clinic completed self-report measures and their clinical data were
obtained from medical records. Results suggested that the association between
perceived community stigma and affective, cognitive, and mental health outcomes
(self-esteem, depressive symptoms, avoidance coping, self-blame) are mediated by
internalized stigma. Furthermore, a serial mediation model suggested that
perceived community stigma leads to internalized stigma, which leads to
anticipated community stigma, which in turn leads to lower medication adherence.
The associations between perceived community stigma and interpersonal outcomes
(social support, trust in physicians) were mediated by internalized stigma and
anticipated stigma, again in a serial fashion (perceived community stigma leads
to internalized stigma, which leads to anticipated stigma, which in turn leads to
interpersonal outcomes). These results suggest that perceived HIV-related stigma
in the community may cause people living with HIV to internalize stigma and
anticipate stigmatizing experiences, resulting in adverse health and psychosocial
outcomes-information that can be used to shape interventions.
DOI: 10.1007/s10461-016-1451-5
PMCID: PMC5143223
Conflict of interest statement: Bulent Turan, Henna Budhwani, Pariya L. Fazeli,

Wesley R. Browning, James L. Raper, Michael J. Mugavero, and Janet M. Turan,
declares that they has no conflict of interest.

eCollection 2016.
Inter-Rater Agreement in the Assessment of Video Recordings of Eye Drop

Instillation by Glaucoma Patients.
Park MS(1), Patel MM(1), Sarezky D(2), Rojas C(1), Choo C(3), Choi M(4), Liu
D(5), Rademaker AW(5), Tanna AP(1).
Author information:
(1)Department of Ophthalmology, Northwestern University Feinberg School of
Medicine, Chicago, IL, United States of America.
(2)Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United
States of America.
(3)Department of Ophthalmology, University of Arizona, Tucson, AZ, United States
of America.
(4)Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States of
America.
(5)Department of Preventive Medicine, Northwestern University Feinberg School of
Medicine, Chicago, IL, United States of America.
PURPOSE: To create a standardized method for evaluating the video recordings of

patients self-instilling eye drops and to determine the level of agreement of eye
drop instillation efficacy, safety and efficiency ratings by three masked
graders.
DESIGN: Prospective cross-sectional study.
PARTICIPANTS: 78 patients with open-angle glaucoma or ocular hypertension who had
at least 6 months of experience with the use of eye drop medications.
METHODS: Participants were video recorded while self-instilling artificial tears
sequentially to both eyes. Three masked observers graded these video recordings
on three criteria: efficacy (the determination of whether an eye drop was
instilled on the ocular surface), safety (assessment of whether the tip of the
medication bottle made contact with the ocular surface or eyelids), and
efficiency (the number of eye drops expressed from the bottle).
MAIN OUTCOME MEASURES: After grading the video recordings based on efficacy,
safety, and efficiency, kappa statistics were used to estimate inter-rater
agreement.
RESULTS: The mean kappa level of agreement for efficacy, safety, and efficiency
was 0.64 (95% confidence interval (CI), 0.42-0.87), 0.73 (95% CI, 0.58-0.88), and
0.62 (95% CI, 0.42-0.81), respectively.
CONCLUSIONS: We demonstrated good inter-rater reproducibility of the masked
analysis of video recordings of patients self-instilling eye drops based on three
criteria: efficiency, safety, and efficacy.
PMCID: PMC4711577
1532. Sleep. 2016 Jun 1;39(6):1267-74. doi: 10.5665/sleep.5850.
Three-Year Follow-Up of Insomnia and Hypnotics after Controlled Internet

Treatment for Insomnia.
Blom K(1), Jernelöv S(2), Rück C(1), Lindefors N(1), Kaldo V(1).
Author information:
(1)Karolinska Institutet, Department of Clinical Neuroscience, Centre for
Psychiatry Research, Stockholm, Sweden.
(2)Karolinska Institutet, Department of Clinical Neuroscience, Section of
Psychology, Stockholm, Sweden.
STUDY OBJECTIVES: To investigate the long-term effects of therapist-guided

Internet-based insomnia treatment on insomnia severity and sleep medication use,
compared with active control.
METHODS: This study was an 8 week randomized controlled trial with follow-up
posttreatment and at 6, 12, and 36 months, set at the Internet Psychiatry Clinic,
Stockholm, Sweden. Participants were 148 media-recruited nondepressed adults with
insomnia. Interventions were Guided Internet-based cognitive behavioral therapy
for insomnia (ICBT-i) or active control treatment (ICBT-ctrl). Primary outcome
was insomnia severity, measured with the Insomnia Severity Index. Secondary
outcomes were sleep medication use and use of other treatments.
RESULTS: The large pretreatment to posttreatment improvements in insomnia
severity of the ICBT-i group were maintained during follow-up. ICBT-ctrl
exhibited significantly less improvement posttreatment (between-Cohen d = 0.85),
but after 12 and 36 months, there was no longer a significant difference. The
within-group effect sizes from pretreatment to the 36-months follow-up were 1.6
(ICBT-i) and 1.7 (ICBT-ctrl), and 74% of the interviewed participants no longer
had insomnia diagnosis after 36 mo. ICBT-ctrl used significantly more sleep
medication (P = 0.017) and underwent significantly more other insomnia treatments
(P < 0.001) during the follow-up period.
CONCLUSIONS: The large improvements in the ICBT-i group were maintained after 36
months, corroborating that CBT for insomnia has long-term effects. After 36
months, the groups did not differ in insomnia severity, but ICBT-ctrl had used
more sleep medication and undergone more other additional insomnia treatments
during the follow-up period.
CLINICAL TRIAL REGISTRATION: The trial was registered, together with a parallel
trial, at Clinicaltrials.gov as "Internet-CBT for Insomnia" registration ID:
NCT01256099.
© 2016 Associated Professional Sleep Societies, LLC.

DOI: 10.5665/sleep.5850
PMCID: PMC4863216
Randomised controlled trial of a video intervention and behaviour contract to

improve medication adherence after renal transplantation: the VECTOR study
protocol.
Mansell H(1), Rosaasen N(2), West-Thielke P(3), Wichart J(4), Daley C(5), Mainra
R(6), Shoker A(6), Liu J(7), Blackburn D(1).
Author information:
(1)College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Saskatchewan, Canada.
(2)Saskatchewan Transplant Program, Saskatchewan Health Authority, Saskatoon,
Saskatchewan, Canada.
(3)Department of Surgery, University of Illinois Hospital and Health Sciences
System, Chicago, Illinois, USA.
(4)Southern Alberta Transplant Program, Alberta Health Services, Calgary,
Alberta, Canada.
(5)Multi-organ Transplant Program of Atlantic Canada, Halifax, Nova Scotia,
Canada.
(6)College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan,
Canada.
(7)College of Arts and Science, University of Saskatchewan, Saskatoon, SK,
Canada.
INTRODUCTION: Non-adherence after kidney transplantation contributes to increased

rejections, hospitalisations and healthcare expenditures. Although effective
adherence interventions are sorely needed, increasing education and support to
transplant recipients demands greater use of care providers' time and resources
in a healthcare system that is stretched. The objective of this clinical trial is
to determine the effectiveness of an electronically delivered video series and
adherence behaviour contract on improving medication adherence to
immunosuppressant medications.
METHODS AND ANALYSIS: A multicentre, parallel arm, randomised controlled trial
will be conducted with four sites across North America (Saskatoon, Calgary,
Halifax, Chicago). Adult patients will be randomised (1:1) to either the
intervention (ie, home-based video education +behaviour contract plus usual care)
or usual care alone. De novo transplant recipients will be enrolled prior to
their hospital discharge and will be provided with electronic access to the video
intervention (immediately) and adherence contract (1 month post-transplant).
Follow-up electronic surveys will be provided at 3 and 12 months postenrolment.
The primary outcome will be adherence at 12 months post-transplant, as measured
by self-report Basel Assessment of Adherence to Immunosuppressive medications and
immunosuppressant levels. Secondary outcomes include the difference in knowledge
score between the intervention and control in groups (measured by the Kidney
Transplant Understanding Tool); differences in self-efficacy (Generalised
Self-efficacy Scale), Beliefs of Medicine Questionnaire (BMQ), quality of life
(Short Form-12), patient satisfaction and cost utilisation. The study aims to
recruit at least 200 participants across participating sites.
ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of
Saskatchewan Behavioural Ethics Committee (Beh 18-63), and all patients provide
informed consent prior to participating. This educational intervention aims to
improve information retention and self-efficacy, leading to improved medication
adherence after kidney transplantation, at low cost, with little impact to
existing healthcare personnel. If proven beneficial, delivery can be easily
implemented into standard of care.
TRIAL REGISTRATION NUMBER: NCT03540121; Pre-results.

DOI: 10.1136/bmjopen-2018-025495
PMCID: PMC6429879
PMID: 30872550
Conflict of interest statement: Competing interests: HM, NR, RM and AS developed

the video intervention used in this project.
1534. J Am Heart Assoc. 2016 Dec 21;5(12). pii: e004313. doi:

10.1161/JAHA.116.004313.
Insurance Status Among Adults With Hypertension-The Impact of Underinsurance.
Fang J(1), Zhao G(2), Wang G(3), Ayala C(3), Loustalot F(3).
Author information:
Disease Prevention and Health Promotion, Centers for Disease Control and
Prevention, Atlanta, GA jfang@cdc.gov.
(2)Division of Population Health, National Center for Chronic Disease Prevention
and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
Prevention, Atlanta, GA.
Comment in
J Am Heart Assoc. 2016 Dec 21;5(12):.
BACKGROUND: Hypertension is a major risk factor for heart disease and stroke.
Health insurance coverage affects hypertension treatment and control, but limited
information is available for US adults with hypertension who are classified as
underinsured.
METHODS AND RESULTS: Using Behavioral Risk Factor Surveillance System 2013 data,
we identified adults with self-reported hypertension. On the basis of
self-reported health insurance status and health care-related financial burdens,
participants were categorized as uninsured, underinsured, or adequately insured.
Proxies for health care received included whether they reported taking
antihypertensive medications and whether they visited a doctor for a routine
checkup in the past year. We assessed the association between health insurance
status and health care received, adjusting for selected sociodemographic
characteristics. Among 123 257 participants from 38 states and District of
Columbia with self-reported hypertension, 12% were uninsured, 26% were
underinsured, and 62% were adequately insured. In adjusted models using
adequately insured participants as referent, both uninsured (adjusted odds ratio,
0.39; 95% CI, 0.35-0.43) and underinsured (0.83, 0.76-0.89) participants were
less likely to report using antihypertensive medication than those of adequately
insured participants. Similarly, adjusted odds ratio of visiting a doctor for
routine checkup in the past year were 0.25 (0.23-0.28) for those who were
uninsured and 0.78 (0.72-0.84) for those who were underinsured compared to those
with adequate insurance.
CONCLUSIONS: Uninsured and underinsured participants with hypertension were less
likely to report receiving care compared to those with adequate insurance
coverage. Disparities in health care coverage may necessitate targeted
interventions, even among people with health insurance.
by Wiley Blackwell.
DOI: 10.1161/JAHA.116.004313
PMCID: PMC5210449
1535. BMC Health Serv Res. 2019 Jun 24;19(1):420. doi: 10.1186/s12913-019-4260-5.
Understanding patient activation and adherence to nebuliser treatment in adults

with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud
study.
Gao J(1), Arden M(2), Hoo ZH(3)(4), Wildman M(3)(4).
Author information:
(1)Centre for Behavioural Science and Applied Psychology, Sheffield Hallam
University, Sheffield, UK. J.gao@shu.ac.uk.
(2)Centre for Behavioural Science and Applied Psychology, Sheffield Hallam
University, Sheffield, UK.
(3)School of Health and Related Research (ScHARR), University of Sheffield,
Sheffield, UK.
(4)Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield,
UK.
BACKGROUND: Patient activation refers to patients' knowledge, skills, and

confidence in self-managing health conditions. In large cross-sectional studies,
individuals with higher patient activation are observed to have better health
outcomes with the assumption that they are more engaged in health
self-management. However, the association between patient activation and
objectively measured self-care indicators in individuals can be inconsistent.
This research investigated the role of patient activation as measured by the UK
Patient Activation Measure (PAM-13) in adults with Cystic Fibrosis (CF). The aims
were twofold: to explore how adults with CF interpret and respond to the PAM-13;
and to investigate the association between PAM-13 and objectively measured
nebuliser adherence in UK adults with CF.
METHODS: This article describes two studies which examined the PAM-13 from
different perspectives. Study 1 comprised 'think aloud' interviews with 15 adults
with CF. The data were analysed using an a priori coding framework. Study 2
examined the association between PAM-13 and objectively measured nebuliser
adherence in 57 adults with CF.
RESULTS: Study 1 showed that adults with CF encountered several difficulties
while completing the PAM-13. The difficulties were related to understanding how
to interpret aspects of CF in order to respond (i.e., control over the condition,
ability to exercise) and item wording. Some adults with CF responded to the
PAM-13 in an optimistic way in relation to what they thought they should do
rather than what they actually do. These findings were echoed by the results of
Study 2, which showed that PAM-13 scores were not significantly correlated with
objective medication adherence in a different sample. This article synthesises
the results of both studies, providing insights into influences and associations
of patient activation as measured by the UK PAM-13 in adults with CF.
CONCLUSIONS: There were some significant difficulties created by the wording of
the UK PAM-13 for adults with CF. This may partly explain the finding that PAM-13
scores were not related to objectively measured nebuliser adherence in this
study. The UK PAM-13 would benefit from further research to verify its validity
and reliability in different patient populations against objective measures of
behaviour rather than simply self-report.
DOI: 10.1186/s12913-019-4260-5
PMCID: PMC6591841
PMID: 31234848
1536. J Taibah Univ Med Sci. 2017 Jun 16;12(6):504-511. doi:

10.1016/j.jtumed.2017.03.008. eCollection 2017 Dec.
Diabetes self-care and its associated factors among elderly diabetes in primary
care.
Ishak NH(1), Mohd Yusoff SS(2), Rahman RA(2), Kadir AA(2).
Author information:
(1)Klinik Kesihatan Jalan lanang, Sibu, Sarawak, Malaysia.
(2)Department of Family Medicine, School of Medical Sciences, Universiti Sains
Malaysia, Kubang Kerian, Kerian, Kelantan, Malaysia.
Objectives: Diabetes is a primarily self-manageable condition. Healthcare

professionals usually offer education, treatment, and support, but patients
themselves are responsible for the daily management of their condition.
Increasing the effectiveness of self-management support may have a considerable
impact on health care, especially for elderly people. The aim of this study was
to describe diabetes self-care among elderly diabetics and to determine its
associated factors.
Methods: This report describes a cross-sectional study involving 143 elderly
diabetes patients in the outpatient department of the Hospital Universiti Sains
Malaysia (HUSM). Self-care activities assessed in this study included dietary
control, physical activity, self-monitoring of blood glucose, medication
adherence, and situational related adherence behaviour, all of which were
obtained using the validated Malay Elderly Diabetes Self-Care Questionnaire
(MEDSCaQ).
Results: The mean (±SD) age of the subjects was 67.9 (±5.4) years old. A majority
was Malay, with a mean HbA1c of 8.4 (±1.9). The mean diabetes self-care score was
26.5 (±8.0). Factors with a positive impact on diabetes self-care included being
non-Malay (β = 5.275, p = 0.002), having family as care givers (β = 8.995,
p = 0.004), having a higher level of family support (β = 0.159, p = 0.042), and
possessing acceptable (β = 4.375, p = 0.001) or good knowledge of diabetes
(β = 5.893, p = 0.004). The presence of neuropathy negatively impacted self-care,
while diabetes nephropathy had a positive impact on self care (β = -4.053,
p = 0.003).
Conclusions: Elderly individuals with type 2 diabetes in HUSM have a moderate
score of diabetes self-care practice based on the MEDSCaQ. Determinants for good
diabetes self-care include race, social support, having care-takers during
periods of illness, diabetes knowledge, and diabetic microvascular complications.
Publisher: ‫ ويقدم متخصصو‬.‫داء السكري في المقام الول هو داء يمكن التحكم فيه ذاتيا‬
‫ ولكن المرضى هم المسئولين عن الدارة‬،‫ والمساندة‬،‫ والعلج‬،‫الرعاية الصحية التعليم‬
‫الدعم الذاتي تأثير كبير على الرعاية‬-‫ يمكن أن يكون لزيادة فعالية‬.‫اليومية لحياتهم‬
‫ وتهدف هذه الدراسة إلى وصف الرعاية الذاتية لداء السكري‬.‫ خاصة لدى كبار السن‬،‫الصحية‬
١٤٣ ‫ضمت هذه الدراسة المقطعية‬.‫ وتحديد العوامل المرتبطة به‬،‫بين مرضى السكري المسنين‬
‫ في العيادات الخارجية للمستشفى الجامعي في سينز ماليزيا‬،‫من مرضى السكري المسنين‬.
‫ والرصد‬،‫ والنشاط البدني‬،‫بحيث قيمت أنشطة الرعاية الذاتية متضمنة السيطرة الغذائية‬
‫ التي‬،‫ وسلوك اللتزام المتعلق بالمواقف‬،‫ واللتزام بالدواء‬،‫الذاتي للجلوكوز بالدم‬
‫كان‬.‫تم الحصول عليها باستخدام استبانة مالي للرعاية الذاتية لمرضى السكري المسنين‬
‫ وكان معظمهم من‬.‫( عاما‬٥.٤±)٦٧.٩ (‫ النحراف المعياري‬± ) ‫متوسط أعمار المشاركين‬
‫ وكان متوسط درجة الرعاية الذاتية‬.(١.٩±) ٨.٤ ‫ ومتوسط الهيموجلوبين السكري‬،‫مالي‬
‫ والعوامل التي لها تأثير موجب على الرعاية الذاتية لداء‬.(٨.٠±) ٢٦.٥ ‫لداء السكري‬
‫ ودعم أسري أكبر‬،‫ ولديه أسرة مقدمة للرعاية‬،‫ كون المريض ليس من مالي‬:‫السكري تشمل‬،
‫ ووجود العتلل العصبي يؤثر‬.‫ والمعرفة الجيدة‬،‫وامتلك معرفة مقبولة بداء السكري‬
‫لدى كبار السن‬.‫ بينما للعتلل الكلوي تأثير إيجابي‬،‫سلبا على الرعاية الذاتية‬
‫ درجة معتدلة من ممارسة الرعاية الذاتية لداء السكري‬،٢ ‫المصابون بداء السكري النوع‬
‫ وتشمل محددات‬.‫بناء على استبانة مالي للرعاية الذاتية لمرضى السكري المسنين‬
‫ ووجود مقدمي‬،‫ والدعم الجتماعي‬،‫الممارسة الجيدة للرعاية الذاتية لداء السكري الدعرق‬
‫ ومضاعفات الوعية الدموية لداء‬،‫ والمعرفة بداء السكري‬،‫الرعاية أثناء فترات المرض‬
‫السكري‬.
DOI: 10.1016/j.jtumed.2017.03.008
PMCID: PMC6694907
PMID: 31435286

eCollection 2015.
Supporting self-management of type 2 diabetes: is there a role for the community

pharmacist?
Dhippayom T(1), Krass I(2).
Author information:
(1)Pharmaceutical Care Research Unit, Department of Pharmacy Practice, Faculty of
Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
(2)Faculty of Pharmacy, The University of Sydney, Camperdown, NSW, Australia.
BACKGROUND: Evidence supports the efficacy of pharmacy services in type 2

diabetes (T2D). However, little is known about consumer perspectives on the role
of community pharmacists in diabetes care. The objectives of this study were to
identify potential unmet needs and explore preferences for pharmacist-delivered
support for T2D.
METHODS: A qualitative study using focus groups was conducted in Sydney,
Australia. Patients with T2D who were members of the Australian Diabetes Council
in Sydney, Australia, were recruited through a survey on medication use in T2D.
Five focus groups with a total of 32 consumers with T2D were recorded,
transcribed, and thematically analyzed.
RESULTS: The key themes were 1) the experiences of diabetes services received, 2)
the potential to deliver self-management services, and 3) the suggested role of
pharmacist in supporting diabetes management. Gaps in understanding and some
degree of nonadherence to self-management signaled a potential for
self-management support delivered by pharmacists. However, consumers still
perceive that the main role of pharmacists in diabetes care centers on drug
management services, with some enhancements to support adherence and continuity
of supply. Barriers to diabetes care services included time constraints and a
perceived lack of interest by pharmacists.
CONCLUSION: Given the unmet needs in diabetes self-management, opportunities
exist for pharmacists to be involved in diabetes care. The challenge is for
pharmacists to upgrade their diabetes knowledge and skills, organize their
workflow, and become proactive in delivering diabetes care support.
DOI: 10.2147/PPA.S88071
PMCID: PMC4527368
PMID: 26257514
1538. BMC Public Health. 2019 Jun 10;19(1):720. doi: 10.1186/s12889-019-7051-3.

Adherence to antiretroviral treatment and associated factors among people living
with HIV and AIDS in CHITWAN, Nepal.
Neupane S(1), Dhungana GP(2), Ghimire HC(3).
Author information:
(1)Chitwan Sakriya Women's foundation, Bharatpur, Chitwan, Nepal.
smilewith_sujan@yahoo.com.
(2)Department of Statistics, Birendra Multiple Campus, Bharatpur, Nepal.
(3)Tribhuvan University, Kirtipur, Nepal.
BACKGROUND: Adherence to ART is the primary determinant of viral suppression and

the risk of transmission, disease progression and death. Adherence of at least
95% is needed for optimal suppression. This study aimed at determining the
adherence to Anti-Retroviral Therapy (ART) and its associated factors among
People Living with HIV and AIDS in ART Center of Chitwan, Nepal.
METHODS: A descriptive cross-sectional study was conducted among 231 clients aged
18 years to 49 years taking ART from Bharatpur Hospital of Chitwan and those who
have been enrolled in ART for at least 6 months, were interviewed. Systematic
Sampling technique was used. Semi-structured questionnaire was prepared by taking
reference from the AIDS Clinical Trial group questionnaire (ACTG). Adherence was
measured by patient self report. Data was entered Epi Data 3.1 and analyzed using
Statistical Package for Social Sciences (SPSS) software where the P value of
< 0.05 was accepted as being statistically significant. The independent variables
which were found significant at p-value 0.10 in bivariate analysis were fitted in
multivariable logistic regression model. Multivariable logistic regression model
was performed to know the net effect of the independent variables on Adherence to
ART medication.
RESULTS: The overall adherence in the last month was found to be 87.4%. Wrist
watch and mobiles were seen as a facilitating factor for taking ART on time as
clients taking ART used to set alarm to get informed of the medication time.
Adherence was associated with female sex (AOR = 10.550 CI: 1.854-60.046), family
consisting only parents and their children (AOR = 4.877, CI: 1.246-19.079),
having no habit of taking alcohol (AOR = 5.842 CI: 1.294-26.383), HIV duration of
more than 3 years (AOR = 10.055 CI: 2.383-42.430), picking up ART medications on
their own (AOR = 7.861, CI: 1.670-36.998) and not having side effects of ART
(AOR = 8.832, CI: 2.059-37.890).
CONCLUSION: Identifying and evaluating the problems faced by ARV drug users can
foster the achievement of ART related goals and addressing ART related problems
in a rational way. Effective and appropriate monitoring of non adherence
behaviors can help patients increase adherence level fostering improvement in
treatment outcome.
DOI: 10.1186/s12889-019-7051-3
PMCID: PMC6558692
1539. Subst Abuse Treat Prev Policy. 2017 Jun 8;12(1):31. doi:
10.1186/s13011-017-0115-4.
Adherence to methadone maintenance treatment and associated factors among

patients in Vietnamese mountainside areas.
Nguyen LH(1), Nguyen HTT(2)(3), Nguyen HLT(4), Tran BX(2)(5), Latkin CA(5).
Author information:
(1)School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
(2)Institute for Preventive Medicine and Public Health, Hanoi Medical University,
Hanoi, Vietnam.
(3)Thanh Nhan Hospital, Hanoi, Vietnam.
(4)Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
lanhuong.hmu@gmail.com.
(5)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
BACKGROUND: Medication adherence is essential to achieve successful methadone

maintenance treatment (MMT). However, treatment adherence among MMT patients in
the mountainous setting in Vietnam has not been yet investigated. This study
aimed to explore the medication adherence and associated factors in MMT patients
in Tuyen Quang, a mountainous province.
METHODS: A cross-sectional survey was conducted in two MMT clinics namely Tuyen
Quang and Son Duong. Convenience sampling method was used to recruit patients.
Adherence to MMT was assessed by using three questions: 1) number of days that
they missed doses in the last 4 days; 2) whether they missed doses during the
last weekend and 3) when they missed a dose within the last 3 months. Adherence
was considered optimal if patients reported 'no' to three questions.
Socioeconomic status, health status (measured by EuroQol-5 Dimensions - 5 Levels
- EQ5D5L and Visual analogue scale - VAS), substance use and abuse and methods to
support adherence were also collected.
RESULTS: Among 241 patients, 34.4% reported optimal adherence. Self-help was the
most popular (89.2%) method used to support adherence. Risk factors of missing
doses and suboptimal adherence included higher education and economic status;
being a worker/farmer; longer duration of treatment; and suffering
pain/discomfort and anxiety/depression. Protective factors were older age, having
problems in usual activities/self-care, higher EQ-VAS and EQ-5D index; and
reminded by mobile phone and family members.
CONCLUSIONS: This study found a high sub-optimal adherence rate among MMT
patients in a mountainous setting in Vietnam. Measuring adherence by using
several simple items could be used periodically to monitor the treatment
adherence in the clinical setting. Family and mobile phone support would have a
potential role in supporting patients to adhere treatment.
DOI: 10.1186/s13011-017-0115-4
PMCID: PMC5465686
1540. Psychol Belg. 2018 Sep 27;58(1):243-255. doi: 10.5334/pb.420.
Different Clinical Presentations in Eating Disorder Patients with Non-Suicidal

Self-Injury Based on the Co-Occurrence of Borderline Personality Disorder.
Claes L(1)(2), Turner B(3)(4), Dierckx E(5)(6), Luyckx K(1)(7), Verschueren M(1),
Schoevaerts K(5).
Author information:
(1)Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, BE.
(2)Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, BE.
(3)Department of Psychology, University of Victoria, Victoria, BC, CA.
(4)Department of Psychology, Harvard University, Cambridge, MA, US.
(5)Psychiatric Hospital Alexianen Tienen, Tienen, BE.
(6)Department of Psychology and Educational Sciences, Vrije Universiteit Brussel,
Brussels, BE.
(7)UNIBS, University of the Free State, Bloemfontein, ZA.
Non-suicidal self-injury (NSSI) and borderline personality disorder (BPD)

features are common in patients with eating disorders (ED), yet little is known
regarding the clinical presentation of ED patients who present with NSSI with and
without BPD. The current study compared self-injurious, female ED inpatients with
(n = 98; NSSI+BPD) and without BPD (n = 45; NSSI-only) on different self-reported
clinical features. Results suggest that ED patients with NSSI+BPD differ from
those with NSSI-only with regard to frequency of suicidal ideation, alcohol, drug
or medication abuse, internalizing/externalizing psychopathology, interpersonal
problems, and coping strategies, with the NSSI+BPD group demonstrating more
impairment in each of these domains. Despite these differences in clinical
presentation, however, groups did not differ in NSSI features. In sum, while
self-injurious ED patients may present with similar NSSI behavior regardless of
BPD diagnosis, those with NSS+BPD represent a group with much higher clinical
complexity and greater treatment needs.
DOI: 10.5334/pb.420
PMCID: PMC6194535
PMID: 30479820
1541. Health Promot Perspect. 2018 Jul 7;8(3):225-229. doi: 10.15171/hpp.2018.30.

eCollection 2018.
The validity of self-reported drug use with urine test: results from the pilot
phase of Azar cohort study.
Ashrafi S(1), Aminisani N(1), Soltani S(2), Sarbakhsh P(1), Shamshirgaran SM(1),
Rashidi MR(2).
Author information:
(1)Epidemiology and Statistics Departement, Tabriz University of Medical
(2)Department of Medicinal Chemistry, Tabriz University of Medical Sciences,
Tabriz, Iran.
Background: The present study aimed at assessing the validity of self-reported

drug use in people aged 35 and older in a pilot phase of a population-based
cohort study. Methods: A total of 1038 adults over 35 years old in Khamene city
in East Azerbaijan province were recruited for the pilot phase of Azar cohort; a
province-level of a nationwide PERSIAN cohort study completing a questionnaire
and providing biological samples from October to December 2014. Information about
the history and duration of smoking tobacco, using drug and medication were
obtained by the physician. The validity of the drug use was assessed through
comparing the questionnaire response with three urine strip tests for the
detection of morphine, amphetamine and methamphetamine among 259 randomly
selected subjects. Results: The prevalence of drug use according to self-report
was 2.6% (95% CI: 1.7%-3.8%).One-step drug test as the gold standard for the use
of drug self-reported demonstrated a sensitivity(95% CI) and specificity 15%
(10-22) and 99.7% (98.9%-99.9%) respectively. All participants with positive
self-report were male; however, in the urine analysis drug test, it was positive
for 7out of 68 randomly selected women. Conclusion: The validity of self-reported
drug use in this population was low; therefore, the self reported use of the drug
should be used with caution in this population. It is recommended to use
alternative techniques to improve the validity of data using the self-report
procedure.
DOI: 10.15171/hpp.2018.30
PMCID: PMC6064750
PMID: 30087846
1542. Implement Sci. 2015 Sep 24;10:132. doi: 10.1186/s13012-015-0322-1.
Improving medication management in multimorbidity: development of the

MultimorbiditY COllaborative Medication Review And DEcision Making (MY COMRADE)
intervention using the Behaviour Change Wheel.
Sinnott C(1), Mercer SW(2), Payne RA(3), Duerden M(4), Bradley CP(5), Byrne M(6).
Author information:
(1)Department of General Practice, University College Cork, Cork, Ireland.
csinnott@ucc.ie.
(2)General Practice and Primary Care, Institute of Health and Wellbeing,
University of Glasgow, Glasgow, UK. Stewart.Mercer@glasgow.ac.uk.
(3)Cambridge Centre for Health Services Research, Institute of Public Health,
University of Cambridge, Cambridge, UK. rap55@medschl.cam.ac.uk.
(4)Centre for Health Economics and Medicines Evaluation, Bangor University,
Bangor, UK. martin@theduerdens.co.uk.
(5)Department of General Practice, University College Cork, Cork, Ireland.
C.Bradley@ucc.ie.
(6)Health Behaviour Change Research Group, School of Psychology, National
University of Ireland, Galway, Ireland. molly.byrne@nuigalway.ie.
BACKGROUND: Multimorbidity, the presence of two or more chronic conditions,

affects over 60 % of patients in primary care. Due to its association with
polypharmacy, the development of interventions to optimise medication management
in patients with multimorbidity is a priority. The Behaviour Change Wheel is a
new approach for applying behavioural theory to intervention development. Here,
we describe how we have used results from a review of previous research, original
research of our own and the Behaviour Change Wheel to develop an intervention to
improve medication management in multimorbidity by general practitioners (GPs),
within the overarching UK Medical Research Council guidance on complex
interventions.
METHODS: Following the steps of the Behaviour Change Wheel, we sought behaviours
associated with medication management in multimorbidity by conducting a
systematic review and qualitative study with GPs. From the modifiable GP
behaviours identified, we selected one and conducted a focused behavioural
analysis to explain why GPs were or were not engaging in this behaviour. We used
the behavioural analysis to determine the intervention functions, behavioural
change techniques and implementation plan most likely to effect behavioural
change.
RESULTS: We identified numerous modifiable GP behaviours in the systematic review
and qualitative study, from which active medication review (rather than passive
maintaining the status quo) was chosen as the target behaviour. Behavioural
analysis revealed GPs' capabilities, opportunities and motivations relating to
active medication review. We combined the three intervention functions deemed
most likely to effect behavioural change (enablement, environmental restructuring
and incentivisation) to form the MultimorbiditY COllaborative Medication Review
And DEcision Making (MY COMRADE) intervention. MY COMRADE primarily involves the
technique of social support: two GPs review the medications prescribed to a
complex multimorbid patient together. Four other behavioural change techniques
are incorporated: restructuring the social environment, prompts/cues, action
planning and self-incentives.
CONCLUSIONS: This study is the first to use the Behaviour Change Wheel to develop
an intervention targeting multimorbidity and confirms the usability and
usefulness of the approach in a complex area of clinical care. The systematic
development of the MY COMRADE intervention will facilitate a thorough evaluation
of its effectiveness in the next phase of this work.
DOI: 10.1186/s13012-015-0322-1
PMCID: PMC4582886
1543. Drug Alcohol Depend. 2015 Nov 1;156:176-183. doi:

10.1016/j.drugalcdep.2015.09.007. Epub 2015 Sep 14.
Smoking, posttraumatic stress disorder, and alcohol use disorders in a nationally

representative sample of Australian men and women.
Forbes MK(1), Flanagan JC(2), Barrett EL(3), Crome E(4), Baillie AJ(5), Mills
KL(6), Teesson M(7).
Author information:
(1)Centre for Emotional Health and Centre of Research Excellence in Mental Health
and Substance Abuse, Macquarie University, Sydney, NSW 2109, Australia.
Electronic address: miri.forbes@mq.edu.au.
(2)Medical University of South Carolina, 5 Charleston Center Drive, Suite 151,
Charleston, SC 29401, United States. Electronic address: hellmuth@musc.edu.
(3)Centre of Research Excellence in Mental Health and Substance Abuse and
National Drug and Alcohol Research Centre, UNSW, Sydney, NSW 2052, Australia.
Electronic address: e.barrett@unsw.edu.au.
Electronic address: erica.crome@mq.edu.au.
Electronic address: andrew.baillie@mq.edu.au.
Electronic address: k.mills@unsw.edu.au.
Electronic address: m.teesson@unsw.edu.au.
BACKGROUND: Posttraumatic stress disorder (PTSD) and alcohol use disorders (AUDs)
often co-occur with smoking and tobacco use disorders. Each of these disorders is
known to have negative health consequences and impairment independently, but
little is known about the impact of their co-occurrence. The aim of the present
study is to examine the prevalence, correlates, order of onset, and impact of
co-occurring daily smoking, PTSD, and AUDs.
METHOD: The 2007 Australian National Survey of Mental Health and Wellbeing (2007
NSMHWB) was a nationally representative survey of 8841 Australians. The survey
assessed for 12-month DSM-IV mental disorders; the age respondents first started
smoking daily, experienced a traumatic event, or developed problems with alcohol;
and self-reported mental and physical health and impairment.
RESULTS: There were systematic patterns of co-occurrence between daily smoking,
PTSD, and AUDs. Daily smoking and problems with alcohol use tended to develop
after first trauma exposure, which is broadly consistent with the self-medication
hypothesis. Daily smoking, PTSD, and AUDs were also associated with additive
negative effects on mental and physical health and functioning, after controlling
for demographics.
CONCLUSIONS: Smoking, PTSD, and AUDs commonly co-occur in this nationally
representative sample of Australian men and women, and this comorbidity was
associated with greater severity of mental and physical health problems and
impairment in several areas of functioning. This study highlights the importance
of identifying and eliminating these patterns of co-occurrence, potentially
through integrated interventions.
DOI: 10.1016/j.drugalcdep.2015.09.007
PMCID: PMC4633362
Safety culture perceptions of pharmacists in Malaysian hospitals and health

clinics: a multicentre assessment using the Safety Attitudes Questionnaire.
Samsuri SE(1), Pei Lin L(2), Fahrni ML(3).
Author information:
(1)Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor,
Malaysia Department of Pharmacy Practice and Development, Malacca State
Pharmaceutical Services Division, Ayer Keroh, Malacca, Malaysia.
(2)Community Health Research Cluster, Faculty of Health Sciences, Universiti
Sultan Zainal Abidin (UniSZA), Kampus Gong Badak, Kuala Nerus, Terengganu,
Malaysia.
(3)Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor,
Malaysia Department of Pharmaceutical & Life Sciences, Communities of Research,
Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia.
OBJECTIVE: To assess the safety attitudes of pharmacists, provide a profile of

their domains of safety attitude and correlate their attitudes with self-reported
rates of medication errors.
DESIGN: A cross-sectional study utilising the Safety Attitudes Questionnaire
(SAQ).
SETTING: 3 public hospitals and 27 health clinics.
PARTICIPANTS: 117 pharmacists.
MAIN OUTCOME MEASURES: Safety culture mean scores, variation in scores across
working units and between hospitals versus health clinics, predictors of safety
culture, and medication errors and their correlation.
RESULTS: Response rate was 83.6% (117 valid questionnaires returned). Stress
recognition (73.0±20.4) and working condition (54.8±17.4) received the highest
and lowest mean scores, respectively. Pharmacists exhibited positive attitudes
towards: stress recognition (58.1%), job satisfaction (46.2%), teamwork climate
(38.5%), safety climate (33.3%), perception of management (29.9%) and working
condition (15.4%). With the exception of stress recognition, those who worked in
health clinics scored higher than those in hospitals (p<0.05) and higher scores
(overall score as well as score for each domain except for stress recognition)
correlated negatively with reported number of medication errors. Conversely,
those working in hospital (versus health clinic) were 8.9 times more likely
(p<0.01) to report a medication error (OR 8.9, CI 3.08 to 25.7). As stress
recognition increased, the number of medication errors reported increased
(p=0.023). Years of work experience (p=0.017) influenced the number of medication
errors reported. For every additional year of work experience, pharmacists were
0.87 times less likely to report a medication error (OR 0.87, CI 0.78 to 0.98).
CONCLUSIONS: A minority (20.5%) of the pharmacists working in hospitals and
health clinics was in agreement with the overall SAQ questions and scales.
Pharmacists in outpatient and ambulatory units and those in health clinics had
better perceptions of safety culture. As perceptions improved, the number of
medication errors reported decreased. Group-specific interventions that target
specific domains are necessary to improve the safety culture.
DOI: 10.1136/bmjopen-2015-008889
PMCID: PMC4663412
1545. BMC Psychiatry. 2018 Dec 27;18(1):399. doi: 10.1186/s12888-018-1993-3.
Relative toxicity of mood stabilisers and antipsychotics: case fatality and fatal
toxicity associated with self-poisoning.
Ferrey AE(1)(2), Geulayov G(3), Casey D(3), Wells C(4), Fuller A(5), Bankhead
C(5), Ness J(6), Clements C(7), Gunnell D(8), Kapur N(7), Hawton K(3).
Author information:
(1)Centre for Suicide Research, Department of Psychiatry, University of Oxford,
Warneford Hospital, Oxford, UK. anne.ferrey@phc.ox.ac.uk.
Oxford, UK. anne.ferrey@phc.ox.ac.uk.
(3)Centre for Suicide Research, Department of Psychiatry, University of Oxford,
Warneford Hospital, Oxford, UK.
(4)Office for National Statistics, Newport, UK.
Oxford, UK.
(6)Centre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare
NHS Foundation Trust, Derby, UK.
(7)Centre for Suicide Prevention, University of Manchester, Manchester, UK.
(8)School of Social and Community Medicine, University of Bristol, Bristol, UK.
BACKGROUND: Bipolar and other psychiatric disorders are associated with

considerably increased risk of suicidal behaviour, which may include
self-poisoning with medication used to treat the disorder. Therefore, choice of
medication for treatment should include consideration of toxicity, especially for
patients at risk. The aim of this study was to estimate the relative toxicity of
specific drugs within two drug categories, antipsychotics and mood stabilizers,
using large-scale databases to provide evidence that could assist clinicians in
making decisions about prescribing, especially for patients at risk of suicidal
behaviour.
METHOD: Two indices were used to assess relative toxicity of mood stabilisers and
antipsychotics: case fatality (the ratio between rates of fatal and non-fatal
self-poisoning) and fatal toxicity (the ratio between rates of fatal
self-poisoning and prescription). Mood stabilisers assessed included lithium
[reference], sodium valproate, carbamazepine, and lamotrigine, while
antipsychotics included chlorpromazine [reference], clozapine, olanzapine,
quetiapine and risperidone. Fatal self-poisoning (suicide) data were provided by
the Office for National Statistics (ONS), non-fatal self-poisoning data by the
Multicentre Study of Self-harm in England, and information on prescriptions by
the Clinical Practice Research Datalink. The primary analysis focussed on deaths
due to a single drug. Cases where the drug of interest was listed as the likely
primary toxic agent in multiple drug overdoses were also analysed. The study
period was 2005-2012.
RESULTS: There appeared to be little difference in toxicity between the mood
stabilisers, except that based on case fatality where multiple drug poisonings
were considered, carbamazepine was over twice as likely to result in death
relative to lithium (OR 2.37 95% CI 1.16-4.85). Of the antipsychotics, clozapine
was approximately18 times more likely to result in death when taken in overdose
than chlorpromazine (single drug case fatality: OR 18.53 95% CI 8.69-39.52).
Otherwise, only risperidone differed from chlorpromazine, being less toxic (OR
0.06 95% CI 0.01-0.47).
CONCLUSIONS: There was little difference in toxicity of the individual mood
stabilisers. Clozapine was far more toxic than the other antipsychotics. The
findings are relevant to prescribing policy, especially for patients at
particular risk of suicidal behaviour.
DOI: 10.1186/s12888-018-1993-3
PMCID: PMC6307121
PMID: 30587176
1546. P T. 2018 Aug;43(8):485-504.
Variation in Generic Drug Manufacturers' Product Characteristics.
Matuszewski K, Kapusnik-Uner J, Man M, Pardini R, Suko J.
Objectives: Studies suggest appearance may be an important factor in medication

nonadherence. This study was undertaken to characterize the range of appearances
and costs of 16 oral solid generic medications in four major chronic
diseases/conditions.
Methods: We identified frequently prescribed medications in four therapeutic
classes-antidiabetics, 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors
(statins), beta blockers, and heart failure drugs-and verified that each had at
least three generic manufacturer sources in 2016. The color, shape, scoring, and
size for each formulation were compared. Prices were determined based on
manufacturers' self-reported wholesale acquisition costs effective December 31,
2016.
Results: We identified 40 unique manufacturers for the antidiabetics, 35 for the
statins, 38 for the beta blockers, and 71 for the heart failure agents. For all
16 drugs across all four disease states, there was an average of three colors,
two shapes, 11 manufacturers, and four appearances when color and shape together
are considered. The cost variance per drug ranged from 2% to more than 62,253%.
Conclusion: Substantial appearance variation among generically equivalent
products raises the strong possibility that patients may experience product
switches that could increase the likelihood of nonadherence. Our data support the
need to further study drug appearance changes and interventions as a potential
factor affecting chronic disease adherence outcomes.
PMCID: PMC6065490
PMID: 30100689
Conflict of interest statement: Disclosures: The authors report no commercial or

financial interests in regard to this article. Dr. Matuszewski is Associate
Editor-in-Chief of P&T.
1547. J Clin Aesthet Dermatol. 2018 Mar;11(3):42-48. Epub 2018 Mar 1.
Behaviors and Attitudes Toward Cosmetic Treatments Among Men.
Girdwichai N(1), Chanprapaph K(1), Vachiramon V(1).
Author information:
(1)Drs. Girdwichai, Chanprapaph, and Vachiramon are with the Division of
Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University in
Bangkok, Thailand.
Background: Cosmetic treatments have gained popularity worldwide. However, little
is known about the behaviors and attitudes toward cosmetic treatments in men.
Objective: The authors sought to explore the behaviors and attitudes toward
cosmetic treatments in male patients. Patients/Methods: A cross-sectional study
was conducted involving male patients aged 18 to 70 years, who presented for
cosmetic consultation at an outpatient dermatology clinic in a university-based
hospital. Behaviors and attitudes were assessed using a self-response
questionnaire. For comparison, female patients with the same inclusion criteria
were also assessed. Results: A total of 302 male patients completed the
questionnaire. The internet and close family members were the two most important
sources of cosmetic treatment information. Men preferred oral medication compared
to women (p<0.01). Regarding topical medication, men prefer gel formulations,
tube containers, and white-colored packaging. The maximum chosen number of
topical medication is three items. The most important factor in medical provider
selection was the dermatologists' knowledge and expertise. Conclusion: Behaviors
and attitudes toward cosmetic treatment in male patients were different from
those seen in female patients. It is essential to alter the approaches regarding
cosmetic treatments when treating men.
PMCID: PMC5868785
PMID: 29607001
Conflict of interest statement: FUNDING:No funding was provided for this article.
DISCLOSURES:The authors have no conflicts of interest relevant to the content of
this article.
1548. Aust N Z J Psychiatry. 2019 Sep;53(9):844-850. doi: 10.1177/0004867419857821.

Epub 2019 Jun 25.
Resolving the paradox of increased mental health expenditure and stable

prevalence.
Meadows GN(1)(2)(3), Prodan A(4)(5), Patten S(6), Shawyer F(1), Francis S(1),
Enticott J(1)(7), Rosenberg S(8)(9), Atkinson JA(6)(10)(11)(12), Fossey E(13),
Kakuma R(14).
Author information:
(1)1 Southern Synergy, Department of Psychiatry, School of Clinical Sciences at
Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash
University, Melbourne, VIC, Australia.
(2)2 Adult Mental Health, Monash Health, Melbourne, VIC, Australia.
(3)3 Melbourne School of Population and Global Health, The University of
Melbourne, VIC, Australia.
(4)4 Computing & ICT Organisational Unit, School of Computing, Engineering and
Mathematics, Western Sydney University, Sydney, NSW, Australia.
(5)5 Decision Analytics, Sax Institute, Sydney, NSW, Australia.
(6)6 Department of Community Health Sciences and Psychiatry, University of
Calgary, Calgary, AB, Canada.
(7)7 Department of General Practice, School of Primary and Allied Health Care,
Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne,
VIC, Australia.
(8)8 Brain and Mind Centre, School of Medical Sciences, The University of Sydney,
(9)9 Centre for Mental Health Research, Australian National University, Canberra,
ACT, Australia.
(10)10 Menzies Centre for Health Policy, Faculty of Medicine, The University of
Sydney, Sydney, NSW, Australia.
(11)11 Simulation for Policy, The Australian Prevention Partnership Centre,
(12)12 Translational Health Research Institute, Western Sydney University,
(13)13 Department of Occupational Therapy, School of Primary and Allied Health
Care, Faculty of Medicine, Nursing and Health Sciences, Monash University,
(14)14 Faculty of Epidemiology and Population Health, Department of Population
Health, London School of Hygiene & Tropical Medicine, London, UK.
A doubling of Australian expenditure on mental health services over two decades,

inflation-adjusted, has reduced prevalence of neither psychological distress nor
mental disorders. Low rates of help-seeking, and inadequate and inequitable
delivery of effective care may explain this partially, but not fully. Focusing on
depressive disorders, drawing initially on ideas from the work of philosopher and
socio-cultural critic Ivan Illich, we use evidence-based medicine statistics and
simulation modelling approaches to develop testable hypotheses as to how
iatrogenic influences on the course of depression may help explain this seeming
paradox. Combined psychological treatment and antidepressant medication may be
available, and beneficial, for depressed people in socioeconomically advantaged
areas. But more Australians with depression live in disadvantaged areas where
antidepressant medication provision without formal psychotherapy is more typical;
there also are urban/non-urban disparities. Depressed people often engage in
self-help strategies consistent with psychological treatments, probably often
with some benefit to these people. We propose then, if people are encouraged to
rely heavily on antidepressant medication only, and if they consequently reduce
spontaneous self-help activity, that the benefits of the antidepressant
medication may be more than offset by reductions in beneficial effects as a
consequence of reduced self-help activity. While in advantaged areas, more
comprehensive service delivery may result in observed prevalence lower than it
would be without services, in less well-serviced areas, observed prevalence may
be higher than it would otherwise be. Overall, then, we see no change. If the
hypotheses receive support from the proposed research, then implications for
service prioritisation and delivery could include a case for wider application of
recovery-oriented practice. Critically, it would strengthen the case for action
to correct inequities in the delivery of psychological treatments for depression
in Australia so that combined psychological therapy and antidepressant
medication, accessible and administered within an empowering framework, should be
a nationally implemented standard.
DOI: 10.1177/0004867419857821
PMID: 31238699
1549. Addiction. 2018 Jan;113(1):67-79. doi: 10.1111/add.13922. Epub 2017 Aug 10.
To take or not to take: the association between perceived addiction risk,

expected analgesic response and likelihood of trying novel pain relievers in
self-identified chronic pain patients.
Tompkins DA(1), Huhn AS(1), Johnson PS(2), Smith MT(1), Strain EC(1), Edwards
RR(3), Johnson MW(1).
Author information:
(1)Department of Psychiatry and Behavioral Sciences, Johns Hopkins University
School of Medicine, Baltimore, MD, USA.
(2)Department of Psychology, California State University, Chico, Chico, CA, USA.
(3)Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard
Medical School, Brigham and Women's Hospital, Boston, MA, USA.
BACKGROUND AND AIMS: Probability discounting refers to the effect of outcome
uncertainty on decision making. Using probability discounting, we examined the
degree to which self-identified chronic pain patients (CPP) were likely to try a
novel analgesic medication given increasing addiction risk. We postulated that
propensity for opioid misuse, trait impulsivity and previous opioid experience
would be associated positively with likelihood of risky medication use.
DESIGN: This cross-sectional on-line study determined state/trait associations
with addiction-related medication decisions in CPP.
SETTING: US-based CPP participated via Amazon Mechanical Turk; data were
collected and analyzed in Baltimore, Maryland.
PARTICIPANTS: A total of 263 CPP (70.6% female) participated in the study from
12-13 December 2014.
MEASUREMENTS: CPP responded to the Benefit versus Addiction Risk Questionnaire
(BARQ) assessing likelihood of taking a hypothetical once-daily oral analgesic
medication as a function of two factors: risk of addiction (0-50%) and duration
of expected complete pain relief (3, 30 or 365 days). The primary outcome was the
BARQ, quantified as area under the curve (AUC). Grouping of CPP at high or low
risk for opioid misuse was based on the Screener and Opioid Assessment for
Patients with Pain-Revised (SOAPP-R). Predictors included previous experience
with opioids, as well as various measures of chronic pain and mental health.
FINDINGS: Across hypothetical addiction risk assessed in the BARQ, the likelihood
of taking a novel analgesic medication was elevated significantly in patients
with high (≥18; n = 137) versus low (<18; n = 126) SOAPP-R scores [P < 0.001;
3-day: Cohen's d = 0.66, 95% confidence interval (CI) = 0.63, 0.69; 30-day:
d = 0.74, 95% CI = 0.71, 0.78; 365-day: d = 0.75, 95% CI = 0.72, 0.79].
CONCLUSIONS: In the United States, self-identified chronic pain patients (CPP) at
higher risk for opioid misuse were more likely to report willingness to try a
novel analgesic despite increasing addiction risk than CPP with low risk of
opioid misuse.
DOI: 10.1111/add.13922
PMCID: PMC5725253
1550. BMC Public Health. 2017 Dec 19;17(1):962. doi: 10.1186/s12889-017-4973-5.
SMS education for the promotion of diabetes self-management in low & middle
income countries: a pilot randomized controlled trial in Egypt.
Abaza H(1), Marschollek M(2).
Author information:
(1)Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School,
Carl-Neuberg-Str. 1, 30625, Hannover, Germany. haitham.abaza@plri.de.
(2)Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School,
Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
BACKGROUND: Due to the ubiquity of mobile phones in low and middle income
countries, we aimed to examine the feasibility of SMS education among diabetic
patients in Egypt, and assess the impact of educational text messages, compared
to traditional paper-based methods, on glycemic control and self-management
behaviors.
METHODS: We conducted a 12-week randomized controlled trial at Misr University
for Science & Technology hospital in Cairo-Egypt. Known as MUST diabetes
awareness program, patients were included if they had diabetes, owned a mobile
phone, and could read SMS messages or lived with someone that could read for
them. Intervention patients received daily messages and weekly reminders
addressing various diabetes care categories. We expected greater improvement in
their glycemic control compared to controls who only received paper-based
educational material. The primary outcome was the change in HbA1c, measured by
the difference between endpoint and baseline values and by the number of patients
who experienced at least 1% reduction from baseline to endpoint. Key secondary
outcomes included blood glucose levels, body weight, treatment and medication
adherence, self-efficacy, and diabetes knowledge. Data were analyzed using
ANCOVA, chi-square, and t-tests.
RESULTS: Thirty four intervention and 39 control patients completed the study.
Over 12 weeks, 3880 messages were sent. Each intervention patient received 84
educational and 12 reminder messages plus one welcome message. Our primary
outcome did not differ significantly (Δ 0.290; 95% CI -0.402 to 0.983; p = 0.406)
between groups after 3 months, demonstrating a mean drop of -0.69% and -1.05% in
the control and intervention group respectively. However, 16 intervention
patients achieved the targeted 1% drop versus only 6 controls, suggesting clear
association between study group and 1% HbA1c reductions (chi-square = 8.655;
df = 1; p = 0.003). Secondary outcomes seemed in favor of intervention patients
at endpoint, with considerable improvements in treatment and medication
adherence, self-efficacy, and knowledge scores. Participants also indicated full
satisfaction with the program.
CONCLUSIONS: SMS education is a feasible and acceptable method for improving
glycemic control and self-management behaviors among Egyptian diabetics. However,
whether it is more effective than traditional paper-based methods needs further
investigation.
TRIAL REGISTRATION: ClinicalTrials.gov NCT02868320 . Registered 9 August 2016.
Retrospectively registered.
DOI: 10.1186/s12889-017-4973-5
PMCID: PMC5735794
1551. J Hum Hypertens. 2016 Feb;30(2):141-6. doi: 10.1038/jhh.2015.37. Epub 2015

Apr
23.
Supporting the self-management of hypertension: Patients' experiences of using a

mobile phone-based system.
Hallberg I(1)(2), Ranerup A(2)(3), Kjellgren K(1)(2).
Author information:
(2)Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of
(3)Department of Applied IT, University of Gothenburg, Gothenburg, Sweden.
Globally, hypertension is poorly controlled and its treatment consists mainly of

preventive behavior, adherence to treatment and risk-factor management. The aim
of this study was to explore patients' experiences of an interactive mobile
phone-based system designed to support the self-management of hypertension.
Forty-nine patients were interviewed about their experiences of using the
self-management system for 8 weeks regarding: (i) daily answers on self-report
questions concerning lifestyle, well-being, symptoms, medication intake and side
effects; (ii) results of home blood-pressure measurements; (iii) reminders and
motivational messages; and (iv) access to a web-based platform for visualization
of the self-reports. The audio-recorded interviews were analyzed using
qualitative thematic analysis. The patients considered the self-management system
relevant for the follow-up of hypertension and found it easy to use, but some
provided insight into issues for improvement. They felt that using the system
offered benefits, for example, increasing their participation during follow-up
consultations; they further perceived that it helped them gain understanding of
the interplay between blood pressure and daily life, which resulted in increased
motivation to follow treatment. Increased awareness of the importance of adhering
to prescribed treatment may be a way to minimize the cardiovascular risks of
hypertension.
DOI: 10.1038/jhh.2015.37
PMCID: PMC4705419
1552. Pediatr Diabetes. 2016 Nov;17(7):500-508. doi: 10.1111/pedi.12331. Epub 2015

Oct
21.
A multivariate model exploring the predictive value of demographic, adolescent,

and family factors on glycemic control in adolescents with type 1 diabetes.
Agarwal S(1)(2), Jawad AF(2)(3), Miller VA(4)(5).
Author information:
(1)Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine,
University of Pennsylvania, Philadelphia, PA, USA.
(2)Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
USA.
(3)Department of Pediatrics, The Children's Hospital of Philadelphia,
Philadelphia, PA, USA.
(4)Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,
USA. millerv@email.chop.edu.
(5)Department of Pediatrics, The Children's Hospital of Philadelphia,
Philadelphia, PA, USA. millerv@email.chop.edu.
OBJECTIVE: The current study examined how a comprehensive set of variables from
multiple domains, including at the adolescent and family level, were predictive
of glycemic control in adolescents with type 1 diabetes (T1D).
METHODS: Participants included 100 adolescents with T1D ages 10-16 yrs and their
parents. Participants were enrolled in a longitudinal study about youth
decision-making involvement in chronic illness management of which the baseline
data were available for analysis. Bivariate associations with glycemic control
(HbA1C) were tested. Hierarchical linear regression was implemented to inform the
predictive model.
RESULTS: In bivariate analyses, race, family structure, household income, insulin
regimen, adolescent-reported adherence to diabetes self-management, cognitive
development, adolescent responsibility for T1D management, and parent behavior
during the illness management discussion were associated with HbA1c. In the
multivariate model, the only significant predictors of HbA1c were race and
insulin regimen, accounting for 17% of the variance. Caucasians had better
glycemic control than other racial groups. Participants using pre-mixed insulin
therapy and basal-bolus insulin had worse glycemic control than those on insulin
pumps.
CONCLUSIONS: This study shows that despite associations of adolescent and
family-level variables with glycemic control at the bivariate level, only race
and insulin regimen are predictive of glycemic control in hierarchical
multivariate analyses. This model offers an alternative way to examine the
relationship of demographic and psychosocial factors on glycemic control in
adolescents with T1D.
DOI: 10.1111/pedi.12331
PMCID: PMC4840099
1553. Clin Infect Dis. 2017 Jun 1;64(11):1612-1614. doi: 10.1093/cid/cix176.
Impact of Medication Adherence on Virologic Failure in A5202: A Randomized,

Partially Blinded, Phase 3B Study.
Parker RA(1)(2)(3)(4), Rabideau DJ(1), Sax PE(3)(5), Tierney C(6), Daar ES(7)(8),
Collier AC(9), Losina E(2)(3)(4)(10)(11)(12), Freedberg KA(2)(3)(4)(11)(13)(14).
Author information:
(1)Biostatistics Center, and.
(2)Medical Practice Evaluation Center, Massachusetts General Hospital.
(3)Harvard Medical School.
(4)Harvard University Center for AIDS Research.
(5)Division of Infectious Diseases, Brigham and Women's Hospital, and.
(6)Center for Biostatistics in AIDS Research in the Department of Biostatistics,
Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
(7)Division of HIV Medicine, Los Angeles Biomedical Research Institute at
Harbor-UCLA Medical Center, Torrance, and.
(8)David Geffen School of Medicine at UCLA, Los Angeles, California.
(9)Division of Allergy and Infectious Diseases, University of Washington,
Seattle; and.
(10)Department of Orthopedic Surgery, Brigham and Women's Hospital.
(11)Department of Epidemiology, Boston University School of Public Health.
(12)Department of Biostatistics, Boston University School of Public Health.
(13)Divisions of General Internal Medicine and Infectious Diseases, Massachusetts
General Hospital, and.
(14)Department of Health Policy and Management, Harvard School of Public Health,
Boston, Massachusetts.
In AIDS Clinical Trials Group A5202, participants who reported missing their
medication within the past month or not providing adherence reports at both 8 and
24 weeks had 5 times the hazard of virological failure compared to more adherent
participants. Adherence interventions should focus on such patients.
© The Author 2017. Published by Oxford University Press for the Infectious
Diseases Society of America.
DOI: 10.1093/cid/cix176
PMCID: PMC5434358
1554. J Affect Disord. 2016 Mar 15;193:145-50. doi: 10.1016/j.jad.2015.12.016. Epub

2015 Dec 15.
The temporal course and clinical correlates of subjective impulsivity in bipolar

disorder as revealed through ecological momentary assessment.
Depp CA(1), Moore RC(2), Dev SI(2), Mausbach BT(3), Eyler LT(2), Granholm EL(2).
Author information:
(1)UC San Diego Department of Psychiatry, La Jolla, CA, United States; VA San
Diego, La Jolla, CA, United States. Electronic address: cdepp@ucsd.edu.
(2)UC San Diego Department of Psychiatry, La Jolla, CA, United States; VA San
Diego, La Jolla, CA, United States.
(3)UC San Diego Department of Psychiatry, La Jolla, CA, United States.
BACKGROUND: Impulsivity is frequently linked with bipolar disorder and is

associated with mania and negative outcomes. The temporal dynamics of subjective
impulsivity are unclear, in particular whether impulsivity precedes or follows
changes in positive or negative affect.
METHODS: A total of 41 outpatients with bipolar disorder (I or II) were provided
with mobile devices for 11 weeks and completed twice-daily surveys about
affective states and subjective impulsivity. We examined the association between
aggregate subjective impulsivity with baseline global cognitive function, suicide
risk ratings, and medication adherence, as well as concurrent and lagged
associations with momentary positive and negative affect ratings.
RESULTS: A total of 2902 ratings were available across study subjects. Higher
aggregate mean ratings of impulsivity were associated with worse baseline global
cognitive function, prior suicide attempts, and self-reported problems with
medication adherence, as well as more severe manic (but not depressive) symptoms.
Time-lagged models indicated that greater negative affect, but not positive
affect, predicted subsequent increases in subjective impulsivity, which, in turn,
predicted diminished positive affect.
LIMITATIONS: Other measures of impulsivity with which to validate subjective
ratings were unavailable and the sample was restricted to generally clinically
stable outpatients.
CONCLUSIONS: Subjective impulsivity as measured by daily monitoring was
associated with worse cognitive function and self-rated medication adherence, and
higher suicide risk ratings. Impulsivity may be a maladaptive strategy to
regulate negative affect in bipolar disorder.
DOI: 10.1016/j.jad.2015.12.016
PMCID: PMC4915941
1555. JMIR Diabetes. 2017 Jul 11;2(2):e12. doi: 10.2196/diabetes.6468.
iOS Appstore-Based Phone Apps for Diabetes Management: Potential for Use in
Martinez M(1), Park SB(1), Maison I(1), Mody V(1), Soh LS(1), Parihar HS(1).
Author information:
(1)Philadelphia College of Osteopathic Medicine - GA campus, School of Pharmacy,
Suwanee, GA, United States.
BACKGROUND: Currently, various phone apps have been developed to assist patients.
Many of these apps are developed to assist patients in the self-management of
chronic diseases such as diabetes. It is essential to analyze these various apps
to understand the key features that would potentially be instrumental in helping
patients successfully achieve goals in disease self-management.
OBJECTIVE: The objective of this study was to conduct a review of all the
available diabetes-related apps in the iOS App Store to evaluate which diabetic
app is more interactive and offers a wide variety of operations such as
monitoring glucose, water, carbohydrate intake, weight, body mass index (BMI),
medication, blood pressure (BP) levels, reminders or push notifications, food
database, charts, exercise management, email, sync between devices, syncing data
directly to the prescribers, and other miscellaneous functions such as (Twitter
integration, password protection, retina display, barcode scanner, apple watch
functionality, and cloud syncing).
METHODS: Data was gathered using the iOS App Store on an iPad. The search term
"diabetes" resulted in 1209 results. Many of the results obtained were remotely
related to diabetes and focused mainly on diet, exercise, emergency services,
refill reminders, providing general diabetes information, and other
nontherapeutic options. We reviewed each app description and only included apps
that were meant for tracking blood glucose levels. All data were obtained in one
sitting by one person on the same device, as we found that carrying out the
search at different times or on different devices (iPhones) resulted in varying
results. Apps that did not have a feature for tracking glucose levels were
excluded from the study.
RESULTS: The search resulted in 1209 results; 85 apps were retained based on the
inclusion criteria mentioned above. All the apps were reviewed for average
customer ratings, number of reviews, price, and functions. Of all the apps
surveyed, 18 apps with the highest number of user ratings were used for in-depth
analysis. Of these 18 apps, 50% (9/18) also had a medication adherence function.
Our analysis revealed that the Diabetes logbook used by the mySugr app was one of
the best; it differentiated itself by introducing fun as a method of increasing
adherence.
CONCLUSIONS: A large variation was seen in patient ratings of app features. Many
patient reviewers desired simplicity of app functions. Glucose level tracking and
email features potentially helped patients and health care providers manage the
disease more efficiently. However, none of the apps could sync data directly to
the prescribers. Additional features such as graph customization, availability of
data backup, and recording previous entries were also requested by many users.
Thus, the use of apps in disease management and patient and health-care provider
involvement in future app refinement and development should be encouraged.
©Mark Martinez, Su Bin Park, Isaac Maison, Vicky Mody, Lewis Sungkon Soh, Harish
Singh Parihar. Originally published in JMIR Diabetes (http://diabetes.jmir.org),
11.07.2017.
DOI: 10.2196/diabetes.6468
PMCID: PMC6238890
PMID: 30291096
1556. BMC Med Inform Decis Mak. 2017 Jan 9;17(1):5. doi: 10.1186/s12911-016-0397-x.
Understanding how primary care practitioners perceive an online intervention for

the management of hypertension.
Bradbury K(1), Morton K(2), Band R(2), May C(3), McManus R(4), Little P(5),
Yardley L(2).
Author information:
(1)Academic unit of psychology, University of Southampton, Southampton, UK.
kjb1e08@soton.ac.uk.
(2)Academic unit of psychology, University of Southampton, Southampton, UK.
(3)Faculty of Health Sciences, University of Southampton, Southampton, UK.
Oxford, UK.
(5)Primary Care and Population Sciences, Faculty of Medicine, University of
Southampton, Southampton, UK.
BACKGROUND: In order to achieve successful implementation an intervention needs
to be acceptable and feasible to its users and must overcome barriers to
behaviour change. The Person-Based Approach can help intervention developers to
improve their interventions to ensure more successful implementation. This study
provides an example of using the Person-Based Approach to refine a digital
intervention for hypertension (HOME BP).
METHODS: Our Person-Based Approach involved conducting qualitative focus groups
with practice staff to explore their perceptions of HOME BP and to identify any
potential barriers to implementation of the HOME BP procedures. We took an
iterative approach moving between data collection, analysis and modifications to
the HOME BP intervention, followed by further data collection. The data was
analysed using thematic analysis.
RESULTS: Many aspects of HOME BP appeared to be acceptable, persuasive and
feasible to implement. Practitioners perceived benefits in using HOME BP,
including that it could empower patients to self-manage their health, potentially
overcome clinical inertia around prescribing medication and save both the patient
and practitioner time. However, practitioners also had some concerns. Some
practitioners were concerned about the accuracy of patients' home blood pressure
readings, or the potential for home monitoring to cause patients anxiety and
therefore increase consultations. Some GPs lacked confidence in choosing multiple
medication changes, or had concerns about unanticipated drug interactions. A few
nurses were concerned that the model of patient support they were asked to
provide was not consistent with their perceived role. Modifications were made to
the intervention based on this feedback, which appeared to help overcome
practitioners' concerns and improve the acceptability and feasibility of the
intervention.
CONCLUSIONS: This paper provides a detailed example of using the Person-Based
Approach to refine HOME BP, demonstrating how we improved the acceptability and
feasibility of HOME BP based on feedback from practice staff. This demonstration
may be useful to others developing digital interventions.
DOI: 10.1186/s12911-016-0397-x
PMCID: PMC5223423
1557. Health Serv Res. 2016 Apr;51(2):610-24. doi: 10.1111/1475-6773.12346. Epub

2015
Aug 9.
Financial Strain and Medication Adherence among Diabetes Patients in an

Integrated Health Care Delivery System: The Diabetes Study of Northern California
(DISTANCE).
Lyles CR(1)(2), Seligman HK(3), Parker MM(2), Moffet HH(2), Adler N(4),
Schillinger D(3)(2), Piette JD(5), Karter AJ(2).
Author information:
(1)University of California San Francisco, 1001 Potrero Ave, San Francisco, CA.
(2)Kaiser Permanente Northern California Division of Research, Oakland, CA.
(3)Division of General Internal Medicine at SFGH, UCSF Center for Vulnerable
Populations, San Francisco, CA.
(4)UCSF Departments of Psychiatry and Pediatrics, San Francisco, CA.
(5)Schools of Public Health and Medicine, VA Ann Arbor Center for Clinical
Management Research, University of Michigan, Ann Arbor, MI.
OBJECTIVE: To examine self-reported financial strain in relation to pharmacy

utilization adherence data.
DATA SOURCES/STUDY SETTING: Survey, administrative, and electronic medical data
from Kaiser Permanente Northern California.
STUDY DESIGN: Retrospective cohort design (2006, n = 7,773).
DATA COLLECTION/EXTRACTION METHODS: We compared survey self-reports of general
and medication-specific financial strain to three adherence outcomes from
pharmacy records, specifying adjusted generalized linear regression models.
PRINCIPAL FINDINGS: Eight percent and 9 percent reported general and
medication-specific financial strain. In adjusted models, general strain was
significantly associated with primary nonadherence (RR = 1.37; 95 percent CI:
1.04-1.81) and refilling late (RR = 1.34; 95 percent CI: 1.07-1.66); and
medication-specific strain was associated with primary nonadherence (RR = 1.42,
95 percent CI: 1.09-1.84).
CONCLUSIONS: Simple, minimally intrusive questions could be used to identify
patients at risk of poor adherence due to financial barriers.
© Health Research and Educational Trust.
DOI: 10.1111/1475-6773.12346
PMCID: PMC4799896
1558. AIDS. 2018 Jan 2;32(1):35-48. doi: 10.1097/QAD.0000000000001685.
Concomitant medication polypharmacy, interactions and imperfect adherence are

common in Australian adults on suppressive antiretroviral therapy.
Siefried KJ(1), Mao L, Cysique LA, Rule J, Giles ML, Smith DE, McMahon J, Read
TR, Ooi C, Tee BK, Bloch M, de Wit J, Carr A; PAART study investigators.
Author information:
(1)aSt Vincent's Centre for Applied Medical Research, St Vincent's Hospital,
SydneybCentre for Social Research in HealthcNeuroscience Research Australia,
University of New South Wales, SydneydNational Association of People with HIV
Australia, NewtowneSchool of Public Health and Community Medicine, University of
New South Wales, Sydney, New South WalesfDepartment of Infectious Diseases,
Alfred Hospital and Monash UniversitygDepartment of Infectious Diseases, The
Royal Women's HospitalhMonash Infectious Diseases, Monash Health, Melbourne,
VictoriaiAlbion Centre, South Eastern Sydney Local Hospital Network, Sydney, New
South WalesjCentre for Population Health, Burnet InstitutekMelbourne Sexual
Health Centre, Alfred HealthlCentral Clinical School, Faculty of Medicine,
Nursing and Health Sciences, Monash University, Melbourne, VictoriamWestern
Sydney Sexual Health Centre, University of Sydney, ParramattanWestmead Clinical
School, Sydney Medical School, University of Sydney, Westmead, New South
WalesoCentre Clinic, St Kilda, Melbourne, VictoriapHoldsworth House Medical
PracticeqThe Kirby Institute, University of New South Wales, Sydney, New South
Wales, AustraliarDepartment of Interdisciplinary Social Science, Utrecht
University, Utrecht, The Netherlands.
OBJECTIVES: We quantified concomitant medication polypharmacy, pharmacokinetic

and pharmacodynamic interactions, adverse effects and adherence in Australian
adults on effective antiretroviral therapy.
DESIGN: Cross-sectional.
METHODS: Patients recruited into a nationwide cohort and assessed for prevalence
and type of concomitant medication (including polypharmacy, defined as ≥5
concomitant medications), pharmacokinetic or pharmacodynamic interactions,
potential concomitant medication adverse effects and concomitant medication
adherence. Factors associated with concomitant medication polypharmacy and with
imperfect adherence were identified using multivariable logistic regression.
RESULTS: Of 522 participants, 392 (75%) took a concomitant medication (mostly
cardiovascular, nonprescription or antidepressant). Overall, 280 participants
(54%) had polypharmacy of concomitant medications and/or a drug interaction or
contraindication. Polypharmacy was present in 122 (23%) and independently
associated with clinical trial participation, renal impairment, major
comorbidity, hospital/general practice-based HIV care (versus sexual health
clinic) and benzodiazepine use. Seventeen participants (3%) took at least one
concomitant medication contraindicated with their antiretroviral therapy, and 237
(45%) had at least one pharmacokinetic/pharmacodynamic interaction. Concomitant
medication use was significantly associated with sleep disturbance and myalgia,
and polypharmacy of concomitant medications with diarrhoea, fatigue, myalgia and
peripheral neuropathy. Sixty participants (12%) reported imperfect concomitant
medication adherence, independently associated with requiring financial support,
foregoing necessities for financial reasons, good/very good self-reported general
health and at least 1 bed day for illness in the previous 12 months.
CONCLUSION: In a resource-rich setting with universal healthcare access, the
majority of this sample took a concomitant medication. Over half had at least one
of concomitant medication polypharmacy, pharmacokinetic or pharmacodynamic
interaction. Concomitant medication use was associated with several adverse
clinical outcomes.
DOI: 10.1097/QAD.0000000000001685
PMCID: PMC5732638
1559. JMIR Mhealth Uhealth. 2016 Aug 3;4(3):e94. doi: 10.2196/mhealth.6002.
Evaluating an Adaptive and Interactive mHealth Smoking Cessation and Medication

Adherence Program: A Randomized Pilot Feasibility Study.
McClure JB(1), Anderson ML, Bradley K, An LC, Catz SL.
Author information:
(1)Group Health Research Institute, Seattle, WA, United States.
McClure.J@ghc.org.
BACKGROUND: Mobile health (mHealth) interventions hold great promise for helping
smokers quit since these programs can have wide reach and facilitate access to
comprehensive, interactive, and adaptive treatment content. However, the
feasibility, acceptability, and effectiveness of these programs remain largely
untested.
OBJECTIVE: To assess feasibility and acceptability of the My Mobile Advice
Program (MyMAP) smoking cessation program and estimate its effects on smoking
cessation and medication adherence to inform future research planning.
METHODS: Sixty-six smokers ready to quit were recruited from a large regional
health care system and randomized to one of two mHealth programs: (1) standard
self-help including psychoeducational materials and guidance how to quit smoking
or (2) an adaptive and interactive program consisting of the same standard
mHealth self-help content as controls received plus a) real-time, adaptively
tailored advice for managing nicotine withdrawal symptoms and medication
side-effects and b) asynchronous secure messaging with a cessation counselor.
Participants in both arms were also prescribed a 12-week course of varenicline.
Follow-up assessments were conducted at 2 weeks post-target quit date (TQD), 3
months post-TQD, and 5 months post-TQD. Indices of program feasibility and
acceptability included acceptability ratings, utilization metrics including use
of each MyMAP program component (self-help content, secure messaging, and
adaptively tailored advice), and open-ended feedback from participants. Smoking
abstinence and medication adherence were also assessed to estimate effects on
these treatment outcomes.
RESULTS: Utilization data indicated the MyMAP program was actively used, with
higher mean program log-ins by experimental than control participants (10.6 vs
2.7, P<.001). The majority of experimental respondents thought the MyMAP program
could help other people quit smoking (22/24, 92%) and consistently take their
stop-smoking medication (17/22, 97%) and would recommend the program to others
(20/23, 87%). They also rated the program as convenient, responsive to their
needs, and easy to use. Abstinence rates at 5-month follow-up were 36% in the
experimental arm versus 24% among controls (odds ratio 1.79 [0.61-5.19], P=.42).
Experimental participants used their varenicline an average of 46 days versus 39
among controls (P=.49). More than two-thirds (22/33, 67%) of experimental
participants and three-quarters (25/33, 76%) of controls prematurely discontinued
their varenicline use (P=.29).
CONCLUSIONS: The MyMAP intervention was found to be feasible and acceptable.
Since the study was not powered for statistical significance, no conclusions can
be drawn about the program's effects on smoking abstinence or medication
adherence, but the overall study results suggest further evaluation in a larger
randomized trial is warranted.
CLINICALTRIAL: ClinicalTrials.gov NCT02136498;
http://www.webcitation.org/6jT3UMFLj).
PMCID: PMC4989120
PMID: 27489247
1560. J Am Soc Hypertens. 2015 Jun;9(6):420-426.e2. doi:

10.1016/j.jash.2015.04.004.
Epub 2015 Apr 28.
Comparison of Morisky Medication Adherence Scale with therapeutic drug monitoring

in apparent treatment-resistant hypertension.
Pandey A(1), Raza F(2), Velasco A(3), Brinker S(2), Ayers C(4), Das SR(1),
Morisky DE(5), Halm EA(2), Vongpatanasin W(6).
Author information:
(1)Cardiology Division, University of Texas Southwestern Medical Center, Dallas,
TX, USA.
(2)Internal Medicine Department, University of Texas Southwestern Medical Center,
Dallas, TX, USA.
(3)Hypertension Section, University of Texas Southwestern Medical Center, Dallas,
TX, USA.
(4)Department of Clinical Science, University of Texas Southwestern Medical
Center, Dallas, TX, USA.
(5)Department of Community Health Sciences, Univeristy of California, Los
Angeles, Fielding School of Public Health, Los Angeles, CA, USA.
(6)Cardiology Division, University of Texas Southwestern Medical Center, Dallas,
TX, USA; Hypertension Section, University of Texas Southwestern Medical Center,
Dallas, TX, USA. Electronic address: wanpen.vongpatanasin@utsouthwestern.edu.
The Morisky Medication Adherence Scale (MMAS-8) is a questionnaire developed for

screening of non-adherence in patients with several chronic conditions, including
uncomplicated hypertension. However, its accuracy in predicting non-adherence in
patients with apparent treatment-resistant hypertension (a-TRH) is not known.
Accordingly, we performed a retrospective study in 47 patients with a-TRH who had
completed the eight-item MMAS during the initial clinic visit. Non-adherence was
defined as presence of undetected serum levels of at least one prescribed
antihypertensive drug by therapeutic drug monitoring. We found that 26% of
patients were considered to have low adherence score (<6), while the actual
prevalence of non-adherence was 51% by therapeutic drug monitoring. Sensitivity
of the MMAS-8 was 26% (95% confidence interval, 10.3%-48.4%) with specificity of
75% (95% confidence interval, 53.3%-90.2%). By multivariate analysis, the MMAS-8
score was not an independent predictor of non-adherence, while certain clinical
parameters such as heart rate were found to be independent predictors of
non-adherence. Our study suggested limited accuracy of the MMAS-8 in detecting
medication non-adherence in a-TRH.

rights reserved.
DOI: 10.1016/j.jash.2015.04.004
1561. J Am Acad Child Adolesc Psychiatry. 2016 Jun;55(6):479-86. doi:

10.1016/j.jaac.2016.03.011. Epub 2016 Apr 7.
Age of Onset, Duration, and Type of Medication Therapy for

Attention-Deficit/Hyperactivity Disorder and Substance Use During Adolescence: A
Multi-Cohort National Study.
McCabe SE(1), Dickinson K(2), West BT(3), Wilens TE(4).
Author information:
(1)Institute for Research on Women and Gender and Substance Abuse Research
Center, University of Michigan, Ann Arbor. Electronic address: plius@umich.edu.
(2)Institute for Research on Women and Gender.
(3)Institute for Social Research, Survey Research Center, University of Michigan.
(4)Pediatric and Adult Psychopharmacology Units, Massachusetts General Hospital,
Boston and School of Medicine, Harvard University, Boston.
OBJECTIVE: To examine whether age of onset, duration, or type of medication

therapy for attention-deficit/hyperactivity disorder (ADHD) is associated with
substance use during adolescence.
METHOD: Nationally representative samples of high school seniors were surveyed
via self-administered questionnaires. The sample consisted of 40,358 individuals
from 10 independent cohorts (2005-2014) and represented a population that was 52%
female, 62% white, 10% African American, 14% Hispanic, and 14% other
race/ethnicity. Design-based logistic regression analyses were used to test the
associations between age of onset, duration, and type of ADHD medication therapy
and recent substance use, controlling for potential confounding factors.
RESULTS: Individuals who initiated stimulant medication therapy for ADHD later
(aged 10-14 years and 15 years and older) and for shorter duration (2 years or
less and 3-5 years) as well as those who reported only nonstimulant medication
therapy for ADHD had significantly greater odds of substance use in adolescence
relative to individuals who initiated stimulant medication therapy for ADHD
earlier (aged 9 years or less) and for longer duration (6 or more years). The
odds of substance use generally did not differ between population controls (youth
without ADHD and unmedicated youth with ADHD) and individuals who initiated
stimulant medication for ADHD early (aged 9 years or less) and for longer
duration (aged 6 or more years).
CONCLUSION: Relative to later onset and shorter duration of stimulant treatment
for ADHD, early onset and longer duration of stimulant treatment for ADHD was
associated with a risk of substance use during adolescence that is lower than and
similar to that in the general population.
Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published
DOI: 10.1016/j.jaac.2016.03.011
PMCID: PMC4921895
1562. BMC Psychiatry. 2015 Nov 4;15:273. doi: 10.1186/s12888-015-0659-7.
Tecla: a telephone- and text-message based telemedical concept for patients with
severe mental health disorders--study protocol for a controlled, randomized,
study.
Stentzel U(1), Grabe HJ(2), Strobel L(3), Penndorf P(4), Langosch J(5),
Freyberger HJ(6), Hoffmann W(7), van den Berg N(8).
Author information:
(1)Institute for Community Medicine, University Medicine Greifswald,
Ellernholzstraße 1-2, 17487, Greifswald, Germany.
ulrike.stentzel@uni-greifswald.de.
(2)Department of Psychiatry and Psychotherapy, University Medicine Greifswald,
Ellernholzstraße 1-2, 17487, Greifswald, Germany. grabeh@uni-greifswald.de.
Ellernholzstraße 1-2, 17487, Greifswald, Germany. lara.strobel@uni-greifswald.de.
peter.penndorf@uni-greifswald.de.
(5)Bethanien Hospital for Psychiatry, Psychosomatics and Psychotherapy, Gützkower
Landstraße 69, 17489, Greifswald, Germany. langosch@odebrecht-stiftung.de.
Ellernholzstraße 1-2, 17487, Greifswald, Germany. freyberg@uni-greifswald.de.
wolfgang.hoffmann@uni-greifswald.de.
neeltje.vandenberg@uni-greifswald.de.
BACKGROUND: Severe mental disorders like psychotic disorders including

schizophrenia and schizoaffective disorders have a 12-month-prevalence of 2.6,
bipolar disorders of 1.5% in Germany. The relapse risk is high; so many patients
need intensive monitoring and lifelong treatment. A high medication adherence is
essential for a successful treatment. But in practice, medication adherence is
low and decreases over time. Telemedical care concepts might improve treatment
and bridge gaps between in- and outpatient treatment. A telemedical care concept
based on regular telephone calls and short text messages was developed. The
primary objective is to assess whether regular telephone calls and text messages
can improve the medication adherence of patients. Secondary objectives are the
reduction of rehospitalization rates, the improvement of quality of life and of
the severity of symptoms.
METHODS/DESIGN: The Tecla study (Post stationary telemedical care of patients
with severe psychiatric disorders) is a two-armed prospective randomized
controlled trial. The participants in the intervention group receive in addition
to usual care regular telephone calls every 2 weeks and weekly text messages on
patient-individual topics during a 6 months period. Patients in the control group
receive only regular care. Inclusion criteria are a physician-diagnosed bipolar
disorder, schizoaffective disorder or schizophrenia and a signed informed
consent. Exclusion criteria are planned inpatient treatments within the next 6
months and being non-reachable by phone. After 3 and 6 months both groups receive
follow up assessments.
DISCUSSION: The primary objective of this study is the medication adherence that
is measured with the Medication Adherence Report Scale, German version (MARS-D).
The MARS-D is a self-report with five items. Adherent behaviour is mostly
overestimated using self-reports. The strength of the MARS-D is to detect
non-adherent behaviour. The original Medication Adherence Report Scale in English
language (MARS-5) was developed to encourage the patient to answer truthfully to
the questions that are asked in a non-threatening and non-judgmental way to
minimize social desirability bias in admitting non-adherent behaviour.
TRIAL REGISTRATION: This study is registered at 2015\05\21 at the German Clinical
Trials Register DRKS00008548.
DOI: 10.1186/s12888-015-0659-7
PMCID: PMC4634903
Four types of barriers to adherence of antiretroviral therapy are associated with

decreased adherence over time.
Genberg BL(1), Lee Y, Rogers WH, Wilson IB.
Author information:
(1)Program in Public Health, Department of Health Services, Policy & Practice,
Brown University, Box G-121-6, 121 South Main Street, Providence, RI, 02912, USA,
becky_genberg@brown.edu.
The objectives of this study were to understand how different types of barriers
to adherence to antiretroviral therapy (ART) were related and their differential
impact on objectively measured adherence over time. Data from 151 patients taking
ART were used to describe four sub-types of self-reported adherence barriers:
medication and health concerns (MHC), stigma (S), family responsibilities (FR),
and problems with schedule and routine (PSR). Generalized linear models with
generalized estimating equations (GEE) were used to examine the impact of
barriers on adherence over time. The sample was 23 % female, mean age 42 years,
with 26 % African-American and 20 % Hispanic. The overall average adherence was
73 %. Patients reported at least one PSR barrier in 66 % of study visits, MHC in
40 %, S in 17 %, and FR in 6 %. In 40 % of visits, patients reported two or more
barrier sub-types. There were statistically significant (p ≤ 0.05) decreases of
3.9, 2.5, and 2.4 in percent adherence, for MHC, PSR, and S, respectively, per
unit increase in barrier score. Interventions to address different types of
patient-identified barriers to ART adherence using targeted approaches are
needed.
DOI: 10.1007/s10461-014-0775-2
PMCID: PMC4203705
1564. Arch Osteoporos. 2018 Jul 5;13(1):74. doi: 10.1007/s11657-018-0487-8.
Effect of a patient-support program on once-daily teriparatide adherence and

persistence in the Japan Fracture Observational Study (JFOS).
Sato M(1), Tsujimoto M(2), Kajimoto K(2), Uetake H(3), Shimoda H(3), Fujiwara
S(4).
Author information:
(1)Medicines Development Unit Japan, Eli Lilly Japan K.K, Kobe, Hyogo, Japan.
sato_masayo@lilly.com.
(2)Medicines Development Unit Japan, Eli Lilly Japan K.K, Kobe, Hyogo, Japan.
(3)Statistical Analysis Department, CDM Division, CMIC Co., Ltd., Tokyo, Japan.
(4)Health Management and Promotion Center, Hiroshima Atomic Bomb Casualty
Council, Hiroshima, Japan.
Japanese patients with osteoporosis prescribed once-daily teriparatide for

24 months could enroll in a patient-support program designed to aid adherence and
persistence. Patients enrolled in the program had higher adherence and
persistence rates than those who did not enroll, highlighting the value of
patient-support programs for improving adherence and persistence.OBJECTIVE: To
assess the effect of a patient-support program on once-daily teriparatide
adherence and persistence of patients who did and did not enroll.
METHODS: In the 24-month Japan Fracture Observational Study, patients with
osteoporosis prescribed teriparatide 20 μg/day (N = 1996) could freely enroll in
a patient-support program (call center support, monthly calendar, certificates of
recognition). Outcome measures were medication adherence (investigator assessed)
and persistence (first date of teriparatide use to last date of use or study
end). Multivariate logistic models were applied for adherence, and Kaplan-Meier
survival curve for persistence.
RESULTS: Overall, mean ± standard deviation (SD) age was 76.9 ± 7.9 years, and
the proportion of female patients was 90.1%. Program enrollment status was 39.6%
yes (n = 790), 22.9% no (n = 458), and 37.5% unknown (n = 748). In the analysis
sample (1248 patients), adherence (> 75%) to teriparatide was more likely for
patients enrolled in the support program (54.2 vs. 48.3%; adjusted odds ratio
1.44 [95% confidence intervals 1.04-2.00], p = 0.030). Good to very good (> 75%)
adherence was also associated with smoking (negative association) and previous
osteoporosis therapy (marginal positive association). Persistence rates were
greater for patients enrolled in the support program than not enrolled (12 months
77.2 vs. 69.6%; 24 months 63.2 vs. 54.8%).
CONCLUSIONS: Once-daily teriparatide adherence and persistence rates were higher
among patients who enrolled in a patient-support program than among those who did
not, highlighting the value of patient-support programs for improving adherence
and persistence.
DOI: 10.1007/s11657-018-0487-8
PMCID: PMC6310708
1565. Malar J. 2017 Jan 28;16(1):52. doi: 10.1186/s12936-017-1699-x.
Working towards consensus on methods used to elicit participant-reported safety

data in uncomplicated malaria clinical drug studies: a Delphi technique study.
Mandimika N(1), Barnes KI(1), Chandler CI(2), Pace C(3), Allen EN(4).
Author information:
(1)Division of Clinical Pharmacology, Department of Medicine, University of Cape
Town, Cape Town, South Africa.
(2)Department of Global Health & Development, London School of Hygiene & Tropical
(3)Department of Clinical Sciences, Liverpool School of Tropical Medicine,
Liverpool, UK.
(4)Division of Clinical Pharmacology, Department of Medicine, University of Cape
Town, Cape Town, South Africa. elizabeth.allen@uct.ac.za.
BACKGROUND: Eliciting adverse event (AE) and non-study medication data reports
from clinical research participants is integral to evaluating drug safety.
However, using different methods to question participants yields inconsistent
results, compromising the interpretation, comparison and pooling of data across
studies. This is particularly important given the widespread use of
anti-malarials in vulnerable populations, and their increasing use in healthy,
but at-risk individuals, as preventive treatment or to reduce malaria
transmission.
METHODS: Experienced and knowledgeable anti-malarial drug clinical researchers
were invited to participate in a Delphi technique study, to facilitate consensus
on what are considered optimal (relevant, important and feasible) methods, tools,
and approaches for detecting participant-reported AE and non-study medication
data in uncomplicated malaria treatment studies.
RESULTS: Of 72 invited, 25, 16 and 10 panellists responded to the first, second
and third rounds of the Delphi, respectively. Overall, 68% (68/100) of all
questioning items presented for rating achieved consensus. When asking general
questions about health, panellists agreed on the utility of a question/concept
about any change in health, taking care to ensure that such questions/concepts do
not imply causality. Eighty-nine percent (39/44) of specific signs and symptoms
questions were rated as optimal. For non-study medications, a general question
and most structured questioning items were considered an optimal approach. The
use of mobile phones, patient diaries, rating scales as well as openly engaging
with participants to discuss concerns were also considered optimal complementary
data-elicitation tools.
CONCLUSIONS: This study succeeded in reaching consensus within a section of the
anti-malarial drug clinical research community about using a general question
concept, and structured questions for eliciting data about AEs and non-study
medication reports. The concepts and items considered in this Delphi to be
relevant, important and feasible should be further investigated for potential
inclusion in a harmonized approach to collect participant-elicited anti-malarial
drug safety data. This, in turn, should improve understanding of anti-malarial
drug safety.
DOI: 10.1186/s12936-017-1699-x
PMCID: PMC5273807
1566. J Comp Eff Res. 2016 Mar;5(2):155-68. doi: 10.2217/cer.15.60. Epub 2016 Mar
7.
Home-based interventions for black patients with uncontrolled hypertension: a

cluster randomized controlled trial.
Feldman PH(1), McDonald MV(1), Barrón Y(1), Gerber LM(2), Peng TR(1).
Author information:
(1)Center for Home Care Policy & Research, Visiting Nurse Service of New York,
New York, NY 10021, USA.
(2)Department Healthcare Policy & Research, Weill Cornell Medical College, New
York, NY 10065, USA.
AIM: Assess the comparative effectiveness of two blood pressure (BP) control
interventions for black patients with uncontrolled hypertension.
PATIENTS & METHODS: A total of 845 patients were enrolled in a three-arm cluster
randomized trial. On admission of an eligible patient, field nurses were
randomized to usual care, a basic or augmented intervention.
RESULTS: Across study arms there were no significant 12 months differences in BP
control rates (primary outcome) (25% usual care, 26% basic intervention, 22%
augmented intervention); systolic BP (143.8 millimeters of mercury [mmHg], 146.9
mmHG, 143.9 mmHG, respectively); medication intensification (47, 43, 54%,
respectively); or self-management score (18.7, 18.7, 17.9, respectively).
Adjusted systolic BP dropped more than 10 mmHg from baseline to 12 months
(155.5-145.4 mmHg) among all study participants.
CONCLUSION: Neither the augmented nor basic intervention was more effective than
usual care in improving BP control, systolic BP, medication intensification or
patient self-management. Usual home care yielded substantial improvements,
creating a high comparative effectiveness threshold.
CLINICAL TRIAL REGISTRATION: NCT00139490.
DOI: 10.2217/cer.15.60
PMCID: PMC5543816
1567. Rev Bras Epidemiol. 2018 Nov 29;21(suppl 1):e180021. doi:

10.1590/1980-549720180021.supl.1.
Prevalence of arterial hypertension according to different diagnostic criteria,

National Health Survey.

publisher]
Malta DC(1), Gonçalves RPF(1), Machado ÍE(1), Freitas MIF(1), Azeredo C(2),
Szwarcwald CL(3).
Author information:
(1)Escola de Enfermagem, Universidade Federal de Minas Gerais - Belo Horizonte
(MG), Brasil.
(2)Coordenação de Trabalho e Rendimento, Instituto Brasileiro de Geografia e
Estatística - Rio de Janeiro (RJ), Brasil.
(3)Instituto de Comunicação e Informação Científica e Tecnológica em Saúde,
Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil.
OBJECTIVE: To determine the population prevalence of arterial hypertension in

adults according to different diagnostic criteria.
METHODS: This is a cross-sectional study, analyzing information from the
Brazilian National Health Survey in 2013, consisted of interviews, physical and
laboratory measurements (n = 60,202). The prevalence of hypertension was defined
according to three diagnostic criteria: self-reported; measured by instrument
(blood pressure ≥ 140/90 mmHg); measured and/or using medication. Prevalence and
95% confidence interval (95%CI) were estimated by the three diagnostic criteria
of hypertension.
RESULTS: The high blood pressure measurements were: 21.4% (95%CI 20.8 - 22.0)
using the criterion self-reported; 22.8% (95%CI 22.1 - 23.4) by measured
hypertension; and 32.3% (95%CI 31.7 - 33.0) by measured hypertension and/or
reported use of medication. Women presented higher prevalence for the
self-reported criterion (24.2%; 95%CI 23.4 - 24.9) and men, for the measured
criterion (25.8%; 95%CI 24.8 - 26.8). Hypertension increases with age and is more
frequent in urban areas. Using these three criteria, the hypertension was higher
in the Southeast and South regions, in relation to the average of the country and
the other regions. Using these three criteria, hypertension increased with age,
was more frequent in urban areas and in the Southeast and South regions, in
relation to the average of the country and the other regions.
CONCLUSION: These findings are important to support policies that aim to achieve
the World Health Organization's goal of reducing hypertension by 25% over the
next decade.
Publisher: Determinar a prevalência populacional de hipertensão arterial em

adultos, segundo diferentes critérios diagnósticos.Trata-se de um estudo
transversal, que analisa informações da Pesquisa Nacional de Saúde de 2013, que
consistiu em entrevistas, medidas físicas e laboratoriais da população brasileira
(n = 60.202). A prevalência de hipertensão arterial foi definida segundo três
critérios diagnósticos: hipertensão autorreferida; medida por instrumento
(pressão arterial ≥ 140/90 mmHg); medida e/ou em uso de medicamentos
anti-hipertensivos. Foram estimadas as prevalências de hipertensão arterial
segundo os três critérios diagnósticos e seus respectivos intervalos de confiança
de 95% (IC95%).As prevalências de hipertensão arterial encontradas foram: 21,4%
(IC95% 20,8 - 22,0) utilizando-se o critério autorreferido, 22,8% (IC95% 22,1 -
23,4) para hipertensão arterial medida e 32,3% (IC95% 31,7 - 33,0) para
hipertensão arterial medida e/ou relato de uso de medicação. As mulheres
apresentaram prevalências de hipertensão mais elevadas no critério autorreferido
(24,2%; IC95% 23,4 - 24,9). Entre os homens, a prevalência foi maior no critério
hipertensão arterial medida (25,8%; IC95% 24,8 - 26,7). Utilizando os três
critérios, a hipertensão arterial aumentou com a idade, foi mais frequente na
região urbana e maior nas regiões sudeste e sul, em relação à média do país e às
demais regiões.Estes resultados são importantes para apoiar políticas que visem
atingir a meta da Organização Mundial de Saúde de redução da hipertensão em 25%
na próxima década.
DOI: 10.1590/1980-549720180021.supl.1
1568. Open Forum Infect Dis. 2018 Apr 26;5(4):ofy046. doi: 10.1093/ofid/ofy046.
Advancing Patient-Centered Care in Tuberculosis Management: A Mixed-Methods

Appraisal of Video Directly Observed Therapy.
Holzman SB(1), Zenilman A(1), Shah M(1)(2).
Author information:
(1)Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore,
Maryland.
(2)Baltimore City Health Department, Baltimore, Maryland.
Background: Directly observed therapy (DOT) remains an integral component of

treatment support and adherence monitoring in tuberculosis care. In-person DOT is
resource intensive and often burdensome for patients. Video DOT (vDOT) has been
proposed as an alternative to increase treatment flexibility and better meet
patient-specific needs.
Methods: We conducted a pragmatic, prospective pilot implementation of vDOT at 3
TB clinics in Maryland. A mixed-methods approach was implemented to assess (1)
effectiveness, (2) acceptability, and (3) cost. Medication adherence on vDOT was
compared with that of in-person DOT. Interviews and surveys were conducted with
patients and providers before and after implementation, with framework analysis
utilized to extract salient themes. Last, a cost analysis assessed the economic
impacts of vDOT implementation across heterogeneous clinic structures.
Results: Medication adherence on vDOT was comparable to that of in-person DOT
(94% vs 98%, P = .17), with a higher percentage of total treatment doses
(inclusive of weekend/holiday self-administration) ultimately observed during the
vDOT period (72% vs 66%, P = .03). Video DOT was well received by staff and
patients alike, who cited increased treatment flexibility, convenience, and
patient privacy. Our cost analysis estimated a savings with vDOT of $1391 per
patient for a standard 6-month treatment course.
Conclusions: Video DOT is an acceptable and important option for measurement of
TB treatment adherence and may allow a higher proportion of prescribed treatment
doses to be observed, compared with in-person DOT. Video DOT may be cost-saving
and should be considered as a component of individualized, patient-centered case
management plans.
DOI: 10.1093/ofid/ofy046
PMCID: PMC5917780
PMID: 29732378
1569. BMJ Qual Improv Rep. 2015 Jun 8;4(1). pii: u208804.w3544. doi:
10.1136/bmjquality.u208804.w3544. eCollection 2015.
Quality improvement in resident education: a pilot project to mitigate metabolic

side effects from atypical antipsychotic medications in youth.
Jeffrey J(1).
Author information:
(1)UCLA, USA.
This resident physician-led quality improvement project was conducted with aims
to improve the health of youth prescribed atypical antipsychotic medications by
increasing physician monitoring for metabolic side effects, while simultaneously
educating trainees in quality improvement methodology. The plan, do, study, act
quality improvement framework was utilized. Baseline metabolic monitoring rates
of patients prescribed atypical antipsychotic medications in the two psychiatry
resident outpatient clinics were obtained. Rates were stratified based on time on
medication (<1 year, ≥1 year) and parameter monitored. Metabolic monitoring rates
subsequent to targeted changes were obtained. Problem solving with residents
revealed barriers to monitoring, such as limited awareness of specific guideline
recommendations and lack of convenient access to medical equipment (calibrated
scales). Residents received education about atypical antipsychotic monitoring
guidelines and side effect treatment. Residents were provided with calibrated
scales. Atypical antipsychotic monitoring templates were introduced. Online
surveys using were conducted to determine self-reported baseline-monitoring rates
and comfort with guidelines following targeted change. The baseline metabolic
monitoring rates of patients prescribed atypical antipsychotic medications was 9%
(range: 0 to 17.6%) for youth in their first year taking an atypical
antipsychotic medication and 58.9% (range: 29% to 100%) in subsequent years on
medication. The results of relatively easy changes resulted in modest improvement
in monitoring rates. The metabolic monitoring rate of a patient initiated on an
atypical antipsychotic medication was 29% after targeted quality improvement
measures were employed. Following quality improvement changes, residents reported
increased knowledge about guidelines and increased monitoring for side effects.
Use of a standardized data collection instrument to track monitoring of patients
increased from 0% to 70% (range: 30% to 90%). Quality improvement projects
provide an avenue with which to improve atypical antipsychotic monitoring rates.
Through active participation in quality improvement projects, psychiatry
residents may be taught to employ quality improvement methodology.
DOI: 10.1136/bmjquality.u208804.w3544
PMCID: PMC4645906
PMID: 26734359
1570. BMC Nephrol. 2015 Jul 11;16:102. doi: 10.1186/s12882-015-0097-2.

Understanding barriers to optimal medication management for those requiring
long-term dialysis: rationale and design for an observational study, and a
quantitative description of study variables and data.
Aspden T(1), Wolley MJ(2), Ma TM(3), Rajah E(4), Curd S(5), Kumar D(6), Lee S(7),
Pireva K(8), Taule'alo O(9), Tiavale P(10), Kam AL(11), Suh JS(12), Kennedy
J(13), Marshall MR(14).
Author information:
(1)School of Pharmacy, Faculty of Medical and Health Sciences, The University of
Auckland, 85 Park Rd, Auckland, 1142, New Zealand. t.aspden@auckland.ac.nz.
(2)School of Medicine, University of Queensland, 288 Herston Road, Brisbane,
4006, Australia. martin.wolley@gmail.com.
(3)Department of Renal Medicine, Counties Manukau District Health Board, Hospital
Road, Otahuhu, Auckland, 1640, New Zealand. maggiema.aut@gmail.com.
(4)Marketing Department, Faculty of Business, Auckland University of Technology,
46 Wakefield St, Auckland, 1010, New Zealand. erajah@aut.ac.nz.
(5)Formerly of the School of Pharmacy, Faculty of Medical and Health Sciences,
The University of Auckland, 85 Park Rd, Auckland, 1142, New Zealand.
samlouisecurd@gmail.com.
dharni_k91@hotmail.com.
sophia.lee2404@gmail.com.
krenny_p@hotmail.com.
olita_85@hotmail.com.
pjtiavale@gmail.com.
(11)Pharmacy Services, Counties Manukau District Health Board, Hospital Road,
Otahuhu, Auckland, 1640, New Zealand. angela.kam@middlemore.co.nz.
(12)Department of Renal Medicine, Counties Manukau District Health Board,
Hospital Road, Otahuhu, Auckland, 1640, New Zealand. junssuh@gmail.com.
(13)School of Pharmacy, Faculty of Medical and Health Sciences, The University of
Auckland, 85 Park Rd, Auckland, 1142, New Zealand. julia.kennedy@auckland.ac.nz.
(14)School of Medicine, Faculty of Medical and Health Sciences, The University of
Auckland, 85 Park Rd, Auckland, 1142, New Zealand. mrmarsh@woosh.co.nz.
BACKGROUND: Rates of medication non-adherence in dialysis patients are high, and

improving adherence is likely to improve outcomes. Few data are available
regarding factors associated with medication adherence in dialysis patients, and
these data are needed to inform effective intervention strategies.
METHODS/DESIGN: This is an observational cross-sectional study of a multi-ethnic
dialysis cohort from New Zealand, with the main data collection tool being an
interviewer-assisted survey. A total of 100 participants were randomly sampled
from a single centre, with selection stratified by ethnicity and dialysis
modality (facility versus home). The main outcome measure is self-reported
medication adherence using the Morisky 8-Item Medication Adherence Scale
(MMAS-8). Study data include demographic, clinical, social and psychometric
characteristics, the latter being constructs of health literacy, medication
knowledge, beliefs about medications, and illness perceptions. Psychometric
constructs were assessed through the following survey instruments; health
literacy screening questions, the Medication Knowledge Evaluation Tool (Okuyan et
al.), the Beliefs about Medication Questionnaire (Horne et al.), the Brief
Illness Perception Questionnaire (Broadbent et al.). Using the study data,
reliability analysis for internal consistency is satisfactory for the scales
evaluating health literacy, medication knowledge, and beliefs about medications,
with Chronbach's α > 0.7 for all. Reliability analysis indicated poor internal
consistency for scales relating to illness perceptions. MMAS-8 and all
psychometric scores are normally distributed in the study data.
DISCUSSION: This study will provide important information on the factors involved
in medication non-adherence in New Zealand dialysis patients. The resulting
knowledge will inform long-term initiatives to reduce medication non-adherence in
dialysis patients, and help ensure that they are addressing appropriate and
evidence based targets for intervention.
DOI: 10.1186/s12882-015-0097-2
PMCID: PMC4499205
1571. Integr Cancer Sci Ther. 2015 Dec;2(6):300-304. Epub 2015 Nov 6.
Risk factors for cost-related medication non-adherence among older patients with
cancer.
Zhang JX(1), Meltzer DO(2).
Author information:
(1)Section of Hospital Medicine, Department of Medicine, The University of
Chicago, USA.
(2)Section of Hospital Medicine, Department of Medicine, The University of
Chicago, USA; Department of Economics, The University of Chicago, USA; Harris
School of Public Policy, The University of Chicago, USA.
We aimed to assess the risk factors for cost-related medication non-adherence

(CRN) among older patients with cancer in the United States. We used data from
the 2010 Health and Retirement Study (HRS) to assess risk factors for CRN
including age, insurance coverage, nursing home residence, functional
limitations, and frequency of hospitalization among old patients with cancer. CRN
was self-reported. We conducted a multivariate regression analysis to assess the
effect of each risk factor. 293 (9.9%) of 2,953 older patients (50+ years) cancer
patients reported CRN. Those who reported CRN were more likely to be younger,
women, African American, and Hispanics. Compared to those with Medicare, those
with no health insurance coverage were 97% more likely to report CRN. High number
in limitation in activities of daily living and hospitalization significantly
increased risk for CRN. Sicker cancer patients were more likely to report CRN.
Lack of health insurance may have prevented the cancer patients from receiving
optimal care. Together, these results suggest that expanding insurance coverage
and improving insurance benefit design for cancer patients is likely to decrease
CRN and improve outcomes.
PMCID: PMC4827776
PMID: 27087984
1572. Contemp Clin Trials. 2017 Jul;58:1-12. doi: 10.1016/j.cct.2017.04.004. Epub

2017
Apr 23.
Jump starting shared medical appointments for diabetes with weight management:
Rationale and design of a randomized controlled trial.
Crowley MJ(1), Edelman D(2), Voils CI(2), Maciejewski ML(2), Coffman CJ(2),
Jeffreys AS(3), Turner MJ(3), Gaillard LA(3), Hinton TA(3), Strawbridge E(3),
Zervakis J(3), Barton AB(4), Yancy WS Jr(5).
Author information:
Durham, NC, United States; Department of Medicine, Division of Endocrinology,
Duke University Medical Center, Durham, NC, United States. Electronic address:
matthew.crowley@dm.duke.edu.
Durham, NC, United States; Department of Medicine, Division of General Internal
Medicine, Duke University Medical Center, Durham, NC, United States.
Durham, NC, United States.
(4)Department of Medicine, Division of Endocrinology, Duke University Medical
Center, Durham, NC, United States.
Durham, NC, United States; Department of Medicine, Division of General Internal
Medicine, Duke University Medical Center, Durham, NC, United States; Duke Diet
and Fitness Center, Durham, NC, United States.
BACKGROUND: Rates of glycemic control remain suboptimal nationwide. Medication

intensification for diabetes can have undesirable side effects (weight gain,
hypoglycemia), which offset the benefits of glycemic control. A Shared Medical
Appointment (SMA) intervention for diabetes that emphasizes weight management
could improve glycemic outcomes and reduce weight while simultaneously lowering
diabetes medication needs, resulting in less hypoglycemia and better quality of
life. We describe the rationale and design for a study evaluating a novel SMA
intervention for diabetes that primarily emphasizes low-carbohydrate diet-focused
weight management.
METHODS: Jump Starting Shared Medical Appointments for Diabetes with Weight
Management (Jump Start) is a randomized, controlled trial that is allocating
overweight Veterans (body mass index≥27kg/m2) with type 2 diabetes into two arms:
1) a traditional SMA group focusing on medication management and self-management
counseling; or 2) an SMA group that combines low-carbohydrate diet-focused weight
management (WM/SMA) with medication management. Hemoglobin A1c reduction at
48weeks is the primary outcome. Secondary outcomes include hypoglycemic events,
diabetes medication use, weight, medication adherence, diabetes-related quality
of life, and cost-effectiveness. We hypothesize that WM/SMA will be non-inferior
to standard SMA for glycemic control, and will reduce hypoglycemia, diabetes
medication use, and weight relative to standard SMA, while also improving quality
of life and costs.
CONCLUSIONS: Jump Start targets two common problems that are closely related but
infrequently managed together: diabetes and obesity. By focusing on diet and
weight loss as the primary means to control diabetes, this intervention may
improve several meaningful patient-centered outcomes related to diabetes.
DOI: 10.1016/j.cct.2017.04.004
PMCID: PMC5505724
Protocol for a non-randomised pilot and feasibility study evaluating a

multicomponent intervention to simplify medication regimens for people receiving
community-based home care services.
Sluggett JK(1)(2), Page AT(1), Chen EYH(1)(2), Ilomäki J(1)(3), Corlis M(2)(4),
Van Emden J(2)(4), Hogan M(2)(4), Caporale T(4), Angley M(5), Hilmer SN(2)(6),
Ooi CE(1), Bell JS(1)(2)(3)(5).
Author information:
(1)Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical
Sciences, Monash University, Parkville, Victoria, Australia.
(2)National Health and Medical Research Council (NHMRC) Cognitive Decline
Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales,
Australia.
(3)Department of Epidemiology and Preventive Medicine, School of Public Health
and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
(4)Research and Development, Helping Hand Aged Care, North Adelaide, South
Australia, Australia.
(5)School of Pharmacy and Medical Sciences, University of South Australia,
(6)Kolling Institute of Medical Research, Royal North Shore Hospital, Northern
Clinical School, Faculty of Medicine and Health, The University of Sydney,
Sydney, New South Wales, Australia.
INTRODUCTION: Managing medication regimens is one of the most complex and

burdensome tasks performed by older people, and can be prone to errors. People
living with dementia may require medication administration assistance from formal
and informal caregivers. Simplified medication regimens maintain the same
therapeutic intent, but have less complex instructions and administration
schedules. This protocol paper outlines a study to determine the feasibility of a
multicomponent intervention to simplify medication regimens for people receiving
community-based home care services.
METHODS AND ANALYSIS: This is a non-randomised pilot and feasibility study.
Research nurses will recruit 50 people receiving community-based home care
services. All participants will receive the intervention from a clinical
pharmacist, who will undertake medication reconciliation, assess each
participant's capacity to self-manage their medication regimen and apply a
structured tool to identify opportunities for medication simplification. The
pharmacist will communicate recommendations regarding medication simplification
to registered nurses at the community-based home care provider organisation. The
primary outcome will be a description of study feasibility (recruitment and
retention rates, protocol adherence and stakeholder acceptability). Secondary
outcomes include the change in number of medication administration times per day,
medication adherence, quality of life, participant satisfaction, medication
incidents, falls and healthcare utilisation at 4 months.
ETHICS AND DISSEMINATION: Ethical approval was obtained from the Monash
University Human Research Ethics Committee and the community-based home care
provider organisation's ethical review panel. Research findings will be
disseminated to consumers and caregivers, health professionals, researchers and
healthcare providers through the National Health and Medical Research Council
Cognitive Decline Partnership Centre and through conference presentations, lay
summaries and peer-reviewed publications. This study will enable an improved
understanding of medication management and administration among people receiving
community-based home care services. This study will inform the decision to
proceed with a randomised controlled trial to assess the effect of this
intervention.

DOI: 10.1136/bmjopen-2018-025345
PMCID: PMC6661559
PMID: 31326924
Conflict of interest statement: Competing interests: This study was funded

through the NHMRC CDPC and the community-based home care provider involved in
this research is one of the funding partners of the NHMRC CDPC. JKS and JI are
supported by NHMRC Early Career Fellowships. EYHC is supported by a postgraduate
research scholarship funded through the NHMRC CDPC and Monash Institute of
Pharmaceutical Sciences, Monash University. JSB is supported by an NHMRC Dementia
Leadership Fellowship. MC, JVE, MH and TC are employed by the organisation
providing community-based home care services to study participants.
1574. Blood Coagul Fibrinolysis. 2017 Apr;28(3):224-229. doi:

10.1097/MBC.0000000000000584.
The potential correlation between patient-reported symptoms and the use of

additional haemostatic medication for joint bleeding in haemophilia patients with
inhibitors: a post hoc exploratory analysis of recombinant activated factor VII
data from the ADEPT2 trial.
Lentz SR(1), Rangarajan S, Karim FA, Andersen PD, Arkhammar P, Rosu G, Mahlangu
J.
Author information:
(1)aDepartment of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
bNorth Hampshire Haemophilia Centre, Basingstoke, UK cNational Blood Centre,
Kuala Lumpur, Malaysia dNovo Nordisk A/S, Søborg, Denmark eFaculty of Health
Science, University of the Witwatersrand, and NHLS, Johannesburg, South Africa.
: Haemophilia treatment guidelines advocate early home-based treatment of acute

bleeds. In the ADEPT2 trial, data were collected on the home treatment of bleeds
with recombinant activated factor VII (rFVIIa) in haemophilia patients with
inhibitors and self-reported bleeding-related symptoms. A total of 93% of all
bleeds, and 91.5% of joint bleeds, were treated successfully with one to three
doses of 90 μg/kg rFVIIa. However, some patients self-administered additional
haemostatic medication (AHM) up to 48 h after the first rFVIIa treatment. The aim
of this trial was to investigate the relationship between patient-reported
symptoms, time to treatment initiation, and the use of AHM. A post hoc analysis
was conducted on 177 joint bleeds and the patient-reported categorical symptoms
of pain, swelling, mobility, tingling, and warmth, and the pain visual analogue
scale (VAS) score. Analyses were descriptive and used logistic regression
modelling. Complete symptom data were available for 141, 136, and 129 joint
bleeds at 0 or 1, 3, and 6 h, respectively. Pain and pain VAS assessments were
the best predictors of AHM use. Patients who self-administered AHM had higher
mean pain VAS scores at each time point; both pain and pain VAS scores declined
over time. Time to treatment initiation was an independent predictor for AHM use.
Higher initial pain scores and longer time to treatment were the best predictors
for administration of AHM. The observation that some patients chose to
self-infuse in the face of declining levels of pain warrants further study to
better understand the reasons behind patient decision-making.
DOI: 10.1097/MBC.0000000000000584
PMCID: PMC5407628
1575. Eur Thyroid J. 2015 Jun;4(2):93-8. doi: 10.1159/000381768. Epub 2015 May 27.
A Prospective Investigation of Graves' Disease and Selenium: Thyroid Hormones,

Auto-Antibodies and Self-Rated Symptoms.
Calissendorff J(1), Mikulski E(2), Larsen EH(3), Möller M(4).
Author information:
(1)Department of Clinical Science and Education, Section of Endocrinology,
Karolinska Institutet, Södersjukhuset, Uppsala, Sweden.
(2)Department of Medicine, Mälarsjukhuset, Eskilstuna, Uppsala, Sweden ; Centre
for Clinical Research in Sörmland, Uppsala University, Uppsala, Sweden.
(3)National Food Institute, Technical University of Denmark, Søborg, Denmark.
(4)Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital,
Stockholm, Uppsala, Sweden ; Centre for Clinical Research in Sörmland, Uppsala
University, Uppsala, Sweden.
BACKGROUND: In Graves' thyrotoxicosis tachycardia, weight loss and mental

symptoms are common. Recovery takes time and varies between patients. Treatment
with methimazole reduces thyroid hormone levels. According to previous research,
this reduction has been faster if selenium (Se) is added.
OBJECTIVE: The objective was to investigate whether supplementing the
pharmacologic treatment with Se could change the immune mechanisms, hormone
levels and/or depression and anxiety.
METHODS: We prospectively investigated 38 patients with initially untreated
thyrotoxicosis by measuring the thyroid-stimulating hormone (TSH), free thyroxine
(FT4), free triiodothyronine (FT3), thyroid receptor antibodies and thyroid
peroxidase auto-antibodies before medication and at 6, 18 and 36 weeks after
commencing treatment with methimazole and levo-thyroxine, with a randomized
blinded oral administration of 200 µg Se/day or placebo. The selenoprotein P
concentration was determined in plasma at inclusion and after 36 weeks. The
patients were also assessed with questionnaires about depression, anxiety and
self-rated symptoms before medication was started and after 36 weeks.
RESULTS: FT4 decreased more in the Se group at 18 weeks (14 vs. 17 pmol/l
compared to the placebo group, p = 0.01) and also at 36 weeks (15 vs. 18 pmol/l,
p = 0.01). The TSH increased more in the Se group at 18 weeks (0.05 vs. 0.02
mIU/l, p = 0.04). The depression and anxiety scores were similar in both groups.
In the Se group, the depression rates correlated negatively with FT3 and
positively with TSH. This was not seen in the placebo group.
CONCLUSIONS: Se supplementation can enhance biochemical restoration of
hyperthyroidism, but whether this could shorten clinical symptoms of
thyrotoxicosis and reduce mental symptoms must be investigated further.
DOI: 10.1159/000381768
PMCID: PMC4521074
PMID: 26279994
1576. J Parkinsons Dis. 2015;5(4):961-70.
Impaired Switching from Self-Prepared Actions in Mild Parkinson Disease.
Cohen ML, Schwab NA, Price CC, Heilman KM.
BACKGROUND: Planned and initiated actions frequently need to be terminated in

favor of another action. It is known that many individuals with Parkinson's
disease (PD) have more difficulty self-initiating movement (i.e., endogenously
evoked movement)than moving in response to environmental stimuli (i.e.,
exogenously evoked movement). However, it is not known if individuals with PD
display this same endogenous-exogenous asymmetry when needing to terminate,
disengage, and reprogram movements.
OBJECTIVE: This study used a novel reaction time (RT) paradigm to test whether
patients with mild PD have subclinical deficits of endogenous movement initiation
and endogenous movement reprogramming.
METHODS: Twelve non-demented individuals with PD on medication and 15
demographically similar healthy control (HC)participants completed an
experimental paradigm that examined their RTs (key press) following self-selected
valid action preparation (endogenous cues) versus valid exogenously presented
cues. The paradigm also assessed participants' ability to rapidly stop their
endogenous or exogenous preparation following an invalid cue and execute an
alternative action (key press).
RESULTS: Participants with PD produced similar RTs as controls following
endogenous and exogenous valid cues, and following invalid exogenous cues.
However, following invalid endogenous cues, PD participants were slower than HC
participants to stop an endogenous preparation and execute an alternative action.
CONCLUSIONS: Despite having mild disease and being on dopaminergic medication,
these individuals with PD displayed deficits in motor disengagement and
reprograming of self-selected actions. Future studies should examine how this
phenomenon influences every day actions, as well as possible treatments for this
deficit.
PMCID: PMC4962557
1577. Health Qual Life Outcomes. 2017 Mar 14;15(1):50. doi: 10.1186/s12955-017-
0622-z.
Glatiramer acetate treatment persistence - but not adherence - in multiple

sclerosis patients is predicted by health-related quality of life and
self-efficacy: a prospective web-based patient-centred study (CAIR study).
Jongen PJ(1)(2), Lemmens WA(3), Hoogervorst EL(4), Donders R(3).
Author information:
(1)University Medical Centre Groningen, Department of Community and Occupational
Medicine, University Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The
Netherlands. p.j.h.jongen@rug.nl.
(2)MS4 Research Institute, Ubbergseweg 34, 6522, KJ, Nijmegen, The Netherlands.
p.j.h.jongen@rug.nl.
(3)Department for Health Evidence, Radboud University Medical Centre, P.O. Box
9101, 6500, HB, Nijmegen, The Netherlands.
(4)St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands.
BACKGROUND: In patients with relapsing remitting multiple sclerosis (RRMS) the

persistence of and adherence to disease modifying drug (DMD) treatment is
inadequate. To take individualised measures there is a need to identify patients
with a high risk of non-persistence or non-adherence. As patient-related factors
have a major influence on persistence and adherence, we investigated whether
health-related quality of life (HRQoL) and self-efficacy could predict
persistence or adherence.
METHODS: In a prospective web-based patient-centred study in 203 RRMS patients,
starting treatment with glatiramer acatete (GA) 20 mg subcutaneously daily, we
measured physical and mental HRQoL (Multiple Sclerosis Quality of Life-54
questionnaire), functional and control self-efficacy (Multiple Sclerosis
Self-Efficacy Scale), the 12-month persistence rate and, in persistent patients,
the percentage of missed doses. HRQoL and self-efficacy were compared between
persistent and non-persistent patients, and between adherent and non-adherent
patients. Logistic regression analysis was used to assess whether persistence and
adherence were explained by HRQoL and self-efficacy.
RESULTS: Persistent patients had higher baseline physical (mean 58.1 [standard
deviation, SD] 16.9) and mental HRQoL (63.8 [16.8]) than non-persistent patients
(49.5 [17.6]; 55.9 [20.4]) (P = 0.001; P = 0.003) with no differences between
adherent and non-adherent patients (P = 0.46; P = 0.54). Likewise, in persistent
patients function (752 [156]) and control self-efficacy (568 [178]) were higher
than in non-persistent patients (689 [173]; 491 [192]) (P = 0.009; P = 0.004),
but not in adherent vs. non-adherent patients (P = 0.26; P = 0.82). Logistic
regression modelling identified physical HRQoL and control self-efficacy as
factors that explained persistence. Based on predicted scores from the model,
patients were classified into quartiles and the percentage of non-persistent
patients per quartile was calculated: non-persistence in the highest quartile was
23.4 vs. 53.2% in the lowest quartile. Risk differentiation with respect to
adherence was not possible. Based on these findings we propose a practical
work-up scheme to identify patients with a high risk of non-persistence and to
identify persistence-related factors.
CONCLUSIONS: Findings suggest that pre-treatment physical HRQoL and control
self-efficacy may identify RRMS patients with a high risk of early
discontinuation of injectable DMD treatment. Targeting of high-risk patients may
enable the efficient use of persistence-promoting measures.
TRIAL REGISTRATION: Nederlands Trial Register code: NTR2432 .
DOI: 10.1186/s12955-017-0622-z
PMCID: PMC5351176
1578. Trials. 2017 Sep 29;18(1):445. doi: 10.1186/s13063-017-2172-4.
TAILOR - tapered discontinuation versus maintenance therapy of antipsychotic

medication in patients with newly diagnosed schizophrenia or persistent
delusional disorder in remission of psychotic symptoms: study protocol for a
randomized clinical trial.
Stürup AE(1)(2), Jensen HD(3), Dolmer S(4), Birk M(4), Albert N(3), Nielsen M(4),
Hjorthøj C(3), Eplov L(3), Ebdrup BH(5), Mors O(4), Nordentoft M(3)(6).
Author information:
(1)Copenhagen University Hospital, Mental Health Center Copenhagen, Kildegårsvej
28, opg. 15 4. sal, 2900, Hellerup, Denmark. anne.emilie.stuerup@regionh.dk.
(2)University of Copenhagen, Institute for Clinical Medicine, Faculty of Health
and Medical Science, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
anne.emilie.stuerup@regionh.dk.
(3)Copenhagen University Hospital, Mental Health Center Copenhagen, Kildegårsvej
28, opg. 15 4. sal, 2900, Hellerup, Denmark.
(4)Psychosis Research Unit, Aarhus University Hospital, Skovagervej 2, 8240,
Risskov, Denmark.
(5)Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research
(CINS) and Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental
Health Centre Glostrup, Copenhagen University Hospital, Nordre Ringvej 69, 2600,
Glostrup, Denmark.
(6)University of Copenhagen, Institute for Clinical Medicine, Faculty of Health
and Medical Science, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
BACKGROUND: The aim of the TAILOR trial is to investigate the effect of closely
monitored tapering/discontinuation versus maintenance therapy with antipsychotic
medication in patients with newly diagnosed schizophrenia or persistent
delusional disorder and with minimum 3 months' remission of psychotic symptoms.
METHODS AND DESIGN: Two hundred and fifty patients will be included from the
psychiatric early intervention program, OPUS, in two regions in Denmark.
Inclusion criteria are: ICD-10 diagnoses schizophrenia (F20, except F20.6) or
persistent delusional disorder (F22), minimum 3 months' remission of psychotic
symptoms and in treatment with antipsychotic medication (except clozapine). The
patients will be randomized to maintenance therapy or tapering/discontinuation
with antipsychotic medication in a 1-year intervention. The
tapering/discontinuation group will be using a smartphone application to monitor
early warning signs of psychotic relapse. Patients will be assessed at baseline,
1-, 2- and 5-year follow-up regarding psychotic and negative symptoms,
side-effects of antipsychotic medication, social functioning, cognitive
functioning, perceived health status, patient satisfaction, substance and alcohol
use, sexual functioning and quality of life. The primary outcome will be
remission of psychotic symptoms and no antipsychotic medication after 1 year.
Secondary outcome measures will include: co-occurrence of remission of psychotic
symptoms and 0-1-mg haloperidol equivalents of antipsychotic medication after
1-year intervention; antipsychotic dose; antipsychotic side effects; negative
symptoms; social functioning; cognitive functioning; and patient satisfaction.
Exploratory outcomes will include remission, clinical recovery, substance and
alcohol use, sexual functioning, quality of life, self-beliefs of coping and user
experience of support from health workers. Safety measures will include death,
admissions to psychiatric hospital, severe self-harm and psychotic relapses.
DISCUSSION: The TAILOR trial will contribute knowledge about the effect of
tapering/discontinuation of antipsychotic medication in the early phases of
schizophrenia and related disorders and the results may guide future clinical
treatment regimens of antipsychotic treatment.
TRIAL REGISTRATION: EU Clinical Trials Register - EudraCT number: 2016-000565-23
. Registered on 5 February 2016.
DOI: 10.1186/s13063-017-2172-4
PMCID: PMC5622425
1579. BMJ Open. 2018 May 8;8(5):e020843. doi: 10.1136/bmjopen-2017-020843.
Qualitative process study to explore the perceived burdens and benefits of a

digital intervention for self-managing high blood pressure in Primary Care in the
UK.
Morton K(1), Dennison L(1), Bradbury K(1), Band RJ(1), May C(2), Raftery J(3),
Little P(4), McManus RJ(5), Yardley L(1).
Author information:
(1)Academic Unit of Psychology, University of Southampton, Southampton, UK.
(3)Faculty of Medicine, Southampton University, Southampton, UK.
(4)Primary Care Research, University of Southampton, Southampton, UK.
Oxford, UK.
OBJECTIVES: Digital interventions can change patients' experiences of managing

their health, either creating additional burden or improving their experience of
healthcare. This qualitative study aimed to explore perceived burdens and
benefits for patients using a digital self-management intervention for reducing
high blood pressure. A secondary aim was to further our understanding of how best
to capture burdens and benefits when evaluating health interventions.
DESIGN: Inductive qualitative process study nested in a randomised controlled
trial.
SETTING: Primary Care in the UK.
PARTICIPANTS: 35 participants taking antihypertensive medication and with
uncontrolled blood pressure at baseline participated in semistructured telephone
interviews.
INTERVENTION: Digital self-management intervention to support blood pressure
self-monitoring and medication change when recommended by the healthcare
professional.
ANALYSIS: Data were analysed using inductive thematic analysis with techniques
from grounded theory.
RESULTS: Seven themes were developed which reflected perceived burdens and
benefits of using the intervention, including worry about health, uncertainty
about self-monitoring and reassurance. The analysis showed how beliefs about
their condition and treatment appeared to influence participants' appraisal of
the value of the intervention. This suggested that considering illness and
treatment perceptions in Burden of Treatment theory could further our
understanding of how individuals appraise the personal costs and benefits of
self-managing their health.
CONCLUSIONS: Patients' appraisal of the burden or benefit of using a complex
self-management intervention seemed to be influenced by experiences within the
intervention (such as perceived availability of support) and beliefs about their
condition and treatment (such as perceived control and risk of side effects).
Developing our ability to adequately capture these salient burdens and benefits
for patients could help enhance evaluation of self-management interventions in
the future. Many participants perceived important benefits from using the
intervention, highlighting the need for theory to recognise that engaging in
self-management can include positive as well as negative aspects.
TRIAL REGISTRATION NUMBER: ISRCTN13790648; Pre-results.
DOI: 10.1136/bmjopen-2017-020843
PMCID: PMC5942415
Conflict of interest statement: Competing interests: RJM has received BP monitors

for research purposes from Omron and Lloyds Pharmacies.
1580. BMC Psychiatry. 2016 Jul 4;16:205. doi: 10.1186/s12888-016-0921-7.
Results of a pilot cluster randomised trial of the use of a Medication Review

Tool for people taking antipsychotic medication.
Moncrieff J(1), Azam K(2), Johnson S(3), Marston L(4), Morant N(3), Darton K(5),
Wood N(6).
Author information:
(1)Division of Psychiatry, University College London, Maple House, 149 Tottenham
Court Road, London, W1T 7NF, UK. j.moncrieff@ucl.ac.uk.
(2)North East London Foundation Trust, Research & Development Department,
Goodmayes Hospital, Barley Lane, Ilford, Essex, IG3 8XJ, UK.
(3)Division of Psychiatry, University College London, Maple House, 149 Tottenham
Court Road, London, W1T 7NF, UK.
(4)Department of Primary Care and Population Health and Priment Clinical Trials
Unit, University College London, Rowland Hill Street, London, NE3 2PF, UK.
(5)Mind, 15-19 Broadway, Stratford, London, E15 4BQ, UK.
(6)Goodmayes Hospital, Barley Lane, Ilford, Essex, IG3 8XJ, UK.
BACKGROUND: Government policy encourages increasing involvement of patients in

their long-term care. This paper describes the development and pilot evaluation
of a 'Medication Review Tool' designed to assist people to participate more
effectively in discussions about antipsychotic drug treatment.
METHODS: The Medication Review Tool developed consisted of a form to help
patients identify pros and cons of their current antipsychotic treatment and any
desired changes. It was associated with a website containing information and
links about antipsychotics. For the trial, participants diagnosed with psychotic
disorders were recruited from community mental health services. Cluster
randomisation was used to allocate health professionals (care co-ordinators) and
their associated patients to use of the Medication Review Tool or usual care. All
participants had a medical consultation scheduled, and those in the intervention
group completed the Medication Review Tool, with the help of their health
professional prior to this, and took the completed Form into the consultation.
Two follow-up interviews were conducted up to three months after the
consultation. The principal outcome was the Decision Self Efficacy Scale (DSES).
Qualitative feedback was collected from patients in the intervention group.
RESULTS: One hundred and thirty patients were screened, sixty patients were
randomised, 51 completed the first follow-up assessment and 49 completed the
second. Many patients were not randomised due to the timing of their
consultation, and involvement of health professionals was inconsistent. There was
no difference between the groups on the DSES (-4.16 95 % CI -9.81, 1.49),
symptoms, side effects, antipsychotic doses or patient satisfaction. Scores on
the Medication Adherence Questionnaire indicated an increase in participants'
reported inclination to adherence in the intervention group (coefficient adjusted
for baseline values -0.44; 95 % CI -0.76, -0.11), and there was a small increase
in positive attitudes to antipsychotic medication (Drug Attitude Inventory,
adjusted coefficient 1.65; 95 % CI -0.09, 3.40). Qualitative feedback indicated
patients valued the Tool for identifying both positive and negative aspects of
drug treatment.
CONCLUSIONS: The trial demonstrated the design was feasible, although challenges
included service re-configurations and maintaining health professional
involvement. Results may indicate a more intensive and sustained intervention is
required to facilitate participation in decision-making for this group of
patients.
TRIAL REGISTRATION: Current controlled trials ISRCTN12055530 , Retrospectively
registered 9/12/2013.
DOI: 10.1186/s12888-016-0921-7
PMCID: PMC4932750
1581. BJGP Open. 2019 Jul 23;3(2). pii: bjgpopen18X101638. doi:

10.3399/bjgpopen18X101638. Print 2019 Jul.
Engagement in e-cycling and the self-management of type 2 diabetes: a qualitative

study in primary care.
Searle A(1), Ranger E(2), Zahra J(3), Tibbitts B(4), Page A(5), Cooper A(5).
Author information:
(1)Senior Research Associate, BRC Nutrition Theme School of Oral and Dental
Science, University of Bristol Education and Research Centre, Bristol, UK
A.J.Searle@bristol.ac.uk.
(2)PhD Student, Centre for Exercise, Nutrition and Health Sciences School for
Policy Studies, University of Bristol, Bristol, UK.
(3)Senior Research Associate, BRC Nutrition Theme School of Oral and Dental
Science, University of Bristol Education and Research Centre, Bristol, UK.
(4)Senior Research Associate, Centre for Exercise, Nutrition and Health Sciences
School for Policy Studies, University of Bristol, Bristol, UK.
(5)Professor of Physical Activity and Public Health, Centre for Exercise,
Nutrition and Health Sciences School for Policy Studies, University of Bristol,
Bristol, UK.
BACKGROUND: Physical activity (PA) is important in the management of type 2

diabetes (T2DM), however many people find it difficult to implement and/or
sustain in the self-management of the condition. Electrically assisted cycling
(e-cycling) may be viewed as a means of self-management in which effort is
invested to balance the interplay of lifestyle factors and disease progression.
AIM: To explore engagement with an e-cycling intervention conducted with adults
with T2DM.
DESIGN & SETTING: Prospective qualitative interview study with adults in central
Bristol (UK) and surrounding suburbs, in the context of the self-management of
T2DM in primary care.
METHOD: Interviews were conducted with 20 individuals with T2DM (42-70 years, 11
male, 9 female) prior to their participation in a 20-week e-cycling intervention.
Post-intervention interviews were conducted with 18 participants (11 male, 7
female). Interviews were transcribed verbatim and inductive thematic analysis was
undertaken.
RESULTS: Participants were aware that PA contributed to the management of their
diabetes. Engagement with e-cycling was viewed as both an acceptable and a social
lifestyle intervention. Furthermore, participants were unhappy with the volume of
medication used to manage their diabetes and e-cycling fostered autonomy in the
management of T2DM. GPs and practice nurses were regarded as an important source
of reliable information, and were considered to be best placed to talk about
interventions to increase PA.
CONCLUSION: E-cycling is viewed as an acceptable form of PA to aid the
self-management of T2DM. E-cycling may support people with T2DM to reduce their
medication intake and in turn foster greater autonomy in managing the condition.
The findings have implications for the role of primary care health professionals
in supporting both patients and significant others in adoption of e-cycling.
Copyright © 2019, The Authors.
DOI: 10.3399/bjgpopen18X101638
PMCID: PMC6662872
PMID: 31366669
1582. Am J Manag Care. 2017 Aug;23(13 Suppl):S247-S252.
Strategies for addressing the cost of nonadherence in diabetes.
Morello CM, Hirsch JD.
Diabetes accounts for the second largest amount of avoidable healthcare costs in
the United States-an estimated $24.6 billion in wasteful and avoidable spending.
Diabetes is a lifelong disease that is highly dependent on patient
self-management. Unfortunately, studies demonstrate that almost 50% of patients
with diabetes fail to reach the glycemic goal of glycated hemoglobin <7%. Patient
nonadherence poses a significant barrier to effective management of diabetes and
can place a significant burden on the patient and the healthcare system,
resulting in even greater increases in costs, morbidity, and mortality.
Therefore, effective treatment and long-term management of diabetes requires a
patient-centered collaborative model of care with an understanding of the factors
associated with nonadherence. This may help develop patient-, provider-, and
system-focused strategies to help increase the rates of medication adherence,
reduce complications associated with uncontrolled diabetes, and lower the overall
cost of management.
1583. J Family Med Prim Care. 2015 Jul-Sep;4(3):439-43. doi: 10.4103/2249-

4863.161349.
Knowledge about diabetes and relationship between compliance to the management

among the diabetic patients from Rural Area of Sangli District, Maharashtra,
India.
Chavan GM(1), Waghachavare VB(1), Gore AD(1), Chavan VM(1), Dhobale RV(1),
Dhumale GB(1).
Author information:
(1)Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical
College and Hospital, Sangli, Maharashtra, India.
INTRODUCTION: Diabetes is an important public health problem of India. Studies

have shown that increase in patients' knowledge regarding the disease results in
better compliance to treatment and decrease in complications. This study was
planned to assess the knowledge about diabetes and its correlation with
pharmacological and non-pharmacological compliance, among the diabetic patients
attending rural health center from Sangli District, Maharashtra (India).
MATERIALS AND METHODS: The study was conducted during September to November 2014.
The study subjects were all willing adult patients with type II diabetes mellitus
attending a selected rural hospital. The study tool was pretested and
self-administered questionnaire. Analysis was done using Microsoft Excel and
SPSS-22.
RESULTS: Total study participants were 307 in number, with the mean age of 55.6
years. The mean morbidity with diabetes was 10.7 years. Only 23.8% had good
knowledge regarding diabetes, while 19.2% participants had poor knowledge.
Knowledge was significantly associated with the compliance to the pharmacological
and non-pharmacological management.
CONCLUSION: Although most of the patients were suffering with diabetes for many
years there is lack of knowledge regarding the disease and self care. The
compliance to the management of diabetes was better in patients with good
knowledge. Seminars, counseling sessions and workshop should be arranged
periodically for diabetic patients to increase their awareness.
DOI: 10.4103/2249-4863.161349
PMCID: PMC4535111
PMID: 26288789
1584. J Addict. 2019 Mar 5;2019:2491063. doi: 10.1155/2019/2491063. eCollection

2019.
Suboxone Treatment and Recovery Trial (STAR-T): Study Protocol for a Randomised
Controlled Trial of Opioid Medication Assisted Treatment with Adjunctive
Medication Management Using Therapeutic Drug Monitoring and Contingency
Management.
Elarabi H(1)(2), Elrasheed A(2), Ali A(2), Shawky M(2), Hasan N(2), Gawad TA(2),
Adem A(3), Marsden J(4).
Author information:
(1)Addictions Department, Institute of Psychiatry, Psychology and Neurosciences,
King's College London, 4-Windsor Walk, ASB, Denmark Hill, SE5 8BB, London, UK.
(2)National Rehabilitation Centre, UAE, P.O. Box 55001, Abu Dhabi, Shakhboot
City, UAE.
(3)College of Medicine and Health Sciences, United Arab Emirates University, P.O.
Box 15551, Alain, AD, UAE.
(4)Addictions Department, Institute of Psychiatry, Psychology and Neurosciences,
King's College London, Addiction Sciences Building, 4 Windsor Walk, Demark Hill,
London, Denmark Hill, SE5 8AF, UK.
Introduction: Opioid assisted treatment (OAT) with buprenorphine (BUP) is

front-line medical maintenance intervention for illicit and prescription opioid
use disorder (OUD). In many clinics, opioid medication is dispensed for several
days for self-administration. This provides flexibility to the patient but may
compromise the effectiveness of OAT because of nonadherence or medication
diversion. OAT can be delivered as an entirely supervised intervention, but many
patients discontinue treatment under this arrangement and dispensing costs may be
prohibitive. An alternative is to enable patients to receive take-home doses
contingent on OAT adherence guided by a medication management framework using
Therapeutic Drug Monitoring (TDM) alongside negative urine drug screens (UDS) to
provide evidence of abstinence. TDM is recommended to monitor adherence with BUP
but it has not been applied in OAT programs and evaluation research to date.
Methods: The Suboxone Treatment and Recovery Trial (STAR-T) is a single site,
16-week, parallel-group, randomised controlled trial. The aim of the study is to
determine the effectiveness of a medication management framework including TDM
and UDS to enable patients enrolled on outpatient OAT (with
buprenorphine/naloxone [sublingual film formulation; BUP/NX-F; Suboxone™]) to
receive stepped take-home doses. Following stabilisation during inpatient care,
adult participants with illicit or prescription OUD were allocated (1:1) to
receive (1) BUP/NX-F plus medication management for take-home doses based on TDM,
UDS, and contingency management protocol (the experimental group) or (2) BUP/NX-F
plus UDS only (treatment-as-usual, the control group). The primary outcome is the
mean percentage of negative UDS over 16 weeks. The secondary outcome is treatment
retention defined as completion of 16 weeks of OAT without interruption. There
will be an exploratory analysis of the association between participant
characteristics, clinical data, and outcomes.
Conclusions: Providing BUP/NX-F take-home doses contingent on adherence and
opioid abstinence may enable OAT to be delivered flexibly and effectively.
Trial Registration: ISRCTN41645723 is retrospectively registered on 15/11/2015.
DOI: 10.1155/2019/2491063
PMCID: PMC6425325
PMID: 30956839
1585. JMIR Res Protoc. 2016 Sep 13;5(3):e187. doi: 10.2196/resprot.5750.
A Multifaceted Nurse- and Web-Based Intervention for Improving Adherence to

Treatment in Patients With Cardiovascular Disease: Rationale and Design of the
MIRROR Trial.
Sieben A(1), van Onzenoort HA, van Laarhoven KJ, Bredie SJ.
Author information:
(1)Radboud University Nijmegen Medical Centre, Department of Surgery, Division of
Vascular Surgery, Radboud University Nijmegen Medical Centre, Nijmegen,
Netherlands. angelien.sieben@radboudumc.nl.
BACKGROUND: Poor adherence to medication is one of the limitations in the

treatment of cardiovascular diseases, thereby increasing the risk of premature
death, hospital admissions, and related costs. There is a need for simple and
easy-to-implement interventions that are based on patients' perspectives,
beliefs, and perceptions of their illness and medication.
OBJECTIVE: The objective is to test the effectivity of this intervention to
improve medication adherence in patients with established cardiovascular disease,
that is, in secondary prevention.
METHODS: In this study the effect of a personalized visualization of
cardiovascular risk levels through a website aiming at supporting self management
in combination with a group consultation and communication intervention by a
nurse on adherence to treatment in 600 patients with manifest cardiovascular
diseases will be assessed. The health belief model was chosen as main theoretical
model for the intervention.
RESULTS: Primary outcome is adherence to treatment calculated by refill data.
Secondary outcomes include the Beliefs about Medication Questionnaire and the
Modified Morisky Scale. Patients are followed for one year. Results are expected
by 2015.
CONCLUSIONS: This study assesses adherence to treatment in a high-risk
cardiovascular population by applying an intervention that addresses patients'
capacity and practical barriers as well as patients' beliefs and perceptions of
their illness and medication.
CLINICALTRIAL: ClinicalTrials.gov NCT01449695;
http://www.webcitation.org/6kCzkIKH3).
PMCID: PMC5039334
PMID: 27624877
1586. Malays Fam Physician. 2017 Dec 31;12(3):8-17. eCollection 2017.
Self-management approaches among hypertensive residents in nursing homes in

Malaysia.
Wei TM(1), Omar MS(2).
Author information:
(1)BPharm (Hons) UKM Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan
Raja Muda Abdul Aziz 50300 Kuala Lumpur, Malaysia.
(2)(Corresponding author) RPh, BPharm (Hons) (UKM), MClinPharm (UKM), PhD
(Australia) Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda
Abdul Aziz, 50300 Kuala Lumpur, Malaysia Email: marhanis@ukm.edu.my.
Introduction: The prevalence of hypertension in Malaysia is increasing and an

effective management of hypertension is important to reduce cardiovascular
morbidity and mortality.
Objective: To determine the knowledge, awareness and perception towards
hypertension among residents in nursing homes as well as the roles of caregivers
in hypertension management.
Methods: A face-to-face survey with 200 hypertensive residents and 30 caregivers
from 24 nursing homes in Kuala Lumpur and Selangor, Malaysia was conducted.
Results: Of all the hypertensive residents, 90.5% (n = 181) knew that lowering
their blood pressure could improve their health. Most residents strongly believed
that taking antihypertensive drugs is important for keeping their high blood
pressure under control (n = 162, 81%). Taking medication was perceived as the
most important factor in controlling the high blood pressure (58%, n = 116)
compared to lifestyle or diet modification. The majority of the caregivers
reported that they played a major role in managing hypertension, especially with
regards to medication-taking. task (66.7%, n = 20).
Conclusion: The knowledge, attitude and perceptions of hypertension play a
relatively major role in the self-management of hypertension. The role of
caregivers also needed to be recognised in managing hypertension in nursing
homes.
PMCID: PMC5842418
PMID: 29527274
1587. Ann Behav Med. 2014 Dec;48(3):293-9. doi: 10.1007/s12160-014-9595-x.
Does electronic monitoring influence adherence to medication? Randomized

controlled trial of measurement reactivity.
Sutton S(1), Kinmonth AL, Hardeman W, Hughes D, Boase S, Prevost AT, Kellar I,
Graffy J, Griffin S, Farmer A.
Author information:
(1)Behavioural Science Group, Primary Care Unit, Department of Public Health and
Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK,
srs34@medschl.cam.ac.uk.
Comment in
Ann Behav Med. 2014 Dec;48(3):287-8.
BACKGROUND: Electronic monitoring is recommended for accurate measurement of

medication adherence but a possible limitation is that it may influence
adherence.
PURPOSE: To test the reactive effect of electronic monitoring in a randomized
controlled trial.
METHODS: A total of 226 adults with type 2 diabetes and HbA1c ≥58 mmol/mol were
randomized to receiving their main oral glucose lowering medication in electronic
containers or standard packaging. The primary outcomes were self-reported
adherence measured with the MARS (Medication Adherence Report Scale; range 5-25)
and HbA1c at 8 weeks.
RESULTS: Non-significantly higher adherence and lower HbA1c were observed in the
electronic container group (differences in means, adjusting for baseline value:
MARS, 0.4 [95 % CI -0.1 to 0.8, p = 0.11]; HbA1c (mmol/mol), -1.02 [-2.73 to
0.71, p = 0.25]).
CONCLUSIONS: Electronic containers may lead to a small increase in adherence but
this potential limitation is outweighed by their advantages. Our findings support
electronic monitoring as the method of choice in research on medication
adherence. (Trial registration Current Controlled Trials ISRCT N30522359).
DOI: 10.1007/s12160-014-9595-x
PMCID: PMC4223537
1588. BMC Pediatr. 2016 Jan 11;16:4. doi: 10.1186/s12887-016-0542-9.
Motivational techniques to improve self-care in hemophilia: the need to support

autonomy in children.
Bérubé S(1), Mouillard F(1), Amesse C(1), Sultan S(2).
Author information:
(1)CHU Sainte-Justine, Université de Montreal, 3175 Chemin de la
Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
(2)CHU Sainte-Justine, Université de Montreal, 3175 Chemin de la
Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. serge.sultan@umontreal.ca.
BACKGROUND: In pediatric hemophilia, caregivers are facing unique challenges to

adherence and self-care in children and adolescents with hemophilia. Hemophilia
treatment requires adequate prophylaxis and on-demand treatment, as well as a
clear behavioral strategy to limit risk-taking in terms of physical exercise and
diet. Medication adherence rates of hemophilia patients have been reported to
decrease during late childhood and adolescence. In the developing child, moving
safely from parent-care to self-care is one of the greatest challenges of
integrative care within this domain. There is a clear need for initiatives
designed to increase an individual's motivation for treatment and self-care
activities.
DISCUSSION: Among motivational approaches, the self-determination perspective
offers a useful framework to explain how the transition to self-care can be
facilitated. We discuss how motivation regarding hemophilia treatment may be
increased through parental autonomy support and we offer examples of applied
communication techniques to facilitate autonomy-supportive caregiving. Although
it has not yet been tested in the context of hemophilia, these communication
techniques could potentially help caregivers promote adherence and self-care in
children. Confronted by unique challenges to adherence and self-care, caregivers
of children with hemophilia should move from an exclusive focus on
illness-management education to an integrative strategy, including
motivation-enhancing communication. The self-determination perspective provides
important proximal objectives (e.g. autonomy support) to maintain optimal
adherence in adolescents as they move from parent-care to self-care. Future
research initiatives should address the practice of these communication
techniques and evaluate them in the context of hemophilia.
DOI: 10.1186/s12887-016-0542-9
PMCID: PMC4707725
1589. BMC Complement Altern Med. 2017 Apr 4;17(1):196. doi: 10.1186/s12906-017-
1714-3.
Prevalence, knowledge and attitudes toward herbal medication use by Saudi women
in the central region during pregnancy, during labor and after delivery.
Al-Ghamdi S(1), Aldossari K(2), Al-Zahrani J(2), Al-Shaalan F(3), Al-Sharif S(3),
Al-Khurayji H(3), Al-Swayeh A(3).
Author information:
(1)Department of Family Medicine, College of Medicine, Prince Sattam bin
Abdulaziz University, Al Kharj, Saudi Arabia. sam3443@gmail.com.
(2)Department of Family Medicine, College of Medicine, Prince Sattam bin
Abdulaziz University, Al Kharj, Saudi Arabia.
(3)College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi
Arabia.
BACKGROUND: Herbal medication usage is prevalent in both developing and developed

countries. The low level of awareness of the possible dangers of some herbs
during pregnancy increases the risk of unwarranted sequelae. This manuscript
describes the first study of herbal medication use among pregnant women in Saudi
Arabia. It aims to determine the prevalence of herbal medication use during
pregnancy, during labor and after delivery in the central region of Saudi Arabia.
METHODS: A cross-sectional descriptive study was conducted over a 5-month period
from May 15 to October 15, 2016. A self-administered questionnaire was
distributed at 4 main hospitals and 3 primary care centers in Riyadh and Al
Kharj. Data from 612 participants were collected and analyzed. Descriptive
statistics in the form of frequency and percentage were determined, and
Chi-squared tests were performed.
RESULTS: Of the 612 participants, 25.3%, 33.7% and 48.9% used herbs during
pregnancy, during labor, and after delivery, respectively. The primary motives
for using herbal medication during pregnancy, during labor and after delivery
were to boost general health, ease and accelerate labor and clean the womb,
respectively. There was a significant association between use during pregnancy
and prior use (P = 0.001). Most pregnant women used herbs based on advice from
family and friends (52.9%). Only 40.7% of pregnant women disclosed their herbal
use to their doctors.
CONCLUSION: The prevalence of herbal medication use among pregnant Saudi women in
Riyadh and Al Kharj is relatively high. Doctors should be aware of evidence
regarding the potential benefits or harm of herbal medication use during
pregnancy.
DOI: 10.1186/s12906-017-1714-3
PMCID: PMC5379727
1590. ARYA Atheroscler. 2019 Mar;15(2):82-92. doi: 10.22122/arya.v15i2.1807.
Prevalence of medication adherence in patients with hypertension in Iran: A

systematic review and meta-analysis of studies published in 2000-2018.
Jafari Oori M(1), Mohammadi F(2), Norouzi-Tabrizi K(3), Fallahi-Khoshknab M(4),

Ebadi A(5).
Author information:
(1)Department of Nursing, University of Social Welfare and Rehabilitation
(2)Associate Professor, Iranian Research Center on Aging AND Department of
Nursing Education, University of Social Welfare and Rehabilitation Sciences,
Tehran, Iran.
(3)Associate Professor, Department of Nursing, University of Social Welfare and
Rehabilitation Sciences, Tehran, Iran.
(4)Professor, Department of Nursing, University of Social Welfare and
Rehabilitation Sciences, Tehran, Iran.
(5)Professor, Behavioral Sciences Research Center, Lifestyle Institute, School of
Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran.
BACKGROUND: Medication adherence (MA) has a crucial role in controlling of

hypertension (HTN). A difference was observed in the prevalence of
anti-hypertensive MA reported in different studies in Iran, so we aimed to
determine the overall prevalence of MA.
METHODS: Using the English and Persian keywords extracted from Mesh, the
databases of MagIran, Barakat Knowledge Network System, Scientific Information
Database (SID), Web of Sciences, PubMed, Science Direct, and Google Scholar were
reviewed from 2000 to 2018. The overall prevalence of MA was estimated using
Random effect mode. The I2 and Egger's tests were used to assess heterogeneity
and publication bias, respectively. Meta-regression and subgroup analysis were
conducted based on variables such as age, marital status, regions, and tools.
RESULTS: The overall prevalence of MA was 33%. Moreover, the prevalence of MA
based on the 8-Item Morisky Medication Adherence Scale (MMAS-8), Hill-Bone
Medication Adherence (HBMA) scale, researcher-made tools, and self-care tools,
were 13%, 34%, 48%, and 47%, respectively. A higher MA prevalence (38%) was
observed among older adults compared to other age groups, and married patients
(32%) compared to single (23%) individuals. The highest MA prevalence (50%) was
related to region 5 of the country. Meta-regression results showed a significant
relationship between the used tools and MA prevalence.
CONCLUSION: The overall prevalence of MA is low in Iran. Furthermore, MA was
measured using different questionnaires, such as standard international scales
and researcher-made tools. It is proposed that a standard international
questionnaire should be used in future studies.
DOI: 10.22122/arya.v15i2.1807
PMCID: PMC6679658
PMID: 31440290
1591. J Behav Health Serv Res. 2014 Oct;41(4):529-38. doi: 10.1007/s11414-013-9342-

2.
Perceived symptom targets of antidepressants, anxiolytics, and sedatives: the

search for modifiable factors that improve adherence.
Garrido MM(1), Boockvar KS.
Author information:
(1)Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of
Medicine at Mount Sinai, New York, NY, USA, melissa.garrido@mssm.edu.
Expectations about treatment and beliefs about illness influence adherence in

physical disorders, but the extent to which this occurs in mood disorders is
unknown. Identifying modifiable factors, such as beliefs, may improve adherence
to mood disorder medications. Data from the Collaborative Psychiatric
Epidemiology Surveys were used to examine relationships among perceived symptom
targets of medication (mood only, non-mood only, mood, and non-mood) and
self-reported adherence to antidepressants, anxiolytics, and sedatives. The
sample included 807 community-dwelling individuals with and without depression
and anxiety who regularly took one of these medications in the year before the
survey. Slightly over half (53.2 %) of respondents were adherent. Perceived
medication purpose was only significantly related to adherence among Latino
respondents. Latino respondents who viewed their symptom target as non-mood only
were the most adherent. Perceived symptom targets of medications were not
associated with most patients' adherence behaviors for antidepressants,
anxiolytics, and sedatives.
DOI: 10.1007/s11414-013-9342-2
PMCID: PMC3883894
1592. Prev Chronic Dis. 2017 Jul 13;14:E57. doi: 10.5888/pcd14.160512.
Age-Related Differences in Antihypertensive Medication Adherence in Hispanics: A

Cross-Sectional Community-Based Survey in New York City, 2011-2012.
Bandi P(1), Goldmann E(2), Parikh NS(2), Farsi P(2), Boden-Albala B(2)(3)(4).
Author information:
(1)College of Global Public Health, New York University, 665 Broadway, 11th
Floor, New York, NY 10003. Email: pb1349@nyu.edu.
(2)College of Global Public Health, New York University, New York, New York.
(3)Department of Neurology, School of Medicine, Langone Medical Center, New York
University, New York, New York.
(4)Department of Epidemiology and Health Promotion, College of Dentistry, New
York University, New York, New York.
INTRODUCTION: US Hispanics, particularly younger adults in this population, have

a higher prevalence of uncontrolled hypertension than do people of other
racial/ethnic groups. Little is known about the prevalence and predictors of
antihypertensive medication adherence, a major determinant of hypertension
control and cardiovascular disease, and differences between age groups in this
fast-growing population.
METHODS: The cross-sectional study included 1,043 community-dwelling Hispanic
adults with hypertension living in 3 northern Manhattan neighborhoods from 2011
through 2012. Age-stratified analyses assessed the prevalence and predictors of
high medication adherence (score of 8 on the Morisky Medication Adherence Scale
[MMAS-8]) among younger (<60 y) and older (≥60 y) Hispanic adults.
RESULTS: Prevalence of high adherence was significantly lower in younger versus
older adults (24.5% vs 34.0%, P = .001). In younger adults, heavy alcohol
consumption, a longer duration of hypertension, and recent poor physical health
were negatively associated with high adherence, but poor self-rated general
health was positively associated with high adherence. In older adults, advancing
age, higher education level, high knowledge of hypertension control, and private
insurance or Medicare versus Medicaid were positively associated with high
adherence, whereas recent poor physical health and health-related activity
limitations were negatively associated with high adherence.
CONCLUSION: Equitable achievement of national hypertension control goals will
require attention to suboptimal antihypertensive medication adherence found in
this study and other samples of US Hispanics, particularly in younger adults. Age
differences in predictors of high adherence highlight the need to tailor efforts
to the life stage of people with hypertension.
DOI: 10.5888/pcd14.160512
PMCID: PMC5510304
1593. BMJ Qual Saf. 2016 Oct;25(10):759-69. doi: 10.1136/bmjqs-2015-004670. Epub

2016
Jan 11.
The Medicines Advice Service Evaluation (MASE): a randomised controlled trial of

a pharmacist-led telephone based intervention designed to improve medication
adherence.
Lyons I(1), Barber N(2), Raynor DK(3), Wei L(4).
Author information:
(1)UCL Interaction Centre, University College London, London, UK.
(2)Health Foundation, London, UK.
(3)School of Healthcare, University of Leeds, Leeds, UK.
(4)Research Department of Practice and Policy, UCL School of Pharmacy, University
College London, London, UK.
AIM: To test the effectiveness of a tailored, pharmacist-led centralised advice

service to improve adherence to patients on established medications.
METHODS: A parallel group randomised controlled trial was conducted. Patients
prescribed at least one oral medication for type 2 diabetes and/or lipid
regulation were eligible to participate. 677 patients of a mail-order pharmacy
were recruited and randomised (340 intervention, 337 control). The intervention
comprised two tailored telephone consultations with a pharmacist, 4-6 weeks
apart, plus a written summary of the discussion and a medicines reminder chart.
The primary outcome was self-reported adherence to medication at 6-month
follow-up, collected via a postal questionnaire, analysed using generalised
estimating equations. Secondary outcomes included prescription refill adherence,
lipid and glycaemic control and patient satisfaction.
RESULTS: In intention-to-treat analysis 36/340 (10.6%) of the intervention group
were non-adherent (<90% of medication taken in the past 7 days) at 6 months
compared with 66/337 (19.6%) in the control group, yielding an unadjusted OR of
1.54 (95% CI 1.11 to 2.15, p=0.01). Analyses of dispensing data also showed that
the odds of being classified as adherent (≥90%) were 60% greater for the
intervention group compared with the control group (OR 1.60, 95% CI 1.14 to 2.24,
p<0.01). In a subsample of patients who provided blood samples, glycaemic and
lipid control did not differ significantly between groups (p=0.06 and p=0.24,
respectively) but positive trends were observed. Ninety-two per cent of
intervention group patients reported that they were satisfied with the service
overall.
CONCLUSIONS: A telephone intervention, led by a pharmacist and tailored to the
individuals' needs, can significantly improve medication adherence in patients
with long-term conditions, using a mail-order pharmacy. Further work is needed to
confirm a trend towards improved clinical outcome.
TRIAL REGISTRATION NUMBER: NCT01864239.
DOI: 10.1136/bmjqs-2015-004670
1594. Am J Manag Care. 2015 Oct;21(10):696-704.
Medication adherence and healthcare disparities: impact of statin co-payment

reduction.
Lewey J, Shrank WH, Avorn J, Liu J, Choudhry NK(1).
Author information:
(1)Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, Ste
3030, Boston, MA 02120. Email: nchoudhry@bwh.harvard.edu.
OBJECTIVES: Minority patients have lower rates of cardiovascular medication

adherence, which may be amenable to co-payment reductions. Our objective was to
evaluate the effect of race on adherence changes following a statin co-payment
reduction intervention.
STUDY DESIGN: Retrospective analysis.
METHODS: The intervention was implemented by a large self-insured employer.
Eligible individuals in the intervention cohort (n = 1961) were compared with a
control group of employees of other companies without such a policy (n = 37,320).
As a proxy for race, we categorized patients into tertiles based on the
proportion of black residents living in their zip code of residence. Analyses
were performed using difference-in-differences design with generalized estimating
equations.
RESULTS: Prior to the new co-payment policy, adherence rates were higher for
individuals living in areas with fewer black residents. In multivariable models
adjusting for demographic factors, clinical covariates and baseline trends, the
co-payment reduction increased adherence by 2.0% (P = .14), 2.1% (P = .15) and 6%
(P < .0001) for intervention patients living in areas with the bottom, middle and
top tertiles of the proportion of black residents. These results persisted after
adjusting for income.
CONCLUSIONS: Co-payment reduction for statins preferentially improved adherence
among patients living in communities with a higher proportion of black residents.
Further research is needed on the impact of value-based insurance design programs
on reducing racial disparities in cardiovascular care.
Shared decision-making about cardiovascular disease medication in older people: a

qualitative study of patient experiences in general practice.
Jansen J(1)(2), McKinn S(1), Bonner C(1)(2), Muscat DM(1), Doust J(3), McCaffery
K(1)(2).
Author information:
(1)Faculty of Medicine and Health, School of Public Health, Sydney Health
Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia.
(2)Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, The
University of Sydney, Sydney, New South Wales, Australia.
(3)Faculty of Health Sciences and Medicine, Bond University, Gold Coast,
Queensland, Australia.
OBJECTIVES: To explore older people's perspectives and experiences with shared

decision-making (SDM) about medication for cardiovascular disease (CVD)
prevention.
DESIGN, SETTING AND PARTICIPANTS: Semi-structured interviews with 30 general
practice patients aged 75 years and older in New South Wales, Australia, who had
elevated CVD risk factors (blood pressure, cholesterol) or had received
CVD-related lifestyle advice. Data were analysed by multiple researchers using
Framework analysis.
RESULTS: Twenty eight participants out of 30 were on CVD prevention medication,
half with established CVD. We outlined patient experiences using the four steps
of the SDM process, identifying key barriers and challenges: Step 1. Choice
awareness: taking medication for CVD prevention was generally not recognised as a
decision requiring patient input; Step 2. Discuss benefits/harms options: CVD
prevention poorly understood with emphasis on benefits; Step 3. Explore
preferences: goals, values and preferences (eg, length of life vs quality of
life, reducing disease burden vs risk reduction) varied widely but generally not
discussed with the general practitioner; Step 4. Making the decision: overall
preference for directive approach, but some patients wanted more active
involvement. Themes were similar across primary and secondary CVD prevention,
different levels of self-reported health and people on and off medication.
CONCLUSIONS: Results demonstrate how older participants vary widely in their
health goals and preferences for treatment outcomes, suggesting that CVD
prevention decisions are preference sensitive. Combined with the fact that the
vast majority of participants were taking medications, and few understood the
aims and potential benefits and harms of CVD prevention, it seems that older
patients are not always making an informed decision. Our findings highlight
potentially modifiable barriers to greater participation of older people in SDM
about CVD prevention medication and prevention in general.

DOI: 10.1136/bmjopen-2018-026342
PMCID: PMC6475217
PMID: 30898831
1596. Behav Anal Pract. 2018 Feb 23;11(4):350-357. doi: 10.1007/s40617-018-0237-9.

Board Certified Behavior Analysts and Psychotropic Medications: Slipshod

Training, Inconsistent Involvement, and Reason for Hope.
Li A(1), Poling A(1)(2).
Author information:
(1)1Western Michigan University, Kalamazoo, MI USA.
(2)2Department of Psychology, Western Michigan University, Kalamazoo, MI 49008
USA.
People with autism spectrum disorder often receive psychotropic medications and
two drugs, risperidone and aripiprazole, are approved for treating "irritability"
in this population. A number of authors have suggested that behavior analysts can
contribute to the prudent use of such drugs, but little is known regarding Board
Certified Behavior Analysts' involvement in practices relevant to the use of
psychotropic drugs. We e-mailed Board Certified Behavior Analysts an anonymous
web-based survey regarding such practices. A majority of respondents work with
individuals with autism spectrum disorder who take at least one psychotropic
medication but respondents' training relevant to psychotropic medications is
inconsistent. Many report that their training is inadequate, they do not
regularly work as part of interdisciplinary teams concerned with medication, and
behavior-analytic interventions are not typically evaluated before drugs are
prescribed. Nonetheless, the majority of respondents reported that medications
sometimes produce beneficial effects. Those involved in training behavior
analysts should consider the competencies needed for graduates to work
effectively as members of teams concerned with the optimal use of medications and
how to foster and assess those competencies. Behavior analysts should also work
to develop and implement strategies that foster collaboration with psychiatrists
and other physicians. • Psychotropic drugs are often prescribed for people with
autism, and both risperidone and aripiprazole are approved for reducing
"irritability," which comprises self-injury, aggression, tantrums, and other
challenging responses. • Respondents are not consistently involved in monitoring
the effects of psychotropic drugs, which are often administered prior to
evaluating an alternative, less restrictive, intervention. • Respondents are not
trained consistently with respect to matters relevant to psychotropic drugs, and
many apparently are not trained adequately. • People involved in training
behavior analysts should consider the competencies needed for graduates to work
effectively as members of teams concerned with the optimal use of medications and
how to foster and assess those competencies. • Behavior analysts should also work
to develop and implement strategies that foster collaboration with psychiatrists
and other physicians.
DOI: 10.1007/s40617-018-0237-9
PMCID: PMC6269390
PMID: 30538908
Conflict of interest statement: All procedures performed in studies involving

human participants were in accordance with the ethical standards of the
institutional and/or national research committee and with the 1964 Helsinki
declaration and its later amendments or comparable ethical standards.Informed
consent was obtained from all individual participants included in the study.The
authors declare that they have no conflict of interest.
1597. Lancet Glob Health. 2018 Jan;6(1):e111-e120. doi: 10.1016/S2214-

109X(17)30453-9.
The incidence of abortion and unintended pregnancy in India, 2015.
Singh S(1), Shekhar C(2), Acharya R(3), Moore AM(4), Stillman M(4), Pradhan
MR(2), Frost JJ(4), Sahoo H(2), Alagarajan M(2), Hussain R(4), Sundaram A(4),
Vlassoff M(4), Kalyanwala S(5), Browne A(4).
Author information:
(1)Guttmacher Institute, New York, NY, USA. Electronic address:
ssingh@guttmacher.org.
(2)International Institute for Population Sciences, Mumbai, India.
(3)Population Council, New York, NY, USA.
(4)Guttmacher Institute, New York, NY, USA.
(5)S Kalyanwala MA is an independent consultant.
Erratum in
Lancet Glob Health. 2017 Dec 12;:.
Comment in
Lancet Glob Health. 2018 Jan;6(1):e16-e17.
BACKGROUND: Reliable information on the incidence of induced abortion in India is

lacking. Official statistics and national surveys provide incomplete coverage.
Since the early 2000s, medication abortion has become increasingly available,
improving the way women obtain abortions. The aim of this study was to estimate
the national incidence of abortion and unintended pregnancy for 2015.
METHODS: National abortion incidence was estimated through three separate
components: abortions (medication and surgical) in facilities (including private
sector, public sector, and non-governmental organisations [NGOs]); medication
abortions outside facilities; and abortions outside of facilities and with
methods other than medication abortion. Facility-based abortions were estimated
from the 2015 Health Facilities Survey of 4001 public and private health
facilities in six Indian states (Assam, Bihar, Gujarat, Madhya Pradesh, Tamil
Nadu, and Uttar Pradesh) and from NGO clinic data. National medication abortion
drug sales and distribution data were obtained from IMS Health and six principal
NGOs (DKT International, Marie Stopes International, Population Services
International, World Health Partners, Parivar Seva Santha, and Janani). We
estimated the total number of abortions that are not medication abortions and are
not obtained in a health facility setting through an indirect technique based on
findings from community-based study findings in two states in 2009, with
adjustments to account for the rapid increase in use of medication abortion since
2009. The total number of women of reproductive age and livebirth data were
obtained from UN population data, and the proportion of births from unplanned
pregnancies and data on contraceptive use and need were obtained from the 2015-16
National Family Health Survey-4.
FINDINGS: We estimate that 15·6 million abortions (14·1 million-17·3 million)
occurred in India in 2015. The abortion rate was 47·0 abortions (42·2-52·1) per
1000 women aged 15-49 years. 3·4 million abortions (22%) were obtained in health
facilities, 11·5 million (73%) abortions were medication abortions done outside
of health facilities, and 0·8 million (5%) abortions were done outside of health
facilities using methods other than medication abortion. Overall, 12·7 million
(81%) abortions were medication abortions, 2·2 million (14%) abortions were
surgical, and 0·8 million (5%) abortions were done through other methods that
were probably unsafe. We estimated 48·1 million pregnancies, a rate of 144·7
pregnancies per 1000 women aged 15-49 years, and a rate of 70·1 unintended
pregnancies per 1000 women aged 15-49 years. Abortions accounted for one third of
all pregnancies, and nearly half of pregnancies were unintended.
INTERPRETATION: Health facilities can have a greater role in abortion service
provision and provide quality care, including post-abortion contraception.
Interventions are needed to expand access to abortion services through better
equipping existing facilities, ensuring adequate and continuous supplies of
medication abortion drugs, and by increasing the number of trained providers. In
view of how many women rely on self-administration of medication abortion drugs,
interventions are needed to provide women with accurate information on these
drugs and follow-up care when needed. Research is needed to test interventions
that improve knowledge and practice in providing medication abortion, and the
Indian Government at the national and state level needs to prioritise improving
policies and practice to increase access to comprehensive abortion care and
quality contraceptive services that prevent unintended pregnancy.
FUNDING: Government of UK Department for International Development (until 2015),
the David and Lucile Packard Foundation, the John D. and Catherine T. MacArthur
Foundation, and the Ford Foundation.
article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights
reserved.
DOI: 10.1016/S2214-109X(17)30453-9
PMCID: PMC5953198
1598. Am J Gastroenterol. 2015 Oct;110(10):1382-7. doi: 10.1038/ajg.2015.132. Epub

2015
Apr 28.
Beliefs about GI medications and adherence to pharmacotherapy in functional GI

disorder outpatients.
Cassell B(1), Gyawali CP(1), Kushnir VM(1), Gott BM(1)(2), Nix BD(1), Sayuk
GS(1)(2)(3).
Author information:
(1)Division of Gastroenterology, Washington University School of Medicine, St
Louis, Missouri, USA.
(2)Department of Psychiatry, Washington University School of Medicine, St Louis,
Missouri, USA.
(3)John Cochran VA Medical Center, St Louis, Missouri, USA.
OBJECTIVES: Pharmacotherapy is a mainstay in functional gastrointestinal (GI)

disorder (FGID) management, but little is known about patient attitudes toward
medication regimens. Understanding patient concerns and adherence to
pharmacotherapy is particularly important for off-label medication use (e.g.,
antidepressants) in FGID.
METHODS: Consecutive tertiary GI outpatients completed the Beliefs About
Medications questionnaire (BMQ). Subjects were categorized as FGID and structural
GI disease (SGID) using clinician diagnoses and Rome criteria; GI-specific
medications and doses were recorded, and adherence to medication regimens was
determined by patient self-report. BMQ domains (overuse, harm, necessity, and
concern) were compared between FGID and SGID, with an interest in how these
beliefs affected medication adherence. Psychiatric measures (depression, anxiety,
and somatization) were assessed to gauge their influence on medication beliefs.
RESULTS: A total of 536 subjects (mean age 54.7±0.7 years, range 22-100 years;
n=406, 75.7% female) were enrolled over a 5.5-year interval: 341 (63.6%) with
FGID (IBS, 64.8%; functional dyspepsia, 51.0%, ≥2 FGIDs, 38.7%) and 142 (26.5%)
with SGID (IBD, 28.9%; GERD, 23.2%). PPIs (n=231, 47.8%), tricyclic
antidepressants (TCAs) (n=167, 34.6%), and anxiolytics (n=122, 25.3%) were common
medications prescribed. FGID and SGID were similar across all BMQ domains (P>0.05
for overuse, harm, necessity, and concern). SGID subjects had higher
necessity-concern framework (NCF) scores compared with FGID subjects (P=0.043).
FGID medication adherence correlated negatively with concerns about medication
harm (r=-0.24, P<0.001) and overuse (r=-0.15, P=0.001), whereas higher NCF
differences predicted medication compliance (P=0.006). Medication concern and
overuse scores correlated with psychiatric comorbidity among FGID subjects
(P<0.03 for each). FGID patients prescribed TCAs (n=142, 41.6%) expressed a
greater medication necessity (17.4±0.4 vs. 16.2±0.4, P=0.024) and found their GI
regimen to be more helpful (P=0.054). FGID subjects not on TCAs expressed a
greater apprehension about medication overuse (10.7±0.3 vs. 9.7±0.2, P=0.002) on
the BMQ.
CONCLUSIONS: FGID subjects report medication necessity and concern scores
comparable to patients with SGID but have negative perceptions about medications,
particularly in the presence of psychiatric comorbidity; these factors may affect
treatment adherence and willingness to initiate neuromodulator regimens.
DOI: 10.1038/ajg.2015.132
PMCID: PMC5051635
1599. Eur Heart J Qual Care Clin Outcomes. 2016 Oct 1;2(4):237-244. doi:
10.1093/ehjqcco/qcw018.
The role of mHealth for improving medication adherence in patients with

cardiovascular disease: a systematic review.
Gandapur Y(1), Kianoush S(2), Kelli HM(3), Misra S(2), Urrea B(2), Blaha MJ(2),
Graham G(4)(5), Marvel FA(2), Martin SS(2).
Author information:
(1)Department of Internal Medicine, Good Samaritan/Union Memorial Hospital, 201
East University Parkway, Baltimore, MD 21218, USA.
(2)Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology,
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore,
MD, USA.
(3)Emory Clinical Cardiovascular Research Institute, Emory University School of
Medicine, Atlanta, GA, USA.
(4)Aetna Foundation, Hartford, CT, USA.
(5)University of Connecticut School of Medicine, Farmington, CT, USA.
Comment in
Eur Heart J Qual Care Clin Outcomes. 2016 Oct 1;2(4):231-232.
Cardiovascular disease is a leading cause of morbidity and mortality worldwide,

and a key barrier to improved outcomes is medication non-adherence. The aim of
this study is to review the role of mobile health (mHealth) tools for improving
medication adherence in patients with cardiovascular disease. We performed a
systematic search for randomized controlled trials that primarily investigated
mHealth tools for improving adherence to cardiovascular disease medications in
patients with hypertension, coronary artery disease, heart failure, peripheral
arterial disease, and stroke. We extracted and reviewed data on the types of
mHealth tools used, preferences of patients and healthcare providers, the effect
of the mHealth interventions on medication adherence, and the limitations of
trials. We identified 10 completed trials matching our selection criteria, mostly
with <100 participants, and ranging in duration from 1 to 18 months. mHealth
tools included text messages, Bluetooth-enabled electronic pill boxes, online
messaging platforms, and interactive voice calls. Patients and healthcare
providers generally preferred mHealth to other interventions. All 10 studies
reported that mHealth interventions improved medication adherence, though the
magnitude of benefit was not consistently large and in one study was not greater
than a telehealth comparator. Limitations of trials included small sample sizes,
short duration of follow-up, self-reported outcomes, and insufficient assessment
of unintended harms and financial implications. Current evidence suggests that
mHealth tools can improve medication adherence in patients with cardiovascular
diseases. However, high-quality clinical trials of sufficient size and duration
are needed to move the field forward and justify use in routine care.
DOI: 10.1093/ehjqcco/qcw018
PMCID: PMC5862021
1600. Patient Prefer Adherence. 2016 Dec 2;10:2449-2457. eCollection 2016.
Utility of the Morisky Medication Adherence Scale in gout: a prospective study.
Tan C(1), Teng GG(2), Chong KJ(3), Cheung PP(2), Lim A(2), Wee HL(4), Santosa
A(2).
Author information:
(1)University Medicine Cluster, Division of Rheumatology, National University
Health System.
(2)University Medicine Cluster, Division of Rheumatology, National University
Health System; Department of Medicine, Yong Loo Lin School of Medicine.
(3)Department of Medicine, Yong Loo Lin School of Medicine.
(4)Department of Pharmacy, Faculty of Science; Saw Swee Hock School of Public
Health, National University of Singapore, Singapore.
Erratum in
Patient Prefer Adherence. 2018 Apr 09;12 :527.
BACKGROUND: The outcomes of any chronic illness often depend on patients'

adherence with their treatment. A tool is lacking to assess adherence in gout
that is standardized, allows real-time feedback, and is easy to understand.
OBJECTIVE: We set out to evaluate the utility of the 8-item Morisky Medication
Adherence Scale (MMAS-8) in monitoring medication adherence in a multiethnic
Asian gout cohort on urate-lowering therapy (ULT).
METHODS: This cohort study recruited patients with gout where baseline and
6-monthly clinical data, self-report of adherence, and health status by Gout
Impact Scale (GIS) and EuroQoL-5 dimension 3 levels were collected. Those who
received at least 9 months of ULT were analyzed. Convergent and construct
validities of MMAS-8 were evaluated against medication possession ratio (MPR) and
known groups, clinical outcomes, and patient-reported outcomes. Internal
consistency and test-retest reliability were assessed using Cronbach's alpha and
intraclass correlation coefficient (ICC), respectively.
RESULTS: Of 91 patients, 92.3% were male, 72.5% Chinese with mean age 53.5 years.
MMAS-8 (mean 6.17) and MPR (mean 96.3%) were poorly correlated (r=0.069,
P=0.521). MMAS-8 did not differ between those who did or did not achieve target
serum urate (SU) <360 µmol/L (P=0.852); or among those whose SU improved,
stagnated, or worsened during follow-up (P=0.777). Adherence was associated with
age (β=0.256, P=0.015) and education level (P=0.011) but not comorbidities,
polypharmacy, or flare frequency. Concerns for medication side effects and
anxiety or depression were associated with lower MMAS-8 (P<0.005). Internal
consistency was acceptable (α=0.725) and test-retest reliability was satisfactory
(ICC =0.70, 95% confidence interval [CI] 0.36-0.88).
CONCLUSION: MMAS-8 had limited construct validity in assessing medication
adherence to ULT in our gout patients. Nevertheless, it identified patients
bothered or worried about ULT side effects, and those with underlying anxiety or
depression, for whom targeted education and coping support may be useful.
DOI: 10.2147/PPA.S119719
PMCID: PMC5144895
PMID: 27980395

this work.
1601. Rev Saude Publica. 2017 Sep 4;51:81. doi: 10.11606/S1518-8787.2017051006926.
Psychological model of ART adherence behaviors in persons living with HIV/AIDS in

Mexico: a structural equation analysis.
Sagarduy JLY(1), López JAP(2), Ramírez MTG(3), Dávila LEF(4).
Author information:
(1)Unidad de Trabajo Social y Ciencias para el Desarrollo Humano. Universidad
Autónoma de Tamaulipas. Ciudad Victoria, Tamaulipas, México.
(2)Investigador independiente. Hermosillo, Sonora, México.
(3)Facultad de Psicología. Universidad Autónoma de Nuevo León. Monterrey, NL,
México.
(4)Departamento de Psicología y Ciencias de la Comunicación. Universidad de
Sonora. Hermosillo, Sonora, México.
OBJECTIVE: The objective of this study has been to test the ability of variables
of a psychological model to predict antiretroviral therapy medication adherence
behavior.
METHODS: We have conducted a cross-sectional study among 172 persons living with
HIV/AIDS (PLWHA), who completed four self-administered assessments: 1) the
Psychological Variables and Adherence Behaviors Questionnaire, 2) the
Stress-Related Situation Scale to assess the variable of Personality, 3) The Zung
Depression Scale, and 4) the Duke-UNC Functional Social Support Questionnaire.
Structural equation modeling was used to construct a model to predict medication
adherence behaviors.
RESULTS: Out of all the participants, 141 (82%) have been considered 100%
adherent to antiretroviral therapy. Structural equation modeling has confirmed
the direct effect that personality (decision-making and tolerance of frustration)
has on motives to behave, or act accordingly, which was in turn directly related
to medication adherence behaviors. In addition, these behaviors have had a direct
and significant effect on viral load, as well as an indirect effect on CD4 cell
count. The final model demonstrates the congruence between theory and data
(x2/df. = 1.480, goodness of fit index = 0.97, adjusted goodness of fit index =
0.94, comparative fit index = 0.98, root mean square error of approximation =
0.05), accounting for 55.7% of the variance.
CONCLUSIONS: The results of this study support our theoretical model as a
conceptual framework for the prediction of medication adherence behaviors in
persons living with HIV/AIDS. Implications for designing, implementing, and
evaluating intervention programs based on the model are to be discussed.
DOI: 10.11606/S1518-8787.2017051006926
PMCID: PMC5574467
1602. BMC Nurs. 2016 Jan 14;15:4. doi: 10.1186/s12912-015-0121-7. eCollection 2016.
Nurses' perceptions of and satisfaction with the use of automated dispensing

cabinets at the Heart and Cancer Centers in Qatar: a cross-sectional study.
Zaidan M(1), Rustom F(2), Kassem N(3), Al Yafei S(3), Peters L(4), Ibrahim MI(5).
Author information:
(1)Pharmacy Department of NCCCR, and Pharmacy Department of Heart Hospital, Hamad
Medical Corporation, Doha, Qatar.
(2)Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
(3)Pharmacy Department NCCCR, Hamad Medical Corporation, Doha, Qatar.
(4)Nursing Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
(5)Social & Administrative Pharmacy, College of Pharmacy, Qatar University, PO
Box 2713, Doha, Qatar.
BACKGROUND: Automated dispensing cabinets (ADCs) were introduced in 2010 and 2012
at the Heart Hospital (HH) and National Center for Cancer Care and Research
(NCCCR), both run by Hamad Medical Corporation in Qatar. These medication
distribution systems provide computer-controlled storage, dispensing, and
tracking of drugs at the point of care in patient care units. The purpose of this
study was to assess nurses' perceptions of and satisfaction with the use of ADCs
at HH and NCCCR.
METHODS: A cross-sectional study was conducted in the two institutions in May and
November 2012 using a piloted, validated, online, and anonymous questionnaire.
The questionnaire consisted of four parts: nurses' sociodemographic and practice
characteristics, 21 questions about their perceptions, one question about their
overall satisfaction, and one about the system's ease of use. The
self-administered survey was distributed to 503 nurses working at HH and NCCCR
over three weeks using Survey Monkey®.
RESULTS: The survey response rate was 80 % (n = 403). No significant difference
was found in perception scores between the two institutions (p = 0.06).
Ninety-four percent (n = 378) of nurses agreed that the medication delivery
system allowed them to do their job more safely, and 90 % (n = 363) nurses agreed
that they now spent less time waiting for medication from the pharmacy than they
did before the ADC system was introduced. Eighty seven percent (n = 349) nurses
agreed that they were able to administer medication more efficiently with the ADC
system. The overall satisfaction rate (either "very satisfied" or "satisfied")
for the two hospitals was 91 %.
CONCLUSIONS: The nurses' perceptions of and levels of satisfaction with the ADC
system were very good over the 6 months after complete implementation and
integration at HH and NCCCR. ADCs appear to increase efficiency in the medication
process and should therefore improve the quality of care.
DOI: 10.1186/s12912-015-0121-7
PMCID: PMC4712505
PMID: 26770071
1603. Case Rep Psychiatry. 2017;2017:3701012. doi: 10.1155/2017/3701012. Epub 2017
Sep
10.
Trichloroacetic Acid Ingestion: Self-Harm Attempt.
Black ER(1).
Author information:
(1)Department of Psychiatry, Southern Illinois University, Springfield, IL 62702,
USA.
OBJECTIVE: Trichloroacetic acid (TCAA), or trichloroethanoic acid, is a chemical

analogue of acetic acid where three methyl group hydrogen atoms are replaced by
chlorine. TCAAs are also abbreviated and referred to as TCAs, causing confusion
with the psychiatric antidepressant drug class, especially among patients. TCAAs
exist in dermatological treatments such as chemical peels or wart chemoablation
medication. TCAA ingestion or overdose can cause gastric irritation symptoms
including vomiting, diarrhea, or lassitude. This symptomatology is less severe
than TCA overdose, where symptoms may include elevated body temperature, blurred
vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and
cardiac arrest. Owing to the vast difference in symptoms, the need for clinical
intervention differs greatly. While overdose of either in a self-harm attempt can
warrant psychiatric hospital admission, the risk of death in TCAA ingestion is
far less.
CASE REPORT: A patient ingested TCAA in the form of a commercially available
dermatological chemical peel as a self-harm attempt, thinking that it was a more
injurious TCA.
CONCLUSION: Awareness among physicians, particularly psychiatrists, regarding
this relatively obscure chemical compound (TCAA) and its use by suicidal patients
mistakenly believing it to be a substance that can be significantly more lethal
(TCA), is imperative.
DOI: 10.1155/2017/3701012
PMCID: PMC5610788
PMID: 29082058
1604. BMC Health Serv Res. 2018 Oct 11;18(1):772. doi: 10.1186/s12913-018-3572-1.
Improving medication adherence in stroke survivors: the intervention development

process.
Crayton E(1)(2), Wright AJ(3), Ashworth M(4).
Author information:
(1)Faculty of Life Sciences and Medicine, School of Population Health &
Environmental Sciences, King's College London, London, UK.
elise.crayton@kcl.ac.uk.
(2)Centre for Behaviour Change, University College London, 1-19 Torrington Place,
London, UK. elise.crayton@kcl.ac.uk.
(3)Centre for Behaviour Change, University College London, 1-19 Torrington Place,
London, UK.
(4)Faculty of Life Sciences and Medicine, School of Population Health &
Environmental Sciences, King's College London, London, UK.
BACKGROUND: Medications targeting stroke risk factors have shown good efficacy,
yet adherence is suboptimal. A lack of underlying theory may contribute to the
ineffectiveness of eliciting or sustaining behaviour change in many existing
interventions targeting medication adherence in stroke. Intervention
effectiveness and implementation could be enhanced by consideration of evidence
base and theory to drive development. The purpose of this study is to identify
appropriate components for a theory-driven and evidence-based medication
adherence intervention for stroke survivors.
METHODS: The Behaviour Change Wheel (BCW), a guide to intervention development,
informed our systematic process of intervention development. Our earlier
systematic review had identified important determinants of medication adherence
that were mapped into the Theoretical Domains Framework (TDF), with Knowledge,
Beliefs about consequences and Emotions found to be more influential. Utilising
the BCW facilitated selection of intervention options and behaviour change
techniques (BCTs); the active ingredients within an intervention. To further
refine BCT selection, APEASE criteria were employed, allowing evaluation of
potential BCTs within context: The National Health Service (NHS), United Kingdom
(UK).
RESULTS: Five intervention functions (Education, Persuasion, Training,
Environmental Restructuring and Enablement) and five policy categories
(Communication/marketing, Guidelines, Regulation, Environmental/social planning
and Service provision) were identified as potential intervention options,
underpinned by our systematic review findings. Application of APEASE criteria led
to an initial pool of 21 BCTs being reduced to 11 (e.g. Habit Formation,
Information about Health Consequences and Action Planning) identified as
potential intervention components that would both be feasible and directly target
the underlying determinants of stroke survivors' medication adherence.
CONCLUSIONS: Careful consideration of underlying evidence and theory to drive
intervention design, facilitated by the BCW, enabled identification of
appropriate intervention components. BCTs including Habit Formation, Information
about Health Consequences and Self-monitoring of Behaviour were considered
potentially effective and appropriate to deliver within the NHS. Having reduced
the pool of potential intervention components to a manageable number, it will now
be possible to explore the perceived acceptability of selected BCTs in interviews
with stroke survivors and healthcare professionals. This approach to intervention
development should be generalisable to other chronic conditions and areas of
behaviour change (e.g. exercise adherence).
DOI: 10.1186/s12913-018-3572-1
PMCID: PMC6182841
1605. BMC Geriatr. 2017 Jan 11;17(1):14. doi: 10.1186/s12877-016-0408-x.
Diabetes mellitus medication use and catastrophic healthcare expenditure among

adults aged 50+ years in China and India: results from the WHO study on global
AGEing and adult health (SAGE).
Gwatidzo SD(1), Stewart Williams J(2)(3).
Author information:
(1)Umeå International School of Public Health, Unit of Epidemiology and Global
Health, Department of Public Health and Clinical Medicine, Faculty of Medicine,
Umeå University, SE-90185, Umeå, Sweden. shingai.gwatidzo@outlook.com.
(2)Unit of Epidemiology and Global Health, Department of Public Health and
Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185, Umeå, Sweden.
(3)Research Centre for Gender, Health and Ageing, Faculty of Health, University
of Newcastle, New Lambton Heights, Newcastle, NSW 2305, New South Wales,
Australia.
BACKGROUND: Expenditure on medications for highly prevalent chronic conditions

such as diabetes mellitus (DM) can result in financial impoverishment. People in
developing countries and in low socioeconomic status groups are particularly
vulnerable. China and India currently hold the world's two largest DM
populations. Both countries are ageing and undergoing rapid economic development,
urbanisation and social change. This paper assesses the determinants of DM
medication use and catastrophic expenditure on medications in older adults with
DM in China and India.
METHODS: Using national standardised data collected from adults aged 50 years and
above with DM (self-reported) in China (N = 773) and India (N = 463),
multivariable logistic regression describes: 1) association between respondents'
socio-demographic and health behavioural characteristics and the dependent
variable, DM medication use, and 2) association between DM medication use
(independent variable) and household catastrophic expenditure on medications
(dependent variable) (China: N = 630; India: N = 439). The data source is the
World Health Organization (WHO) Study on global AGEing and adult health (SAGE)
Wave 1 (2007-2010).
RESULTS: Prevalence of DM medication use was 87% in China and 71% in India.
Multivariable analysis indicates that people reporting lifestyle modification
were more likely to use DM medications in China (OR = 6.22) and India
(OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56).
Respondents in poorer wealth quintiles in China were more likely to use DM
medications whereas the reverse was true in India. Almost 17% of people with DM
in China experienced catastrophic healthcare expenditure on medications compared
with 7% in India. Diabetes medication use was not a statistically significant
predictor of catastrophic healthcare expenditure on medications in either
country, although the odds were 33% higher among DM medications users in China
(OR = 1.33).
CONCLUSIONS: The country comparison reflects major public policy differences
underpinned by divergent political and ideological frameworks. The DM epidemic
poses huge public health challenges for China and India. Ensuring equitable and
affordable access to medications for DM is fundamental for healthy ageing
cohorts, and is consistent with the global agenda for universal healthcare
coverage.
DOI: 10.1186/s12877-016-0408-x
PMCID: PMC5225610
1606. Innov Clin Neurosci. 2016 Oct 1;13(9-10):12-19. eCollection 2016 Sep-Oct.
Performance, Reliability, Usability, and Safety of the ID-Cap System for

Ingestion Event Monitoring in Healthy Volunteers: A Pilot Study.
Flores GP(1), Peace B(1), Carnes TC(1), Baumgartner SL(1), Buffkin DE Jr(1),
Euliano NR(1), Smith LN(1).
Author information:
(1)Drs. Flores, Carnes, Euliano, Mr. Peace, and Mr. Buffkin are with etectRx,
Inc. in Newberry, Florida; and Drs. Baumgartner and Smith are from Gainesville,
Florida.
Background: Nonadherence to prescribed medications is an important consideration

in the clinical management of patients and in clinical research and drug
development. The ID-Cap System is a novel technology that provides an objective
measure of medication ingestion and enables real-time reporting of verified
medication adherence data at the dose level. The ID-Cap System consists of an
ingestible microsensor that is embedded in an oral dosage form and, once
activated by stomach fluid, communicates digital messages to an external wearable
reader to confirm ingestion. Objective: The objective of this exploratory study
was to evaluate the performance, reliability, usability, and safety of the ID-Cap
System for remote monitoring of 20 ingestion events over four weeks in 20 healthy
volunteers. Design: This study was an open-label, single-arm, exploratory study
of the ID-Cap System. The study design included the following three phases: 1)
screening phase, 2) treatment phase consisting of 20 daily capsule ingestion
events over a four-week period, and 3) follow-up phase consisting of a follow-up
study visit that included an abdominal X-ray and a follow-up phone call. The
initial use of the ID-Cap Reader and ingestion of the first study capsule were
directly observed by the investigator during the first study visit. Subsequent
study capsule ingestions were completed outside the research facility at the
study participant's home or other location of his or her choice with ingestion
assessed using the ID-Cap System. Setting: The study was conducted at a single
clinical research site in Gainesville, Florida. Participants: Twenty healthy
volunteers were enrolled in this four-week pilot study that was conducted between
September and November 2014. Measurements: Study measurements included ID-Tag
detection indicating capsule ingestion, utilization of the ID-Cap System
consistent with instructions for use, adverse event reports, discontinuations of
the System during the study, and safety assessments related to excretion of the
ID-Tags through abdominal X-ray evaluations. Results: Positive detection accuracy
was 100 percent for the 20 directly observed ingestions of study capsules that
occurred during the initial study visits. Of the 384 ingestion events that were
self-administered by the study participants without direct observation, 371 were
accurately detected using the ID-Cap System. Overall adherence to the prescribed
study capsules as measured by the ID-Cap System was 97.75 percent (391
detections/400 expected ingestion events). Significant intra-individual and
inter-individual variability in the timing of self-administered doses was
observed in this study. No adverse events were reported, and no study
participants discontinued use of the ID-Cap System for any reason during the
study. There was no evidence indicating retention of ID-Tags based on abdominal
X-ray evaluations. Conclusion: The ID-Cap System enables accurate measurement of
medication adherence for oral drug therapy at the dose level. This study supports
the clinical validation of the technology and feasibility in using the system for
the collection and real-time reporting of medication adherence in the clinical
management of patients and in clinical research and drug development.
PMCID: PMC5141592
PMID: 27974996
1607. Parasit Vectors. 2017 Jun 6;10(1):284. doi: 10.1186/s13071-017-2217-2.
Assessment of dog owner adherence to veterinarians' flea and tick prevention

recommendations in the United States using a cross-sectional survey.
Lavan RP(1), Tunceli K(2), Zhang D(2), Normile D(3), Armstrong R(3).
Author information:
(1)Outcomes Research, Animal Health, Center for Observational and Real-World
Evidence, Merck & Co., Inc, Kenilworth, NJ, USA. Robert.lavan@merck.com.
(2)Outcomes Research, Animal Health, Center for Observational and Real-World
Evidence, Merck & Co., Inc, Kenilworth, NJ, USA.
(3)MSD Animal Health, 2 Giralda Farms, Madison, NJ, USA.
BACKGROUND: Adherence to a prescribed therapeutic regimen is a critical factor

for achieving medication effectiveness and therefore treatment success. In the
case of companion animal ectoparasite control, suboptimal owner adherence to
medication recommendations is thought to be a common cause of treatment failure,
and previous reports have found pet owners applying an average of 4.0-4.6 monthly
flea and tick treatments per year to their dogs. This study investigated: US
veterinary hospital self-reported flea and tick prevention recommendations; dog
owner recollection of these recommendations; dog owner opinion on flea/tick
recommendations and estimated owner flea and tick medication adherence based on
veterinary hospital purchase records.
RESULTS: Veterinarians at 24 veterinary hospitals in 4 United States regions
provided their flea and tick prevention recommendations. Five hundred fifty-nine
dog owners, clients of the 24 hospitals, completed a survey evaluating their
recollection of the hospitals' recommendations and their opinions regarding
required treatment frequency. Almost all veterinary hospitals in this study
recommended 12 months of flea and tick prevention but only 62% of participating
dog owners recalled this recommendation. The average owner response was that
their dogs require 10.5 months of flea and tick prevention annually. Owner
opinions were significantly different among U.S. regions with pet owners in the
northeast U.S. believing that they needed significantly less canine flea and tick
protection than pet owners in other parts of the United States. The estimated
actual flea and tick prevention coverage was 6.1 months based on owner medication
purchases over a 12-month period.
CONCLUSIONS: In the United States, dog owner opinions and actions show that their
flea and tick treatment adherence falls short of veterinarians' recommendations.
DOI: 10.1186/s13071-017-2217-2
PMCID: PMC5460448
1608. Przegl Epidemiol. 2016;70(1):27-32, 115-8.
Adherence to antiviral therapy in HIV or HBV-infected patients.
Wójcik K(1), Piekarska A(1), Jabłonowska E(1).
Author information:
(1)Medical University of Lodz, Department of Infectious Diseases and Hepatology.
BACKGROUND: Antiviral therapies in HIV and chronic HBV infection are lifelong and
require strict adherence to medication to ensure therapeutic success.
AIMS: The aim of this study was to analyze adherence levels in HIV patients on
antiretroviral regimen and in B-infected patients treated with nucleos(t)ide
reverse transcriptase inhibitors.
MATERIAL AND METHODS: The study group consisted of 134 HIV-infected patients and
42 with chronic hepatitis B. The self-reported Morisky 8-Item Medication
Adherence Scale (MMAS-8) was used to assess the adherence to medication. We
analyzed potential predictors of optimal adherence to the antiretroviral therapy.
RESULTS: Mean adherence levels according to MMAS-8 in HIV-infected patients on
antiretroviral therapy was 6.64 (SD+/- 1.47) and was significant lower than in
patients with chronic hepatitis B 7.48 (SD+/- 1.40) (p < 0.0001). However,
adherence levels in HIV-infected patients treated with One-pill-Once a-day
antiretroviral regimen were similar to patients with chronic hepatitis B
(p>0.05). In univariante logistic regression alcohol abstinence, sexual route of
HIV transmission, once daily dosing and reduced number of pills were
significantly associated with high adherence. According to multivariante logistic
regression analysis, only once-daily drug regimen was independent factor of high
adherence (OR=2.89, p=0.038). Higher adherence had positive impact on the
effectiveness of antiretroviral therapy (p=0.04).
CONCLUSIONS: The implementation of once-daily antiretroviral regimen has improved
adherence that had beneficial effect on the effectiveness of antiretroviral
therapy.
Assessing the knowledge, perception and practices of physicians and pharmacists

towards medication reconciliation in Kuwait governmental hospitals: a
Lemay J(1), Bayoud T(2), Husain H(1), Sharma P(3).
Author information:
(1)Faculty of Pharmacy, Department of Pharmacology & Therapeutics, Kuwait
University - Shuwaikh Campus, Shuwaikh, Kuwait.
(2)Faculty of Pharmacy, Department of Pharmacy Practice, Kuwait University -
Shuwaikh Campus, Shuwaikh, Kuwait.
(3)Dasman Diabetes Institute, Kuwait City, Kuwait.
OBJECTIVES: To assess the knowledge, perception and practices towards medication

reconciliation (MedRec) and its related institutional policies among physicians
and pharmacists in governmental hospitals in Kuwait and identifying potential
obstacles that prevent the successful implementation of MedRec.
DESIGN: A descriptive, cross-sectional study.
SETTING: Six governmental hospitals across Kuwait in January-May 2017.
PARTICIPANTS: 351 physicians and 214 pharmacists.
BRIEF INTERVENTION: A self-administered questionnaire distributed to the
participants.
MAIN OUTCOME MEASURES: Knowledge, perception, attitudes and practices of hospital
physicians and pharmacists towards MedRec, and major barriers to implementing a
MedRec process in their institution/department.
RESULTS: Of the 739 questionnaires distributed, 565 were completed (351
physicians and 214 pharmacists), giving a response rate of 76.5%. Results showed
that most participants were familiar with the term MedRec (n=419; 75.2%) with
significantly more pharmacists compared with physicians (n=171; 81.8% vs n=248;
71.3%; p=0.005). Most participants (n=432; 80.0%) reported perceiving MedRec as a
valuable process for patient safety. However, significantly more physicians
compared with pharmacists were aware of a MedRec policy in their institution
(n=195; 55.9% vs n=78; 37.9%; p<0.001) and routinely asked patients about their
current list of medication on arrival (n=339; 96.6% vs n=129; 61.1%; p<0.001) and
provided an updated list on discharge (n=281; 80.1% vs n=107; 52.0%; p<0.001).
These results are supported by the findings that participants perceived
physicians as providers, mainly responsible for various steps of MedRec.
CONCLUSIONS: Overall, this study showed low awareness among physicians and
pharmacists of hospital policy despite MedRec being perceived as valuable.
Physicians were the providers most responsible and involved in MedRec, who may be
driven by the policy putting them at core of the process. The current findings
could pave the way for the expansion of the existing MedRec policies and
processes in Kuwait to include pharmacists and improve patient safety.

DOI: 10.1136/bmjopen-2018-027395
PMCID: PMC6589008
PMID: 31209092
1610. Contraception. 2019 Feb;99(2):118-124. doi:

10.1016/j.contraception.2018.10.007.
Epub 2018 Nov 15.
Support for and interest in alternative models of medication abortion provision

among a national probability sample of U.S. women.
Biggs MA(1), Ralph L(2), Raifman S(2), Foster DG(2), Grossman D(2).
Author information:
(1)Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for
Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive
Sciences, University of California San Francisco, Oakland, CA 94612, USA.
Electronic address: antonia.biggs@ucsf.edu.
(2)Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for
Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive
Sciences, University of California San Francisco, Oakland, CA 94612, USA.
OBJECTIVE: The objective was to assess women's personal interest in and support
for three alternative models of medication abortion (MA) provision.
STUDY DESIGN: Using an online survey of a U.S. national, probability-based
representative sample of women ages 18-49, we gauged personal interest in and
general support for three alternative models for accessing abortion pills: (1) in
advance from a doctor for future use, (2) over-the-counter (OTC) from a drugstore
and (3) online without a prescription. We conducted multivariable analyses to
identify characteristics associated with support for these provision models.
RESULTS: Fifty percent (n=7022) of eligible women invited completed the survey.
Nearly half (49%) supported and 30% were personally interested in one or more of
the three access models; 44% supported advance provision, 37% supported OTC
access, and 29% supported online access. Common advantages reported for advance
provision, OTC and online access included privacy (49%, 29% and 46%,
respectively), convenience (38%, 44% and 38%) and being able to end the pregnancy
earlier (48%, 40% and 29%). Common disadvantages included concern that women
might take the pills incorrectly (55%, 53% and 57%), not seeing a clinician
before the abortion (52%, 54% and 53%) and safety (42%, 43% and 60%). History of
abortion and experiencing barriers accessing reproductive health services were
associated with greater support for the alternative models.
CONCLUSION: Women are interested in and support alternative models of MA
provision, in particular, advance provision. However, they also reported concerns
about incorrect pill use and not seeing a clinician beforehand.
IMPLICATIONS: Offering women more choices in how they access medication abortion,
including options where they can safely self-manage their own care, has the
potential to expand access to care.
PMID: 30448203
1611. Int J Environ Res Public Health. 2019 Aug 23;16(17). pii: E3060. doi:
10.3390/ijerph16173060.
Measurement of Key Constructs in a Holistic Framework for Assessing

Self-Management Effectiveness of Pediatric Asthma.
Rangachari P(1), May KR(2), Stepleman LM(3), Tingen MS(4), Looney S(5), Liang
Y(6), Rockich-Winston N(7), Rethemeyer RK(8).
Author information:
(1)Department of Interdisciplinary Health Sciences, College of Allied Health
Sciences, Augusta University, Augusta, GA 30912, USA. prangachari@augusta.edu.
(2)Division of Allergy-Immunology and Pediatric Rheumatology, Department of
Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA 30912,
USA.
(3)Department of Psychiatry & Health Behavior, Medical College of Georgia,
Augusta University, Augusta, GA 30912, USA.
(4)Georgia Prevention Institute, Medical College of Georgia, Augusta University,
Augusta, GA 30912, USA.
(5)Department of Population Health Sciences, Medical College of Georgia, Augusta
University, Augusta, GA 30912, USA.
(6)Department of Interdisciplinary Health Sciences, College of Allied Health
Sciences, Augusta University, Augusta, GA 30912, USA.
(7)Department of Pharmacology & Toxicology, Medical College of Georgia, Augusta
University, Augusta, GA 30912, USA.
(8)Rockefeller College of Public Affairs & Policy, University at Albany, State
University of New York, Albany, NY 12222, USA.
The 2007 U.S. National Institutes of Health EPR-3 guidelines emphasize the
importance creating a provider-patient partnership to enable patients/families to
monitor and take control of their asthma, so that treatment can be adjusted as
needed. However, major shortfalls continue to be reported in provider adherence
to EPR-3 guidelines. For providers to be more engaged in asthma management, they
need a comprehensive set of resources for measuring self-management effectiveness
of asthma, which currently do not exist. In a previously published article in the
Journal of Asthma and Allergy, the authors conducted a literature review, to
develop a holistic framework for understanding self-management effectiveness of
pediatric asthma. The essence of this framework, is that broad socioecological
factors can influence self-agency (patient/family activation), to impact
self-management effectiveness, in children with asthma. A component of
socio-ecological factors of special relevance to providers, would be the quality
of provider-patient/family communication on asthma management. Therefore, the
framework encompasses three key constructs: (1) Provider-patient/family
communication; (2) Patient/family activation; and (3) Self-management
effectiveness. This paper conducts an integrative review of the literature, to
identify existing, validated measures of the three key constructs, with a view to
operationalizing the framework, and discussing its implications for asthma
research and practice.
DOI: 10.3390/ijerph16173060
PMID: 31443605
1612. JMIR Mhealth Uhealth. 2019 Mar 25;7(3):e12535. doi: 10.2196/12535.
Mobile Health Features Supporting Self-Management Behavior in Patients With

Chronic Arthritis: Mixed-Methods Approach on Patient Preferences.
Geuens J(1), Geurts L(1), Swinnen TW(2)(3), Westhovens R(2)(3), Vanden Abeele
V(1).
Author information:
(1)e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium.
(2)Division of Rheumatology, Universitaire Ziekenhuizen Gasthuisberg, University
Hospitals Leuven, Leuven, Belgium.
(3)Department of Development and Regeneration, Skeletal Biology and Engineering
Research Center, Katholieke Universiteit Leuven, Leuven, Belgium.
BACKGROUND: Patients with chronic arthritis (CA) ideally apply self-management

behaviors between consultations. This enduring, tedious task of keeping track of
disease-related parameters, adhering to medication schemes, and engaging in
physical therapy may be supported by using a mobile health (mHealth) app.
However, further research is needed to determine which self-management features
are valued most by adult patients with CA patients.
OBJECTIVE: The aim of this study was to determine the preference of features for
an mHealth app to support self-management behavior in patients with CA. In
addition, we aimed to explore the motives behind these ratings.
METHODS: A mixed-methods approach was used to gather information from 31 adult
patients (14 females), aged 23 to 71 years (mean 51 [SD 12.16]), with CA.
Structured interviews were conducted to gather data pertaining to preferences of
app features. Interviews were analyzed qualitatively, whereas ratings for each of
the 28 features studied were analyzed quantitatively.
RESULTS: In general, patients with CA favored the use of features pertaining to
supporting active and direct disease management, (eg, medication intake and
detecting and alarming of bad posture), helping them to keep a close watch on
their disease status and inform their health care professional (eg, providing a
means to log and report disease-related data) and receiving personalized
information (eg, offering tailored information based on the patient's health
data). Patients strongly disliked features that provide a means of social
interaction or provide incentivization for disease-related actions (eg, being
able to compare yourself with other patients, cooperating toward a common goal,
and receiving encouragement from friends and/or family). Driving these
evaluations is the finding that every patient with CA hurts in his/her own way,
the way the disease unfolds over time and manifests itself in the patient and
social environment is different for every patient, and patients with CA are well
aware of this.
CONCLUSIONS: We have offered an insight into how patients with CA favor mHealth
features for self-management apps. The results of this research can inform the
design and development of prospective self-management apps for patients with CA.
©Jonas Geuens, Luc Geurts, Thijs W Swinnen, Rene Westhovens, Vero Vanden Abeele.
Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org),
25.03.2019.
DOI: 10.2196/12535
PMCID: PMC6452281
PMID: 30907737
1613. Health Expect. 2017 Oct;20(5):1114-1120. doi: 10.1111/hex.12556. Epub 2017

Mar
17.
"I have nine specialists. They need to swap notes!" Australian patients'
perspectives of medication-related problems following discharge from hospital.
Eassey D(1), McLachlan AJ(1)(2), Brien JA(1), Krass I(1), Smith L(1).
Author information:
(1)Faculty of Pharmacy Camperdown, The University of Sydney, Sydney, NSW,
Australia.
(2)Centre for Education and Research on Ageing, Concord Repatriation General
Hospital, Concord, NSW, Australia.
BACKGROUND: Research has shown that patients are most susceptible to
medication-related problems (MRPs) when transitioning from hospital to home.
Currently, the literature in this area focuses on interventions, which are mainly
orientated around the perspective of the health-care professional and do not take
into account patient perspectives and experiences.
OBJECTIVE: To capture the experiences and perceptions of Australian patients
regarding MRPs following discharge from hospital.
DESIGN: A cross-sectional study was conducted using a questionnaire collecting
quantitative and qualitative data. Thematic analysis was conducted of the
qualitative data.
SETTING AND PARTICIPANTS: Survey participants were recruited through The Digital
Edge, an online market research company. Five hundred and six participants
completed the survey.
RESULTS: A total of 174 participants self-reported MRPs. Two concepts and seven
subthemes emerged from the analysis. The first concept was types of MRPs and
patient experiences. Three themes were identified: unwanted effects from
medicines, confusion about medicines and unrecognized medicines. The second
concept was patient engagement in medication management, of which four themes
emerged: informing patients, patient engagement, communication amongst
health-care professionals and conflicting advice.
DISCUSSION AND CONCLUSION: This study provides an important insight into
patients' experiences and perceptions of MRPs following discharge from hospital.
Future direction for practice and research should look into implementing
patient-centred care at the time of hospital discharge to ensure the provision of
clear and consistent information, and developing ways to support and empower
patients to ensure a smooth transition post-discharge from hospital.
© 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.
DOI: 10.1111/hex.12556
PMCID: PMC5600251
1614. BMC Nephrol. 2017 Jan 31;18(1):42. doi: 10.1186/s12882-017-0449-1.
Medication adherence in randomized controlled trials evaluating cardiovascular or

mortality outcomes in dialysis patients: A systematic review.
Murali KM(1), Mullan J(2), Chen JH(3), Roodenrys S(4), Lonergan M(3).
Author information:
(1)Department of Nephrology, Wollongong Hospital, Wollongong, NSW, 2500,
Australia. karumathil.murali@health.nsw.gov.au.
(2)Graduate School of Medicine, University of Wollongong, Wollongong, NSW,
Australia.
(3)Department of Nephrology, Wollongong Hospital, Wollongong, NSW, 2500,
Australia.
(4)School of Psychology, University of Wollongong, Wollongong, NSW, Australia.
BACKGROUND: Medication non-adherence is common among renal dialysis patients.

High degrees of non-adherence in randomized controlled trials (RCTs) can lead to
failure to detect a true treatment effect. Cardio-protective pharmacological
interventions have shown no consistent benefit in RCTs involving dialysis
patients. Whether non-adherence contributes to this lack of efficacy is unknown.
We aimed to investigate how medication adherence and drug discontinuation were
assessed, reported and addressed in RCTs, evaluating cardiovascular or mortality
outcomes in dialysis patients.
METHODS: Electronic database searches were performed in MEDLINE, EMBASE &
Cochrane CENTRAL for RCTs published between 2005-2015, evaluating
self-administered medications, in adult dialysis patients, which reported
clinical cardiovascular or mortality endpoints, as primary or secondary outcomes.
Study characteristics, outcomes, methods of measuring and reporting adherence,
and data on study drug discontinuation were analyzed.
RESULTS: Of the 642 RCTs in dialysis patients, 22 trials (12 placebo controlled),
which included 19,322 patients, were eligible. The trialed pharmacological
interventions included anti-hypertensives, phosphate binders, lipid-lowering
therapy, cardio-vascular medications, homocysteine lowering therapy, fish oil and
calcimimetics. Medication adherence was reported in five trials with a mean of
81% (range: 65-92%) in the intervention arm and 84.5% (range: 82-87%) in the
control arm. All the trials that reported adherence yielded negative study
outcomes for the intervention. Study-drug discontinuation was reported in 21
trials (mean 33.2%; 95% CI, 22.0 to 44.5, in intervention and 28.8%; 95% CI, 16.8
to 40.8, in control). Trials with more than 20% study drug discontinuation, more
often yielded negative study outcomes (p = 0.018). Non-adherence was included as
a contributor to drug discontinuation in some studies, but the causes of
discontinuation were not reported consistently between studies, and non-adherence
was listed under different categories, thereby potentiating the misclassification
of adherence.
CONCLUSIONS: Reporting of medication adherence and study-drug discontinuation in
RCTs investigating cardiovascular or mortality endpoints in dialysis patients are
inconsistent, making it difficult to compare studies and evaluate their impact on
outcomes. Recommendations for consistent reporting of non-adherence and causes of
drug discontinuation in RCTs will therefore help to assess their impact on
clinical outcomes.
DOI: 10.1186/s12882-017-0449-1
PMCID: PMC5282698
1615. World J Diabetes. 2019 Jun 15;10(6):341-349. doi: 10.4239/wjd.v10.i6.341.
Diabetes self-care in primary health facilities in India - challenges and the way
forward.
Basu S(1), Sharma N(2).
Author information:
110002, India. saurav.basu.mph@gmail.com.
110002, India.
India has approximately 73 million people living with diabetes and another 37
million with prediabetes while nearly 47% of the diabetes cases are undiagnosed.
The high burden of poor glycemic control and early onset of complications with
associated economic costs indicates a high prevalence of poor self-management
practices. It is well-established that achieving patient-centered primary care
consistent with a chronic care model ensures optimum diabetes self-management
support and improves long-term clinical and health outcomes in diabetes patients.
The public sector primary care system in India provides services free of cost to
beneficiaries but lacks patient-centered care that undermines diabetes
self-management education and support. Furthermore, factors like poor patient
knowledge of diabetes, suboptimal medication adherence, persistent clinical
inertia, lack of data for monitoring and evaluation through clinical audit
worsens the standards of diabetes care in primary care settings of India. There
is a need for government initiatives to be directed towards the provision of
comprehensive outpatient care that is inclusive of uninterrupted supply of drugs,
provision of essential laboratory investigators, training and availability of
qualified diabetes educators and availability of specialist support when
required. Furthermore, the integration of depression screening and smoking
cessation services at the primary care level is warranted.
DOI: 10.4239/wjd.v10.i6.341
PMCID: PMC6571487
PMID: 31231457
Conflict of interest statement: Conflict-of-interest statement: The authors have

no conflicts of interest to declare.
1616. J Health Commun. 2015;20 Suppl 2:34-42. doi: 10.1080/10810730.2015.1080331.
Medication Nonadherence Before Hospitalization for Acute Cardiac Events.
Kripalani S(1)(2)(3), Goggins K(2)(3), Nwosu S(4), Schildcrout J(4), Mixon

AS(1)(2)(3)(5), McNaughton C(6), McDougald Scott AM(3)(6)(7), Wallston KA(8);
Vanderbilt Inpatient Cohort Study.
Collaborators: Bell SP, Cawthon C, Couey C, Donato KM, Fuentes V, Harrell FE,
Hendrickson B, Leak C, Lewis D, Meyers AG, Rothman RL, Schnelle JF, Vasilevskis
EE, Wright KH.
Author information:
(1)a Section of Hospital Medicine, Division of General Internal Medicine and
Public Health, Department of Medicine , Vanderbilt University Medical Center ,
Nashville , Tennessee , USA.
(2)b Center for Clinical Quality and Implementation Research , Vanderbilt
University Medical Center , Nashville , Tennessee , USA.
(3)c Center for Health Services Research , Vanderbilt University Medical Center ,
(4)d Department of Biostatistics , Vanderbilt University Medical Center ,
(5)e Department of Veterans Affairs , Tennessee Valley Healthcare System
Geriatric Research Education and Clinical Center , Nashville , Tennessee , USA.
(6)f Department of Emergency Medicine , Vanderbilt University Medical Center ,
(7)g Department of Biomedical Informatics , Vanderbilt University Medical Center
, Nashville , Tennessee , USA.
(8)h School of Nursing , Vanderbilt University Medical Center , Nashville ,
Tennessee , USA.
Medication nonadherence increases the risk of hospitalization and poor outcomes,

particularly among patients with cardiovascular disease. The purpose of this
study was to examine characteristics associated with medication nonadherence
among adults hospitalized for cardiovascular disease. Patients in the Vanderbilt
Inpatient Cohort Study who were admitted for acute coronary syndrome or heart
failure completed validated assessments of self-reported medication adherence
(the Adherence to Refills and Medications Scale), demographic characteristics,
health literacy, numeracy, social support, depressive symptoms, and health
competence. We modeled the independent predictors of nonadherence before
hospitalization, standardizing estimated effects by each predictor's
interquartile range. Among 1,967 patients studied, 70.7% indicated at least some
degree of medication nonadherence leading up to their hospitalization. Adherence
was significantly lower among patients with lower health literacy (0.18-point
change in adherence score per interquartile range change in health literacy),
lower numeracy (0.28), lower health competence (0.30), and more depressive
symptoms (0.52) and those of younger age, of non-White race, of male gender, or
with less social support. Medication nonadherence in the period before
hospitalization is more prevalent among patients with lower health literacy,
numeracy, or other intervenable psychosocial factors. Addressing these factors in
a coordinated care model may reduce hospitalization rates.
DOI: 10.1080/10810730.2015.1080331
PMCID: PMC4705844
1617. Ann Med Health Sci Res. 2015 Jan-Feb;5(1):59-64. doi: 10.4103/2141-
9248.149791.
Self-care activities among patients with diabetes attending a tertiary care

hospital in mangalore karnataka, India.
Rajasekharan D(1), Kulkarni V(1), Unnikrishnan B(1), Kumar N(1), Holla R(1),
Thapar R(1).
Author information:
(1)Department of Community Medicine, Kasturba Medical College (Affiliated to
Manipal University), Mangalore, Karnataka, India.
BACKGROUND: Increasing prevalence of diabetes in India is resulting in an

epidemiological transition. The care of the people with diabetes is traditionally
seen as doctor centered, but the concept of self-care of people with diabetes is
a new domain and is proven beneficial.
AIM: The aim was to determine the practice of self-care activities among people
with diabetes attending a tertiary care hospital in Mangalore.
SUBJECTS AND METHODS: A facility-based cross-sectional study was conducted in
Government Wenlock Hospital, Mangalore during September-October 2012. A total of
290 patients with >1-year duration of diabetes mellitus (DM) were asked to
respond to summary diabetes self-care activities questionnaire after obtaining
the consent from them. The statistical analysis was performed in terms of
descriptive statistics and association between the variables was tested using
Mann-Whitney U-test.
RESULTS: A healthy eating plan on a daily basis was followed by 45.9% (133/290)
of the participants, daily exercises for 30 min were followed by 43.4% (126/290),
and regular blood sugar monitoring was done by 76.6% (222/290). Regarding the
adherence to oral hypoglycemic agents and insulin, daily adherence to medication
was seen among 60.5% (155/256) and 66.9% (138/206) were found to be adherent to
insulin injections on a daily basis.
CONCLUSIONS: Self-care practices were found to be unsatisfactory in almost all
aspects except for blood sugar monitoring and treatment adherence. As these
practices are essential for prevention of complications and better quality-of
-life, more efforts should be put to educate the people with diabetes.
DOI: 10.4103/2141-9248.149791
PMCID: PMC4350065
PMID: 25745579
1618. J Vis Exp. 2017 Jan 29;(119). doi: 10.3791/53305.
A Method for Evaluating the Reinforcing Properties of Ethanol in Rats without

Water Deprivation, Saccharin Fading or Extended Access Training.
Augier E(1), Dulman RS(2), Singley E(2), Heilig M(3).
Author information:
(1)Center for Social and Affective Neuroscience, IKE, Linköping University;
eric.augier@liu.se.
(2)Laboratory of Clinical and Translational Studies, National Institute on
Alcohol Abuse and Alcoholism, National Institutes of Health.
(3)Center for Social and Affective Neuroscience, IKE, Linköping University.
Operant oral self-administration methods are commonly used to study the

reinforcing properties of ethanol in animals. However, the standard methods
require saccharin/sucrose fading, water deprivation and/or extended training to
initiate operant responding in rats. This paper describes a novel and efficient
method to quickly initiate operant responding for ethanol that is convenient for
experimenters and does not require water deprivation or saccharin/sucrose fading,
thus eliminating the potential confound of using sweeteners in ethanol operant
self-administration studies. With this method, Wistar rats typically acquire and
maintain self-administration of a 20% ethanol solution in less than two weeks of
training. Furthermore, blood ethanol concentrations and rewards are positively
correlated for a 30 min self-administration session. Moreover, naltrexone, an
FDA-approved medication for alcohol dependence that has been shown to suppress
ethanol self-administration in rodents, dose-dependently decreases alcohol intake
and motivation to consume alcohol for rats self-administering 20% ethanol, thus
validating the use of this new method to study the reinforcing properties of
alcohol in rats.
DOI: 10.3791/53305
PMCID: PMC5352301
1619. Int J Nurs Sci. 2017 Jul 6;4(3):260-265. doi: 10.1016/j.ijnss.2017.06.010.

eCollection 2017 Jul 10.
Predictors of diabetes self-management among type 2 diabetics in Indonesia:

Application theory of the health promotion model.
Kurnia AD(1), Amatayakul A(2), Karuncharernpanit S(3).
Author information:
(1)Nursing Department, Faculty of Health Science, University of Muhammadiyah
Malang, Indonesia.
(2)Faculty of Nursing, H.R.H Princess Chulabhorn's College of Medical Science,
Thailand.
(3)Boromarajonani College of Nursing Chakriraj, Thailand.
Objective: This study aimed to identify factors predicting diabetes

self-management among adults with type 2 diabetes mellitus in Malang City, East
Java, Indonesia.
Methods: A cross-sectional design was used in this study. Participants were
selected from five primary health centers in Malang City, East Java, Indonesia
using the multistage sampling method. A total of 127 adults with type 2 diabetes
mellitus were recruited. Data were collected by questionnaires which were the
general diabetes knowledge, the Beliefs of Treatment Effectiveness, the Diabetes
Distress Scale, the Self-efficacy for Diabetes Scale, the brief Chronic Illness
Resources Survey, the Situational Questionnaire and the Summary of Diabetes
Self-care Activities. A self-administered questionnaire was used to collect the
data. Multiple linear regression with stepwise method was used toanalyze the
data.
Results: The scores of seven questionnaires (i.e, diabetes knowledge, perceived
benefit of diabetes self-management, diabetes distress, perceived self-efficacy,
social support, situational influence, and diabetes self-management) were
13.75 ± 3.59, 34.9 ± 4.89, 3.03 ± 0.86, 3.60 ± 0.53, 27.79 ± 5.56,
3.27 ± 0.58,3.81 ± 1.08, respectively. The significant predictors of diabetes
self-management were treatment, perceived self-efficacy, and situational
influences. These variables explained 20.8% (adjusted R 2 = 0.208) of the
variance in diabetes self-management among adults with type 2 diabetes mellitus
in Malang City.
Conclusion: Diabetes self-management among adults with type 2 diabetes mellitus
could be improved by enhancing their perceived self-efficacy to achieve their
self-management behavior, such as having a healthy diet, exercising regularly,
actively monitoring blood glucose level, taking medication and foot care, and
providing support to promote good situational influence.
DOI: 10.1016/j.ijnss.2017.06.010
PMCID: PMC6626170
PMID: 31406750
1620. J Diabetes Sci Technol. 2015 Dec 20;10(1):35-41. doi:

10.1177/1932296815622453.
A Digital Ecosystem of Diabetes Data and Technology: Services, Systems, and Tools
Enabled by Wearables, Sensors, and Apps.
Heintzman ND(1).
Author information:
(1)Dexcom Inc, San Diego, CA, USA nheintzman@dexcom.com.
The management of type 1 diabetes (T1D) ideally involves regimented measurement

of various health signals; constant interpretation of diverse kinds of data; and
consistent cohesion between patients, caregivers, and health care professionals
(HCPs). In the context of myriad factors that influence blood glucose dynamics
for each individual patient (eg, medication, activity, diet, stress, sleep
quality, hormones, environment), such coordination of self-management and
clinical care is a great challenge, amplified by the routine unavailability of
many types of data thought to be useful in diabetes decision-making. While much
remains to be understood about the physiology of diabetes and blood glucose
dynamics at the level of the individual, recent and emerging medical and consumer
technologies are helping the diabetes community to take great strides toward
truly personalized, real-time, data-driven management of this chronic disease.
This review describes "connected" technologies--such as smartphone apps, and
wearable devices and sensors--which comprise part of a new digital ecosystem of
data-driven tools that can link patients and their care teams for precision
management of diabetes. These connected technologies are rich sources of
physiologic, behavioral, and contextual data that can be integrated and analyzed
in "the cloud" for research into personal models of glycemic dynamics, and
employed in a multitude of applications for mobile health (mHealth) and
telemedicine in diabetes care.
DOI: 10.1177/1932296815622453
PMCID: PMC4738231
1621. Glob J Health Sci. 2016 Oct 1;8(10):55593. doi: 10.5539/gjhs.v8n10p57.
Reliability and Validity of the Korean-Parental Self-Efficacy with Eczema Care

Index.
Lee H(1), Son HK, Kim JS, Han MY, Noh G.
Author information:
(1)Department of Nursing, College of Nursing, Yonsei University, Seoul, Korea.
dream0211@hanmail.net.
BACKGROUND: Atopic dermatitis is a global problem affecting children, and its

prevalence in Korea is steadily increasing. Since it is a chronically relapsing
inflammatory skin disease, caregiver management of young children's atopic
dermatitis is crucial for positive treatment outcomes. A factor that contributes
to adherence to recommended prescriptions is parents' self-efficacy. However,
accurate measurements of parental self-efficacy in relation to disease-specific
task management are scarce.
OBJECTIVES: This study examined the psychometric properties of the Korean
language version of the Parental Self-Efficacy with Eczema Care Index (K-PASECI).
METHODS: One hundred twenty five mothers of children younger than 13 years old
who had atopic dermatitis were recruited from three tertiary hospitals across
Korea. The K-PASECI was developed in accordance with the published guidelines.
Psychometric testing included factor analysis, internal consistency testing, and
concurrent validity analysis by comparing K-PASECI domains with parenting
self-efficacy subscales.
RESULTS: Factor analysis revealed a four-factor structure that explained 69.4% of
the variance. The four factors were as follows; managing a child's symptoms and
behaviour, communicating with medical staff, managing medication, and using
moisturizer as part of routine management. The findings showed acceptable
internal consistency (α=.94) and a moderate positive correlation with parenting
self-efficacy (r=.48, p<.001).
CONCLUSION: The K-PASECI, a reliable and valid scale for measuring self-efficacy
in parents caring for children with atopic dermatitis, may be used in clinical
and research settings to measure parents' self-efficacy in Korea, as well as in
other English-speaking countries.
DOI: 10.5539/gjhs.v8n10p57
PMID: 27302444
1622. J Asthma Allergy. 2017 Apr 12;10:111-122. doi: 10.2147/JAA.S133481.

eCollection
2017.
A framework for measuring self-management effectiveness and health care use among
pediatric asthma patients and families.
Rangachari P(1).
Author information:
(1)College of Allied Health Sciences, Augusta University, Augusta, GA, USA.
Asthma is associated with substantial health care expenditures, including an

estimated US$56 billion per year in direct costs. A recurring theme in the asthma
management literature is that costly asthma symptoms, including hospitalizations
and multiple emergency department (ED)/outpatient visits, can often be prevented
through patient/family adherence to the national (National Institutes of Health
Expert Panel Report-3) guidelines for effective self-management of asthma,
specifically 1) medication adherence and 2) environmental trigger avoidance, as
outlined in the patient's personalized Asthma-Action Plan. It is important to
note however that while effective self-management of asthma is known to reduce ED
visits and hospitalizations, the relationship between asthma self-management
effectiveness and outpatient visit frequency remains ambiguous, reflecting a gap
in the literature. For instance, do patients/families who self-manage effectively
visit outpatient clinics more frequently for asthma care (compared to those who
do not self-manage effectively), after accounting for differences in asthma
severity, demographic characteristics, and risk factors? Do patients/families who
visit outpatient clinics more frequently for asthma care, in turn have fewer ED
and inpatient encounters for asthma? On the other hand, do patients/families who
do not revisit outpatient clinics regularly have higher ED visits and
hospitalizations? It is important to address these gaps, in order to reduce the
costs and public health burden of asthma. This paper provides a foundation for
addressing these gaps, by conducting an integrative review of the asthma
management literature, to develop a conceptual framework for measuring
self-management effectiveness and health care use among pediatric asthma
patients/families. In doing so, the paper lays the groundwork for future research
seeking to explicate the relationship between asthma self-management
effectiveness and health care use, which in turn has potential to engage asthma
providers in promoting ideal self-management and optimal health care use for
pediatric asthma, in accordance with national evidence-based guidelines for
asthma management.
DOI: 10.2147/JAA.S133481
PMCID: PMC5396924
PMID: 28442924
Conflict of interest statement: Disclosure The author has no conflicts of

interest to declare in this work.
1623. Psychol Res Behav Manag. 2016 Jan 21;9:7-20. doi: 10.2147/PRBM.S36238.
eCollection 2016.
The influence of cognition on self-management of type 2 diabetes in older people.
Tomlin A(1), Sinclair A(1).
Author information:
(1)Institute of Diabetes for Older People, University of Bedfordshire, Luton,
Bedfordshire, UK.
Diabetes is a growing public health issue, increasing in prevalence, eroding

quality of life, and burdening health care systems. The complications of diabetes
can be avoided or delayed by maintaining good glycemic control, which is
achievable through self-management and, where necessary, medication. Older people
with diabetes are at increased risk for cognitive impairment. This review aims to
bring together current research that has investigated both cognition and diabetes
self-management together. The Cumulative Index to Nursing and Allied Health
(Cinahl), Excerpta Medica Database (Embase), Medical Literature Analysis and
Retrieval System (Medline), and Psychological Information (PsychInfo) databases
were searched. Studies were included if they featured older people with type 2
diabetes and had looked for associations between at least one distinct measure of
cognition and at least one distinct measure of diabetes self-management. English
language publications from the year 2000 were included. Cognitive measures of
executive function, memory, and low scores on tests of global cognitive
functioning showed significant correlations with multiple areas of diabetes
self-management, including diabetes-specific numeracy ability, diabetes
knowledge, insulin adjustment skills, ability to learn to perform insulin
injections, worse adherence to medications, decreased frequency of self-care
activities, missed appointments, decreased frequency of diabetes monitoring, and
increased inaccuracies in reporting blood glucose monitoring. The nature of the
subjects studied was quite variable in terms of their disease duration, previous
medical histories, associated medical comorbidities, and educational level
attained prior to being diagnosed with diabetes. The majority of studies were of
an associational nature and not findings confirmed by repeat testing or by the
effects of an intervention, neither were the majority of studies designed to give
a view or conclusion on the clinical value or implications of the research. This
only allows speculation of their importance. Most studies do not separate out the
influence of aging itself in altering diabetes self-care behavior. We conclude
that older people with type 2 diabetes are at increased risk for cognitive
dysfunction. Changes in cognition may negatively affect diabetes self-management
behaviors, influencing self-care outcomes. Age and depression may exacerbate any
cognitive impairment.
DOI: 10.2147/PRBM.S36238
PMCID: PMC4727517
PMID: 26855601
1624. BMC Public Health. 2014 Sep 24;14:993. doi: 10.1186/1471-2458-14-993.
Adherence to antiretroviral therapy during pregnancy and the first year

postpartum among HIV-positive women in Ukraine.
Bailey H(1), Thorne C, Malyuta R, Townsend CL, Semenenko I, Cortina-Borja M;

Ukraine European Collaborative Study Group in EuroCoord.
Collaborators: Pilipenko T, Zayats A, Posokhova S, Kaleeva T, Barishnikova Y,

Servetsky S, Teretsenko R, Stelmah A, Kiseleva G, Dotsenko E, Zalata O, Solokha
S, Grazhdanov M, Kulakovskaya E, Bashkatova N, Gigil V, Raus I, Yurchenko O,
Adeyanova I, Ruban Z, Govorun O, Ostrovskaya O, Kochergina I, Kvasha L, Kruglenko
G, Primak N.
Author information:
(1)Population Policy and Practice Programme, UCL Institute of Child Health,
University College London, 30 Guilford Street, London WC1N 1EH, UK.
heather.bailey@ucl.ac.uk.
BACKGROUND: Poor adherence to antiretroviral therapy (ART) is associated with HIV

disease progression and, during pregnancy, increased mother-to-child transmission
risk. In Ukraine, access to combination ART is expanding but data on adherence
are scarce.
METHODS: Cross-sectional surveys of HIV-positive women were conducted i) at
delivery (on antenatal ART adherence) and ii) during the first year postpartum
(on ART adherence in the preceding four weeks). Factors associated with a score ≤
11 on the self-report Case Adherence Support Evaluation (CASE) index or ≥ 1
self-reported missed dose were assessed using Fisher's exact test.
RESULTS: Of 185 antenatal participants and 102 postnatal participants, median
ages were 27.5 and 29.5 years respectively: 28% (50/180) and 27% (26/98) reported
an unplanned pregnancy, and 13% (24/179) and 17% (17/98) an illicit drug-use
history (excluding marijuana). One quarter (49/180 antenatally, 27/101
postnatally) screened positive for depression. The proportion reporting 'low'
ART-related self-efficacy (i.e. unable to do ≥ 1/5 ART-taking activities) was 20%
(28/141) antenatally and 17% (11/66) postnatally. Antenatally, 14% (95% CI
10-21%) had a CASE score ≤ 11 and 35% (95% CI 28-42%) reported missing ≥ 1 dose.
Factors associated with a CASE score ≤ 11 were unplanned pregnancy (25% (12/48)
vs. 11% (13/120) where planned, p = 0.03) and living with extended family (23%
(13/57) vs. 10% (12/125) living with partner/alone, p = 0.04). Self-report of ≥ 1
missed dose antenatally was additionally associated with younger age (p = 0.03)
and lower self-efficacy (50% (14/28) reported ≥ 1 missed dose vs. 28% (30/108) of
those with high self-efficacy, p = 0.04). Of 102 postnatal participants, 8% (95%
CI 4-15%) had a CASE score ≤ 11 and 31% (95% CI 22-41%) reported ≥ 1 missed dose.
Of 11 women with low self-efficacy, 3 (27%) had a CASE score ≤ 11 compared with
3/55 (5%) of those with high self-efficacy (p = 0.05). Current smokers more
commonly reported ≥ 1 missed dose postnatally (50% (13/26) vs. 25% (18/72) of
non-smokers, p = 0.03).
CONCLUSIONS: Our results highlight unmet needs for counselling and support. We
identify some groups at risk of poor ART adherence, including women with markers
of social vulnerability and those with low ART-related self-efficacy, who may
benefit from targeted interventions.
DOI: 10.1186/1471-2458-14-993
PMCID: PMC4180980
1625. Respir Res. 2017 May 8;18(1):86. doi: 10.1186/s12931-017-0566-1.
Rescue medication use as a patient-reported outcome in COPD: a systematic review

and regression analysis.
Punekar YS(1), Sharma S(2), Pahwa A(2), Takyar J(2), Naya I(3), Jones PW(4).
Author information:
(1)Health Outcomes, ViiV Healthcare, 980 Great West Road, Brentford, Middlesex,
TW8 9GS, UK. yogesh.q.punekar@gsk.com.
(2)PAREXEL® Access Consulting, PAREXEL® International, Chandigarh, India.
(3)Respiratory Medical, GSK, Brentford, Middlesex, UK.
(4)Institute of Infection and Immunity, St George's, University of London,
London, UK.
BACKGROUND: Reducing rescue medication use is a guideline-defined goal of asthma

treatment, however, little is known about the validity of rescue medicine use as
a marker of symptoms in chronic obstructive pulmonary disease (COPD). To improve
patient outcomes, greater insight is needed into the relationship between rescue
medication use and alternative COPD outcomes.
METHODS: A systematic search of electronic databases (Embase®, MEDLINE® and
Cochrane CENTRAL) was conducted from database start to 26 May, 2015. Studies of
bronchodilator therapy with a duration of ≥24 weeks were included if they
reported either mean change from baseline (CFB) in rescue medication use in
puffs/day or % rescue-free days (%RFD), and at least one other COPD endpoint.
Correlation and meta-regression analyses were undertaken to test the association
between rescue medication use and other COPD outcomes using weighted means
(weights proportional to the sample size of the treatment group) and unweighted
means (equal weight for each treatment group). Each association was assessed at
6 months and study end.
RESULTS: Forty-six studies involving 46,531 patients provided mean data from 145
treatment groups for evaluation. Changes in both measures of rescue medication
use were correlated with changes in trough forced expiratory volume in one second
([FEV1]; Pearson correlation coefficients |r| ≥ 0.63; p < 0.0001) and with St
George's Respiratory Questionnaire (SGRQ) score (|r| ≥ 0.70; p < 0.0001) at study
end. Change in rescue medication use in puffs/day during the study correlated
with annualized rates of moderate/severe exacerbations at 6 months and study end
(both r = 0.66; p ≤ 0.0028). CFB in puffs/day was not well correlated with
Transition Dyspnoea Index (TDI), but %RFD did correlate with TDI score at
6 months and study end (both r = 0.69; p < 0.0001). The values for CFB in
puffs/day corresponding to the proposed minimal clinically important differences
for trough FEV1 and SGRQ score were -1.3 and -0.6 puffs/day, respectively. A -1.0
puffs/day CFB in rescue use corresponded to a change of 0.26 events/patient-year
in moderate/severe exacerbations.
CONCLUSION: This analysis provides clear evidence of associations at a patient
group level between rescue medication use and other clinically important COPD
outcomes.
DOI: 10.1186/s12931-017-0566-1
PMCID: PMC5422957
1626. Drug Healthc Patient Saf. 2014 Oct 24;6:155-65. doi: 10.2147/DHPS.S68786.
eCollection 2014.
Predictors of poor glycemic control in type 2 diabetic patients attending public

hospitals in Dar es Salaam.
Kamuhabwa AR(1), Charles E(1).
Author information:
(1)Unit of Pharmacology and Therapeutics, School of Pharmacy, Muhimbili
University of Health and Allied Sciences, Dar es Salaam, Tanzania.
BACKGROUND: Tanzania has recently experienced a significant rise in the burden of

diabetes, and it is estimated that more than 400,000 people are living with
diabetes. A major concern in the management of diabetes is the occurrence of
diabetic complications that occur as a result of poor glycemic control.
Identification of the factors associated with poor glycemic control is important
in order to institute appropriate interventions for the purpose of improving
glycemic control and prevention of chronic complications.
AIM: The aim of this study was to determine the level of glycemic control and
explore the factors associated with poor glycemic control among patients with
type 2 diabetes mellitus (T2DM).
METHODOLOGY: A cross-sectional study was carried out at the diabetic clinics for
T2DM patients at the national and municipal hospitals in Dar es Salaam. A total
of 469 patients were enrolled over a period of 8 weeks from March 2013 to May
2013. Patients' information such as sociodemographic characteristics, self-care
management behaviors, and medication adherence were obtained through interviews.
Blood pressure, weight, and height were measured during the day of the interview.
All available last readings for fasting blood glucose (FBG) measurements, lipid
profile, and other clinical characteristics were obtained from patients' records.
RESULTS: The mean age of patients was 54.93 years. The majority (63.5%) of
patients were females and only eight patients had records of lipid profile
measurements. Out of 469 patients, 69.7% had FBG of ≥7.2 mmol/L, indicating poor
glycemic control. Females aged between 40 years and 59 years had significantly
higher poor glycemic control (76.1%) as compared with their male counterparts.
Thirty-eight percent of patients had poor medication adherence, which was
associated with poor glycemic control. The proportion of poor glycemic control
increased with age. A significantly high proportion of poor glycemic control was
observed in patients who had had the disease for more than 20 years since
diagnosis. Factors associated with poor glycemic control included lack of health
insurance, using more than one oral hypoglycemic agent, normal body mass index,
obesity, and nonadherence to diabetic medications.
CONCLUSION: Patients in this study had generally poor glycemic control. From
these findings it is recommended that diabetic patients should be routinely
screened for lipid profile to determine levels of cholesterol, triglycerides, and
low-density lipoproteins, which are risk factors for cardiovascular events. An
education program should be developed to educate patients on the importance of
medication adherence and weight management for better glycemic control.
DOI: 10.2147/DHPS.S68786
PMCID: PMC4216043
PMID: 25368533
1627. Asia Pac J Oncol Nurs. 2016 Jul-Sep;3(3):259-265.
Challenges in Cancer Self-management of Patients with Limited English

Proficiency.
Chou FY(1), Kuang LY(2), Lee J(3), Yoo GJ(4), Fung LC(5).
Author information:
(1)School of Nursing, San Francisco State University, San Francisco, CA, USA.
(2)Department of Nursing, Chinese Hospital, San Francisco, CA, USA.
(3)Physical Therapy, San Francisco State University, San Francisco, CA, USA.
(4)Asian American Studies, San Francisco State University, San Francisco, CA,
USA.
(5)Health Education, Chinatown Public Health Center, San Francisco, CA, USA.
OBJECTIVE: This paper summarizes the barriers and challenges in cancer care
reported from a validation project of a self-management intervention handbook
from Chinese-American cancer patients with limited English proficiency (LEP).
METHODS: Seven health-care providers (HCPs) and 16 Chinese-American cancer
survivors with LEP were invited to validate a self-management intervention
handbook through networking sampling method. Bilingual versions were developed
and validated using the repeated translation process. Online and paper-based
survey and interview were conducted to collect information on the perception of
barriers and experiences on cancer care. Data were analyzed by the content
analysis method.
RESULTS: The HCPs reported a bilingual self-management handbook which is useful
and feasible for patient self-management. The challenges in giving cancer care to
LEP patients included: patients do not engage in discussion, different cultural
health beliefs, unable to speak to patients in their primary language, and
patients are less likely to discuss emotional and social challenges during
treatments. The common barriers and experiences during cancer care included:
limited understanding about treatment/medication and side effects, language
barriers such as unable to communicate to make the decision, unable to understand
information related to resources and do not know what questions to ask, and do
not know what to expect during their cancer treatment.
CONCLUSIONS: The current findings highlight the need of cancer self-management
support for culturally diverse LEP cancer patients. Further research can include
applying the supportive intervention to all LEP cancer patients.
DOI: 10.4103/2347-5625.189815
PMCID: PMC5123524
PMID: 27981169
1628. NPJ Prim Care Respir Med. 2017 Apr 24;27(1):29. doi: 10.1038/s41533-017-0031-
0.
Practice makes perfect: self-reported adherence a positive marker of inhaler
technique maintenance.
Azzi E(1), Srour P(2), Armour C(2)(3), Rand C(4), Bosnic-Anticevich S(2)(3).
Author information:
(1)Woolcock Institute of Medical Research, University Of Sydney, Sydney, NSW,
Australia. elizabeth.azzi@sydney.edu.au.
(2)Woolcock Institute of Medical Research, University Of Sydney, Sydney, NSW,
Australia.
(3)Sydney Local Health District, Sydney, NSW, Australia.
(4)Department of Medicine, John Hopkins University, Baltimore, MD, USA.
Poor inhaler technique and non-adherence to treatment are major problems in the
management of asthma. Patients can be taught how to achieve good inhaler
technique, however maintenance remains problematic, with 50% of patients unable
to demonstrate correct technique. The aim of this study was to determine the
clinical, patient-related and/or device-related factors that predict inhaler
technique maintenance. Data from a quality-controlled longitudinal community care
dataset was utilized. 238 patients using preventer medications where included.
Data consisted of patient demographics, clinical data, medication-related factors
and patient-reported outcomes. Mixed effects logistic regression was used to
identify predictors of inhaler technique maintenance at 1 month. The variables
found to be independently associated with inhaler technique maintenance using
logistic regression (Χ 2 (3,n = 238) = 33.24, p < 0.000) were inhaler technique
at Visit 1 (OR 7.1), device type (metered dose inhaler and dry powder inhalers)
(OR 2.2) and self-reported adherent behavior in the prior 7 days (OR 1.3). This
research is the first to unequivocally establish a predictive relationship
between inhaler technique maintenance and actual patient adherence, reinforcing
the notion that inhaler technique maintenance is more than just a physical skill.
Inhaler technique maintenance has an underlying behavioral component, which
future studies need to investigate.ASTHMA: BEHAVIORAL ELEMENT TO CORRECT
LONG-TERM INHALER TECHNIQUES: Patients who consciously make an effort to perfect
asthma inhaler technique will maintain their skills long-term. Elizabeth Azzi at
the University of Sydney, Australia, and co-workers further add evidence that
there is a strong behavioral component to patients retaining correct inhaler
technique over time. Poor inhaler technique can limit asthma control, affecting
quality of life and increasing the chances of severe exacerbations. Azzi's team
followed 238 patients to determine the key predictors of inhaler technique
maintenance from factors including age, asthma knowledge and perceived future
risks. Correct inhaler technique at initial assessment was the strongest
predictor of long-term success, but this was strengthened further when patients
reported good adherence to their own medication regimen. This suggests that
maintaining correct inhaler technique is more than just a physical skill. Careful
guidance towards this 'practice makes perfect' approach may improve patients'
long-term technique maintenance.
DOI: 10.1038/s41533-017-0031-0
PMCID: PMC5435088
Association between depressive symptoms, use of antidepressant medication and the

metabolic syndrome: the Maine-Syracuse Study.
Crichton GE(1), Elias MF(2)(3), Robbins MA(2)(3).

Author information:
(1)Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom
Institute for Health Research, University of South Australia, GPO Box 2471,
Adelaide, South Australia, 5001, Australia. georgina.crichton@unisa.edu.au.
(2)Department of Psychology, University of Maine, Orono, ME, USA.
(3)Graduate School of Biomedical Sciences and Engineering, University of Maine,
Orono, ME, USA.
BACKGROUND: Both depression and the metabolic syndrome (MetS) are two major
public health issues. The aim of this study was to examine associations between
depressive symptoms, the use of antidepressant medications, and the prevalence of
MetS.
METHODS: Cross-sectional analyses were undertaken on 970 participants from the
Maine-Syracuse Study. Depressive symptoms were measured using two self-reported
depression scales, the Center for Epidemiological Studies Depression Scale
(CES-D), and the Zung self-rating depression scale. Antidepressant medication use
was also self-reported. MetS was defined according to the recent harmonized
criteria.
RESULTS: The risk of MetS were approximately 79 and 86 % higher for those in the
highest quartile for the CESD and the Zung (CES-D: OR = 1.79, p = 0.003; Zung:
OR = 1.71, p = 0.006), compared to those in the lowest quartile. With adjustment
for socio-demographic variables, lifestyle factors and C-reactive protein (CRP),
risk was attenuated, but remained statistically significant for the CES-D. In
those who reported using antidepressant medication, the odds of having MetS were
over 2-fold higher (OR = 2.22, p < 0.001, fully adjusted model), compared to
those who did not use antidepressants. Both measures of depressed mood were also
associated with low high density-lipoprotein (HDL) cholesterol levels.
Antidepressant use was associated with elevated fasting plasma glucose
concentrations, hypertension, and low HDL-cholesterol.
CONCLUSION: Depressive symptoms and the use of antidepressant medications are
associated with the prevalence of MetS, and with some of the individual
components of the syndrome.
DOI: 10.1186/s12889-016-3170-2
PMCID: PMC4902917
1630. Pan Afr Med J. 2019 May 6;33:4. doi: 10.11604/pamj.2019.33.4.16963.

eCollection
2019.
Prevalence and determinants of self referrals to a District-Regional Hospital in

KwaZulu Natal, South Africa: a cross sectional study.
Pillay I(1), Mahomed OH(2).
Author information:
(1)Stanger Hospital and Discipline of Public Health Medicine, University of
KwaZulu Natal, Durban, South Africa.
(2)Discipline of Public Health Medicine; University of KwaZulu Natal, Durban,
South Africa.
Introduction: Self-referrals to inappropriate levels of care result in an

increased patient waiting time, overburdening of higher levels of care, reduced
primary healthcare utilisation rate and increasing healthcare costs. Furthermore,
self-referral places an additional encumbrance on various levels of care as
allocation of resources and infrastructure cannot be accurately planned, based on
the facility catchment population. The aim of this study was to determine the
prevalence and determinants of patient self-referral at the out-patient
department of Stanger Hospital, KwaZulu-Natal between January and June 2017.
Methods: A cross-sectional study was conducted at the out-patient department in
Stanger Hospital, using interviewer administered questionnaires to collect
information from 385 patients, through convenience sampling, between January and
June 2017. Multivariable regression analysis was used to test for factors
associated with self-referral.
Results: of the 385 patients interviewed 36% (n = 138) were self-referrals. Most
of the self-referrals were male (51.5%) and of the African race (57.2%). Five
institutional factors namely: care received from healthcare workers (91.3%);
waiting times (88.4%); help offered (87%); treatment and attitude of healthcare
workers (63%) and availability of medication (55.8%) were considered as the main
drivers of self-referral. Multivariable regression analysis established a
significant positive association between patient self-referral and age (40 years
and below), attitude of healthcare workers, quality of care received form
healthcare workers, waiting times and the availability of diagnostic tests.
Conclusion: This study indicates that most patients attending Stanger Hospital do
comply with the prescribed referral pathway, however a significant proportion
still bypass the referral system.
DOI: 10.11604/pamj.2019.33.4.16963
PMCID: PMC6607454
Conflict of interest statement: The authors declare no competing interests.
1631. Games Health J. 2015 Oct;4(5):362-74. doi: 10.1089/g4h.2015.0014. Epub 2015

Jun
26.
Clinical and Neurobiological Perspectives of Empowering Pediatric Cancer Patients

Using Videogames.
Govender M(1), Bowen RC(2), German ML(2), Bulaj G(3), Bruggers CS(1)(2)(4)(5).
Author information:
(1)1 Division of Hematology-Oncology, University of Utah School of Medicine ,
Salt Lake City, Utah.
(2)2 Department of Pediatrics, University of Utah School of Medicine , Salt Lake
City, Utah.
(3)3 Department of Medicinal Chemistry, College of Pharmacy, University of Utah ,
Salt Lake City, Utah.
(4)4 Huntsman Cancer Institute, University of Utah School of Medicine , Salt Lake
City, Utah.
(5)5 Primary Children's Hospital , Salt Lake City, Utah.
Pediatric oncology patients often experience fatigue and physical and mental
deconditioning during and following chemotherapy treatments, contributing to
diminished quality of life. Patient empowerment is a core principle of
patient-centered care and reflects one's ability to positively affect his or her
own health behavior and health status. Empowerment interventions may enhance
patients' internal locus of control, resilience, coping skills, and
self-management of symptoms related to disease and therapy. Clinical and
technological advancements in therapeutic videogames and mobile medical
applications (mobile health) can facilitate delivery of the empowerment
interventions for medical purposes. This review summarizes clinical strategies
for empowering pediatric cancer patients, as well as their relationship with
developing a "fighting spirit" in physical and mental health. To better
understand physiological aspects of empowerment and to elucidate videogame-based
intervention strategies, brain neuronal circuits and neurotransmitters during
stress, fear, and resilience are also discussed. Neuroimaging studies point to
the role of the reward system pathways in resilience and empowerment in patients.
Taken together, videogames and mobile health applications open translational
research opportunities to develop and deliver empowerment interventions to
pediatric cancer patients and also to those with other chronic diseases.
DOI: 10.1089/g4h.2015.0014
PMCID: PMC4545566
1632. Epidemiology. 2017 Sep;28(5):747-752. doi: 10.1097/EDE.0000000000000695.
Validation of Self-reported Diagnosis of Gestational Diabetes at 6-weeks

Postpartum.
Hinkle SN(1), Rawal S, Zhu Y, Grewal J, Albert PS, Zhang C.
Author information:
(1)From the aEpidemiology Branch, Division of Intramural Population Health
Research, Eunice Kennedy Shriver National Institute of Child Health and Human
Development, National Institutes of Health, Bethesda, MD; bDivision of Research,
Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA; cOffice of the
Director, Division of Intramural Population Health Research, Eunice Kennedy
Shriver National Institute of Child Health and Human Development, National
Institutes of Health, Bethesda, MD; and dBiostatistics and Bioinformatics Branch,
Division of Intramural Population Health Research, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of
Health, Bethesda, MD.
BACKGROUND: Self-report is often used in identifying gestational diabetes events

in epidemiologic studies; however, validity data are limited, with little to no
data on self-reported severity or treatment.
METHODS: We aimed to assess the validity of self-reported gestational diabetes
diagnosis and evaluate the accuracy of glucose diagnosis results and gestational
diabetes treatment self-reported at 6-week postpartum. Data were from 82 and 83
women with and without gestational diabetes, respectively, within the prospective
National Institute Child Health and Human Development Fetal Growth
Studies-Singletons (2009-2013). Medical record data were considered the gold
standard.
RESULTS: Sensitivity was 95% (95% confidence interval [CI] = 88, 98), and
specificity was 100% (95% CI = 96, 100); four women with gestational diabetes
incorrectly reported not having the disease, and none of the women without
gestational diabetes reported having gestational diabetes. Sensitivity did not
vary substantially across maternal characteristics including race/ethnicity. For
women who attempted to recall their values (84/159 women), self-reported glucose
challenge test results did not differ from the medical records (median
difference: 0; interquartile range: 0-0 mg/dl). Medical records indicated that 42
(54%) of 78 women with confirmed gestational diabetes were treated by diet only
and 33 (42%) were treated by medication. All 42 women with diet-treated
gestational diabetes correctly reported having had diet and lifestyle
modification, and 28 (85%) of 33 women with medication-treated gestational
diabetes indicated postpartum that they had medication treatment.
CONCLUSIONS: At 6-week postpartum, regardless of race/ethnicity or socioeconomic
status, women accurately recalled whether they had gestational diabetes and, as
applicable, their treatment method.
DOI: 10.1097/EDE.0000000000000695
PMCID: PMC5538910
1633. J Couns Psychol. 2016 Jul;63(4):452-9. doi: 10.1037/cou0000142. Epub 2016 Feb
11.
Dependency and self-criticism in treatments for depression.
Chui H(1), Zilcha-Mano S(2), Dinger U(3), Barrett MS(4), Barber JP(1).
Author information:
(1)Derner Institute of Advanced Psychological Studies.
(2)Department of Psychology, University of Haifa.
(3)Department for General Internal Medicine and Psychosomatics, University of
Heidelberg.
(4)Department of Psychiatry, University of Pennsylvania.
Dependency and self-criticism are vulnerability factors for depression. How these
personality factors change with treatment for depression and how they relate to
symptom change across different types of treatment require further research. In
addition, cultural differences that interact with the
dependency/self-criticism-depression relation remain underinvestigated. We
randomly assigned 149 adults with major depression to receive active medication
(MED; n = 50), supportive-expressive therapy (SET; n = 49), or placebo pill (PBO;
n = 50). Participants completed the Depressive Experiences Questionnaire (DEQ;
Blatt, D'Afflitti, & Quinlan, 1976) before and after treatment and completed the
Hamilton Rating Scale for Depression (Hamilton, 1967) throughout the course of
treatment. Self-criticism as measured on the DEQ decreased with treatment
similarly across conditions. DEQ Dependency decreased in MED but remained
unchanged in SET and PBO. Higher initial dependency, but not higher initial
self-criticism, predicted poor treatment response across conditions. Greater
reduction in self-criticism was associated with greater reduction in depressive
symptoms, but the effect was weaker for racial minorities (vs. White). Increase
in connectedness, an adaptive form of dependency, was associated with symptom
improvement in SET but not MED. Hence, different pathways of change seem to be
implicated in the treatment of depression depending on culture and type of
intervention. Implications for future research are discussed. (PsycINFO Database
Record
DOI: 10.1037/cou0000142
PMCID: PMC4935564
1634. J Pediatr Psychol. 2017 Oct 1;42(9):910-921. doi: 10.1093/jpepsy/jsw092.
Testing the Utility of a Bio-Neuropsychosocial Model for Predicting Medical

Adherence and Responsibility During Early Adolescence in Youth With Spina Bifida.
Psihogios AM(1)(2), Murray C(1), Zebracki K(3)(4), Acevedo L(1), Holmbeck GN(1).
Author information:
(1)Loyola University Chicago.
(2)The Children's Hospital of Philadelphia.
(3)Shriners Hospitals for Children.
(4)Northwestern University Feinberg School of Medicine.
Objectives: The present longitudinal, multi-method, and multi-informant study

examined biological, neuropsychological, and social predictors of medical
adherence and responsibility among early adolescents with spina bifida (SB).
Methods: Youth with SB (M age = 11.40 at Time 1) and their parents and teachers
completed surveys, and families and peers completed observational assessments, at
two biennial data collection time points (n = 112 for both time points).
Multinomial logistic regressions tested predictors of group membership (adherent
vs. nonadherent and child responsible vs. not responsible with SB medical tasks).
Results: Consistent with the bio-neuropsychosocial model, several risk factors
emerged for SB management. Impaired gross motor classification and low IQ were
barriers to obtaining medical responsibility, and high family stress and
executive dysfunction were barriers to adherence and responsibility.
Conclusions: This study offered intervention targets to promote self-management
and adherence for youth with SB and their families, including parent
stress-management and family problem-solving.
DOI: 10.1093/jpepsy/jsw092
PMCID: PMC6251535
1635. J Clin Hypertens (Greenwich). 2016 Feb;18(2):101-8. doi: 10.1111/jch.12682.

Epub
2015 Oct 12.
Improved Blood Pressure Control Using an Interactive Mobile Phone Support System.
Bengtsson U(1)(2), Kjellgren K(1)(2), Hallberg I(1)(2), Lindwall M(2)(3), Taft

C(1)(2).
Author information:
(1)Institute of Health and Care Science, Sahlgrenska Academy, University of
(2)University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden.
(3)Department of Food, Nutrition and Sport Science, Department of Psychology,
University of Gothenburg, Gothenburg, Sweden.
This explorative, longitudinal study evaluated the effect of the daily use of a
mobile phone-based self-management support system for hypertension in reducing
blood pressure (BP) among 50 primary care patients with hypertension over 8
weeks. The self-management system comprises modules for (1) self-reports of BP,
pulse, lifestyle, symptoms, and well-being; (2) delivery of reminders and
encouragements; and (3) graphical feedback of self-reports. Daily use of the
support system significantly reduced BP (systolic BP -7 mm Hg, diastolic BP -4.9
mm Hg) between baseline and week 8, with daily improvements leveling off as the
study progressed. Three homogenous subsets of patients were identified who,
despite different initial BP levels, showed similar decreases in BP during the
study, indicating that patients benefited irrespective of baseline BP. In showing
significant reductions in BP, our results suggest that the self-management
support system may be a useful tool in clinical practice to help patients
self-manage their hypertension.
© 2015 The Authors. The Journal of Clinical Hypertension Published by Wiley
Periodicals, Inc.
DOI: 10.1111/jch.12682
PMCID: PMC5057328
1636. Influenza Other Respir Viruses. 2016 Nov;10(6):462-478. doi:

10.1111/irv.12406.
Epub 2016 Aug 8.
A systematic review of factors affecting intended and actual adherence with

antiviral medication as treatment or prophylaxis in seasonal and pandemic flu.
Smith LE(1), D'Antoni D(2), Jain V(1), Pearce JM(3), Weinman J(2), Rubin GJ(4).
Author information:
(1)Department of Psychological Medicine, King's College London, London, UK.
(2)Institute of Pharmaceutical Science, King's College London, London, UK.
(3)Department of War Studies, King's College London, London, UK.
(4)Department of Psychological Medicine, King's College London, London, UK.
Gideon.rubin@kcl.ac.uk.
The aim of this review was to identify factors predicting actual or intended
adherence to antivirals as treatment or prophylaxis for influenza. Literature
from inception to March 2015 was systematically reviewed to find studies
reporting predictors of adherence to antivirals and self-reported reasons for
non-adherence to antivirals. Twenty-six studies were included in the review;
twenty identified through the literature search and six through other means. Of
these studies, 18 assessed predictors of actual adherence to antivirals, whereas
eight assessed predictors of intended adherence. The most commonly found
predictor of, and self-reported reason for, non-adherence was the occurrence of
side effects. Other predictors include perceptions surrounding self-efficacy,
response efficacy and perceived personal consequences as well as social
influences of others' experiences of taking antivirals. Predictors identified in
this review can be used to help inform communications to increase adherence to
antivirals in both seasonal and pandemic influenza.
© 2016 The Authors. Influenza and Other Respiratory Viruses Published by John
Wiley & Sons Ltd.
DOI: 10.1111/irv.12406
PMCID: PMC5059947
1637. J Nutr Health Aging. 2015 Nov;19(9):929-34. doi: 10.1007/s12603-015-0545-5.
Preliminary Findings of the Brief Everyday Activities Measurement (BEAM) in Older

Adults.
Scharaga EA(1), Holtzer R.
Author information:
(1)Roee Holtzer, Ph.D. Ferkauf Graduate School of Psychology and Department of
Neurology, Albert Einstein College of Medicine, Yeshiva University, NY, USA.
Phone: 718 430-3962; Fax: 718 430-3960; email: roee.holtzer@einstein.yu.edu.
OBJECTIVES: Functional losses are common in healthy and cognitively impaired
older adults. However, subtle declines in instrumental activities of daily living
(IADLs) are not always detected in self-reports. Performance IADL measurements
are financially and time burdensome, restricting their use in varied settings. To
address these limitations, we developed the Brief Everyday Activities Measure
(BEAM), a short (< 5 minutes) objective IADL measure that assesses medication and
finance management.
DESIGN AND PARTICIPANTS: The BEAM was administered to 209 cognitively
non-demented community-dwellers (ages 65 - 95 years).
MEASUREMENTS: Participants completed standardized motor, neuropsychological,
psychological, and self-report functional assessments.
RESULTS: BEAM completion time ranged from 54.16 to 259.31 seconds. Interclass
correlations (ICC) for total BEAM completion time was moderate (0.65, 95% CI [.43
-.78]). Accuracy for total BEAM performance was in the low-moderate range (Kappa
= 0.38, p < .001, 95% CI [.18 -.54]). As predicted, lower accuracy and longer
time to complete the BEAM were both associated with worse executive functions,
attention, and processing speed.
CONCLUSIONS: Medication and finance management can be efficiently assessed within
five minutes. The BEAM may be a valuable screening tool to evaluate these
functional abilities.
DOI: 10.1007/s12603-015-0545-5
PMCID: PMC5331926
Longitudinal cohort study describing persistent frequent attenders in Australian

primary healthcare.
Pymont C(1), Butterworth P(1).
Author information:
(1)Psychiatric Epidemiology and Social Issues Unit, Centre for Research on
Ageing, Health & Wellbeing, Research School for Population Health, Australian
National University, Canberra, Australia.
OBJECTIVES: To describe patterns of frequent attendance in Australian primary

care, and identify the prospective risk factors for persistent frequent
attendance.
DESIGN, SETTING AND PARTICIPANTS: This study draws on data from the Personality
and Total Health (PATH) Through Life Project, a representative community cohort
study of residents from the Canberra region of Australia. Participants were
assessed on 3 occasions over 8 years. The survey assessed respondents' experience
of chronic physical conditions, self-reported health, symptoms of common mental
disorders, personality, life events, sociodemographic characteristics and
self-reported medication use. A balanced sample was used in analysis, comprising
1734 respondents with 3 waves of data. The survey data for each respondent were
individually linked to their administrative health service use data which were
used to generate an objective measure of general practitioner (GP) consultations
in the 12 months surrounding their interview date.
MAIN OUTCOME MEASURES: Respondents in the (approximate) highest decile of
attenders on number of GP consultations over a 12-month period at each time point
were defined as frequent attenders (FAs).
RESULTS: Baseline FAs (8.4%) were responsible for 33.4% of baseline
consultations, while persistent FAs (3.6%) for 15.5% of all consultations over
the 3 occasions. While there was considerable movement between FA status over
time, consistency was greater than expected by chance alone. While there were
many factors that differentiated non-FAs from FAs in general, persistent frequent
attendance was specifically associated with gender, baseline reports of
depression, self-reported physical conditions and disability, and medication use.
CONCLUSIONS: The degree of persistence in GP consultations was limited. The
findings of this study contribute to our understanding of the risk factors that
predict subsequent persistent frequent attendance in primary care. However,
further detailed investigation of longitudinal patterns of frequent attendance
and consideration of time-varying determinants of frequent attendance is
required.
DOI: 10.1136/bmjopen-2015-008975
PMCID: PMC4606421
1639. Pharmacol Biochem Behav. 2016 Nov - Dec;150-151:8-13. doi:

10.1016/j.pbb.2016.08.009. Epub 2016 Sep 1.
Modafinil decreases cocaine choice in human cocaine smokers only when the
response requirement and the alternative reinforcer magnitude are large.
Foltin RW(1), Haney M(2), Bedi G(2), Evans SM(2).
Author information:
(1)Division on Substance Abuse, New York State Psychiatric Institute and
Drive, Unit 120, New York, NY 10032, USA. Electronic address:
rwf2@cumc.columbia.edu.
(2)Division on Substance Abuse, New York State Psychiatric Institute and
Drive, Unit 120, New York, NY 10032, USA.
This study examined how response effort (pressing a keyboard button) for cocaine
and the value of an alternative reinforcer (opportunity to play a game of chance
for money) combined with 'free' cocaine (with no response effort) affected
cocaine choice when participants were maintained on modafinil or placebo.
Nontreatment-seeking current cocaine smokers were enrolled in a
placebo-controlled, double-blind, within-subject study comprising both inpatient
and outpatient phases. Participants were maintained on placebo capsules (0mg/day)
during one inpatient phase and modafinil (300mg/day) capsules during another
inpatient phase in counter-balanced order. A minimum of 8 medication-free days
separated the two 15-day inpatient phases to allow for medication clearance.
Under each medication condition participants had the opportunity to
self-administer smoked cocaine (25mg) when the response effort for cocaine was
low (500responses/dose) and had a low value alternative (2 game plays for money)
or when the response effort for cocaine was large (2500responses/dose) and had a
more valuable alternative (4 game plays for money). Under both conditions,
participants received one free dose of cocaine (0, 12, 25 or 50mg) prior to
making their first choice of the session. Fifteen individuals began the study and
7 completed it. Participants chose fewer cocaine doses when the response effort
for cocaine and the alternative value was high (4.4±0.19) compared to when the
response effort for cocaine and the alternative value was low (5.3±0.14).
Providing individuals a free "priming" dose of cocaine prior to making their
cocaine choice did not alter cocaine taking. Modafinil decreased cocaine choice
only when the response effort for cocaine and the alternative value was high.
These results suggest that modafinil may be most effective when combined with
therapy emphasizing the large personal costs of using cocaine.
Copyright Â© 2016 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.pbb.2016.08.009
PMCID: PMC5145770
1640. Kidney Int Rep. 2018 Feb 2;3(3):645-651. doi: 10.1016/j.ekir.2018.01.007.

eCollection 2018 May.
Self-reported Medication Adherence and CKD Progression.
Cedillo-Couvert EA(1), Ricardo AC(1), Chen J(1), Cohan J(1), Fischer MJ(1)(2)(3),
Krousel-Wood M(4), Kusek JW(5), Lederer S(1)(2)(3), Lustigova E(4), Ojo A(6),
Porter AC(1), Sharp LK(1), Sondheimer J(7), Diamantidis C(8), Wang X(9), Roy
J(9), Lash JP(1); CRIC Study Investigators.
Collaborators: Appel LJ, Feldman HI, Go AS, He J, Kusek JW, Lash JP, Rahman M,
Rao PS, Townsend RR.
Author information:
(1)Department of Medicine, University of Illinois at Chicago, Chicago, Ilinois,
USA.
(2)Department of Medicine, Jesse Brown VAMC, Chicago, Illinois, USA.
(3)Research Service, Center of Innovation for Complex Chronic Healthcare, Edward
Hines Jr., VA Hospital, Hines, Illinois, USA.
(4)Department of Medicine and Epidemiology, Tulane University, New Orleans,
Louisiana, USA; Research Division, Ochsner Health System, New Orleans, Louisiana,
USA.
(5)National Institute of Diabetes and Digestive and Kidney Diseases, National
Institutes of Health, Bethesda, Maryland, USA.
(6)Department of Medicine, University of Arizona, Phoenix, Arizona, USA.
(7)Department of Internal Medicine, Wayne State University, Detroit, Michigan,
USA.
(8)Department of Medicine, Duke University School of Medicine, Durham, North
Carolina, USA.
(9)Department of Biostatistics and Epidemiology, University of Pennsylvania,
Philadelphia, Pennsylvania, USA.
Comment in
Natl Med J India. 2018 Nov-Dec;31(6):351-353.
Introduction: In the general population, medication nonadherence contributes to

poorer outcomes. However, little is known about medication adherence among adults
with chronic kidney disease (CKD). We evaluated the association of self-reported
medication adherence with CKD progression and all-cause death in patients with
CKD.
Methods: In this prospective observational study of 3305 adults with
mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC)
Study, the baseline self-reported medication adherence was assessed by responses
to 3 questions and categorized as high, medium, and low. CKD progression (50%
decline in eGFR or incident end-stage renal disease) and all-cause death were
measured using multivariable Cox proportional hazards.
Results: Of the patients, 68% were categorized as high adherence, 17% medium
adherence, and 15% low adherence. Over a median follow-up of 6 years, there were
969 CKD progression events and 675 deaths. Compared with the high-adherence
group, the low-adherence group experienced increased risk for CKD progression
(hazard ratio = 1.27, 95% confidence interval = 1.05, 1.54) after adjustment for
sociodemographic and clinical factors, cardiovascular medications, number of
medication types, and depressive symptoms. A similar association existed between
low adherence and all-cause death, but did not reach standard statistical
significance (hazard ratio = 1.14 95% confidence interval = 0.88, 1.47).
Conclusion: Baseline self-reported low medication adherence was associated with
an increased risk for CKD progression. Future work is needed to better understand
the mechanisms underlying this association and to develop interventions to
improve adherence.
DOI: 10.1016/j.ekir.2018.01.007
PMCID: PMC5976857
PMID: 29854972
1641. J Headache Pain. 2018 Oct 19;19(1):98. doi: 10.1186/s10194-018-0928-1.
Practical and clinical utility of non-invasive vagus nerve stimulation (nVNS) for
the acute treatment of migraine: a post hoc analysis of the randomized,
sham-controlled, double-blind PRESTO trial.
Grazzi L(1)(2), Tassorelli C(3)(4), de Tommaso M(5), Pierangeli G(6), Martelletti

P(7), Rainero I(8), Geppetti P(9), Ambrosini A(10), Sarchielli P(11), Liebler
E(12), Barbanti P(13); PRESTO Study Group.
Collaborators: Tassorelli C, Bitetto V, De Icco R, Martinelli D, Sances G,

Bianchi M, Grazzi L, Padovan AM, de Tommaso M, Ricci K, Vecchio E, Cortelli P,
Cevoli S, Pierangeli G, Terlizzi R, Martelletti P, Negro A, Chiariello GA,
Rainero I, De Martino P, Gai A, Govone F, Masuzzo F, Rubino E, Torrieri MC, Vacca
A, Geppetti P, Chiarugi A, De Cesaris F, Puma SL, Lupi C, Marone I, Ambrosini A,
Perrotta A, Sarchielli P, Bernetti L, Corbelli I, Romoli M, Simoni S, Verzina A,
Barbanti P, Aurilia C, Egeo G, Fofi L, Liebler E, Andersson A, Spitzer L, Marin
J, McClure C, Thackeray L, Baldi MG, Di Maro D.
Author information:
(1)Neuroalgology Unit, Carlo Besta Neurological Institute and Foundation, Milan,
Italy. licia.grazzi@istituto-besta.it.
(2)Department of Fondazione IRCCS Istituto Neurologico C. Besta, U.O. Neurologia
III - Cefalee e Neuroalgologia, Via Celoria 11, 20133, Milan, Italy.
licia.grazzi@istituto-besta.it.
(3)Headache Science Centre, IRCCS C. Mondino Foundation, Pavia, Italy.
(4)Department of Brain and Behavioral Sciences, University of Pavia, Pavia,
Italy.
(5)Neurophysiology and Pain Unit, University of Bari Aldo Moro, Bari, Italy.
(6)IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
(7)Department of Clinical and Molecular Medicine, Sapienza University, Rome,
Italy.
(8)Department of Neuroscience, University of Turin, Turin, Italy.
(9)Headache Centre, University Hospital of Careggi, Florence, Italy.
(10)IRCCS Neuromed, Pozzilli (IS), Italy.
(11)Neurologic Clinic, Santa Maria della Misericordia Hospital, Perugia, Italy.
(12)electroCore, Inc, Basking Ridge, NJ, USA.
(13)Headache and Pain Unit, IRCCS San Raffaele Pisana, Rome, Italy.
Erratum in
J Headache Pain. 2019 Jan 7;20(1):1.
BACKGROUND: The PRESTO study of non-invasive vagus nerve stimulation (nVNS;

gammaCore®) featured key primary and secondary end points recommended by the
International Headache Society to provide Class I evidence that for patients with
an episodic migraine, nVNS significantly increases the probability of having mild
pain or being pain-free 2 h post stimulation. Here, we examined additional data
from PRESTO to provide further insights into the practical utility of nVNS by
evaluating its ability to consistently deliver clinically meaningful improvements
in pain intensity while reducing the need for rescue medication.
METHODS: Patients recorded pain intensity for treated migraine attacks on a
4-point scale. Data were examined to compare nVNS and sham with regard to the
percentage of patients who benefited by at least 1 point in pain intensity. We
also assessed the percentage of attacks that required rescue medication and
pain-free rates stratified by pain intensity at treatment initiation.
RESULTS: A significantly higher percentage of patients who used acute nVNS
treatment (n = 120) vs sham (n = 123) reported a ≥ 1-point decrease in pain
intensity at 30 min (nVNS, 32.2%; sham, 18.5%; P = 0.020), 60 min (nVNS, 38.8%;
sham, 24.0%; P = 0.017), and 120 min (nVNS, 46.8%; sham, 26.2%; P = 0.002) after
the first attack. Similar significant results were seen when assessing the
benefit in all attacks. The proportion of patients who did not require rescue
medication was significantly higher with nVNS than with sham for the first attack
(nVNS, 59.3%; sham, 41.9%; P = 0.013) and all attacks (nVNS, 52.3%; sham, 37.3%;
P = 0.008). When initial pain intensity was mild, the percentage of patients with
no pain after treatment was significantly higher with nVNS than with sham at
60 min (all attacks: nVNS, 37.0%; sham, 21.2%; P = 0.025) and 120 min (first
attack: nVNS, 50.0%; sham, 25.0%; P = 0.018; all attacks: nVNS, 46.7%; sham,
30.1%; P = 0.037).
CONCLUSIONS: This post hoc analysis demonstrated that acute nVNS treatment
quickly and consistently reduced pain intensity while decreasing rescue
medication use. These clinical benefits provide guidance in the optimal use of
nVNS in everyday practice, which can potentially reduce use of acute
pharmacologic medications and their associated adverse events.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02686034 .
DOI: 10.1186/s10194-018-0928-1
1642. Rev Bras Enferm. 2018 Jul-Aug;71(4):1875-1882. doi: 10.1590/0034-7167-2016-

0469.
Antihypertensive treatment adherence in workers of a General Hospital.
Feriato KT(1), Gusmão JL(1), Silva A(1), Santos CAD(2), Pereira RSF(3), Amendola
F(1).
Author information:
(1)Universidade Guarulhos. Guarulhos, São Paulo, Brazil.
(2)Hospital Municipal Dr. José de Carvalho Florence, Occupational Medicine. São
José dos Campos, São Paulo, Brazil.
(3)Centro Universitário AGES, Department of Nursing. Paripiranga, Bahia, Brazil.
OBJECTIVE: to assess antihypertensive treatment adherence and associated factors

in workers from a hospital.
METHOD: cross-sectional research, consisting of 108 workers who self-reported as
being hypertensive. Associations between sociodemographic, work and health
variables were assessed regarding adherence.
RESULTS: the mean age was 44.2 years, with predominance of the female sex and
workers from the nursing area. Through blood pressure measurement, 25% of
participants were classified as non-controlled hypertensive patients.
Approximately 88% reported taking some sort of medication; however, 79.6% did not
adhere to the antihypertensive treatment. In the multiple regression analysis,
the independent factors for non-adherence were hypercholesterolemia (OR=8.10;
p=0.024) and missing medical appointments (OR=4.06; p=0.048).
CONCLUSION: we verified a significant percentage of non-adherence. Since
hypertension and cholesterol are asymptomatic diseases that require continuous
treatment, hypertensive patients have difficulties to understand the importance
of adhering to the treatment, even being health professionals or working in
hospitals.
DOI: 10.1590/0034-7167-2016-0469
1643. AIDS Res Treat. 2016;2016:2607249. doi: 10.1155/2016/2607249. Epub 2016 Sep
8.
Perceptions and Experiences about Self-Disclosure of HIV Status among Adolescents

with Perinatal Acquired HIV in Poor-Resourced Communities in South Africa.
Madiba S(1), Mokgatle M(2).
Author information:
(1)School of Public Health, Department of Environmental and Occupational Heath,
Sefako Makgatho Health Sciences University, Pretoria, South Africa.
(2)School of Public Health, Department of Biostatistics, Sefako Makgatho Health
Sciences University, Pretoria, South Africa.
Background. There is limited research on the disclosure experiences of

adolescents with perinatal acquired HIV (PAH). The study explores how adolescents
with PAH experience living with HIV and examined their perceptions and
experiences regarding disclosure and onward self-disclosure to friends and sexual
partners. Methods. Thematic analysis was used to analyze in-depth interviews
conducted with 37 adolescents. Findings. Adolescents received disclosure about
their status at mean age of 12 years. They perceived disclosure as necessary and
appreciated the truthful communication they received. Adolescents have learned to
accept and live with HIV, and they desired to be healthy and normal like other
people. After receiving disclosure, they found their treatment meaningful, and
they adhered to medication. However, they also expressed a strong message that
their HIV status was truly their secret and that self-disclosure to others will
take the feeling of being normal away from them because they will be treated
differently. Conclusion. Adolescents maintained secrecy in order to be accepted
by their peers but also to protect themselves from stigma and isolation. Given
that adolescents want to be informed of their HIV status but desire controlling
self-disclosure of their HIV status, these should form the basis for development
of disclosure interventions.
DOI: 10.1155/2016/2607249
PMCID: PMC5031873
PMID: 27672451
1644. Rev Bras Enferm. 2019 Aug 19;72(4):1001-1006. doi: 10.1590/0034-7167-2018-

0680.
Interruptions and nursing workload during medication administration process.

Sassaki RL(1), Cucolo DF(2), Perroca MG(3).
Author information:
(1)Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil.
(2)Universidade Federal de São Carlos. São Carlos, São Paulo, Brazil.
(3)Faculdade de Medicina de São José do Rio Preto. São José do Rio Preto, São
Paulo, Brazil.
OBJECTIVE: To investigate the sources and causes of interruptions during the

medication administration process performed by a nursing team and measure its
frequency, duration and impact on the team's workload.
MÉTODOS: This is an observational study that timed 121 medication rounds
(preparation, administration and documentation) performed by 15 nurses and nine
nursing technicians in a Neonatal Intensive Care Unit in the countryside of the
state of São Paulo.
RESULTADOS: 63 (52.1%) interruptions were observed. In each round, the number of
interruptions that happened ranged from 1-7, for 127 in total; these occurred
mainly during the preparation phase, 97 (76.4%). The main interruption sources
were: nursing staff - 48 (37.8%) - and self-interruptions - 29 (22.8%). The main
causes were: information exchanges - 54 (42.5%) - and parallel conversations - 28
(22%). The increase in the mean time ranged from 53.7 to 64.3% (preparation) and
from 18.3 to 19.2% (administration) - p≤0.05.
CONCLUSÃO: Interruptions in the medication process are frequent, interfere in the
workload of the nursing team and may reflect on the safety of care.
DOI: 10.1590/0034-7167-2018-0680
PMID: 31432958
1645. Psychiatry J. 2017;2017:5812817. doi: 10.1155/2017/5812817. Epub 2017 Nov 14.
Self-Reported Adverse Drug Reactions, Medication Adherence, and Clinical Outcomes

among Major Depressive Disorder Patients in Ethiopia: A Prospective Hospital
Based Study.
Abegaz TM(1), Sori LM(2), Toleha HN(3).
Author information:
(1)Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and
(2)Department of Psychiatry, Gondar University Hospital, Gondar, Ethiopia.
(3)Pharmaceutics Unit, Department of Pharmacy, College of Medicine and Health
Sciences, Wollo University, Dessie, Ethiopia.
Erratum in
Psychiatry J. 2018 Feb 20;2018:9274278.
Background: There is paucity of data on prevalence of Adverse Drug Reactions

(ADRs) and adherence and clinical outcomes of antidepressants. The present study
determined the magnitude of ADRs of antidepressants and their impact on the level
of adherence and clinical outcome.
Methods: A prospective cross-sectional study was conducted among depression
patients from September 2016 to January 2017 at Gondar University Hospital
psychiatry clinic. The Naranjo ADR probability scale was employed to assess the
ADRs. The rate of medication adherence was determined using Morisky Medication
Adherence Measurement Scale-Eight.
Results: Two hundred seventeen patients participated in the study, more than half
of them being males (122; 56.2%). More than one-half of the subjects had low
adherence to their medications (124; 57.1%) and about 186 (85.7%) of the patients
encountered ADR. The most common ADR was weight gain (29; 13.2%). More than
one-half (125; 57.6%) of the respondents showed improved clinical outcome.
Optimal level of medication adherence decreased the likelihood of poor clinical
outcome by 56.8%.
Conclusion: ADRs were more prevalent. However, adherence to medications was very
poor in the setup. Long duration of depression negatively affects the rate of
adherence. In addition, adherence was found to influence the clinical outcome of
depression patients.
DOI: 10.1155/2017/5812817
PMCID: PMC5733980
PMID: 29349061
1646. J Epidemiol Glob Health. 2015 Jun;5(2):125-32. doi:

10.1016/j.jegh.2014.05.005.
Epub 2014 Jun 21.
Adherence to medications and associated factors: A cross-sectional study among

Palestinian hypertensive patients.
Al-Ramahi R(1).
Author information:
(1)Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah
National University, P.O. Box: 7, Nablus, Palestine. Electronic address:
rawa_ramahi@najah.edu.
OBJECTIVE: To assess adherence of Palestinian hypertensive patients to therapy

and to investigate the effect of a range of demographic and psychosocial
variables on medication adherence.
METHODS: A questionnaire-based, cross-sectional descriptive study was undertaken
at a group of outpatient clinics of the Ministry of Health, in addition to a
group of private clinics and pharmacies in the West Bank. Social and demographic
variables and self-reported drug adherence (Morisky scale) were determined for
each patient.
RESULTS: Low adherence with medications was present in 244 (54.2%) of the
patients. The multivariate logistic regression showed that younger age (<45
years), living in a village compared with a city, evaluating health status as
very good, good or poor compared with excellent, forgetfulness, fear of getting
used to medication, adverse effect, and dissatisfaction with treatment had a
statistically significant association with lower levels of medication adherence
(P<0.05).
CONCLUSIONS: Poor adherence to medications was very common. The findings of this
study may be used to identify the subset of population at risk of poor adherence
who should be targeted for interventions to achieve better blood pressure control
and hence prevent complications. This study should encourage the health policy
makers in Palestine to implement strategies to reduce non-compliance, and thus
contribute toward reducing national health care expenditures. Better patient
education and communication with healthcare professionals could improve some
factors that decrease adherence such as forgetfulness and dissatisfaction with
treatment.
Copyright © 2014 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All
rights reserved.
DOI: 10.1016/j.jegh.2014.05.005
1647. Seizure. 2017 Feb;45:160-168. doi: 10.1016/j.seizure.2016.12.006. Epub 2016
Dec
23.
Identifying the barriers to antiepileptic drug adherence among adults with

epilepsy.
O' Rourke G(1), O' Brien JJ(2).
Author information:
(1)Sligo University Hospital, Sligo, Ireland. Electronic address:
geraldineorourke-meehan@hotmail.com.
(2)Royal College of Surgeons in Ireland, Dublin, Ireland. Electronic address:
Juliejordanobrien@rcsi.ie.
PURPOSE: To identify the barriers to antiepileptic drug (AED) adherence among

adults with epilepsy (AWE). The impact of AED non-adherence on quality of life
(QoL) was also examined.
METHOD: Systematic design (SR) study. A search strategy was undertaken with no
time limits, for articles published in English, in MEDLINE, CINANL, PsycINFO,
EMBASE, Cochrane databases and grey literature sources. Eligibility criteria
included participants with epilepsy over 18 years, who were prescribed AEDs.
Adherence had to be defined and adherence assessment measurements identified. A
screening process was undertaken to select eligible studies. Eight studies met
the inclusion criteria and were included in a quantitative synthesis. Quality of
evidence was conducted using the EBL critical appraisal checklist and assessing
risk of bias within individual studies.
RESULTS: Across the included studies a high prevalence of non-adherence was
identified. AED non-adherence was associated with specific beliefs about
medications, being depressed or anxious, poor medication self-administration
management, uncontrolled recent seizures, frequent medication dosage times, poor
physician-patient relationship and perceived social support. Additionally, AED
non-adherence impacted negatively on QoL as a result of poor seizure control.
CONCLUSION: Although included studies were of good quality, risk of biases
reduced the generalisability of results. Findings suggested that comprehensive
adherence assessments should routinely be performed. Recommendations for future
research include the use of longitudinal research designs and a follow up SR to
include the 16-18-year-old population.

rights reserved.
DOI: 10.1016/j.seizure.2016.12.006
1648. J Med Internet Res. 2019 Jul 29;21(7):e14373. doi: 10.2196/14373.
Assessment of Medication Adherence Using a Medical App Among Patients With

Multiple Sclerosis Treated With Interferon Beta-1b: Pilot Digital Observational
Study (PROmyBETAapp).
Limmroth V(1), Hechenbichler K(2), Müller C(3), Schürks M(3).
Author information:
(1)Clinic for Neurology and Palliative Medicine, Municipal Hospital Köln-Merheim,
Cologne, Germany.
(2)Institut Dr. Schauerte, Munich, Germany.
(3)Bayer Vital GmbH, Leverkusen, Germany.
BACKGROUND: Accurate measurement of medication adherence using classical

observational studies typically depends on patient self-reporting and is often
costly and slow. In contrast, digital observational studies that collect data
directly from the patient may pose minimal burden to patients while facilitating
accurate, timely, and cost-efficient collection of real-world data. In Germany,
~80% of patients with multiple sclerosis (MS) treated with interferon beta 1b
(Betaferon) use an electronic autoinjector (BETACONNECT), which automatically
records every injection. Patients may also choose to use a medical app
(myBETAapp) to document injection data and their well-being (using a "wellness
tracker" feature).
OBJECTIVE: The goal of this pilot study was to establish a digital study process
that allows the collection of medication usage data and to assess medication
usage among patients with MS treated with interferon beta-1b who use myBETAapp.
METHODS: The PROmyBETAapp digital observational study was a mixed prospective and
retrospective, noninterventional, cohort study conducted among users of myBETAapp
in Germany (as of December 2017: registered accounts N=1334; actively used
accounts N=522). Between September and December 2017, users received two
invitations on their app asking them to participate. Interested patients were
provided detailed information and completed an electronic consent process. Data
from consenting patients' devices were collected retrospectively starting from
the first day of usage if historical data were available in the database and
collected prospectively following consent attainment. In total, 6 months of data
on medication usage behavior were collected along with 3 months of wellness
tracker data. Descriptive statistics were used to analyze persistence,
compliance, and adherence to therapy.
RESULTS: Of the 1334 registered accounts, 96 patients (7.2%) provided informed
consent to participate in the study. Of these, one patient withdrew consent
later. For another patient, injection data could not be recorded during the study
period. Follow-up of the remaining 94 patients ended in May 2018. The mean age of
participants was 46.6 years, and 50 (53%) were female. Over the 6-month study
period, persistence with myBETAapp usage was 96% (90/94), mean compliance was 94%
of injections completed, and adherence (persistence and ≥80% compliance) was 89%
(84/94). There was no apparent difference between male and female participants
and no trend across age groups. The wellness tracker was used by 21% of
participants (20/94), with a mean of 3.1 entries per user.
CONCLUSIONS: This study provides important information on medication usage among
patients with MS treated with interferon beta-1b and on consenting behavior of
patients in digital studies. In future studies, this approach may allow patients'
feedback to be rapidly implemented in existing digital solutions.
https://clinicaltrials.gov/ct2/show/NCT03134573.
©Volker Limmroth, Klaus Hechenbichler, Christian Müller, Markus Schürks.

Originally published in the Journal of Medical Internet Research
(http://www.jmir.org), 29.07.2019.
DOI: 10.2196/14373
PMCID: PMC6690164
PMID: 31359863
1649. Front Pharmacol. 2017 Dec 18;8:919. doi: 10.3389/fphar.2017.00919.

eCollection
2017.
Association between Health-Related Quality of Life and Medication Adherence in

Pulmonary Tuberculosis in South Africa.
Kastien-Hilka T(1)(2)(3), Rosenkranz B(4)(5), Schwenkglenks M(2)(6)(7), Bennett

BM(8), Sinanovic E(3).
Author information:
(1)Epidemiology and Public Health Department, Swiss Tropical and Public Health
Institute, Basel, Switzerland.
(2)Department of Public Health, Faculty of Medicine, University of Basel, Basel,
Switzerland.
(3)Health Economics Unit, School of Public Health and Family Medicine, University
of Cape Town, Cape Town, South Africa.
(4)Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences,
Stellenbosch University, Cape Town, South Africa.
(5)Fundisa African Academy of Medicines Development, Cape Town, South Africa.
(6)Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland.
(7)Epidemiology, Biostatistics and Prevention Institute, University of Zürich,
Zurich, Switzerland.
(8)Patient Centered Outcomes, Adelphi Values, Bollington, United Kingdom.
Background: Health-related quality of life (HRQOL) and adherence to treatment are

two often inter-related concepts that have implications for patient management
and care. Tuberculosis (TB) and its treatment present a major public health
concern in South Africa. The study aimed to evaluate the association between
HRQOL and adherence in TB patients in South Africa. Methods: Four self-reported
HRQOL and one self-reported adherence measures were used in an observational
longitudinal multicentre study during 6-month standard TB treatment. These
included the generic Short-Form 12 items (SF-12) and European Quality of Life 5
dimensions 5 levels (EQ-5D-5L), the disease-specific St. George's Respiratory
Questionnaire (SGRQ) and the condition-specific Hospital Anxiety and Depression
Scale (HADS) for HRQOL. Adherence was measured by the Morisky Medication
Adherence Scale 8 items (MMAS-8). The relationship between both concepts was
examined in 131 patients using Spearman's rho correlations, and linear regression
models. Results: HRQOL improved over 6-month TB treatment, whereas adherence mean
scores stayed constant with participants attaining a medium average level. Around
76% of patients reported to be high adherers and 24% were reporting a medium or
low adherence. Associations between HRQOL and adherence were mainly weak. High
adherence at treatment start was positively related to improvements in anxiety
and depression after 6-month treatment. The overall improvement in pain and
discomfort, and psychosocial health aspects over treatment time was positively,
but weakly associated with adherence at 6 months of treatment. Conclusion: A
positive relationship exists between adherence and HRQOL in TB in a South African
setting, but this relationship was very weak, most likely because HRQOL is
affected by a number of different factors and not limited to effects of
adherence. Therefore, management of TB patients should, besides adequate drug
treatment, address the specific mental and psychosocial needs.
DOI: 10.3389/fphar.2017.00919
PMCID: PMC5741974
PMID: 29326591
1650. Rev Assoc Med Bras (1992). 2017 Mar;63(3):252-260. doi:

10.1590/1806-9282.63.03.252.
Patient adherence to ischemic heart disease treatment.
Nobre MRC(1), Domingues RZL(2).

Author information:
(1)Director of the Clinical Epidemiology and Research Support Team - Heart
Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade
de São Paulo (HC-FMUSP), São Paulo, SP, Brazil.
(2)Consultant at Cognos - Health Education. Collaborator for the Clinical
Epidemiology and Research Support Team, InCor-HC-FMUSP, São Paulo, SP, Brazil.
Introduction:: The effectiveness of the treatment of chronic diseases depends on

the participation of the patient, influenced by different sociocultural factors,
which are not fully recognized by the treatment routine.
Objective:: To search for some of these factors that hinder or facilitate
adherence to treatment and use of healthcare resources, approaching patients with
ischemic heart disease.
Method:: A cross-sectional study was conducted using face-to-face interviews. We
applied semi-structured questionnaires to 347 individuals and recorded 141
interviews for qualitative analysis. Descriptors were selected to identify eight
categories of analyses. The quantitative data were submitted to descriptive
analysis of frequency.
Results:: Only 2% had good medication adherence according to score on Morisky
questionnaire. About 23% bought statins; the others obtained statin in the public
health institution. Thirty-six speeches were selected and classified according to
the following categories: knowledge about disease and medication, difficulty of
acquisition, self management of treatment, difficulties of access to health
services, side effect of statins, caregiver support, transportation to health
services and concerns about the disease progression. However, it was noticed that
about 1/3 of the care outside the research institution can be characterized as an
attempt to bring rationalization to the health system.
Conclusion:: The improved adherence to chronic treatment of ischemic heart
disease depends on the establishment of effective flows for referral and
counter-referral from one care unit to another, relevant information and
clarification of the questions for the patients and the attention of health
professionals to the many social and cultural factors involved in treatment
adherence. New research should be focused on educational groups by integrated
multidisciplinary teams in order to share treatment decisions, thereby increasing
the patient's commitment to his own health.
DOI: 10.1590/1806-9282.63.03.252
1651. J Am Geriatr Soc. 2017 Oct;65(10):2265-2271. doi: 10.1111/jgs.15042. Epub

2017
Aug 14.
Effect of the Tool to Reduce Inappropriate Medications on Medication

Communication and Deprescribing.
Fried TR(1)(2), Niehoff KM(1), Street RL(3)(4), Charpentier PA(5), Rajeevan

N(1)(6), Miller PL(1)(6)(7), Goldstein MK(8)(9), O'Leary JR(1)(5), Fenton BT(7).
Author information:
(1)Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare
System, West Haven, Connecticut.
(2)Department of Medicine, Program on Aging, Yale School of Medicine, New Haven,
Connecticut.
(3)Department of Communication, Texas A&M University, College Station, Texas.
(4)Houston Center for Quality of Care and Utilization Studies, Baylor College of
Medicine, Houston, Texas.
(5)Program on Aging, Yale School of Medicine, New Haven, Connecticut.
(6)Center for Medical Informatics, Yale School of Medicine, New Haven,
Connecticut.
(7)Pain Research, Informatics, Multi-morbidities, and Education Center, Veterans
Affairs Connecticut Healthcare System, West Haven, Connecticut.
(8)Palo Alto Geriatric Research, Education and Clinical Center and Medical
Service, Veterans Affairs Palo Alto Health Care System, Palo Alto.
(9)Department of Medicine, Center for Primary Care and Outcomes Research,
Stanford University, Stanford, California.
OBJECTIVES: To examine the effect of the Tool to Reduce Inappropriate Medications

(TRIM), a web tool linking an electronic health record (EHR) to a clinical
decision support system, on medication communication and prescribing.
DESIGN: Randomized clinical trial.
SETTING: Primary care clinics at a Veterans Affairs Medical Center.
PARTICIPANTS: Veterans aged 65 and older prescribed seven or more medications
randomized to receipt of TRIM or usual care (N = 128).
INTERVENTION: TRIM extracts information on medications and chronic conditions
from the EHR and contains data entry screens for information obtained from brief
chart review and telephonic patient assessment. These data serve as input for
automated algorithms identifying medication reconciliation discrepancies,
potentially inappropriate medications (PIMs), and potentially inappropriate
regimens. Clinician feedback reports summarize discrepancies and provide
recommendations for deprescribing. Patient feedback reports summarize
discrepancies and self-reported medication problems.
MEASUREMENTS: Primary: subscales of the Patient Assessment of Care for Chronic
Conditions (PACIC) related to shared decision-making; clinician and patient
communication. Secondary: changes in medications.
RESULTS: 29.7% of TRIM participants and 15.6% of control participants provided
the highest PACIC ratings; this difference was not significant. Adjusting for
covariates and clustering of patients within clinicians, TRIM was associated with
significantly more-active patient communication and facilitative clinician
communication and with more medication-related communication among patients and
clinicians. TRIM was significantly associated with correction of medication
discrepancies but had no effect on number of medications or reduction in PIMs.
CONCLUSION: TRIM improved communication about medications and accuracy of
documentation. Although there was no association with prescribing, the small
sample size provided limited power to examine medication-related outcomes.
Society.
DOI: 10.1111/jgs.15042
PMCID: PMC5641237
1652. Br J Oral Maxillofac Surg. 2017 Nov;55(9):980-981. doi:

10.1016/j.bjoms.2017.06.019. Epub 2017 Sep 28.
Removal of a sequestrum by a patient with medication-related osteonecrosis of the

jaw.
Davies M(1), Power A(1), Kanatas A(2).
Author information:
(1)Leeds General Infirmary, Great George Street, Leeds, UK.
(2)Leeds General Infirmary, Great George Street, Leeds, UK. Electronic address:
a.kanatas@doctors.org.uk.
Comment in
Br J Oral Maxillofac Surg. 2018 Apr;56(3):237-238.
DOI: 10.1016/j.bjoms.2017.06.019
1653. BMC Psychiatry. 2018 Jun 28;18(1):212. doi: 10.1186/s12888-018-1791-y.
Subjective well-being, drug attitude, and changes in symptomatology in chronic

schizophrenia patients starting treatment with new-generation antipsychotic
medication.
Widschwendter CG(1), Kemmler G(2), Rettenbacher MA(2), Yalcin-Siedentopf N(2),

Hofer A(2).
Author information:
(1)Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and
Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020, Innsbruck,
Austria. christian.widschwendter@i-med.ac.at.
(2)Medical University Innsbruck, Department of Psychiatry,Psychotherapy, and
Psychosomatics. Division of Psychiatry I, Anichstrasse 35, 6020, Innsbruck,
Austria.
BACKGROUND: Non-adherence to medication remains a major challenge in the

long-term management of patients with schizophrenia. Next to lack of insight into
the illness, adverse effects of antipsychotic drugs, cognitive deficits, poor
therapeutic alliance, reduced quality of life, missing social support, and
negative attitudes toward medication are predictors of non-adherence. This study
examined potential correlations between attitudes toward antipsychotic drug
therapy, subjective well-being, and symptom change in patients with chronic
schizophrenia.
METHODS: 30 patients with schizophrenia starting monotherapy with a
new-generation antipsychotic were included into the study. The Drug Attitude
Inventory (DAI) and the Subjective Well-being under Neuroleptic Treatment Scale,
short form (SWN-K), were administered after 2, 4, and 12 weeks of treatment. At
the same points in time and at baseline, psychopathological symptoms were rated
by means of the Positive and Negative Syndrome Scale (PANSS), and functioning was
assessed by means of the Global Assessment of Functioning Scale (GAF).
Antipsychotic induced side effects were evaluated by using the Udvalg for
Kliniske Undersogelser (UKU) Side Effect Rating Scale.
RESULTS: Study participants had a mean age of 37.5 ± 9.7 years, baseline symptoms
were mild. The PANSS total score improved significantly from baseline to weeks 4
(p = .003) and 12 (p = .001), respectively. Neither the DAI total score nor the
SWN-K total score changed significantly over the course of time. The severity of
symptoms was not correlated with drug attitude at any time point but was
negatively correlated with wellbeing at weeks 2 (r = -.419, p = .021) and 4
(r = -.441, p = .015). There was no significant correlation between DAI and SWN-K
total scores at any time point.
CONCLUSIONS: Next to showing that the DAI and the SWN-K measure different aspects
of subjective experiences during antipsychotic treatment these findings emphasize
the use of both instruments to optimize adherence to medication.
DOI: 10.1186/s12888-018-1791-y
PMCID: PMC6022409
1654. Trans R Soc Trop Med Hyg. 2016 Dec 1;110(12):696-704. doi:
10.1093/trstmh/trx003.
Markers of poor adherence among adults with HIV attending Themba Lethu HIV
Clinic, Helen Joseph Hospital, Johannesburg, South Africa.
Nnambalirwa M(1), Govathson C(2), Evans D(2), McNamara L(3), Maskew M(2), Nyasulu
P(1)(4).
Author information:
(1)School of Public Health, Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, South Africa.
(2)Health Economics and Epidemiology Research Office, Department of Internal
Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of
the Witwatersrand, Johannesburg, South Africa.
(3)Clinical HIV Research Unit, Department of Internal Medicine, School of
Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South Africa.
(4)Department of Public Health, School of Health Sciences, Monash University,
Johannesburg, South Africa.
Background: To date, there is no consensus on ideal ways to measure

antiretroviral treatment (ART) adherence in resource limited settings. This study
aimed to identify markers of poor adherence to ART.
Methods: Retrospective data of HIV-positive ART-naïve adults initiating standard
first-line ART at Themba Lethu Clinic, Helen Joseph Hospital, Johannesburg, South
Africa from April 2004 to December 2011 were analysed. Poisson regression models
with robust error variance were used to assessed the following potential markers
of poor adherence 'last self-reported adherence, missed clinic visits, mean
corpuscular volume (MCV), CD4 count against definition of adherence, suppressed
HIV viral load using traditional test metrics'.
Results: A total of 11 724 patients were eligible; 1712 (14.6%) had unsuppressed
viral load within 6 months after initiating ART. The main marker of poor
adherence was a combination of change in CD4 count and MCV; change in CD4
≥expected and change in MCV <14.5 fL (RR 2.82, 95% CI 2.16-3.67), change in
CD4 <expected and change in MCV <14.5 fL (RR 5.49, 95% CI 4.13-7.30) compared to
change in CD4 ≥expected and change in MCV ≥14.5 fL.
Conclusions: A combination of less than expected increase in CD4 and MCV at 6
months after treatment initation was found to be a marker of poor adherence. This
could help identify and monitor poor treatment adherence in the absence of viral
load testing.
© The Author 2017. Published by Oxford University Press on behalf of Royal

Society of Tropical Medicine and Hygiene. All rights reserved. For permissions,
DOI: 10.1093/trstmh/trx003
PMCID: PMC5914359
1655. Health Lit Res Pract. 2018 Sep 13;2(3):e166-e174. doi:

10.3928/24748307-20180803-01. eCollection 2018 Jul.
Patient and Professional Perspectives on Nutrition in Chronic Respiratory Disease

Self-Management: Reflections on Nutrition and Food Literacies.
Hakami R, Gillis DE, Poureslami I, FitzGerald JM.
Background: Nutrition literacy (NL) and food literacy (FL) have emerged as
distinct forms of the multifaceted concept of health literacy (HL). Despite
convincing evidence that changes in dietary behavior can improve health, the role
of nutrition in supporting self-management in patients with chronic respiratory
disease tends to be overlooked.
Objective: This study examined patient and key informant (health care
professionals, researchers, and policymakers) perspectives on nutrition in the
context of self-management practices in asthma and chronic obstructive pulmonary
disease with implications for NL and FL.
Methods: Data were collected during 16 focus groups with 93 English- and
French-speaking patients in the Canadian Provinces of British Columbia, Ontario,
and Quebec, and in-depth interviews with 45 key informants mainly from Canada.
Participants' comments, including dietary perception keywords, were extracted and
classified using NVivo software. Thematic analysis was applied.
Key Results: Patients' perspectives on nutrition reflected three broad themes:
(1) importance of nutrition knowledge in self-management, (2) applying nutrition
knowledge in self-management, and (3) challenges in applying nutrition knowledge
in self-management. Embedded within the third theme were six sub-themes:
Limitations in "accessing nutrition information," "understanding nutrition
information," "basic literacy skills," and "ability to act on nutrition
information," along with "lack of supports to act on nutrition information," and
"competing daily demands in mealtime and medication management." Although less
than 10% of key informants provided nutrition-relevant comments, their comments
reinforced patients' concerns about barriers to accessing, understanding, and
using nutrition information in self-management.
Conclusions: Our findings suggest that more attention be directed to nutrition in
the self-management of chronic respiratory disease and warrant further research
on the roles of NL and FL in this health practice context. Such research could
also contribute to the broader agenda of understanding NL and FL and applying
them as subconcepts of HL in chronic disease self-management interventions. [
HLRP: Health Literacy Research and Practice. 2018;2(3):e166-e174.].
Plain Language Summary: Growing evidence supporting the role of diet in chronic
disease calls for more attention to nutrition literacy. This study explored
patient and key informant viewpoints on engaging with nutrition information in
self-management of chronic lung disease. Findings suggest patients encounter many
challenges in accessing, understanding, and acting on relevant nutrition
information.
DOI: 10.3928/24748307-20180803-01
PMCID: PMC6607835
PMID: 31294292
1656. Respir Med. 2015 Aug;109(8):991-1000. doi: 10.1016/j.rmed.2015.05.004. Epub

2015
May 14.
Benefits of an asthma education program provided at primary care sites on asthma

outcomes.
Boulet LP(1), Boulay MÈ(2), Gauthier G(3), Battisti L(4), Chabot V(3), Beauchesne
MF(5), Villeneuve D(3), Côté P(3).
Author information:
(1)Institut universitaire de cardiologie et de pneumologie de Québec, Université
Laval, Québec, QC, Canada. Electronic address: lpboulet@med.ulaval.ca.
(2)Institut universitaire de cardiologie et de pneumologie de Québec, Université
Laval, Québec, QC, Canada.
(3)Réseau québécois de l'asthme et de la MPOC (RQAM), Québec, QC, Canada.
(4)Réseau québécois de l'asthme et de la MPOC (RQAM), Québec, QC, Canada; Hôpital
St-François d'Assise, Québec, QC, Canada.
(5)Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada.
BACKGROUND: Although it is a key-recommendation of all recent asthma guidelines,

self-management education is still insufficiently offered in primary care
settings.
AIMS OF THE STUDY: To demonstrate the benefits of an educational program offered
at the site of primary care (Family Medicine Clinics- FMC) by trained asthma
educators on patient outcomes and healthcare use.
METHODS: This was a one-year pre-post intervention study. Patients with a
diagnosis of mild to moderate asthma were enrolled from six FMC. After an initial
encounter by the educator, an assessment of educational needs and a spirometry
were done, followed by 3 follow-up visits at 4-6 weeks, 4-6 months and one year.
Expiratory flows, asthma control criteria, knowledge about asthma, adherence to
medication and healthcare and medication use were assessed at each visit.
RESULTS: Data from 124 asthma patients (41M/83F), aged 55 ± 18 years, were
analyzed. After initiating the intervention, there was a progressive increase in
asthma knowledge and an improvement in medication adherence. The number of
unscheduled visits for respiratory problems went from 137 to 33 (P < 0.0001), the
number of antibiotic treatments from 112 to 33 (P = 0.0002) and the number of
oral corticosteroids treatments from 26 to 8 (NS). Marked improvements were
observed in regard to inhaler technique and provision of a written action plan.
CONCLUSION: This study shows that an educational intervention applied at the site
of primary care can result in significant improvements in patient asthma outcomes
and reduce unscheduled visits and inappropriate use of medications such as
antibiotics.
DOI: 10.1016/j.rmed.2015.05.004
1657. BMC Nephrol. 2016 Jul 19;17(1):88. doi: 10.1186/s12882-016-0279-6.
The impact of a multidisciplinary self-care management program on quality of

life, self-care, adherence to anti-hypertensive therapy, glycemic control, and
renal function in diabetic kidney disease: A Cross-over Study Protocol.
Helou N(1)(2), Talhouedec D(3), Shaha M(4), Zanchi A(5).
Author information:
(1)HESAV, The University of Health Sciences (HES-SO), Av. de Beaumont 21, 1011,
Lausanne, Switzerland. nancy.helou@hesav.ch.
(2)Faculty of Biology and Medicine, University Institute of Higher Education and
Research in Healthcare (IUFRS), University of Lausanne, Biopôle 2, Route de la
Corniche 10, 1010, Lausanne, Switzerland. nancy.helou@hesav.ch.
(3)Clinique de La Source, Avenue Vinet 30, 1004, Lausanne, Switzerland.
(4)Faculty of Biology and Medicine, University Institute of Higher Education and
Research in Healthcare (IUFRS), University of Lausanne, Biopôle 2, Route de la
Corniche 10, 1010, Lausanne, Switzerland.
(5)Services of Nephrology, Diabetes and Endocrinology, Department of Internal
Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 17,
1011, Lausanne, Switzerland.
BACKGROUND: Diabetic kidney disease, a global health issue, remains associated

with high morbidity and mortality. Previous research has shown that
multidisciplinary management of chronic disease can improve patient outcomes. The
effect of multidisciplinary self-care management on quality of life and renal
function of patients with diabetic kidney disease has not yet been well
established.
METHOD/DESIGN: The aim of this study is to evaluate the impact of a
multidisciplinary self-care management program on quality of life, self-care
behavior, adherence to anti-hypertensive treatment, glycemic control, and renal
function of adults with diabetic kidney disease. A uniform balanced cross-over
design is used, with the objective to recruit 40 adult participants with diabetic
kidney disease, from public and private out-patient settings in French speaking
Switzerland. Participants are randomized in equal number into four study arms.
Each participant receives usual care alternating with the multidisciplinary self-
care management program. Each treatment period lasts three months and is repeated
twice at different time intervals over 12 months depending on the cross-over arm.
The multidisciplinary self-care management program is led by an advanced practice
nurse and adds nursing and dietary consultations and follow-ups, to the habitual
management provided by the general practitioner, the nephrologist and the
diabetologist. Data is collected every three months for 12 months. Quality of
life is measured using the Audit of Diabetes-Dependent Quality of Life scale,
patient self-care behavior is assessed using the Revised Summary of Diabetes
Self-Care Activities, and adherence to anti-hypertensive therapy is evaluated
using the Medication Events Monitoring System. Blood glucose control is measured
by the glycated hemoglobin levels and renal function by serum creatinine,
estimated glomerular filtration rate and urinary albumin/creatinine ratio. Data
will be analyzed using STATA version 14.
DISCUSSION: The cross-over design will elucidate the responses of individual
participant to each treatment, and will allow us to better evaluate the use of
such a design in clinical settings and behavioral studies. This study also
explores the impact of a theory-based nursing practice and its implementation
into a multidisciplinary context.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01967901 , registered on
the 18th of October 2013.
DOI: 10.1186/s12882-016-0279-6
PMCID: PMC4949754
1658. JMIR Res Protoc. 2018 Apr 10;7(4):e92. doi: 10.2196/resprot.9443.
Mobile Phone Support for Diabetes Self-Care Among Diverse Adults: Protocol for a
Three-Arm Randomized Controlled Trial.
Nelson LA(1), Wallston KA(2)(3)(4), Kripalani S(4)(5), Greevy RA Jr(6), Elasy

TA(1)(2), Bergner EM(1), Gentry CK(7), Mayberry LS(1)(2)(4).
Author information:
(1)Center for Health Behavior and Health Education, Department of Medicine,
Vanderbilt University Medical Center, Nashville, TN, United States.
(2)Center for Diabetes Translation Research, Department of Medicine, Vanderbilt
University Medical Center, Nashville, TN, United States.
(3)School of Nursing, Vanderbilt University, Nashville, TN, United States.
(4)Center for Effective Health Communication, Department of Medicine, Vanderbilt
University Medical Center, Nashville, TN, United States.
(5)Center for Clinical Quality and Implementation Research, Department of
Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
(6)Department of Biostatistics, Vanderbilt University Medical Center, Nashville,
TN, United States.
(7)Department of Pharmacy, College of Pharmacy and Health Sciences, Lipscomb
University, Nashville, TN, United States.
BACKGROUND: Nonadherence to self-care is common among patients with type 2
diabetes (T2D) and often leads to severe complications. Moreover, patients with
T2D who have low socioeconomic status and are racial/ethnic minorities
disproportionately experience barriers to adherence and poor outcomes. Basic
phone technology (text messages and phone calls) provides a practical medium for
delivering content to address patients' barriers to adherence; however, trials
are needed to explore long-term and sustainable effects of mobile phone
interventions among diverse patients.
OBJECTIVE: The aim of this study is to evaluate the effects of mobile phone-based
diabetes support interventions on self-care and hemoglobin A1c (HbA1c) among
adults with T2D using a 3-arm, 15-month randomized controlled trial with a Type 1
hybrid effectiveness-implementation approach. The intervention arms are (1) Rapid
Encouragement/Education And Communications for Health (REACH) and (2) REACH +
Family-focused Add-on for Motivating Self-care (FAMS).
METHODS: We recruited primary care patients with T2D (N=512) from Federally
Qualified Health Centers and an academic medical center, prioritizing recruitment
of publicly insured and minority patients from the latter. Eligible patients were
prescribed daily diabetes medication and owned a cell phone with text messaging
capability. We excluded patients whose most recent HbA1c result within 12 months
was <6.8% to support detection of intervention effects on HbA1c. Participants
were randomly assigned to REACH only, REACH + FAMS, or the control condition.
REACH provides text messages tailored to address patient-specific barriers to
medication adherence based on the Information-Motivation-Behavioral skills model,
whereas FAMS provides monthly phone coaching with related text message content
focused on family and friend barriers to diet and exercise adherence. We collect
HbA1c and self-reported survey data at baseline and at 3, 6, and 12 months, and
again at 15 months to assess sustained changes. We will use generalized
estimating equation models to test the effects of REACH (either intervention arm)
on HbA1c relative to the control group, the potential additive effects of FAMS,
and effects of either intervention on adherence to self-care behaviors and
diabetes self-efficacy.
RESULTS: The trial is ongoing; recruitment closed December 2017. We plan to
perform analyses on 6-month outcomes for FAMS in July 2018, and project to have
15-month data for REACH analyses in April 2019.
CONCLUSIONS: Our study will be one of the first to evaluate a long-term,
theory-based text messaging intervention to promote self-care adherence among
racially/ethnically and socioeconomically diverse adults with T2D. Moreover, our
study will assess the feasibility of a family-focused intervention delivered via
mobile phones and compare the effects of text messaging alone versus text
messaging plus phone coaching. Findings will advance our understanding of how
interventions delivered by phone can benefit diverse patients with chronic
conditions.
http://www.webcitation.org/6yHkg9SSl); NCT02481596;
http://www.webcitation.org/6yHkj9XD4).
©Lyndsay A Nelson, Kenneth A Wallston, Sunil Kripalani, Robert A Greevy Jr, Tom A
Elasy, Erin M Bergner, Chad K Gentry, Lindsay S Mayberry. Originally published in
JMIR Research Protocols (http://www.researchprotocols.org), 10.04.2018.
PMCID: PMC5915673
PMID: 29636319
1659. ARYA Atheroscler. 2014 Nov;10(6):319-33.

Self-efficacy strategies to improve exercise in patients with heart failure: A
systematic review.
Rajati F(1), Sadeghi M(2), Feizi A(3), Sharifirad G(4), Hasandokht T(5),
Mostafavi F(6).
Author information:
(1)Assistant Professor, Department of Public Health, School of of Health,
Kermanshah University of Medical Sciences, Kermanshah, Iran.
(2)Associate Professor, Cardiac Rehabilitation Research Center, Isfahan
Cardiovascular Research Institute, Isfahan University of Medical Sciences,
Isfahan, Iran.
(3)Associate Professor, Department of Biostatistic, School of Public Health,
(4)Professor, Department of Public Health, School of Health, Qom University of
Medical Sciences, Qom, Iran.
(5)Department of Community Medicine, School of Medicine, Guilan University of
Medical Sciences, Rasht, Iran.
(6)Assistant Professor, Department of Health Education and Promotion, School of
Health, Isfahan University of Medical Sciences, Isfahan, Iran.
BACKGROUND: Despite exercise is recommended as an adjunct to medication therapy

in patients with heart failure (HF), non-adherence to exercise is a major
problem. While improving self-efficacy is an effective way to increase physical
activity, the evidence concerning the relationship between strategies to enhance
self-efficacy and exercise among HF has not been systematically reviewed. The
objective of this systematic review is to assess the effect of interventions to
change the self-efficacy on exercise in patients with HF.
METHODS: A systematic database search was conducted for articles reporting
exercise self-efficacy interventions. Databases such as PubMed, ProQuest, CINAHL,
Scopus, and PsycINFO, and the Cochrane Library were searched with restrictions to
the years 2000-June 2014. A search of relevant databases identified 10 studies.
Published randomized controlled intervention studies focusing strategies to
change self-efficacy to exercise adherence in HF were eligible for inclusion. In
addition, studies that have applied self-efficacy-based interventions to improve
exercise are discussed.
RESULTS: Limited published data exist evaluating the self-efficacy strategies to
improve exercise in HF. Dominant strategies to improve patients' self-efficacy
were performance accomplishments, vicarious experience, verbal persuasion,
emotional arousal.
CONCLUSION: Evidence from some trials supports the view that incorporating the
theory of self-efficacy into the design of an exercise intervention is
beneficial. Moreover, exercise interventions aimed at integrating the four
strategies of exercise self-efficacy can have positive effects on confidence and
the ability to initiate exercise and recover HF symptoms. Findings of this study
suggest that a positive relationship exists between self-efficacy and initiating
and maintaining exercise in HF, especially in the short-term period.
PMCID: PMC4354085
PMID: 25815022
1660. BMC Nurs. 2016 Oct 24;15:61. eCollection 2016.
Erratum to: Effects of a nurse-led medication self-management programme in cancer

patients: protocol for a mixed-method randomised controlled trial.
Komatsu H(1), Yagasaki K(1), Yamaguchi T(2).

Author information:
(1)Faculty of Nursing and Medical Care, Keio University, 35 Shinanomachi,
Shinjuku-ku, Tokyo, 160-8582 Japan.
(2)Division of Biostatistics, Tohoku University Graduate School of Medicine, 1-1
Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574 Japan.
Erratum for
BMC Nurs. 2016 Feb 08;15:9.
[This corrects the article DOI: 10.1186/s12912-016-0130-1.].
DOI: 10.1186/s12912-016-0180-4
PMCID: PMC5078912
PMID: 27799848
1661. JMIR Hum Factors. 2017 Feb 1;4(1):e5. doi: 10.2196/humanfactors.7133.
A Self-Regulation Theory-Based Asthma Management Mobile App for Adolescents: A

Usability Assessment.
Sage A(1), Roberts C(1), Geryk L(1), Sleath B(1), Tate D(2)(3), Carpenter D(1).
Author information:
University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
(2)Department of Nutrition, Gillings School of Global Public Health, University
of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
(3)Department of Health Behavior, Gillings School of Global Public Health,
University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
BACKGROUND: Self-regulation theory suggests people learn to influence their own

behavior through self-monitoring, goal-setting, feedback, self-reward, and
self-instruction, all of which smartphones are now capable of facilitating.
Several mobile apps exist to manage asthma; however, little evidence exists about
whether these apps employ user-centered design processes that adhere to
government usability guidelines for mobile apps.
OBJECTIVE: Building upon a previous study that documented adolescent preferences
for an asthma self-management app, we employed a user-centered approach to assess
the usability of a high-fidelity wireframe for an asthma self-management app
intended for use by adolescents with persistent asthma.
METHODS: Individual interviews were conducted with adolescents (ages 11-18 years)
with persistent asthma who owned a smartphone (N=8). Adolescents were asked to
evaluate a PDF app wireframe consisting of 76 screen shots displaying app
features, including log in and home screen, profile setup, settings and info,
self-management features, and graphical displays for charting asthma control and
medication. Preferences, comments, and suggestions for each set of screen shots
were assessed using the audio-recorded interviews. Two coders reached consensus
on adolescent evaluations of the following aspects of app features: (1)
usability, (2) behavioral intentions to use, (3) confusing aspects, and (4)
suggestions for improvement.
RESULTS: The app wireframe was generally well received, and several suggestions
for improvement were recorded. Suggestions included increased customization of
charts and notifications, reminders, and alerts. Participants preferred
longitudinal data about asthma control and medication use to be displayed using
line graphs. All participants reported that they would find an asthma management
app like the one depicted in the wireframe useful for managing their asthma.
CONCLUSIONS: Early stage usability tests guided by government usability
guidelines (usability.gov) revealed areas for improvement for an asthma
self-management app for adolescents. Addressing these areas will be critical to
developing an engaging and effective asthma self-management app that is capable
of improving adolescent asthma outcomes.
©Adam Sage, Courtney Roberts, Lorie Geryk, Betsy Sleath, Deborah Tate, Delesha
Carpenter. Originally published in JMIR Human Factors
PMCID: PMC5311420
PMID: 28148471
1662. Indian J Community Med. 2019 Apr-Jun;44(2):107-112. doi:

10.4103/ijcm.IJCM_192_18.
Structured Diabetes Education Program for Improving Self-care Behavior in Primary

Care Settings of Puducherry: Evidence from a Randomized Controlled Trial.
Gehlawat M(1), Lakshminarayanan S(1), Kar SS(1).
Author information:
(1)Department of Preventive and Social Medicine, JIPMER, Puducherry, India.
Context: Diabetes self-management education plays a critical role in improving

patients' clinical outcome and quality of life.
Aims: This study aims to study the effectiveness of a structured diabetes
educational program on improvement of self-care behavior among type 2 diabetics
in urban Primary Health Centres (PHCs) of Puducherry.
Settings and Design: A community-based open-label parallel-arm randomized
controlled trial was conducted in two randomly selected urban PHCs of Puducherry
during December 2015-February 2017.
Subjects and Methods: Using systematic random sampling, 157 eligible participants
were recruited in intervention and control PHCs each. Sociodemographic, disease
characteristics, and anthropometric measures were captured using a pretested
questionnaire at baseline. Self-care behavior was recorded with Summary of
Diabetes Self-Care Activities scale. Intervention consisted of structured
diabetes education sessions with distribution of information leaflets and
self-care kits to the intervention-arm participants, while control arm received
standard care. At the end of 6 months, endline assessment was done for both
groups. Data were analyzed by intention-to-treat, per-protocol, and
difference-in-difference analysis using STATA.
Results: Footcare increased significantly by 1.95 days/week compared to control
arm, while a moderate change of 0.49 days/week in diet compliance and a minimal
change of 0.10 days/week in physical activity were observed. Medication
adherence, regular blood sugar testing, and smoking behavior also showed
improvement in intervention arm.
Conclusions: A structured education program that is culturally tailored showed an
overall improvement in self-care behavior. This research supports the need for
structured education program for diabetics to empower them and improve self-care
practices.
Trial registration: CTRI/2017/06/008772.
DOI: 10.4103/ijcm.IJCM_192_18
PMCID: PMC6625270
PMID: 31333286

1663. Chin Med J (Engl). 2018 Jun 20;131(12):1480-1489. doi: 10.4103/0366-
6999.233767.
Quality Measurement and Improvement Study of Surgical Coronary Revascularization:

Medication Adherence (MISSION-2).
Liu CY(1), Du JZ(1), Rao CF(2), Zhang H(2), Liu HN(2), Zhao Y(1), Yang LM(3), Li
X(1), Li J(2), Wang J(4), Wang HS(5), Liu ZG(6), Cheng ZY(7), Zheng Z(2).
Author information:
(1)National Clinical Research Center of Cardiovascular Diseases, State Key
Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union
Medical College, Beijing 100073, China.
(2)National Clinical Research Center of Cardiovascular Diseases, State Key
Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for
Medical College; Department of Cardiovascular Surgery, Fuwai Hospital, National
Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and
Peking Union Medical College, Beijing 100073, China.
(3)Department of Cardiovascular Surgery, Fuwai Hospital, National Center for
Medical College, Beijing 100073, China.
(4)Department of Thoracic and Cardiovascular Surgery, The First Affiliated
Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
(5)Department of Cardiovascular Surgery, General Hospital of Shenyang Military
Region, Shenyang, Liaoning 110016, China.
(6)Department of Cardiovascular Surgery, TEDA International Cardiovascular
Hospital, Peking Union Medical College and Chinese Academy of Medical Science,
Tianjin 300457, China.
(7)Department of Cardiovascular Surgery, Henan Provincial People's Hospital,
Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan 450003, China.
Background: Secondary preventive therapies play a key role in the prevention of

adverse outcomes after coronary artery bypass grafting (CABG). However,
medication adherence after CABG is often poor, and conventional interventions for
improving adherence have limited success. With increasing penetration of
smartphones, health-related smartphone applications might provide an opportunity
to improve adherence. Carefully designed trials are needed to provide reliable
evidence for the use of these applications in patients after CABG.
Methods: The Measurement and Improvement Studies of Surgical Coronary
Revascularization: Medication Adherence (MISSION-2) study is a multicenter
randomized controlled trial, aiming to randomize 1000 CABG patients to the
intervention or control groups in a 1:1 ratio. We developed the multifaceted,
patient-centered, smartphone-based Heart Health Application to encourage
medication adherence in the intervention group through a health self-management
program initiated during hospital admission for CABG. The application integrated
daily scheduled reminders to take the discharge medications, cardiac educational
materials, a dynamic dashboard to review cardiovascular risk factors and
secondary prevention targets, and weekly questionnaires with interactive
feedback. The primary outcome was secondary preventive medication adherence
measured by the Chinese version of the 8-item Morisky Medication Adherence Scale
at 6 months after randomization. Secondary outcomes included all-cause death,
cardiovascular rehospitalization, and a composite of death, myocardial
infarction, stroke, and repeat revascularization.
Discussion: Findings will not only provide evidence regarding the feasibility and
effectiveness of the described intervention for improving adherence to CABG
secondary preventive therapies but also explore a model for outpatient health
self-management that could be translated to various chronic diseases and widely
disseminated across resource-limited settings.
Trial Registration: https://clinicaltrials.gov (NCT02432469).
Publisher: 冠脉搭桥质量改善研究：患者二级预防用药依从性研究（MISSION-2）摘要背景:
冠脉搭桥术后的二级预防药物治疗，对减少术后心血管不良事件发生至关重要。然而，既往研究显示患者二级预
防用药依从性差，并且传统提高依从性的干预手段效果有限。智能手机在
全球范围内的普及，将有望改变传统的医疗模式，低成本、高效率地提供更多诊疗机会，改善搭桥术后二级预防
水平和患者预后。但目前亟需相关的高质量临床研究提供可靠的临床应用
证据。方法:
MISSION-2 研究是一个前瞻性、多中心、开放标签、随机对照的临床试验，计划入选 1000 例搭桥术后患者，采
用 1:1 随机分组。根据“用户中心”设计思路，我们研发了
手机应用“心健康”APP，对干预组患者从术后住院期间开始提供用药提醒，心脏术后健康宣教，心脏康复指导，
交互式个体化生活方式建议。该研究的一级终点为术后 6 个月的依据
8-MMAS 量表测量的用药依从性。二级终点包括全因死亡、心血管再住院以及死亡、心梗、中风、再次血运重建的
复合终点。讨论:
该研究的结果，将为移动医疗技术在冠脉搭桥术后二级预防中应用的可行性和有效性提供可靠的临床证据。另外，
试验的实施经验将为在医疗资源相对不足条件下，发展移动医疗技术改
善慢病患者预后，探索患者院外自我管理新模式提供重要的借鉴。.
DOI: 10.4103/0366-6999.233767
PMCID: PMC6006808
Home and Online Management and Evaluation of Blood Pressure (HOME BP) digital
intervention for self-management of uncontrolled, essential hypertension: a
protocol for the randomised controlled HOME BP trial.
Band R(1), Morton K(1), Stuart B(2), Raftery J(3), Bradbury K(1), Yao GL(3), Zhu
S(3), Little P(2), Yardley L(1), McManus RJ(4).
Author information:
(1)Academic Unit of Psychology, University of Southampton, Southampton, UK.
(2)Primary Care and Population Sciences, Faculty of Medicine, University of
Southampton, Southampton, UK.
(3)Faculty of Medicine, University of Southampton, Southampton, UK.
Oxford, UK.
INTRODUCTION: Self-management of hypertension, including self-monitoring and

antihypertensive medication titration, lowers blood pressure (BP) at 1 year
compared to usual care. The aim of the current trial is to assess the
effectiveness of the Home and Online Management and Evaluation of Blood Pressure
(HOME BP) intervention for the self-management of hypertension in primary care.
METHODS AND ANALYSIS: The HOME BP trial will be a randomised controlled trial
comparing BP self-management-consisting of the HOME BP online digital
intervention with self-monitoring, lifestyle advice and antihypertensive drug
titration-with usual care for people with uncontrolled essential hypertension.
Eligible patients will be recruited from primary care and randomised to usual
care or to self-management using HOME BP. The primary outcome will be the
difference in mean systolic BP (mm Hg) at 12-month follow-up between the
intervention and control groups adjusting for baseline BP and covariates.
Secondary outcomes (also adjusted for baseline and covariates where appropriate)
will be differences in mean BP at 6 months and diastolic BP at 12 months; patient
enablement; quality of life, and economic analyses including all key resources
associated with the intervention and related services, adopting a broad societal
perspective to include NHS, social care and patient costs, considered within
trial and modelled with a lifetime horizon. Medication beliefs, adherence and
changes; self-efficacy; perceived side effects and lifestyle changes will be
measured for process analyses. Qualitative analyses will explore patient and
healthcare professional experiences of HOME BP to gain insights into the factors
affecting acceptability, feasibility and adherence.
ETHICS AND DISSEMINATION: This study has received NHS ethical approval (REC
reference 15/SC/0082). The findings from HOME BP will be disseminated widely
through peer-reviewed publications, scientific conferences and workshops. If
successful, HOME BP will be directly applicable to UK primary care management of
hypertension.
TRIAL REGISTRATION NUMBER: ISRCTN13790648; pre-results.
DOI: 10.1136/bmjopen-2016-012684
PMCID: PMC5129001
Conflict of interest statement: RJM has received blood pressure monitoring

equipment for research purposes from Omron and Lloyds Pharmacies and travel
expenses and honoraria to speak at conferences from the American Society of
Nephrology and Japanese Society of Hypertension.
1665. Diabet Med. 2016 Jun;33(6):844-50. doi: 10.1111/dme.12896. Epub 2015 Oct 15.
Food insecurity is associated with diabetes self-care behaviours and glycaemic

control.
Heerman WJ(1)(2)(3), Wallston KA(3)(4), Osborn CY(2)(3)(5)(6), Bian A(3)(7),

Schlundt DG(2)(3)(8), Barto SD(3), Rothman RL(2)(3)(5).
Author information:
(1)Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN,
USA.
(2)Vanderbilt Center for Diabetes Translation Research, Center for Diabetes and
Translational Research, Vanderbilt University, Nashville, TN, USA.
(3)Vanderbilt Center for Health Services Research, Nashville, TN, USA.
(4)School of Nursing, Nashville, TN, USA.
(5)Department of Biomedical Informatics and the Center for Health Behavior and
Health Education, Nashville, TN, USA.
(6)Department of Medicine, Vanderbilt University Medical Center, Nashville, TN,
USA.
(7)Department of Biostatistics, Vanderbilt University Medical Center, Nashville,
TN, USA.
(8)Department of Psychology, Vanderbilt University, Nashville, TN, USA.
AIMS: Food insecurity is the 'limited or uncertain availability of nutritionally

adequate and safe foods'. Our objective was to examine the association between
food insecurity, diabetes self-care and glycaemic control.
METHODS: We conducted a cross-sectional analysis of baseline data from adult
patients with Type 2 diabetes who were enrolled in a randomized trial evaluating
a health literacy-focused diabetes intervention in safety net primary care
clinics in middle Tennessee. Food insecurity was assessed with three items from
the U.S. Household Food Security Survey. Diabetes self-care behaviours were
assessed with the Summary of Diabetes Self-Care Activities Scale, Personal
Diabetes Questionnaire and Adherence to Refills and Medication Scale. Glycaemic
control was assessed with HbA1c .
RESULTS: The sample consisted of 401 participants, 73% of whom reported some
level of food insecurity. Food insecurity was significantly associated with
self-care behaviours including less adherence to a general diet [Adjusted Odds
Ratio (AOR) 0.9, P = 0.02], less physical activity (AOR 0.9, P = 0.04) and with a
greater occurrence of medication non-adherence (AOR 1.2, P = 0.002) and calorie
restriction (AOR 1.1, P = 0.02). Food insecurity was also associated with worse
glycaemic control (adjusted β = 0.1, P = 0.03). None of the self-care behaviours
were significantly associated with HbA1c , limiting the ability to test for
self-care as a mechanism linking food insecurity to glycaemic control.
CONCLUSIONS: There was a high rate of food insecurity in a sample of patients
with Type 2 diabetes who were of low socio-economic status. Food insecurity was
associated with less adherence to recommended self-care behaviours and worse
glycaemic control.
© 2015 Diabetes UK.
DOI: 10.1111/dme.12896
PMCID: PMC4769979
1666. Ann Emerg Med. 2015 Jul;66(1):1-12, 12e.1-2. doi:

10.1016/j.annemergmed.2014.12.031. Epub 2015 Jan 19.
Self-care Barriers Reported by Emergency Department Patients With Acute Heart

Failure: A Sociotechnical Systems-Based Approach.
Holden RJ(1), Schubert CC(2), Eiland EC(3), Storrow AB(3), Miller KF(3), Collins
SP(3).
Author information:
(1)Department of BioHealth Informatics, Indiana University School of Informatics
and Computing, and the Center for Health Informatics Research and Innovation,
Indianapolis, IN. Electronic address: rjholden@iupui.edu.
(2)Department of Medical Education, Loma Linda University School of Medicine,
Loma Linda, CA.
(3)Department of Emergency Medicine, Vanderbilt University School of Medicine,
Nashville, TN.
STUDY OBJECTIVE: We pilot tested a sociotechnical systems-based instrument that

assesses the prevalence and nature of self-care barriers among patients
presenting to the emergency department (ED) with acute heart failure.
METHODS: A semistructured instrument for measuring self-reported self-care
barriers was developed and administered by ED clinicians and nonclinician
researchers to 31 ED patients receiving a diagnosis of acute heart failure.
Responses were analyzed with descriptive statistics and qualitative content
analysis. Feasibility was assessed by examining participant cooperation rates,
instrument completion times, item nonresponse, and data yield.
RESULTS: Of 47 distinct self-care barriers assessed, a median of 15 per patient
were indicated as "sometimes" or "often" present. Thirty-four specific barriers
were reported by more than 25% of patients and 9 were reported by more than 50%.
The sources of barriers included the person, self-care tasks, tools and
technologies, and organizational, social, and physical contexts. Seven of the top
10 most prevalent barriers were related to patient characteristics; the next 3,
to the organizational context (eg, life disruptions). A preliminary feasibility
assessment found few item nonresponses or comprehension difficulties, good
cooperation, and high data yield from both closed- and open-ended items, but also
found opportunities to reduce median administration time and variability.
CONCLUSION: An instrument assessing self-care barriers from multiple system
sources can be feasibly implemented in the ED. Further research is required to
modify the instrument for widespread use and evaluate its implementation across
institutions and cultural contexts. Self-care barriers measurement can be one
component of broader inquiry into the distributed health-related "work" activity
of patients, caregivers, and clinicians.
Copyright © 2015 American College of Emergency Physicians. Published by Elsevier

DOI: 10.1016/j.annemergmed.2014.12.031
PMCID: PMC4478102
Predicting poorer health outcomes in older community-dwelling patients with

multimorbidity: prospective cohort study assessing the accuracy of different
multimorbidity definitions.
Sasseville M(1)(2), Smith SM(3), Freyne L(3), McDowell R(3)(4), Boland F(3)(5),
Fortin M(6), Wallace E(3).
Author information:
(1)Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec,
Canada.
(2)Health Science Research, Universite de Sherbrooke, Chicoutimi, Quebec, Canada.
(3)Department of General Practice, HRB Centre for Primary Care Research, Royal
College of Surgeons in Ireland (RCSI), Dublin, Ireland.
(4)Cancer Epidemiology and Health Services Research Group, Centre for Public
Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's
University, Belfast, Ireland.
(5)Division of Population Health Sciences (PHS), HRB Centre For Primary Care
Research , Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
(6)Family Medicine, Université de Sherbrooke, Chicoutimi, Quebec, Canada.
PURPOSE: Multimorbidity is commonly defined and measured using condition counts.

The UK National Institute for Health Care Excellence Guidelines for
Multimorbidity suggest that a medication-orientated approach could be used to
identify those in need of a multimorbidity approach to management.
OBJECTIVES: To compare the accuracy of medication-based and diagnosis-based
multimorbidity measures at higher cut-points to identify older community-dwelling
patients who are at risk of poorer health outcomes.
DESIGN: A secondary analysis of a prospective cohort study with a 2-year
follow-up (2010-2012).
SETTING: 15 general practices in Ireland.
PARTICIPANTS: 904 older community-dwelling patients.
EXPOSURE: Baseline multimorbidity measurements based on both medication classes
count (MCC) and chronic disease count (CDC).
OUTCOMES: Mortality, self-reported health related quality of life, mental health
and physical functioning at follow-up.
ANALYSIS: Sensitivity, specificity, positive predictive values (PPV) and negative
predictive values (NPV) adjusting for clustering by practice for each outcome
using both definitions.
RESULTS: Of the 904 baseline participants, 53 died during follow-up and 673
patients completed the follow-up questionnaire. At baseline, 223 patients had 3
or more chronic conditions and 89 patients were prescribed 10 or more medication
classes. Sensitivity was low for both MCC and CDC measures for all outcomes. For
specificity, MCC was better for all outcomes with estimates varying from 88.8%
(95% CI 85.2% to 91.6%) for physical functioning to 90.9% (95% CI 86.2% to 94.1%)
for self-reported health-related quality of life. There were no differences
between MCC and CDC in terms of PPV and NPV for any outcomes.
CONCLUSIONS: Neither measure demonstrated high sensitivity. However, MCC using a
definition of 10 or more regular medication classes to define multimorbidity had
higher specificity for predicting poorer health outcomes. While having
limitations, this definition could be used for proactive identification of
patients who may benefit from targeted clinical care.

DOI: 10.1136/bmjopen-2018-023919
PMCID: PMC6326333
PMID: 30612111

eCollection 2017.
Factors influencing adherence to psychopharmacological medications in psychiatric

patients: a structural equation modeling approach.
De Las Cuevas C(1), de Leon J(2), Peñate W(3), Betancort M(3).
Author information:
(1)Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de
La Laguna, Canary Islands, Spain.
(2)Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA;
Psychiatry and Neurosciences Research Group (CTS-549), Institute of
Neurosciences, University of Granada, Granada, Spain; Biomedical Research Center
in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the
Basque Country, Vitoria, Spain.
(3)Departamento de Psicología Clínica, Psicobiología y Metodología, Universidad
de La Laguna, Canary Islands, Spain.
PURPOSE: To evaluate pathways through which sociodemographic, clinical,

attitudinal, and perceived health control variables impact psychiatric patients'
adherence to psychopharmacological medications.
METHOD: A sample of 966 consecutive psychiatric outpatients was studied. The
variables were sociodemographic (age, gender, and education), clinical
(diagnoses, drug treatment, and treatment duration), attitudinal (attitudes
toward psychopharmacological medication and preferences regarding participation
in decision-making), perception of control over health (health locus of control,
self-efficacy, and psychological reactance), and level of adherence to
psychopharmacological medications. Structural equation modeling was applied to
examine the nonstraightforward relationships and the interactive effects among
the analyzed variables.
RESULTS: Structural equation modeling demonstrated that psychiatric patients'
treatment adherence was associated: 1) negatively with cognitive psychological
reactance (adherence decreased as cognitive psychological reactance increased),
2) positively with patients' trust in their psychiatrists (doctors' subscale), 3)
negatively with patients' belief that they are in control of their mental health
and that their mental health depends on their own actions (internal subscale),
and 4) positively (although weakly) with age. Self-efficacy indirectly influenced
treatment adherence through internal health locus of control.
CONCLUSION: This study provides support for the hypothesis that perceived health
control variables play a relevant role in psychiatric patients' adherence to
psychopharmacological medications. The findings highlight the importance of
considering prospective studies of patients' psychological reactance and health
locus of control as they may be clinically relevant factors contributing to
adherence to psychopharmacological medications.
DOI: 10.2147/PPA.S133513
PMCID: PMC5378469
PMID: 28405160
Conflict of interest statement: Disclosure No commercial organizations had any

role in the completion or publication of this study. The authors report no
1669. Prev Chronic Dis. 2016 Jul 21;13:E93. doi: 10.5888/pcd13.160046.
Relating Health Locus of Control to Health Care Use, Adherence, and Transition
Readiness Among Youths With Chronic Conditions, North Carolina, 2015.
Nazareth M(1), Richards J(1), Javalkar K(1), Haberman C(2), Zhong Y(1), Rak E(1),
Jain N(1), Ferris M(1), van Tilburg MA(3).
Author information:
(1)The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
(2)Wake Forest University, Winston-Salem, North Carolina.
(3)University of North Carolina, Department of Medicine, Division of
Gastroenterology and Hepatology, 130 Mason Farm Rd, CB 7080, Chapel Hill, NC
27599. Email: tilburg@med.unc.edu.
INTRODUCTION: Health locus of control refers to the belief that health is in

one's control (internal control) or is not in one's control (external control).
Among adults, external locus of control is associated with negative health
outcomes, whereas internal locus of control is associated with favorable
outcomes. Few studies examined these associations among youths. The objective of
our study was to determine how locus of control relates to health care use,
medication adherence, missed school, and readiness for transition to adult
medical care for youths with chronic conditions.
METHODS: Participants at a camp for youths aged 6 to 17 years with chronic health
conditions completed a survey measuring locus of control, readiness for
transition to adult care, and medication adherence. Their parents completed a
separate part of the survey about health care use and missed school days in the
past year.
RESULTS: A total of 163 youths completed the survey (78.5% white; 52.1% female;
mean age, 12.3 y). Internal locus of control (β = 0.196; P = .013) and external
Doctor locus of control with doctors controlling disease (β = 0.181; P = .025)
were positively associated with transition readiness. External control by chance
or with others controlling disease was negatively associated with transition
readiness (β = -0.248; P = .002) and positively associated with emergency
department visits (β = 0.225; P = .004) and with number of hospital inpatient
nights at hospital (β = 0.166; P = .04).
CONCLUSION: Adolescents with external control of their health by chance or by
other people are at increased risk for negative health outcomes and may fail to
develop the self-management skills needed for successful transitioning to adult
care. Future studies should examine effects of changes in locus of control on
health outcomes among youths.
DOI: 10.5888/pcd13.160046
PMCID: PMC4956478
1670. Interact J Med Res. 2019 Jun 20;8(2):e13698. doi: 10.2196/13698.
Using Virtual Reality to Improve Antiretroviral Therapy Adherence in the

Treatment of HIV: Open-Label Repeated Measure Study.
Liran O(1), Dasher R(1), Kaeochinda K(2).
Author information:
(1)Department of Psychiatry and Biobehavioral Sciences, David Geffen School of
Medicine at University of California - Los Angeles, Los Angeles, CA, United
States.
(2)Department of Psychology, Marymount California University, Rancho Palos
Verdes, CA, United States.
BACKGROUND: Nonadherence to HIV medications is a serious unsolved problem and is

a major cause of morbidity and mortality in the HIV-positive population. Although
treatment efficacy is high if compliance is greater than 90%, about 40% of people
with HIV do not meet this threshold.
OBJECTIVE: This study aimed to test a novel approach to improve medication
adherence by using a low-cost virtual reality (VR) experience to educate people
with HIV about their illness. We hypothesized that people with HIV would be more
likely to be compliant with the treatment following the 7-minute experience and,
therefore, should have decreasing viral load (VL), increasing cluster of
differentiation 4+ (CD4+) cell counts, and improved self-reported adherence.
METHODS: We showed the VR experience to 107 participants with HIV at a county
hospital in Los Angeles, California. Participants were asked to self-report how
often they take their medications on a Likert-scale. The self-reported question
(SRQ) was given before and at least 2 weeks after the VR experience. We also
compared VL and CD4+ cell counts before and on average 101 days after the
experience. VL and CD4+ were obtained per the clinic's standard care protocol.
Two-tailed paired t tests were performed on the initial and follow-up SRQ scores,
VL, and CD4+. We restricted the CD4+ analysis to participants who had a pre-CD4+
below normal (defined as 500 cells/mm3). To reduce the possibility that VL were
trending down and CD4+ were trending up regardless of the VR experience, 2 serial
VL and CD4+ obtained before the experience were also compared and analyzed.
Immediately following the VR experience, participants were given a 4-question
Likert-type postexperience questionnaire (PEQ) that assessed their opinions about
the experience.
RESULTS: SRQ scores improved from pre to post experience with high significance
(P<.001). VL decreased from pre to post experience by 0.38 log10 copies/mL (95%
CI 0.06-0.70; P=.02). In contrast, the 2 serial VL obtained before the experience
showed no statistically significant changes. There was also a statistically
significant increase in CD4+ (95% CI -3.4 to -54.3 cells/mm3; P=.03). Analysis of
the PEQ revealed that VR was comfortable for almost all of the participants and
that most participants believed the experience to be educational and that it
would improve their medication adherence.
CONCLUSIONS: The findings suggest that the low-cost VR experience caused an
increased rate of antiretroviral therapy adherence that resulted in a decrease of
VL and an increase of CD4+. Further studies are required to explore the duration
of this effect and whether these results are generalizable to other treatment
settings and populations.
©Omer Liran, Robert Dasher, Kevin Kaeochinda. Originally published in the
Interactive Journal of Medical Research (http://www.i-jmr.org/), 20.06.2019.
DOI: 10.2196/13698
PMCID: PMC6610452
PMID: 31223117
1671. Clin Ther. 2015 Jun 1;37(6):1216-25. doi: 10.1016/j.clinthera.2015.03.022.

Epub
2015 Apr 11.
Evaluation of a Remote Monitoring System for Diabetes Control.
Katalenich B(1), Shi L(2), Liu S(2), Shao H(2), McDuffie R(3), Carpio G(3),
Thethi T(3), Fonseca V(3).
Author information:
(1)Tulane University Health Sciences Center, New Orleans, Louisiana; Southeast
Louisiana Veterans Health Care Systems, New Orleans, Louisiana. Electronic
address: bkatalen@tulane.edu.
(2)Tulane University Health Sciences Center, New Orleans, Louisiana.
(3)Tulane University Health Sciences Center, New Orleans, Louisiana; Southeast
Louisiana Veterans Health Care Systems, New Orleans, Louisiana.
PURPOSE: The use of technology to implement cost-effective health care management

on a large scale may be an alternative for diabetes management but needs to be
evaluated in controlled trials. This study assessed the utility and
cost-effectiveness of an automated Diabetes Remote Monitoring and Management
System (DRMS) in glycemic control versus usual care.
METHODS: In this randomized, controlled study, patients with uncontrolled
diabetes on insulin were randomized to use of the DRMS or usual care.
Participants in both groups were followed up for 6 months and had 3 clinic visits
at 0, 3, and 6 months. The DRMS used text messages or phone calls to remind
patients to test their blood glucose and to report results via an automated
system, with no human interaction unless a patient had severely high or low blood
glucose. The DRMS made adjustments to insulin dose(s) based on validated
algorithms. Participants reported medication adherence through the Morisky
Medication Adherence Scale-8, and diabetes-specific quality of life through the
diabetes Daily Quality of Life questionnaire. A cost-effectiveness analysis was
conducted based on the estimated overall costs of DRMS and usual care.
FINDINGS: A total of 98 patients were enrolled (59 [60%] female; mean age, 59
years); 87 participants (89%) completed follow-up. HbA1c was similar between the
DRMS and control groups at 3 months (7.60% vs 8.10%) and at 6 months (8.10% vs
7.90%). Changes from baseline to 6 months were not statistically significant for
self-reported medication adherence and diabetes-specific quality of life, with
the exception of the Daily Quality of Life-Social/Vocational Concerns subscale
score (P = 0.04).
IMPLICATIONS: An automated system like the DRMS may improve glycemic control to
the same degree as usual clinic care and may significantly improve the
social/vocational aspects of quality of life. Cost-effectiveness analysis found
DRMS to be cost-effective when compared to usual care and suggests DRMS has a
good scale of economy for program scale up. Further research is needed to
determine how to sustain the benefits seen with the automated system over longer
periods.
DOI: 10.1016/j.clinthera.2015.03.022
PMCID: PMC4496944
1672. Int J Environ Res Public Health. 2019 Jul 29;16(15). pii: E2698. doi:
10.3390/ijerph16152698.
Cognitive Impairment Is Independently Associated with Non-Adherence to

Antithrombotic Therapy in Older Patients with Atrial Fibrillation.
Seong HJ(1), Lee K(2), Kim BH(3), Son YJ(4).
Author information:
(1)Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea.
(2)College of Medicine, Division of Cardiology, Gachon University, Incheon 21565,
Korea.
(3)College of Nursing, Gachon University, Incheon 21936, Korea.
(4)Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea.
yjson@cau.ac.kr.
Atrial Fibrillation (AF) patients could reduce their risk of stroke by using oral
antithrombotic therapy. However, many older people with AF experience cognitive
impairment and have limited health literacy, which can lead to non-adherence to
antithrombotic treatment. This study aimed to investigate the influence of
cognitive impairment and health literacy on non-adherence to antithrombotic
therapy. The study performed a secondary analysis of baseline data from a
cross-sectional survey of AF patients' self-care behaviors at a tertiary
university hospital in 2018. Data were collected from a total of 277 AF patients
aged 65 years and older, through self-reported questionnaires administered by
face-to-face interviews. Approximately 50.2% of patients were non-adherent to
antithrombotic therapy. Multiple logistic regression analysis revealed that
cognitive impairment independently increased the risk of non-adherence to
antithrombotic therapy (odds ratio = 2.628, 95% confidence interval =
1.424-4.848) after adjustment for confounding factors. However, health literacy
was not associated with non-adherence to antithrombotic therapy. Cognitive
impairment is a significant risk factor for poor adherence to antithrombotic
therapy. Thus, health professionals should periodically assess both cognitive
function after AF diagnosis and adherence to medication in older patients.
Further studies are needed to identify the factors that affect cognitive decline
and non-adherence among AF patients.
DOI: 10.3390/ijerph16152698
PMCID: PMC6696263
PMID: 31362337
1673. Front Psychol. 2016 Oct 18;7:1552. eCollection 2016.
Relationships between Sleep Problems and Psychiatric Comorbidities among China's

Wenchuan Earthquake Survivors Remaining in Temporary Housing Camps.
Jiang S(1), Yan Z(2), Jing P(3), Li C(4), Zheng T(4), He J(5).
Author information:
(1)Institute of Developmental Psychology, School of Psychology, Beijing Normal
UniversityBeijing, China; Department of Applied Psychology, Wenzhou Medical
UniversityWenzhou, China.
(2)Department of Educational and Counseling Psychology, University at
Albany/State University of New York Albany, NY, USA.
(3)Department of Psychiatry, Ningbo Kangning Hospital Ningbo, China.
(4)Department of Applied Psychology, Wenzhou Medical University Wenzhou, China.
(5)Department of Neurology, The First Affiliated Hospital of Wenzhou Medical
University Wenzhou, China.
Earthquake survivors are a diverse population. This study focused on a special

group of earthquake survivors, who had still stayed in temporary housing camps
for about 2 years after China's Wenchuan Earthquake rather than those who moved
back to rebuild their lives or immigrated to large cities to seek new lives. The
research goals were to (1) assess their sleep problems as well as their PTSD,
depression and anxiety and (2) examine the relationship between different
dimensions of sleep quality and PTSD, depression, and anxiety among these
survivors. Three-hundred and eighty seven earthquake survivors who remained in
temporary housing camps and had sleep problems were recruited 17-27 months after
Wenchuan Earthquake. Four standardized instruments-The Pittsburgh Sleep Quality
Index, PTSD Checklist-Civilian Version, Self-rating Depression Scale, Self-rating
Anxiety Scale, and face-to-face one-on-one structured interviews were used to
assess these survivors' sleep quality, PTSD, depression, and anxiety. It was
found that (1) 83.20% of these survivors reported having sleep problems, and
79.33% of them considered insomnia as the most common sleep problem; (2) 12.14%
suffered PTSD, 36.43% experienced depression, and 38.24% had anxiety; (3) sleep
disturbance, sleep medication use, and subjective sleep quality were
significantly related to PTSD; (4) habitual sleep efficiency, sleep disturbance,
sleep medication use, and daytime dysfunction were significantly related to
depression; and (5) sleep disturbance, sleep medication use, and daytime
dysfunction were significantly related to anxiety. Clinic implications of the
study are discussed.
DOI: 10.3389/fpsyg.2016.01552
PMCID: PMC5068134
PMID: 27803679
1674. Psychiatry Res. 2019 Aug;278:173-179. doi: 10.1016/j.psychres.2019.06.011.

Epub
2019 Jun 11.
Phenotypic analysis of 23andMe survey data: Treatment-resistant depression from

participants' perspective.
Li QS(1), Tian C(2), McIntyre MH(2), Sun Y(3); 23andMe Research Team(2), Hinds
DA(2), Narayan VA(3).
Author information:
(1)Neuroscience Therapeutic Area, Janssen Research & Development, LLC, 1800
American Blvd, Titusville, NJ, USA. Electronic address: QLi2@its.jnj.com.
(2)23andMe, Inc., Mountain View, CA, USA.
(3)Neuroscience Therapeutic Area, Janssen Research & Development, LLC, 1800
American Blvd, Titusville, NJ, USA.
To improve understanding of treatment-resistant depression (TRD) in a large

population of individuals with depression, a self-reported antidepressant
efficacy survey was designed and administered to 23andMe research participants.
Participants with a current depressive episode or with a depressive episode
within the last 5 years were queried for the effect of pharmacotherapy during the
episode. TRD was defined as non-response to at least two antidepressants taken
for at least 5-6 weeks. Non-TRD (NTRD) was defined as responsive to either the
first or second medication taken for at least 3-4 weeks. Participants who could
not be classified as TRD or NTRD were excluded from the analysis. Approximately
56,000 participants completed the survey, among which approximately 33,000 took
medication for a depressive episode. The 3409 participants with self-reported TRD
tended to have younger age of onset, and a more persistent course prior to
initiation of treatment (e.g., a longer prior average episode duration and
residual symptoms between episodes) than the 18,511 participants classified as
NTRD. This survey identified depression characteristics, comorbidities, trigger
events, and early childhood trauma that distinguish TRD from NTRD.
Copyright © 2019 Janssen Research & Development, LLC. Published by Elsevier B.V.
DOI: 10.1016/j.psychres.2019.06.011
PMID: 31207454
1675. BMC Pregnancy Childbirth. 2015 Sep 14;15:219. doi: 10.1186/s12884-015-0650-9.
The MamaMiso study of self-administered misoprostol to prevent bleeding after

childbirth in rural Uganda: a community-based, placebo-controlled randomised
trial.
Weeks AD(1), Ditai J(2), Ononge S(3), Faragher B(4), Frye LJ(5), Durocher J(6),
Mirembe FM(7), Byamugisha J(8), Winikoff B(9), Alfirevic Z(10).
Author information:
(1)Sanyu Research Unit, Department of Women's and Children's Health, University
of Liverpool, Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK.
aweeks@liv.ac.uk.
(2)Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital; and
Sanyu Research Unit, Department of Women's and Children's Health, University of
Liverpool, Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK.
mocmjjd2@liverpool.ac.uk.
(3)Department of Obstetrics and Gynaecology, Makerere University College of
Health Science, P.O Box 7072, Kampala, Uganda. ononge2006@yahoo.com.
(4)Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
Brian.Faragher@lstmed.ac.uk.
(5)Gynuity Health Projects, 15 East 26th Street, Suite 801, New York, NY, 10010,
USA. lfrye@gynuity.org.
USA. jdurocher@gynuity.org.
Health Science, P.O Box 7072, Kampala, Uganda. flomir2002@yahoo.com.
Health Science, P.O Box 7072, Kampala, Uganda. jbyamugisha@gmail.com.
USA. BWinikoff@gynuity.org.
(10)Department of Women's and Children's Health, University of Liverpool,
Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK. zarko@liv.ac.uk.
BACKGROUND: 600 mcg of oral misoprostol reduces the incidence of postpartum

haemorrhage (PPH), but in previous research this medication has been administered
by health workers. It is unclear whether it is also safe and effective when
self-administered by women.
METHODS: This placebo-controlled, double-blind randomised trial enrolled
consenting women of at least 34 weeks gestation, recruited over a 2-month period
in Mbale District, Eastern Uganda. Participants had their haemoglobin measured
antenatally and were given either 600 mcg misoprostol or placebo to take home and
use immediately after birth in the event of delivery at home. The primary
clinical outcome was the incidence of fall in haemoglobin of over 20% in home
births followed-up within 5 days.
RESULTS: 748 women were randomised to either misoprostol (374) or placebo (374).
Of those enrolled, 57% delivered at a health facility and 43% delivered at home.
82% of all medicine packs were retrieved at postnatal follow-up and 97% of women
delivering at home reported self-administration of the medicine. Two women in the
misoprostol group took the study medication antenatally without adverse effects.
There was no significant difference between the study groups in the drop of
maternal haemoglobin by >20% (misoprostol 9.4% vs placebo 7.5%, risk ratio 1.11,
95% confidence interval 0.717 to 1.719). There was significantly more fever and
shivering in the misoprostol group, but women found the medication highly
acceptable.
CONCLUSIONS: This study has shown that antenatally distributed, self-administered
misoprostol can be appropriately taken by study participants. The rarity of the
primary outcome means that a very large sample size would be required to
demonstrate clinical effectiveness.
TRIAL REGISTRATION: This study was registered with the ISRCTN Register
(ISRCTN70408620).
DOI: 10.1186/s12884-015-0650-9
PMCID: PMC4570250
1676. J Diabetes Complications. 2018 Jun;32(6):586-592. doi:

10.1016/j.jdiacomp.2018.03.002. Epub 2018 Mar 8.
US ethnic group differences in self-management in the 2nd diabetes attitudes,

wishes and needs (DAWN2) study.
Peyrot M(1), Egede LE(2), Funnell MM(3), Hsu WC(4), Ruggiero L(5), Siminerio
LM(6), Stuckey HL(7).
Author information:
(1)Loyola University Maryland, Baltimore, MD, USA. Electronic address:
mark.peyrot@gmail.com.
(2)Division of General Internal Medicine Froedtert & The Medical College of
Wisconsin, WI, USA.
(3)University of Michigan Medical School, Ann Arbor, MI, USA.
(4)Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
(5)College of Health Sciences, School of Nursing, University of Delaware, Newark,
DE, USA.
(6)University of Pittsburgh Diabetes Institute, Pittsburgh, PA, USA.
(7)The Pennsylvania State University College of Medicine, Hershey, PA, USA.
AIMS: Understanding the relationship between ethnicity and self-management is

important due to disparities in healthcare access, utilization, and outcomes
among adults with type 2 diabetes from different ethnic groups in the US.
METHODS: Self-reports of self-management and interest in improving
self-management from US people with diabetes (PWD) in the 2nd Diabetes Attitudes,
Wishes and Needs (DAWN2) study, a multinational, multi-stakeholder survey, were
analyzed, including 447 non-Hispanic White, 241 African American, 194 Hispanic
American, and 173 Chinese American PWD (>18 years).
RESULTS: Overall, self-management behavior was highest for medication taking and
lowest for physical activity. Non-Hispanic Whites had lowest physical activity
and highest adherence to insulin therapy. Chinese Americans had lowest foot care
and highest healthy eating. Overall, interest was highest for improving healthy
eating and physical activity. Chinese Americans and Hispanic Americans were more
interested than non-Hispanic Whites in improving most self-management behaviors.
Chinese Americans were more interested than African Americans in improving most
self-management behaviors. Healthcare providers telling PWD that their A1c needs
improvement was associated with lower self-rated glucose control, which was
associated with higher PWD interest in improving self-management behaviors.
CONCLUSIONS: Diabetes care providers should use patient-centered approaches and
consider ethnicity in tailoring self-management support.
DOI: 10.1016/j.jdiacomp.2018.03.002
PMID: 29709335
1677. Indian J Psychol Med. 2018 Jan-Feb;40(1):52-60. doi:

10.4103/IJPSYM.IJPSYM_211_17.
Interepisodic Functioning in Patients with Bipolar Disorder in Remission.
Wesley MS(1), Manjula M(2), Thirthalli J(3).
Author information:
(1)Department of Psychology, Christ University, Bengaluru, Karnataka, India.
(2)Department of Clinical Psychology, National Institute of Mental Health and
Neuro Sciences, Bengaluru, Karnataka, India.
(3)Department of Psychiatry, National Institute of Mental Health and Neuro
Sciences, Bengaluru, Karnataka, India.
Background and Objectives: Patients with bipolar disorder (BD), despite

recovering symptomatically, suffer from several functional impairments even in
remission. The actual causes of impaired functioning are less known.
Materials and Methods: The study aimed to examine the clinical and psychosocial
determinants of functioning in patients with BD in remission. A cross-sectional
single-group design was adopted (n = 150). Participants meeting the study
criteria were screened with Mini-International Neuropsychiatric Interview Scale.
The selected participants were administered various tools to assess the level of
functioning and the clinical, psychosocial determinants of functioning.
Results: The clinical characteristics of the sample included early age of onset
of illness, presence of precipitating factors, fewer episodes, minimal
comorbidities, history of psychotic episodes, family history of mental illness,
good medication adherence, and low depression and mania scores. Psychosocial
factors included higher stress and moderate social support and self-esteem in the
sample. Poor functioning patients had a history of longer hospital stay and had
greater scores on depression, mania, stress, and maladaptive coping styles than
better functioning patients.
Conclusion: Higher depression, mania, stress, and maladaptive coping strategies
were related to poor functioning, while higher medication adherence, self-esteem,
and social support were related to better functioning.
DOI: 10.4103/IJPSYM.IJPSYM_211_17
PMCID: PMC5795680
PMID: 29403131
1678. Prehosp Emerg Care. 2016;20(1):125-31. doi: 10.3109/10903127.2015.1051681.

Epub
2015 Aug 13.
Accuracy of Prehospital Intravenous Fluid Volume Measurement by Emergency Medical

Services.
Coppler PJ, Padmanabhan R, Martin-Gill C, Callaway CW, Yealy DM, Seymour CW.
Prehospital treatment protocols call for intravenous (IV) fluid for patients with
shock, yet the measurement accuracy of administered fluid volume is unknown. The
purpose of the current study was to assess the accuracy of documented and
self-reported fluid volumes administered to medical patients by paramedics during
prehospital care. We conducted a pilot, observational study nested within a
parent cohort study of prehospital biomarkers in a single EMS agency transporting
patients to a tertiary care hospital in Pittsburgh, Pennsylvania over 8 months.
Among eligible nontrauma, noncardiac arrest patients, we studied the
self-reported IV fluid volume on ED arrival by paramedics, documented fluid
volume in the EMS record, and compared those to the mass-derived fluid volume. We
quantified the absolute error between methods, and determined EMS transport times
or initial prehospital systolic blood pressure had any effect on error. We
enrolled 50 patients who received prehospital IV fluid and had mass-derived fluid
volume measured at ED arrival. Of these, 21 (42%) patients had IV fluid volume
subsequently documented in EMS records. The median mass-derived fluid volume was
393 mL [IQR: 264-618 mL]. Mass-derived volume was similar for subjects who did
(386 mL, IQR: 271-642 mL) or did not (399 mL, IQR: 253-602) have documented fluid
administration (p > 0.05). The median self-reported fluid volume was 250 mL [IQR:
150-500 mL] and did not differ by documentation (p > 0.05). The median absolute
error comparing self-reported to mass-derived fluid volume was 109 mL [IQR:
41-205 mL], and less than 250 mL in more than 80% of subjects. The median
absolute error comparing documented fluid to mass-derived fluid volume was 142 mL
[IQR: 64-265 mL], and was less than 250 mL in 71% of subjects. No difference in
absolute error for either self-reported or document fluid volumes were modified
by transport time or prehospital systolic blood pressure. Prehospital IV fluid
administration is variably documented by EMS, and when recorded is typically
within 250 mL of mass-derived fluid volume.KEY WORDS: emergency medical services;
prehospital resuscitation; intravenous fluids; fluids.
DOI: 10.3109/10903127.2015.1051681
PMCID: PMC4701602
1679. JAMA Intern Med. 2017 May 1;177(5):683-691. doi:

Association of Suicidality and Depression With 5α-Reductase Inhibitors.
Welk B(1), McArthur E(2), Ordon M(3), Anderson KK(4), Hayward J(2), Dixon S(4).
Author information:
(1)Department of Surgery, Western University, London, Ontario, Canada2Institute
for Clinical Evaluative Sciences, London, Ontario, Canada3Department of
Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
(2)Institute for Clinical Evaluative Sciences, London, Ontario, Canada.
(3)Division of Urology, Department of Surgery, University of Toronto, Toronto,
Ontario, Canada.
(4)Institute for Clinical Evaluative Sciences, London, Ontario, Canada3Department
of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Comment in
JAMA Intern Med. 2017 May 1;177(5):691-692.
Ann Intern Med. 2017 Jul 18;167(2):JC9.
J Urol. 2017 Nov;198(5):956-957.
JAMA Intern Med. 2017 Nov 1;177(11):1701-1702.
JAMA Intern Med. 2017 Nov 1;177(11):1702.
Importance: There have been concerns raised by patients and regulatory agencies
regarding serious psychiatric adverse effects associated with 5α-reductase
inhibitors.
Objective: To determine if there is an increased risk of suicide, self-harm, or
depression among older men starting a 5α-reductase inhibitor for prostatic
enlargement.
Design, Setting, and Participants: A population-based, retrospective, matched
cohort study using linked administrative data for 93 197 men ages 66 years or
older (median [IQR] age, 75 [70-80] years) in Ontario, Canada, who initiated a
new prescription for a 5α-reductase inhibitor during the study period (2003
through 2013). Participants were matched (using a propensity score that included
44 of our 96 covariates that included medical comorbidities, medication usage,
and health care system utilization) to an equal number of men not prescribed a
5α-reductase inhibitor.
Exposures: Duration of finasteride or dutasteride usage.
Main Outcomes and Measures: Suicide. Secondary outcomes were self-harm and
depression.
Results: Men who used 5α-reductase inhibitors were not at a significantly
increased risk of suicide (HR, 0.88; 95% CI, 0.53-1.45). Risk of self-harm was
significantly increased during the initial 18 months after 5α-reductase inhibitor
initiation (HR, 1.88; 95% CI, 1.34-2.64), but not thereafter. Incident depression
risk was elevated during the initial 18 months after 5α-reductase inhibitor
initiation (HR, 1.94; 95% CI, 1.73-2.16), and continued to be elevated, but to a
lesser degree, for the remainder of the follow-up period (HR, 1.22; 95% CI,
1.08-1.37). The absolute increases in the event rates for these 2 outcomes were
17 per 100 000 patient-years and 237 per 100 000 patient-years, respectively. The
type of 5α-reductase inhibitor (finasteride or dutasteride) did not significantly
modify the observed associations with suicide, self-harm, and depression.
Conclusions and Relevance: In a large cohort of men ages 66 years or older, we
did not demonstrate an increased risk of suicide associated with 5α-reductase
inhibitor use. However, the risk of self-harm and depression were increased
compared with unexposed men. This is in keeping with postmarketing experience and
patient concerns, and discontinuation of the medication in these circ umstances
may be appropriate.
PMCID: PMC5818776
1680. HIV AIDS (Auckl). 2017 Sep 18;9:177-182. doi: 10.2147/HIV.S141903.

eCollection
2017.
Physical therapy as non-pharmacological chronic pain management of adults living

with HIV: self-reported pain scores and analgesic use.
Pullen S(1).
Author information:
(1)Department of Rehabilitation Medicine, Emory University School of Medicine,
Atlanta, GA, USA.
BACKGROUND: HIV-related chronic pain has emerged as a major symptom burden among
people living with HIV (PLHIV). Physical therapy (PT) has been shown to be
effective as a non-pharmacological method of chronic pain management in the
general population; however, there is a gap in research examining the role of PT
for chronic pain among PLHIV.
MATERIALS AND METHODS: This study examined the effect of PT on self-reported pain
scores and pain medication usage in PLHIV enrolled in a multidisciplinary HIV
clinic. Data were collected via reviews of patient medical records within a
certain timeframe. Data were gathered from patient charts for two points: initial
PT encounter (Time 1) and PT discharge or visit ≤4 months after initial visit
(Time 2).
RESULTS: Subjects who received PT during this timeframe reported decreased pain
(65.2%), elimination of pain (28.3%), no change in pain (15.2%), and increased
pain (6.5%). Three-quarters of the subjects reported a minimal clinically
important difference (MCID) in pain score, and more than half reported a decrease
in pain score over the MCID. Subjects showed a trend of decreasing pain
medication prescription and usage during the study period.
CONCLUSION: Results of the current study indicate that in this sample, PT
intervention appears to be an effective, cost-effective, non-pharmacological
method to decrease chronic pain in PLHIV.
DOI: 10.2147/HIV.S141903
PMCID: PMC5609779
PMID: 29075140


eCollection 2016.
The Effects of Classroom Interventions on Off-Task and Disruptive Classroom

Behavior in Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A
Meta-Analytic Review.
Gaastra GF(1), Groen Y(1), Tucha L(1), Tucha O(1).
Author information:
(1)Department of Clinical and Developmental Neuropsychology, University of
Groningen, Groningen, The Netherlands.
Children with attention-deficit/hyperactivity disorder (ADHD) often exhibit

problem behavior in class, which teachers often struggle to manage due to a lack
of knowledge and skills to use classroom management strategies. The aim of this
meta-analytic review was to determine the effectiveness of several types of
classroom interventions (antecedent-based, consequence-based, self-regulation,
combined) that can be applied by teachers in order to decrease off-task and
disruptive classroom behavior in children with symptoms of ADHD. A second aim was
to identify potential moderators (classroom setting, type of measure, students'
age, gender, intelligence, and medication use). Finally, it was qualitatively
explored whether the identified classroom interventions also directly or
indirectly affected behavioral and academic outcomes of classmates. Separate
meta-analyses were performed on standardized mean differences (SMDs) for 24
within-subjects design (WSD) and 76 single-subject design (SSD) studies. Results
showed that classroom interventions reduce off-task and disruptive classroom
behavior in children with symptoms of ADHD (WSDs: MSMD = 0.92; SSDs: MSMD =
3.08), with largest effects for consequence-based (WSDs: MSMD = 1.82) and
self-regulation interventions (SSDs: MSMD = 3.61). Larger effects were obtained
in general education classrooms than in other classroom settings. No reliable
conclusions could be formulated about moderating effects of type of measure and
students' age, gender, intelligence, and medication use, mainly because of power
problems. Finally, classroom interventions appeared to also benefit classmates'
behavioral and academic outcomes.
PMCID: PMC4757442
1682. J Rural Health. 2016 Spring;32(2):156-63. doi: 10.1111/jrh.12138. Epub 2015

Sep
3.
Perceived Social Standing, Medication Nonadherence, and Systolic Blood Pressure

in the Rural South.
Cummings DM(1), Wu JR(2), Cene C(3), Halladay J(4), Donahue KE(4), Hinderliter
A(5), Miller C(6), Garcia B(6), Penn D(7), Tillman J(8), DeWalt D(9).
Author information:
(1)Department of Family Medicine, Brody School of Medicine at East Carolina
University, Greenville, North Carolina, and School of Pharmacy, University of
North Carolina - Chapel Hill, Chapel Hill, North Carolina.
(2)School of Nursing, University of North Carolina - Chapel Hill, Chapel Hill,
North Carolina.
(3)Department of General Internal Medicine, School of Medicine, University of
North Carolina - Chapel Hill, Chapel Hill, North Carolina.
(4)Department of Family Medicine, School of Medicine, University of North
Carolina - Chapel Hill, Chapel Hill, North Carolina.
(5)Division of Cardiology, School of Medicine, University of North Carolina -
Chapel Hill, Chapel Hill, North Carolina.
(6)Center for Health Promotion/Disease Prevention, Gillings School of Global
Public Health, University of North Carolina - Chapel Hill, Chapel Hill, North
Carolina.
(7)Department of Social Medicine, School of Medicine, University of North
Carolina - Chapel Hill, Chapel Hill, North Carolina.
(8)Community Care Plan of Eastern Carolina, Greenville, North Carolina.
(9)CMS Innovation Center, Centers for Medicare and Medicaid Services, Baltimore,
Maryland.
PURPOSE: Little is known about how perceived social standing versus traditional
socioeconomic characteristics influence medication adherence and blood pressure
(BP) among African American and white patients with hypertension in the rural
southeastern United States.
METHODS: Perceived social standing, socioeconomic characteristics, self-reported
antihypertensive medication adherence, and BP were measured at baseline in a
cohort of rural African American and white patients (n = 495) with uncontrolled
hypertension attending primary care practices. Multivariate models examined the
relationship of perceived social standing and socioeconomic indicators with
medication adherence and systolic BP.
FINDINGS: Medication nonadherence was reported by 40% of patients. Younger age [β
= 0.20; P = .001], African American race [β = -0.30; P = .03], and lower
perceived social standing [β = 0.08; P = .002] but not sex or traditional
socioeconomic characteristics including education and household income, were
significantly associated with lower medication adherence. Race-specific analyses
revealed that this pattern was limited to African Americans and not observed in
whites. In stepwise modeling, older age [β = 0.57, P = .001], African American
race [β = 4.4; P = .03], and lower medication adherence [β = -1.7, P = .01] but
not gender, education, or household income, were significantly associated with
higher systolic BP.
CONCLUSIONS: Lower perceived social standing and age, but not traditional
socioeconomic characteristics, were significantly associated with lower
medication adherence in African Americans. Lower medication adherence was
associated with higher systolic BP. These findings suggest the need for tailored,
culturally relevant medication adherence interventions in rural communities.
© 2015 National Rural Health Association.
DOI: 10.1111/jrh.12138
PMCID: PMC5019540
1683. Vasc Health Risk Manag. 2016 Oct 12;12:387-392. eCollection 2016.
International normalized ratio self-testing and self-management: improving

patient outcomes.
Pozzi M(1), Mitchell J(2), Henaine AM(3), Hanna N(4), Safi O(4), Henaine R(2).
Author information:
(1)Department of Adult Cardiac Surgery, "Louis Pradel" Cardiologic Hospital,
Lyon, France.
(2)Department of Congenital Cardiac Surgery, "Louis Pradel" Cardiologic Hospital,
Lyon, France.
(3)Clinical Pharmacology Unit, Lebanese University, Beirut, Lebanon.
(4)Pediatric Unit, "Hotel Dieu de France" Hospital, Saint Joseph University,
Beirut, Lebanon.
Long term oral anti-coagulation with vitamin K antagonists is a risk factor of

hemorrhagic or thromebomlic complications. Periodic laboratory testing of
international normalized ratio (INR) and a subsequent dose adjustment are
therefore mandatory. The use of home testing devices to measure INR has been
suggested as a potential way to improve the comfort and compliance of the
patients and their families, the frequency of monitoring and, finally, the
management and safety of long-term oral anticoagulation. In pediatric patients,
increased doses to obtain and maintain the therapeutic target INR, more frequent
adjustments and INR testing, multiple medication, inconstant nutritional intake,
difficult venepunctures, and the need to go to the laboratory for testing
(interruption of school and parents' work attendance) highlight those
difficulties. After reviewing the most relevant published studies of self-testing
and self-management of INR for adult patients and children on oral
anticoagulation, it seems that these are valuable and effective strategies of INR
control. Despite an unclear relationship between INR control and clinical
effects, these self-strategies provide a better control of the anticoagulant
effect, improve patients and their family quality of life, and are an appealing
solution in term of cost-effectiveness. Structured education and knowledge
evaluation by trained health care professionals is required for children, to be
able to adjust their dose treatment safely and accurately. However, further data
are necessary in order to best define those patients who might better benefit
from this multidisciplinary approach.
DOI: 10.2147/VHRM.S85031
PMCID: PMC5066985

this work.
1684. Trials. 2019 Jun 4;20(1):323. doi: 10.1186/s13063-019-3372-x.
The CHESS trial: protocol for the process evaluation of a randomised trial of an
education and self-management intervention for people with chronic headache.
Nichols VP(1), Ellard DR(2), Griffiths FE(3), Underwood M(1), Taylor SJC(4),
Patel S(1); CHESS team.
Collaborators: Wilkie A, Davies B, Boss D, Ellard D, Carnes D, Achana F, Caldwell

F, Griffiths F, Sandhu H, Higgins H, Mistry H, Probyn K, White K, Haywood K,
Matharu M, Underwood M, Bright M, Potter R, Eldridge S, Patel S, Hee SW, Evans S,
Petrou S, Taylor S, Pincus T, Nichols V.
Author information:
(1)Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical
School, University of Warwick, Coventry, CV4 7AL, UK.
(2)Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical
School, University of Warwick, Coventry, CV4 7AL, UK. d.r.ellard@warwick.ac.uk.
(3)Division of Health Sciences, Warwick Medical School, University of Warwick,
Coventry, CV4 7AL, UK.
(4)Complex Intervention and Social Practice in Health Care unit, Centre for
Primary Care and Public Health, Blizard Institute, Barts and The London School of
Medicine and Dentistry, Queen Mary University of London, London, E1 2AB, UK.
BACKGROUND: Process evaluation is increasingly common alongside complex

randomised controlled trials (RCTs). This evaluation helps in understanding the
mechanisms of impact and how the study processes were executed, and it includes
any contextual factors which may have implications for the trial results and any
future implementation. This process evaluation is for the Chronic Headache
Education and Self-management Study (CHESS) RCT, which is evaluating an education
and self-management group behavioural intervention for people with chronic
headache. Chronic headache is defined as headaches which are present for 15 or
more days per month. The most common types are chronic migraine and chronic
tension type and medication overuse headaches.
METHODS: We will use a mixed methods approach. Quantitative data will be taken
from routine trial data which will help us to assess the reach of the study; i.e.
did we reach those whom we expected and from where? Intervention attendance (dose
received) and attrition and qualitative data will augment our understanding about
reasons why people may not wish to take part in or failed to attend sessions.
Interviews with intervention facilitators and trial participants will gain
different perspectives on taking part in the trial. Fidelity will be assessed
through listening to audio recordings for adherence to course content and
competence of the facilitation of a sample of sessions.
DISCUSSION: Our process evaluation will allow us to gain insight into how the
trial was delivered, the obstacles and enablers encountered and the possible
reasons why the interventions may or may not be effective.
TRIAL REGISTRATION: ISRCTN79708100 . Registered on 16 December 2015.
DOI: 10.1186/s13063-019-3372-x
PMCID: PMC6549347
PMID: 31164158
1685. Isr Med Assoc J. 2017 Mar;19(3):160-163.
Deliberate Self-Harm in Older Adults: A General Hospital Emergency Department

Survey.
Briskman I(1)(2), Shelef A(3)(2), Berger U(4), Baruch Y(3)(2), Bar G(1)(2),
Asherov J(1)(2), Lvovski A(1)(2), Apter A(5)(2), Barak Y(3)(2).
Author information:
(1)Emergency Department, Wolfson Medical Center, Holon, Israel.
(2)Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
(3)Abarbanel Mental Health Center, Bat Yam, Israel.
(4)Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.
(5)Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
BACKGROUND: Deliberate self-harm (DSH) increases the danger of future suicide

death and the risk increases with age. Self-harm in older adults is often
associated with greater suicidal intent and lethality.
OBJECTIVES: To investigate clinical and psychosocial variables of older patients
(age ≥ 65 years) assessed due to DSH, compared with younger adults.
METHODS: Patients admitted to the Emergency Department following DSH during an 8
year period were included.
RESULTS: Of 1149 participants, 187 (16.6%) were older adults (age ≥ 65) and 962
(83.4%) were younger adults (< 65). The older adults reported DSH closer to
mid-day (P < 0.01) and suffered more frequently from adjustment disorder and
depression. Personality disorders and schizophrenia were less commonly diagnosed
(P < 0.001). Prescription medication (sedatives and hypnotics) were a more
frequent means (88% vs. 71%) of DSH among older patients. Younger patients with
DSH used over-the-counter medications (21.9% vs. 6.4%) three times more than did
the older patients (P < 0.01). Past DSH was significantly more frequent in
younger adults. Following DSH the older patients were frequently admitted for
further general hospitalization (P < 0.001).
CONCLUSIONS: Older adults with DSH are a unique group with different clinical
characteristics. There is a need for targeted prevention strategies and education
of caregivers regarding DSH in older adults.
1686. J Pain Symptom Manage. 2017 Mar;53(3):561-570. doi:

10.1016/j.jpainsymman.2016.10.369. Epub 2016 Dec 29.
Hospice Use and Pain Management in Elderly Nursing Home Residents With Cancer.
Hunnicutt JN(1), Tjia J(2), Lapane KL(2).
Author information:
(1)Department of Quantitative Health Sciences; and Clinical and Population Health
Research Program, Graduate School of Biomedical Sciences, University of
Massachusetts Medical School, Worcester, Massachusetts, USA. Electronic address:
Jacob.Hunnicutt@umassmed.edu.
(2)Department of Quantitative Health Sciences; and Clinical and Population Health
Research Program, Graduate School of Biomedical Sciences, University of
Massachusetts Medical School, Worcester, Massachusetts, USA.
CONTEXT: Pain management is suboptimal in nursing homes.

OBJECTIVES: To estimate the extent to which receipt of hospice in nursing homes
(NHs) increases the receipt of pain management for residents with cancer at the
end of life.
METHODS: Study participants included Medicare beneficiaries with cancer who were
NH residents in the last 90 days of life in 2011-2012 (n = 78,160). Residents in
pain on hospice were matched to like residents without hospice by facility, type
of pain assessment (self-report/staff assessment), and weeks until death (9064
matched strata, 16,968 unique residents). Minimum Data Set 3.0 provided
information on residents' pain prevalence and receipt of pain management
(scheduled analgesics, as needed [pro re nata {PRN}] medication, nonpharmacologic
interventions). We developed conditional logistic models to estimate the
association between hospice use and pain management, stratified by self-reported
and staff-assessed pain.
RESULTS: We found that pain prevalence was higher in residents using hospice
versus those without hospice (e.g., residents who self-reported pain: hospice:
59.9%, 95% CIs = 59.3%-60.5%; nonhospice: 50.0%, 95% CI = 49.4%-50.6%). In
matched analyses, untreated pain was uncommon (self-reported pain: 2.9% and 5.6%
in hospice users and nonusers, respectively). Hospice use was associated with
receipt of scheduled analgesics (self-reported: adjusted odds ratio = 1.85, 95%
CI = 1.73-1.971) and PRN medication (self-reported: adjusted odds ratio = 1.31,
95% CI = 1.20-1.43). Pain prevalence and the association between hospice and pain
management were similar in residents with staff-assessed pain.
CONCLUSION: Untreated pain at the end of life among residents with cancer in NHs
is unusual. Hospice is associated with increased pain management among those with
documented pain.

PMCID: PMC5337160

eCollection 2015.
Measuring Patient Adherence to Malaria Treatment: A Comparison of Results from

Self-Report and a Customised Electronic Monitoring Device.
Bruxvoort K(1), Festo C(2), Cairns M(3), Kalolella A(2), Mayaya F(2), Kachur
SP(4), Schellenberg D(5), Goodman C(6).
Author information:
(1)Department of Global Health and Development, London School of Hygiene and
Tropical Medicine, London, United Kingdom; Impact Evaluation Thematic Group,
Ifakara Health Institute, Dar es Salaam, Tanzania.
(2)Impact Evaluation Thematic Group, Ifakara Health Institute, Dar es Salaam,
Tanzania.
(3)Department of Infectious Disease Epidemiology, London School of Hygiene and
(4)Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta,
United States of America.
(5)Department of Disease Control, London School of Hygiene and Tropical Medicine,
London, United Kingdom.
(6)Department of Global Health and Development, London School of Hygiene and
BACKGROUND: Self-report is the most common and feasible method for assessing
patient adherence to medication, but can be prone to recall bias and social
desirability bias. Most studies assessing adherence to artemisinin-based
combination therapies (ACTs) have relied on self-report. In this study, we use a
novel customised electronic monitoring device--termed smart blister packs--to
examine the validity of self-reported adherence to artemether-lumefantrine (AL)
in southern Tanzania.
METHODS: Smart blister packs were designed to look identical to locally available
AL blister packs and to record the date and time each tablet was removed from
packaging. Patients obtaining AL at randomly selected health facilities and drug
stores were followed up at home three days later and interviewed about each dose
of AL taken. Blister packs were requested for pill count and extraction of smart
blister pack data.
RESULTS: Data on adherence from both self-report verified by pill count and smart
blister packs were available for 696 of 1,204 patients. There was no difference
between methods in the proportion of patients assessed to have completed
treatment (64% and 67%, respectively). However, the percentage taking the correct
number of pills for each dose at the correct times (timely completion) was higher
by self-report than smart blister packs (37% vs. 24%; p<0.0001). By smart blister
packs, 64% of patients completing treatment did not take the correct number of
pills per dose or did not take each dose at the correct time interval.
CONCLUSION: Smart blister packs resulted in lower estimates of timely completion
of AL and may be less prone to recall and social desirability bias. They may be
useful when data on patterns of adherence are desirable to evaluate treatment
outcomes. Improved methods of collecting self-reported data are needed to
minimise bias and maximise comparability between studies.
PMCID: PMC4516331
1688. J Vasc Surg. 2018 Sep;68(3):693-699.e2. doi: 10.1016/j.jvs.2017.12.063. Epub

2018
Mar 31.
Antihypertensive medication adherence in chronic type B aortic dissection is an

important consideration in the management debate.
Martin G(1), Patel N(2), Grant Y(2), Jenkins M(3), Gibbs R(4), Bicknell C(4).
Author information:
(1)Department of Surgery and Cancer, Imperial College London, London, United
Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London,
United Kingdom. Electronic address: guy.martin@imperial.ac.uk.
Kingdom.
(3)Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United
Kingdom.
Kingdom; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London,
United Kingdom.
Comment in
J Vasc Surg. 2018 Sep;68(3):699-700.
OBJECTIVE: Early aortic stenting in chronic type B aortic dissection (TBAD) may
lead to long-term benefit, although the optimal treatment strategy is hotly
debated. A robust comparison to outcomes seen in medically managed patients is
challenging as the rate of antihypertensive medication adherence is unknown. The
aims of this study were therefore to identify the rate of antihypertensive
medication adherence and predictors of adherence in TBAD.
METHODS: This was a cross-sectional mixed methods study of patients with TBAD.
Medication adherence was assessed by the eight-item Morisky Medication Adherence
Scale together with an assessment of demographic, behavioral, and psychological
variables and disease-specific knowledge.
RESULTS: There were 47 patients (mean age, 59 years; 81% male) who were recruited
from a tertiary vascular unit. The mean total number of medications taken was 5.8
(2-14), and the mean number of antihypertensive medications was 1.9 (1-6). Of the
47 patients, 20 (43%) reported high levels of medication adherence, 17 (36%)
reported moderate adherence, and 10 (21%) reported low adherence. Previous aortic
surgery was associated with higher levels of adherence (β = 0.332; P = .03), as
was taking a greater number of medications (β = 0.332; P = .026), perceived
benefit from treatment (β = 0.486; P < .001), good memory (β = 0.579; P < .001),
and low fears of side effects (β = 0.272; P < .014).
CONCLUSIONS: Medical management remains the mainstay of treatment in
uncomplicated TBAD; however, the majority of patients are poorly adherent to
their antihypertensive medications. The merits of thoracic endovascular aortic
repair in TBAD are argued, and poor adherence is an important factor in the
debate; one cannot robustly compare two strategies when half of a treatment group
may not be receiving the stated intervention. To develop an evidence-based
treatment strategy for TBAD, we must take into account the direct and indirect
effects of medical therapy and thoracic endovascular aortic repair. Further work
to improve medication adherence and to understand its impact on disease
progression is vital to inform the debate and to deliver the best outcomes for
patients.
Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All
rights reserved.
DOI: 10.1016/j.jvs.2017.12.063
1689. J Clin Hypertens (Greenwich). 2017 Dec;19(12):1276-1284. doi:

10.1111/jch.13098.
Epub 2017 Sep 21.
Mobile phone text messaging improves antihypertensive drug adherence in the

community.
Varleta P(1)(2), Acevedo M(1)(3), Akel C(1)(4), Salinas C(1), Navarrete C(5),
García A(6), Echegoyen C(7), Rodriguez D(8), Gramusset L(9), Leon S(10), Cofré
P(11), Retamal R(12), Romero K(13).
Author information:
(1)Fundación de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular,
Santiago, Chile.
(2)Unidad de Prevención Cardiovascular y Rehabilitación Cardíaca, Centro
Cardiovascular, Hospital DIPRECA, Santiago, Chile.
(3)División de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia
Universidad Católica de Chile, Santiago, Chile.
(4)Facultad de Medicina, Campus Centro Hospital San Borja Arriarán, Universidad
de Chile, Santiago, Chile.
(5)Departamento de Matemáticas, Facultad de Ciencias, Universidad de la Serena,
La Serena, Chile.
(6)Centro de Salud Familiar Ossandón, Santiago, Chile.
(7)Centro de Salud Familiar Santa Amalia, Santiago, Chile.
(8)Centro de Salud Familiar Presidenta Michelle Bachelet, Santiago, Chile.
(9)Centro de Salud Familiar Gustavo Molina, Santiago, Chile.
(10)Centro de Salud Familiar Ignacio Domeiko, Santiago, Chile.
(11)Centro de Salud Familiar Dr. Anibal Ariztía, Santiago, Chile.
(12)Centro de Salud Familiar Santa Julia, Santiago, Chile.
(13)Centro de Salud Familiar Padre Gerardo Whelan, Santiago, Chile.
Comment in
J Clin Hypertens (Greenwich). 2017 Dec;19(12):1285-1287.
Antihypertensive drug adherence (ADA) is a mainstay in blood pressure control.

Education through mobile phone short message system (SMS) text messaging could
improve ADA. The authors conducted a randomized study involving 314 patients with
hypertension with <6 months of antihypertensive treatment from the Preventive
Health Program of 12 different primary care centers in Santiago, Chile. Patients
were randomly assigned to receive or not receive SMS related to ADA and healthy
lifestyle. Adherence was assessed by the self-reported four-item scale
Morisky-Green-Levine questionnaire at baseline and after 6 months of follow-up,
with four of four positive questions classified as good adherence. Group
comparison for adherence was performed by means of a logistic regression model,
adjusting by baseline adherence, age older than 60 years, and sex. A total of 163
patients were randomized to receive and 151 to not receive SMS. After 6 months of
follow-up, ADA in the non-SMS group decreased from 59.3% to 51.4% (P=.1). By
contrast, adherence increased from 49% to 62.3% (P=.01) in the SMS group. Text
messaging intervention improved ADA (risk ratio, 1.3; 95% confidence interval,
1.0-1.6 [P<.05]). At 6-month follow-up, text messaging resulted in an increase in
reporting ADA in this hypertensive Latino population. This approach could become
an effective tool to overcome poor medication adherence in the community.
©2017 Wiley Periodicals, Inc.
DOI: 10.1111/jch.13098
1690. Age Ageing. 2018 Mar 1;47(2):220-225. doi: 10.1093/ageing/afx158.
Medication usage change in older people (65+) in England over 20 years: findings
from CFAS I and CFAS II.
Gao L(1), Maidment I(2), Matthews FE(1)(3), Robinson L(3), Brayne C(4); Medical
Research Council Cognitive Function and Ageing Study.
Author information:
(1)MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK.
(2)School of Life and Health Sciences, Medicines and Devices in Ageing Cluster
Lead, Aston Research Centre for Healthy Ageing (ARCHA), Aston University,
Birmingham, UK.
(3)Institute of Health and Society, Faculty of Medicine, Newcastle University,
Newcastle, UK.
(4)Department of Public Health and Primary Care, Cambridge Institute of Public
Health, Cambridge, UK.
Comment in
Age Ageing. 2018 Mar 1;47(2):160-161.
Background: medical practice has changed over the last decades reflecting the
ageing population, when multi-morbidity requiring multiple medications is more
common.
Objective: describe and quantify self-reported medicine use including both
prescription and over the counter medicines in two comparable population-based
studies of older people (65+) in England and to assess the nature and scale of
polypharmacy.
Methods: data used were from two separate population-based studies; the Cognitive
Function Ageing Study I and II. Descriptive analyses were performed to summarise
and quantify general medicine use. Negative binomial regression models were
fitted to determine factors associated with the number of medicines used.
Results: medication use, including both prescribed medicines and over the counter
products has increased dramatically over the last 2 decades. The number of people
taking five or more items quadrupled from 12 to 49%, while the proportion of
people who did not take any medication has decreased from around 1 in 5 to 1 in
13. Cardiovascular drugs were the most frequently taken medication. Polypharmacy
is associated with increases in the number of diagnosed long-term conditions.
Conclusions: comparison between CFAS I and II reveals marked increases in
medication usage and polypharmacy in the older population. The influence of
healthcare organisation, introduction of new guidelines and technology changes
leading to diagnosis of earlier, milder chronic diseases and treatment may be
contributing to this changing pattern. Further research is needed to develop
practical solutions to optimise medication management in older people, reducing
the harming associated with medication.
Geriatrics Society.All rights reserved. For permissions, please email:
DOI: 10.1093/ageing/afx158
PMCID: PMC6037294
PMID: 29036509
1691. AIDS Patient Care STDS. 2014 Dec;28(12):622-7. doi: 10.1089/apc.2014.0195.
Medication adherence among men who have sex with men at risk for HIV infection in
the United States: implications for pre-exposure prophylaxis implementation.
Liu AY(1), Hessol NA, Vittinghoff E, Amico KR, Kroboth E, Fuchs J, Irvin R,
Sineath RC, Sanchez T, Sullivan PS, Buchbinder SP.
Author information:
(1)1 Bridge HIV, San Francisco Department of Public Health , San Francisco,
California.
Pre-exposure prophylaxis (PrEP) is a promising HIV prevention approach for men

who have sex with men (MSM), however non-adherence could limit its effectiveness.
Understanding the experiences of HIV-uninfected MSM taking routine medications
can provide valuable insights into open label PrEP adherence in real world
settings and guide development of PrEP adherence interventions. In this study, we
examined self-reported medication-taking experiences and facilitators and
barriers of medication adherence among a geographically-diverse online sample of
HIV-uninfected US MSM. Among 1480 participants, 806 (54%) reported taking
medications regularly, of whom 80% reported taking medications for treatment and
55% for prevention purposes. Facilitators of medication adherence included
establishing a routine, keeping medication visible, and using a pill-box;
barriers included forgetting, changes in routine, and being busy or away from
home. Only 45% rated their medication-taking ability as excellent, and 36%
reported not missing any doses in the past 30 days. In multivariable analyses,
older men and those not reporting any adherence barriers were more likely to
report excellent adherence, and men willing to use PrEP were more likely to
report perfect 30-day adherence. Counseling strategies to build pill-taking
routines and support younger MSM are suggested to maximize the public health
impact of PrEP.
DOI: 10.1089/apc.2014.0195
PMCID: PMC4250955
1692. Qual Health Res. 2017 Jul;27(8):1177-1189. doi: 10.1177/1049732317697674.
Epub
2017 Apr 11.
Qualitative Comparison of Barriers to Antiretroviral Medication Adherence Among

Perinatally and Behaviorally HIV-Infected Youth.
Fields EL(1), Bogart LM(2), Thurston IB(3), Hu CH(4), Skeer MR(5)(6), Safren
SA(7), Mimiaga MJ(5)(8).
Author information:
(1)1 Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
(2)2 RAND Corporation, Santa Monica, California, USA.
(3)3 University of Memphis, Memphis, Tennessee, USA.
(4)4 University of Minnesota, Minneapolis, Minnesota, USA.
(5)5 Fenway Health, Boston, Massachusetts, USA.
(6)6 Tufts University, Boston, Massachusetts, USA.
(7)7 University of Miami, Coral Gables, Florida, USA.
(8)8 Brown University, Providence, Rhode Island, USA.
Medication adherence among youth living with HIV (28%-69%) is often insufficient
for viral suppression. The psychosocial context of adherence barriers is complex.
We sought to qualitatively understand adherence barriers among behaviorally
infected and perinatally infected youth and develop an intervention specific to
their needs. We conducted in-depth interviews with 30 youth living with HIV (aged
14-24 years) and analyzed transcripts using the constant comparative method.
Barriers were influenced by clinical and psychosocial factors. Perinatally
infected youth barriers included reactance, complicated regimens, HIV fatigue,
and difficulty transitioning to autonomous care. Behaviorally infected youth
barriers included HIV-related shame and difficulty initiating medication. Both
groups reported low risk perception, medication as a reminder of HIV, and
nondisclosure, but described different contexts to these common barriers. Common
and unique barriers emerged for behaviorally infected and perinatally infected
youth reflecting varying HIV experiences and psychosocial contexts. We developed
a customizable intervention addressing identified barriers and their psychosocial
antecedents.
DOI: 10.1177/1049732317697674
PMCID: PMC5953432
1693. Chest. 2015 May;147(5):1307-1315. doi: 10.1378/chest.14-0914.
Health literacy, cognitive function, proper use, and adherence to inhaled asthma
controller medications among older adults with asthma.
O'Conor R(1), Wolf MS(2), Smith SG(2), Martynenko M(3), Vicencio DP(4), Sano
M(5), Wisnivesky JP(4), Federman AD(3).
Author information:
Northwestern University, Chicago, IL. Electronic address:
r-oconor@northwestern.edu.
Northwestern University, Chicago, IL.
(3)Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York,
NY.
(4)Department of Medicine, Mercy Hospital and Medical Center, Chicago, IL.
(5)Division of Pulmonary, Critical Care and Sleep Medicine, James J. Peters VA
Medical Center, Bronx, Icahn School of Medicine at Mount Sinai, New York, NY.
BACKGROUND: We sought to investigate the degree to which cognitive skills explain

associations between health literacy and asthma-related medication use among
older adults with asthma.
METHODS: Patients aged ≥ 60 years receiving care at eight outpatient clinics
(primary care, geriatrics, pulmonology, allergy, and immunology) in New York, New
York, and Chicago, Illinois, were recruited to participate in structured,
in-person interviews as part of the Asthma Beliefs and Literacy in the Elderly
(ABLE) study (n = 425). Behaviors related to medication use were investigated,
including adherence to prescribed regimens, metered-dose inhaler (MDI) technique,
and dry powder inhaler (DPI) technique. Health literacy was measured using the
Short Test of Functional Health Literacy in Adults. Cognitive function was
assessed in terms of fluid (working memory, processing speed, executive function)
and crystallized (verbal) ability.
RESULTS: The mean age of participants was 68 years; 40% were Hispanic and 30%
non-Hispanic black. More than one-third (38%) were adherent to their controller
medication, 53% demonstrated proper DPI technique, and 38% demonstrated correct
MDI technique. In multivariable analyses, limited literacy was associated with
poorer adherence to controller medication (OR, 2.3; 95% CI, 1.29-4.08) and
incorrect DPI (OR, 3.51; 95% CI, 1.81-6.83) and MDI (OR, 1.64; 95% CI, 1.01-2.65)
techniques. Fluid and crystallized abilities were independently associated with
medication behaviors. However, when fluid abilities were added to the model,
literacy associations were reduced.
CONCLUSIONS: Among older patients with asthma, interventions to promote proper
medication use should simplify tasks and patient roles to overcome cognitive load
and suboptimal performance in self-care.
DOI: 10.1378/chest.14-0914
PMCID: PMC4420182
1694. JMIR Res Protoc. 2018 Jun 28;7(6):e159. doi: 10.2196/resprot.9778.
Important Design Features of Personal Health Records to Improve Medication

Adherence for Patients with Long-Term Conditions: Protocol for a Systematic
Literature Review.
Andrikopoulou E(#)(1), Scott PJ(1), Herrera H(2).
Author information:
(1)School of Computing, Faculty of Technology, University of Portmouth,
Portsmouth, United Kingdom.
(2)School of Pharmacy and Biomedical Sciences, Faculty of Science, University of
Portmouth, Portsmouth, United Kingdom.
BACKGROUND: The National Health Service (NHS) England spent £15.5 billion on
medication in 2015. More than a third of patients affected by at least one
long-term condition do not adhere to their drug regime. Many interventions have
been trialed to improve medication adherence. One promising innovation is the
electronic personal health record.
OBJECTIVE: This systematic literature review aims to identify the important
design features of personal health records to improve medication adherence for
patients with long-term conditions.
METHODS: This protocol follows the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses Protocol (PRISMA-P 2015) statement. The following
databases will be searched for relevant articles: PubMed, Science Direct, BioMed
Central, Cumulative Index to Nursing and Allied Health Literature, Cochrane
Database of Systematic Reviews, and the Cochrane Central Register of Controlled
Trials. Studies published in the last fifteen years, in English, will be included
if the participants are adults who were treated outside the hospital, have the
ability to self-administer their medication, and have at least one long-term
condition. The review will exclude commercial or political sources and papers
without references. Papers that research pediatrics, pregnant, or terminally ill
patients will also be excluded, since their medication management is typically
more complex.
RESULTS: One reviewer will screen the included studies, extract the relevant
data, and assess the quality of evidence utilizing the Grading of Recommendations
Assessment, Development, and Evaluation system and the risk of bias using the
Cochrane RevMan tool. The second reviewer will assess the quality of 25% of the
included studies to assess interrater agreement. Any disagreement will be solved
by a third reviewer. Only studies of high and moderate quality will be included
for narrative synthesis.
CONCLUSIONS: NHS policy assumes that increasing usage of personal health records
by citizens will reduce demand on health care services. There is limited
evidence, however, that the use of health apps can improve patient outcomes, and,
to our knowledge, this is the first systematic literature review aiming to
identify important design features of the personal health record which may
improve medication adherence in the adult population with long-term conditions.
TRIAL REGISTRATION: PROSPERO CRD42017060542;
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=60542 (Archived
by WebCite at http://www.webcitation.org/6zeuWXxVh).
REGISTERED REPORT IDENTIFIER: RR1-10.2196/9778.
©Elisavet Andrikopoulou, Philip James Scott, Helena Herrera. Originally published

in JMIR Research Protocols (http://www.researchprotocols.org), 28.06.2018.
PMCID: PMC6116916
PMID: 29954729
1695. Front Pharmacol. 2018 Oct 9;9:1124. doi: 10.3389/fphar.2018.01124.

eCollection
2018.
Development and Validation of a Novel General Medication Adherence Scale (GMAS)

for Chronic Illness Patients in Pakistan.
Naqvi AA(1), Hassali MA(1), Rizvi M(2), Zehra A(2), Iffat W(2), Haseeb A(3),
Jamshed S(4).
Author information:
Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia.
(2)DOW College of Pharmacy, DOW University of Health Sciences, Karachi, Pakistan.
(3)Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University,
Makkah, Saudi Arabia.
(4)Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic
University Malaysia, Kuantan, Malaysia.
Objective: This study aimed to develop and validate a self-reporting adherence

tool termed as General Medication Adherence Scale (GMAS) in Urdu language for
measuring adherence toward medication use among Pakistani patients with a chronic
disease. Methods: A month-long study (December 2017) was conducted in three
tertiary health care settings of Karachi, Pakistan. The tool underwent content
and face validity as well as factor analyses, i.e., exploratory, partial
confirmatory and confirmatory factor analyses. Random sampling was conducted, and
sample size was calculated using item response theory. The item-to-respondent
ratio was 1:15. Fit indices namely normed fit index (NFI), Tucker Lewis index
(TLI), comparative fit index (CFI), goodness of fit index (GFI), absolute
goodness of fit (AGFI), parsimony goodness of fit index (PGFI), root mean square
error of approximation (RMSEA), and standard root mean square residual (SRMR)
were calculated. Additionally, estimation of the convergent, discriminant and
known group validities, was conducted. Internal consistency was analyzed by
test-retest reliability, McDonald's and Pearson correlation coefficient. The
factor analyses were conducted using IBM SPSS version 22 and IBM SPSS AMOS
version 25. Results: Content validity index (CVI) was reported at 0.8 (SD 0.147)
and the tool was content validated with three hypothetical constructs. Factor
analyses highlighted a 3-factor structure. The fit indices were calculated with
satisfactory results, i.e., PGFI, GFI, AGFI, NFI, TLI, and CFI were greater than
0.9 and PGFI > 0.5. The values of RMSEA and SRMR were less than 0.07. A
Cronbach's alpha value of 0.84 was obtained in reliability analysis. The
test-retest Pearson's correlation coefficient value was reported at 0.996
(p-value < 0.01). Convergent and discriminant validities for all constructs and,
known group validity for two constructs, were established. A high response rate
of 91% was achieved in respondents. Patients without insurance coverage appeared
to be low adherent compared to those with insurance coverage (p-value < 0.05).
Non-comorbid patients were more likely to be highly adherent as compared to
comorbid patients (p-value < 0.01). Conclusion: A novel tool GMAS was developed
in Urdu language and was subsequently validated in patients with chronic
diseases.
DOI: 10.3389/fphar.2018.01124
PMCID: PMC6189444
PMID: 30356775
1696. Res Social Adm Pharm. 2014 Nov-Dec;10(6):809-823. doi:

10.1016/j.sapharm.2014.01.002. Epub 2014 Feb 5.
Addressing medication nonadherence by mobile phone: development and delivery of

tailored messages.
Gatwood J(1), Balkrishnan R(2), Erickson SR(2), An LC(3), Piette JD(4), Farris
KB(2).
Author information:
(1)University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI
48109, USA. Electronic address: gatwood@umich.edu.
(2)University of Michigan College of Pharmacy, 428 Church St., Ann Arbor, MI
48109, USA.
(3)University of Michigan Medical School, Ann Arbor, MI, USA; University of
Michigan Center for Health Communication Research, Ann Arbor, MI, USA.
(4)University of Michigan Medical School, Ann Arbor, MI, USA; Department of
Veterans Affairs, Ann Arbor, MI, USA.
BACKGROUND: Medication nonadherence remains a significant public health problem,

and efforts to improve adherence have shown only limited impact. The tailoring of
messages has become a popular method of developing communication to influence
specific health-related behaviors but the development and impact of tailored text
messages on medication use is poorly understood.
OBJECTIVES: The aim of this paper is to describe an approach to developing
theory-based tailored messages for delivery via mobile phone to improve
medication adherence among patients with diabetes.
METHODS: Kreuter's five-step tailoring process was followed to create tailored
messages for mobile phone delivery. Two focus group sessions, using input from 11
people, and expert review of message content were used to adapt the survey
instrument on which the messages were tailored and edit the developed messages
for the target population.
RESULTS AND CONCLUSIONS: Following established tailoring methods a library of 168
theory-driven and 128 medication-specific tailored messages were developed and
formatted for automated delivery to mobile phones. Concepts from the Health
Belief Model and Self-Determination Theory were used to craft the messages and an
algorithm was applied to determine the order and timing of messages with the aim
of progressively influencing disease and treatment-related beliefs driving
adherence to diabetes medication. The process described may be applied to future
investigations aiming to improve medication adherence in patients with diabetes
and the effectiveness of the current messages will be tested in a planned
analysis.
DOI: 10.1016/j.sapharm.2014.01.002
PMCID: PMC4182163
1697. Rev Port Cardiol. 2018 Apr;37(4):297-303. doi: 10.1016/j.repc.2017.09.017.

Epub
2018 Apr 5.
Cross-cultural adaptation and validation of a European Portuguese version of the

8-item Morisky medication adherence scale.
Cabral AC(1), Moura-Ramos M(2), Castel-Branco M(3), Fernandez-Llimos F(4),

Figueiredo IV(3).
Author information:
(1)Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy,
University of Coimbra, Coimbra, Portugal.
(2)Cognitive and Behavioural Center for Research and Intervention (CINEICC),
Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra,
Portugal.
(3)Institute for Biomedical Imaging and life Sciences, Faculty of Pharmacy,
University of Coimbra, Coimbra, Portugal.
(4)Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon,
Lisboa, Portugal. Electronic address: f-llimos@ff.ul.pt.
Comment in
Rev Port Cardiol. 2018 Apr;37(4):305-306.
INTRODUCTION AND OBJECTIVE: The 8-Item Morisky Medication Adherence Scale

(MMAS-8) is one of the most widely used instruments to assess medication
adherence, but a validated European Portuguese version of MMAS-8 does not exist.
Our aim was to develop and validate a European Portuguese version of the MMAS-8.
METHODS: A process of translation and back-translation of the original MMAS-8 was
performed. The questionnaire was administered in nine community pharmacies and
one public hospital between March 2014 and September 2015. Adult patients taking
at least one antihypertensive drug were invited to participate. A confirmatory
factor analysis was performed and internal consistency, convergent validity and
concurrent validity were examined.
RESULTS: A total of 472 patients were enrolled in the study. The mean MMAS-8
score obtained was 6.74±1.39. One hundred and thirty-two patients were classified
as low adherers (28%), 181 (38.3%) as medium adherers and 159 (33.7%) as high
adherers. For the factorial structure of the Portuguese version of the MMAS-8,
the fit indices of the final model (chi-square [18] 48.465, p<0.001) are
suggestive of very good fit, with comparative fit index 0.95, root mean square
error of approximation 0.06 (90% confidence interval 0.04-0.08), and standardized
root mean square residual 0.04, confirming that the construct tested was
unidimensional. The Cronbach's alpha for all items was 0.60, and the translated
version presents convergent validity and concurrent validity.
CONCLUSION: A European Portuguese version of the MMAS-8 was created that
maintained a similar structure to the original MMAS-8 and good psychometric
properties.
Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier

España, S.L.U. All rights reserved.
DOI: 10.1016/j.repc.2017.09.017
1698. Curr Eye Res. 2016;41(1):50-8. doi: 10.3109/02713683.2014.1002045. Epub 2015

Jan
27.
Feasibility, Patient Acceptability, and Preliminary Efficacy of a Culturally

Informed, Health Promotion Program to Improve Glaucoma Medication Adherence Among
African Americans: "Glaucoma Management Optimism for African Americans Living
with Glaucoma" (GOAL).
Dreer LE(1), Owsley C(1), Campbell L(2), Gao L(1), Wood A(1), Girkin CA(1).
Author information:
(1)a Department of Ophthalmology , University of Alabama at Birmingham ,
Birmingham , AL , USA and.
(2)b Department of Psychology , East Carolina University , Greenville , NC , USA.
PURPOSE/AIMS: To examine the feasibility, patient acceptability, and preliminary

effectiveness of a culturally informed, health promotion program designed to
improve glaucoma medication adherence among African American's (AA's) with
glaucoma.
MATERIALS/METHODS: A sample of 11 AA glaucoma patients (mean age 61 years; 73%
women and 27% men) completed a culturally informed and individually tailored,
health promotion program developed for AAs titled, "Glaucoma Management Optimism
for African Americans Living with Glaucoma" (GOAL)©. The aim of the brief 4-week
program is to enhance glaucoma medication adherence through a combination of
education, motivational interviewing (MI), and problem-solving training (PST).
Feasibility was assessed on the basis of patient satisfaction with the program,
number of sessions completed, and length of sessions. Preliminary efficacy was
evaluated using a pre-post design to determine whether the program improved
objective glaucoma medication adherence via an electronic Travalert dosing aid as
well as satisfaction with aspects of glaucoma treatment, health beliefs about
medications, glaucoma symptoms, emotional well-being, and intraocular pressure.
RESULTS: Overall patient satisfaction and acceptability was high for the program,
interactions with the health educator, program materials, and the length of
sessions. Feasibility was also supported given the need for the program, success
in recruitment/retention, and ease of implementing the program with AA glaucoma
patients in clinic and/or over the telephone. In terms of preliminary efficacy,
patients showed significant pre-post improvements in objective medication
adherence rates by 15% (p = 0.03), self-efficacy for glaucoma management
(p = 0.02), ease of use in administering eye drops (p = 0.03), glaucoma treatment
satisfaction (p = 0.05), beliefs about the necessity of taking glaucoma
medications (p = 0.05), and functional visual ocular symptoms (p = 0.03).
CONCLUSIONS: (GOAL)© holds great promise toward improving glaucoma medication
adherence and beliefs among AA's with glaucoma.
DOI: 10.3109/02713683.2014.1002045
PMCID: PMC4516706
1699. BMC Rheumatol. 2018 Sep 29;2:29. doi: 10.1186/s41927-018-0034-7. eCollection

2018.
Demography, baseline disease characteristics, and treatment history of psoriasis

patients with self-reported psoriatic arthritis enrolled in the PSOLAR registry.
Kavanaugh A(1), Papp K(2), Gottlieb AB(3), de Jong EMGJ(4), Chakravarty SD(5)(6),
Kafka S(5), Langholff W(7), Farahi K(5), Srivastava B(5), Scher JU(8).
Author information:
(1)1Division of Rheumatology, Allergy and Immunology, Department of Medicine,
University of California, San Diego, CA USA.
(2)2K Papp Clinical Research and Probity Medical Research Inc., Waterloo, ON
Canada.
(3)3New York Medical College, Metropolitan Hospital, New York, NY USA.
(4)Department of Dermatology, Radboud University Medical Center, and Radboud
University, Nijmegen, The Netherlands.
(5)5Janssen Scientific Affairs, LLC, Horsham, PA USA.
(6)6Drexel University College of Medicine, Philadelphia, PA USA.
(7)7Janssen Research & Development, LLC, Spring House, PA USA.
(8)8Division of Rheumatology, New York University School of Medicine and Hospital
for Joint Diseases, 301 East 17th Street, Room 1608, New York, NY 10003 USA.
Background: To evaluate demographics, family history, and previous medication use

at enrollment in a subset of psoriasis patients with self-reported psoriatic
arthritis (PsA) enrolled in Psoriasis Longitudinal Assessment and Registry
(PSOLAR).
Methods: PSOLAR is an international, prospective, longitudinal, disease-based
registry that collects data in patients receiving, or are eligible to receive,
systemic or biologic treatments for psoriasis. Baseline demographic, disease
characteristics, medical history, and prior medication use at enrollment were
evaluated in PSOLAR psoriasis patients self-reporting PsA (n = 4315); a subset of
which had their diagnosis of PsA established by a healthcare provider (HCP;
n = 1719); patients with psoriasis only (n = 7775); and the overall PSOLAR
population (n = 12,090).
Results: At enrollment, demographic characteristics were distinct between
psoriasis patients self-reporting PsA and psoriasis only patients. Of the
patients with psoriasis self-reporting PsA, 44.4% had cardiovascular disease
(CVD), 26.3% had psychiatric illness, and 3.2% had inflammatory bowel disease
(IBD), with each more prevalent than among patients with psoriasis only
(p < 0.001). Overall, 17.5% of psoriasis patients self-reporting PsA had a family
history of PsA, 29.8% had used systemic steroids, 39.5% had used nonsteroidal
anti-inflammatory drugs, and 83.5% had used biologics.
Conclusions: Demographics, family history, and previous medication use were
generally comparable between "PsA established by a HCP" patients and psoriasis
patients self-reporting PsA in the PSOLAR registry, but there were statistical
differences compared with the psoriasis only group regarding the prevalence of
certain comorbidities (CVD, psychiatric illness, and IBD). These analyses provide
important data regarding characteristics of psoriasis patients with self-reported
PsA in PSOLAR.
Trial registration: NCT00508547.
DOI: 10.1186/s41927-018-0034-7
PMCID: PMC6390609
PMID: 30886979
Conflict of interest statement: PSOLAR is conducted in accordance with the

International Conference on Harmonizing guidelines on Good Clinical Practices and
the Declaration of Helsinki. An institutional review board or ethics committee
(Goodwyn Institutional Review Board and Ontario Institutional Review Board)
approved the registry protocol. All patients provided written informed consent
before initiation of study procedures and to publish the data.Not applicable.AK
conducted clinical research sponsored by and consulted for Janssen; KP has served
as a consultant and/or speaker and/or advisor and/or steering committee member
and/or received research grants and/or honoraria from AbbVie, Akros, Allergan,
Amgen, Anacor, Astellas, AstraZeneca, Baxalta, Baxter, Boehringer Ingelheim,
Bristol-Myers Squibb, Canfite, Celegene, Coherus, Dermira, Dow Pharma, Eli Lilly,
Forward Pharma, Galderma, Genentech, GSK, Janssen, Kyowa Hakko Kirin, Leo,
Medimmune, Meiji Seika Pharma, Merck, Merck-Serono, Mistusbishi Pharma, Novartis,
Pfizer, Regeneron, Roche, Sanofi-Aventis/Genzyme, Takeda, UCB, and Valeant, and
served as a scientific officer for Akros, Anacor, and Kyowa Hakko Kirin; ABG has
current consulting/advisory board/or speakers bureau agreements with Janssen,
Celgene Corp., Bristol Myers Squibb, Beiersdorf, Inc., AbbVie, UCB, Novartis,
Incyte, Eli Lilly, Reddy Labs, Valeant, Dermira, Allergan, and Sun Pharmaceutical
Industries, and research/educational grants from Incyte and Janssen; EMGJJ has
acted as consultant and/or paid speaker for and/or participated in research
sponsored by companies that manufacture drugs used for the treatment of psoriasis
including: AbbVie, Janssen, Pfizer, Novartis, Eli Lilly, Celgene and Leo, has
received research grants for the independent research fund of the Department of
Dermatology of the Radboud University Medical Centre Nijmegen, the Netherlands
from AbbVie, Pfizer, Janssen, promotion fund Rumc/SMK, ZonMw, the National
Psoriasis Foundation, and VGZ, and all funding is not personal, but goes to the
independent research fund of the Department of Dermatology of Radboud University
Medical Centre Nijmegen, the Netherlands; SDC, SK, WL, KF, and BS are all
employees of Janssen and own stock in Johnson & Johnson, of which Janssen is a
wholly-owned subsidiary; JUS has consulted for Janssen, Novartis, and
UCB.Springer Nature remains neutral with regard to jurisdictional claims in
1700. BMC Health Serv Res. 2019 Apr 24;19(1):246. doi: 10.1186/s12913-019-4059-4.
Critical steps in the path to using cessation pharmacotherapy following

hospital-initiated tobacco treatment.
Liebmann EP(1), Scheuermann TS(2), Faseru B(2), Richter KP(3).
Author information:
(1)Department of Psychology, University of Kansas, Lawrence, KS, USA.
(2)Department of Preventive Medicine and Public Health, University of Kansas
Medical Center, Mailstop 1008, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
(3)Department of Preventive Medicine and Public Health, University of Kansas
Medical Center, Mailstop 1008, 3901 Rainbow Blvd., Kansas City, KS, 66160, USA.
KRICHTER@kumc.edu.
BACKGROUND: Hospital-initiated smoking cessation interventions utilizing
pharmacotherapy increase post-discharge quit rates. Use of smoking cessation
medications following discharge may further increase quit rates. This study aims
to identify individual, smoking-related and hospitalization-related predictors of
engagement in three different steps in the smoking cessation pharmacotherapy
utilization process: 1) receiving medications as inpatient, 2) being discharged
with a prescription and 3) using medications at 1-month post-hospitalization,
while accounting for associations between these steps.
METHODS: Study data come from a clinical trial (N = 1054) of hospitalized smokers
interested in quitting who were randomized to recieve referral to a quitline via
either warm handoff or fax. Variables were from the electronic health record, the
state tobacco quitline, and participant self-report. Relationships among the
predictors and the steps in cessation medication utilization were assessed using
bivariate analyses and multivariable path analysis.
RESULTS: Twenty-eight percent of patients reported using medication at 1-month
post-discharge. Receipt of smoking cessation medications while hospitalized
(OR = 2.09, 95%CI [1.39, 3.15], p < .001) and discharge with a script (OR = 4.88,
95%CI [3.34, 7.13], p < .001) were independently associated with medication use
at 1-month post-hospitalization. The path analysis also revealed that the
likelihood of being discharged with a script was strongly influenced by receipt
of medication as an inpatient (OR = 6.61, 95%CI [4.66, 9.38], p < .001). A number
of other treatment- and individual-level factors were associated with medication
use in the hospital, receipt of a script, and use post-discharge.
CONCLUSIONS: To encourage post-discharge smoking cessation medication use,
concerted effort should be made to engage smokers in tobacco treatment while in
hospital. The individual and hospital-level factors associated with each step in
the medication utilization process provide good potential targets for future
implementation research to optimize treatment delivery and outcomes.
TRIAL REGISTRATION: Number: NCT01305928 . Date registered: February 24, 2011.
DOI: 10.1186/s12913-019-4059-4
PMCID: PMC6480776
1701. Patient Educ Couns. 2014 Dec;97(3):310-26. doi: 10.1016/j.pec.2014.08.021.

Epub
2014 Sep 16.
Patient-centered interventions to improve medication management and adherence: a

qualitative review of research findings.
Kuntz JL(1), Safford MM(2), Singh JA(2), Phansalkar S(3), Slight SP(3), Her
QL(4), Lapointe NA(5), Mathews R(5), O'Brien E(5), Brinkman WB(6), Hommel K(6),
Farmer KC(7), Klinger E(8), Maniam N(4), Sobko HJ(2), Bailey SC(9), Cho I(8),
Rumptz MH(10), Vandermeer ML(10), Hornbrook MC(10).
Author information:
(1)Center for Health Research, Kaiser Permanente Northwest, Portland, USA.
Electronic address: Jennifer.l.kuntz@kpchr.org.
(2)Division Preventive Medicine, Department of Medicine, University of Alabama at
Birmingham, USA.
(3)Partners Healthcare Systems, Inc., Wellesley, USA; Brigham and Women's
Hospital and Harvard Medical School, Boston, USA.
(4)Partners Healthcare Systems, Inc., Wellesley, USA.
(5)Duke University, Durham, USA.
(6)Cincinnati Children's Hospital and Medical Center, Cincinnati, USA.
(7)The University of Oklahoma College of Pharmacy, Oklahoma City, USA.
(8)Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
(9)University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, USA.
(10)Center for Health Research, Kaiser Permanente Northwest, Portland, USA.
OBJECTIVE: Patient-centered approaches to improving medication adherence hold

promise, but evidence of their effectiveness is unclear. This review reports the
current state of scientific research around interventions to improve medication
management through four patient-centered domains: shared decision-making, methods
to enhance effective prescribing, systems for eliciting and acting on patient
feedback about medication use and treatment goals, and medication-taking
behavior.
METHODS: We reviewed literature on interventions that fell into these domains and
were published between January 2007 and May 2013. Two reviewers abstracted
information and categorized studies by intervention type.
RESULTS: We identified 60 studies, of which 40% focused on patient education.
Other intervention types included augmented pharmacy services, decision aids,
shared decision-making, and clinical review of patient adherence. Medication
adherence was an outcome in most (70%) of the studies, although 50% also examined
patient-centered outcomes.
CONCLUSIONS: We identified a large number of medication management interventions
that incorporated patient-centered care and improved patient outcomes. We were
unable to determine whether these interventions are more effective than
traditional medication adherence interventions.
PRACTICE IMPLICATIONS: Additional research is needed to identify effective and
feasible approaches to incorporate patient-centeredness into the medication
management processes of the current health care system, if appropriate.
DOI: 10.1016/j.pec.2014.08.021
PMCID: PMC5830099
1702. Pharmacogenomics. 2018 Oct;19(15):1169-1179. doi: 10.2217/pgs-2018-0088. Epub

2018 Sep 12.
Pharmacogenetic profile and major depressive and/or bipolar disorder treatment: a

retrospective, cross-sectional study.
Tonozzi TR(1), Braunstein GD(1), Kammesheidt A(1), Curran C(2), Golshan S(3),
Kelsoe J(3).
Author information:
(1)Pathway Genomics, San Diego, CA 92121, USA.
(2)Patients Like Me, Cambridge, MA 02142, USA.
(3)Department of Psychiatry, University of California, San Diego, CA 92093, USA.
AIM: To compare pharmacogenetic test predictions with self-reported treatment

experience and side effect tolerability among patients with depression taking
psychotherapeutic medications.
METHODS: Subjects completed a survey recalling medication effectiveness and side
effects and then underwent pharmacogenetic testing.
RESULTS: Our 15 gene pharmacogenetic panel predicted efficacy (p < 0.001) but did
not predict side effect tolerability (p = 0.70) in a group of 352 patients. The
pharmacogenetic panel and reported efficacy corresponded 60% of the time and
medication tolerability agreed 71% of the time.
CONCLUSION: Pharmacogenetic testing may be a useful adjunct to predict efficacy
of medications used to treat depression.
DOI: 10.2217/pgs-2018-0088
PMID: 30207201
1703. J Caring Sci. 2018 Dec 1;7(4):213-218. doi: 10.15171/jcs.2018.032.

eCollection
2018 Dec.
Medication Adherence and its Related Factors in Patients Undergoing Coronary

Artery Angioplasty.
Salari A(1), Rouhi Balasi L(2), Ashouri A(3), Moaddab F(1), Zaersabet F(1),
Nourisaeed A(4).
Author information:
(1)Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat
Hospital, Faculty of Medicine, Guilan University of Medical Sciences, Rasht,
Iran.
(2)Department of Nursing, Faculty of Nursing and Midwifery, Ahvaz Jundishapur
University of Medical Sciences, Ahvaz, Iran.
(3)Department of Health Education and Promotion, Health and Environment Research
Center, Faculty of Health, Guilan University of Medical Sciences, Rasht, Iran.
(4)Department of Psychology, Islamic Azad University of Guilan, Rasht, Iran.
Introduction: Percutaneous Coronary Intervention (PCI) has no effect on coronary

artery atherosclerosis, thus the modification of physiological risk factors seems
essential to prevent coronary artery disease (CAD). Then PCI patients have to
receive multiple drug therapies in an attempt to prevent the recurrence of
cardiac events. In spite of the evidence based on medication adherence to prevent
post-PCI CAD development, medication adherence is the main concern for health
care system. Accordingly, this study aims to determine the medication adherence
and its related factors among these patients. Methods: In this cross-sectional
study, the statistical community was the patients undergoing PCI at medical
educational hospital of Dr. Heshmat in Rasht, Iran. 269 patients were selected by
convenient sampling method. The data were collected by a questionnaire consisting
of 4 parts, namely the socio-individual factors, Morisky medication adherence
scale, hospital anxiety and depression scale and cardiac patient's self-efficacy
scale. Data analysis was done by descriptive statistics and the significance
variables in univariate analysis were examined in a multi logistic regression
model through considering co-linearity. Results: The results showed that 75
patients (28%) didn't adhere to the medication. In addition, the majority of them
were reported to have clinical anxiety (44.2%) and mild depression (55.8%). Also,
based on the results derived from multiple logistic regressions, only the
spouse's educational level and family history of coronary artery disease were
significant predictors of medication adherence. Conclusion: The current study
findings display lack of complete post-PCI medication adherence, which
underscores the importance of the existence of cardiac rehabilitation systems in
the society. Therefore, it is recommended that cardiac rehabilitation centers be
built in the society.
DOI: 10.15171/jcs.2018.032
PMCID: PMC6311628
PMID: 30607362
1704. Front Public Health. 2018 Sep 3;6:244. doi: 10.3389/fpubh.2018.00244.

eCollection
2018.
Evaluation of the Involvement of Pharmacists in Diabetes Self-Care: A Review From
the Economic Perspective.
Jamshed SQ(1), Siddiqui MJ(1), Rana B(2), Bhagavathula AS(3).
Author information:
(1)Pharmacy Practice, International Islamic University Malaysia, Selayang,
Malaysia.
(2)University of Veterinary and Animal Sciences, Lahore, Pakistan.
(3)Department of Internal Medicine, College of Medicine and Health Sciences,
United Arab Emirates University, Al Ain, United Arab Emirates.
Objectives: To analyze the studies encompassing the involvement of pharmacists in

diabetes self-care. Method: We reviewed studies conducted from 2005 to 2017 on
the involvement of pharmacists in diabetes self-care. The keywords mainly used in
this search are pharmacoeconomic analysis, diabetes self-care, pharmacist
involvement,cost-effectiveness analysis, cost of utilization, cost of illness,
cost of minimization and cost-benefit analysis. PubMed, Science Direct, Springer
Link and Medline searched for the relevant studies. These databases searched for
full text articles ranging from 2007 to 2017. We tried to limit the search with
the inclusion of studies having any sort of pharmacoeconomically relevant
component. Key Findings: Cost of illness varied among the countries in managing
diabetes mellitus, and the cost of managing diabetes complications were twice the
cost of management of diabetes. Continuous involvement of the pharmacist in
primary health care is a cost-effective strategy and pronounced to be essential
for helping diabetes patient in controlling and managing their disease.
Implementation of diabetes self-care by pharmacists such as lifestyle
intervention rendered improved quality of life of patient without any increase in
health care cost. Self-care management generates intensive blood glucose control
and improved quality of life. Conclusions: Implementation of diabetic self-care
intervention including intensive lifestyle intervention, education,
self-monitoring of blood glucose and adherence toward medication-initiated
reduction in the overall healthcare cost of diabetic patients compared to
patients relying on only any one of the interventions. Impact of diabetes
self-care intervention by pharmacist reported to significantly reduce the HbA1C
levels of diabetic patients along with the reduction of yearly healthcare cost.
This review showed that pharmacist involvement in diabetes self-care
interventions prove to be cost-effective and can significantly affect the
condition of the diabetic patients and reduces the risk of complications.
DOI: 10.3389/fpubh.2018.00244
PMCID: PMC6129588
PMID: 30234088
1705. Asian Pac J Allergy Immunol. 2018 Jun;36(2):88-92. doi: 10.12932/AP-010217-

0002.
The effectiveness of newly developed written asthma action plan in improvement of

asthma outcome in children.
Lakupoch K(1), Manuyakorn W(1), Preutthipan A(1), Kamalaporn H(1).
Author information:
(1)Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, Bangkok, Thailand.
BACKGROUND: Providing asthma education about controller medication use and

appropriate management of asthma exacerbation are the keys to improving the
disease outcome. Many asthma guidelines recommend that physicians provide written
asthma action plan (WAAP) to all of their asthmatic patients. However, the
benefit of WAAP is unclear. Thus, we have created a new WAAP which is simplified
in Thai and more user friendly.
OBJECTIVE: To determine the effectiveness of the newly developed asthma action
plan in management of children with asthma.
METHODS: Asthmatic children who meet inclusion criteria all received the WAAP and
they were followed up for 6 months with measurement of outcome variables, such as
asthma exacerbation that required emergency room visit, unscheduled OPD visit,
admission and school absence in order to compare with the past 6 months before
receiving the WAAP.
RESULTS: The analyzed outcomes of forty-nine children show significantly reduced
emergency room visit (P-value 0.005), unscheduled OPD visit (P-value 0.046),
admission days (P-value 0.026) and school absence days (P-value 0.022). Well
controlled group and mild severity group were not the factors that contribute to
decreased emergency room visit but step up therapy may be the co-factor to
decreased ER visit.
CONCLUSIONS: The results of this study suggest that the provision of newly
developed WAAP is useful for improving self- care of asthma patients and reducing
asthma exacerbation.
DOI: 10.12932/AP-010217-0002
1706. Schizophr Bull. 2017 Mar 1;43(2):417-424. doi: 10.1093/schbul/sbw092.
Aberrant Force Processing in Schizophrenia.
Martinelli C(1), Rigoli F(2), Shergill SS(1).
Author information:
(2)Wellcome Trust Centre for Neuroimaging, University College London, London, UK.
Initially considered as mere side effects of antipsychotic medication, there is

now evidence that motor and somatosensory disturbances precede the onset of the
illness and can be found in drug-naive patients. However, research on the topic
is scarce. Here, we were interested in assessing the accuracy of the neural
signal in detecting parametric variations of force linked to a voluntary motor
act and a received tactile sensation, either self-generated or externally
generated. Patients with a diagnosis of schizophrenia and healthy controls
underwent functional magnetic resonance imaging while asked to press, or abstain
from pressing, a lever in order to match a visual target force. Forces, exerted
and received, varied on 10 levels from 0.5 N to 5 N in 0.5 N increments. Healthy
participants revealed a positive correlation between force and activity in
contralateral primary somatosensory area (S1) when performing a movement as well
as when receiving a tactile sensation but only when this was externally, and not
self-, generated. Patients showed evidence of altered force signaling in both
motor and tactile conditions, as well as increased correlation with force when
tactile sensation was self-generated. Findings are interpreted in line with
accounts of predictive and sensory integration mechanisms and point toward
alterations in the encoding of parametric forces in the motor and somatosensory
domain in patients affected by schizophrenia.
© The Author 2016. Published by Oxford University Press on behalf of the Maryland
Psychiatric Research Center. All rights reserved. For permissions, please email:
DOI: 10.1093/schbul/sbw092
PMCID: PMC5605270
1707. Med Princ Pract. 2018;27(4):387-391. doi: 10.1159/000490145. Epub 2018 Jun
22.
Atrial Fibrillation and Shock: Unmasking Theophylline Toxicity.
Aggelopoulou E(1), Tzortzis S(2), Tsiourantani F(1), Agrios I(2), Lazaridis K(2).
Author information:
(1)3rd Department of Internal Medicine, 417 Army Share Fund Hospital, Athens,
Greece.
(2)Department of Cardiology, 417 Army Share Fund Hospital, Athens, Greece.
OBJECTIVE: The aim of this report is to describe a case of atrial fibrillation

and shock precipitated by deliberate self-poisoning with theophylline.
CLINICAL PRESENTATION AND INTERVENTION: An 85-year-old male with severe
theophylline intoxication in a suicide attempt was admitted with severe cardiac
arrhythmia and shock; despite poor prognosis, he fully recovered gradually after
proper diagnosis and treatment. Theophylline is a rather forgotten medication;
thus, intoxication is not usually considered among the etiologies of potentially
treatable cardiologic emergencies, especially when its use is intentionally
concealed.
CONCLUSION: This case highlights the importance of identifying a comprehensive
medication history using all available sources of information as early as
possible in an emergency department presentation.
© 2018 The Author(s) Published by S. Karger AG, Basel.
DOI: 10.1159/000490145
PMCID: PMC6170900
1708. J Psychopharmacol. 2019 Apr;33(4):472-481. doi: 10.1177/0269881118817170.

Epub
2018 Dec 19.
The pharmacological management of acute behavioural disturbance: Data from a

clinical audit conducted in UK mental health services.
Paton C(1), Adams CE(2), Dye S(3), Fagan E(1), Okocha C(4), Barnes TR(1)(5).
Author information:
(1)1 Royal College of Psychiatrists, Centre for Quality Improvement, London, UK.
(2)2 Institute of Mental Health, University of Nottingham, Nottingham, UK.
(3)3 Ipswich Access and Treatment Team, Norfolk and Suffolk NHS Foundation Trust,
Ipswich, UK.
(4)4 Oxleas NHS Foundation Trust, Dartford, UK.
(5)5 Centre for Psychiatry, Imperial College London, London, UK.
BACKGROUND:: A quality improvement programme addressing prescribing practice for

acutely disturbed behaviour was initiated by the Prescribing Observatory for
Mental Health.
METHOD:: This study analysed data from a baseline clinical audit conducted in
inpatient mental health services in member trusts.
RESULTS:: Fifty-eight mental health services submitted data on 2172 episodes of
acutely disturbed behaviour. A benzodiazepine alone was administered in 60% of
the 1091 episodes where oral medication only was used and in 39% of the 1081
episodes where parenteral medication (rapid tranquillisation) was used.
Haloperidol was combined with lorazepam in 22% of rapid tranquillisation episodes
and with promethazine in 3%. Physical violence towards others was strongly
associated with receiving rapid tranquillisation in men (odds ratio 1.74,
1.25-2.44; p<0.001) as was actual or attempted self-harm in women (odds ratio
1.87, 1.19-2.94; p=0.007). Where physical violence towards others was exhibited,
a benzodiazepine and antipsychotic was more likely to be prescribed than a
benzodiazepine alone (odds ratio 1.39, 1.00-1.92; p=0.05). The data suggested
that 25% of patients were at least 'extremely or continuously active' in the hour
after rapid tranquillisation was administered.
CONCLUSION:: The current management of acutely disturbed behaviour with
parenteral medication may fail to achieve a calming effect in up to a quarter of
episodes. The most common rapid tranquillisation combination used was lorazepam
and haloperidol, for which the randomised controlled trial evidence is very
limited. Rapid tranquillisation prescribing practice was not wholly consistent
with the relevant National Institute for Health and Care Excellence guideline,
which recommends intramuscular lorazepam on its own or intramuscular haloperidol
combined with intramuscular promethazine. Clinical factors prompting the use of
rapid tranquillisation rather than oral medication may differ between the
genders.
DOI: 10.1177/0269881118817170
PMCID: PMC6431784
PMID: 30565486
1709. Int J Clin Pharm. 2016 Oct;38(5):1200-9. doi: 10.1007/s11096-016-0353-y. Epub

2016 Jul 23.
Medication management of febrile children: a qualitative study on pharmacy

employees' experiences.
Stakenborg JP(1), de Bont EG(2), Peetoom KK(1), Nelissen-Vrancken MH(3), Cals

JW(1).
Author information:
(1)Department of Family Medicine, CAPHRI School for Public Health and Primary
Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
(2)Department of Family Medicine, CAPHRI School for Public Health and Primary
Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
eefje.debont@maastrichtuniversity.nl.
(3)Dutch Institute for Rational Use of Medicine, P.O. Box 3089, 3502 GB, Utrecht,
The Netherlands.
Background While fever is mostly self-limiting, antibiotic prescription rates for

febrile children are high. Although every parent who receives a prescription
visits a pharmacy, we have limited insight into pharmacy employees' experiences
with these parents. Pharmacy employees do however exert an important role in
ensuring children receive correct dosages and in advising parents on
administration of antibiotics. Objective To describe pharmacists' and pharmacy
assistants' experiences with parents contacting a pharmacy for their febrile
child, and to identify ways of improving medication management of these children.
Setting Community pharmacies in the Netherlands. Method A qualitative study
including 24 Dutch pharmacy employees was conducted, performing four focus group
discussions among pharmacy employees. Analysis was based on constant comparative
technique using open and axial coding. Main outcome measure Pharmacy employees'
experiences with parents contacting a pharmacy for their febrile child. Results
Three categories were identified: (1) workload and general experience, (2)
inconsistent information on antibiotic prescriptions, (3) improving communication
and collaboration. Pharmacy employees experienced that dosing errors in
antibiotic prescriptions occur frequently and doctors provide inconsistent
information on prescriptions. Consequently, they have to contact doctors,
resulting in a higher workload for both stakeholders. They believe this can be
improved by providing the indication for antibiotics on prescriptions, especially
when deviating from standard dosages. Conclusion Pharmacy employees experience a
high amount of dosing errors in paediatric antibiotic prescriptions. Providing
the indication for antibiotics in febrile children on prescriptions, especially
when deviating from standard dosages, can potentially reduce dosage errors and
miscommunication between doctors and pharmacy employees.
DOI: 10.1007/s11096-016-0353-y
PMCID: PMC5031752

eCollection 2015.
Antidepressant medication treatment patterns in Asian patients with major

depressive disorder.
Novick D(1), Montgomery W(2), Moneta V(3), Peng X(4), Brugnoli R(5), Haro JM(3).
Author information:
(1)Eli Lilly and Company, Windlesham, Surrey, UK.
(2)Eli Lilly Australia Pty Ltd, West Ryde, Australia.
(3)Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona,
Spain.
(4)Eli Lilly and Company, Indianapolis, IN, USA.
(5)Department of Neuroscience, School of Medicine, Sapienza University of Rome,
Rome, Italy.
PURPOSE: To describe pharmacological treatment patterns in Asian patients with

major depressive disorder (MDD), including duration of treatment, reasons for
medication discontinuation, rate of medication nonadherence, factors associated
with medication nonadherence, and impact of medication nonadherence on depression
outcomes.
PATIENTS AND METHODS: Data were from a prospective, observational 3-month study
of East Asian MDD inpatients from 40 sites in six East Asian countries who
initiated antidepressant treatment at baseline (n=569). Assessments included the
Clinical Global Impression-Severity scale (CGI-S), 17-item Hamilton Depression
Rating Scale (HAMD-17), painful physical symptoms, response and remission,
employment status, quality of life (QoL) (EuroQOL Questionnaire-5 Dimensions
[EQ-5D]) and health state using the visual analog scale, adherence by clinician
opinion, and patient self-report. Cox proportional hazards modeling, Kaplan-Meier
survival analysis, and regression modeling were employed.
RESULTS: Median time to discontinuation for any reason was 70 days (95%
confidence interval: 47; 95). Reasons for discontinuation were inadequate
response in 64.1%, nonadherence in 6.2%, and adverse events in 4.1%; 25.6% who
discontinued experienced an adequate response to treatment. In those patients who
had an adequate response, age and country were significantly associated with time
to medication discontinuation. Patient-reported nonadherence was 57.5% and
clinician-reported nonadherence was 14.6% (62/426). At 3 months, nonadherent
patients had significantly higher disease severity (CGI-S, P=0.0001; HAMD-17,
P<0.0001), lower QoL ratings (EQ-5D tariff, P=0.0007; EQ-5D visual analog scale,
P=0.0024), and lower response and remission rates (both P<0.0001) compared with
adherent patients. The odds of response and remission were greater among adherent
patients.
CONCLUSION: Early discontinuation of antidepressants among Asian MDD patients was
high. A total of 25.6% who discontinued prematurely were experiencing an adequate
response to treatment. Nonadherent patients had significantly higher disease
severity, lower QoL ratings, and lower response and remission rates compared with
adherent patients.
DOI: 10.2147/PPA.S68432
PMCID: PMC4362981
PMID: 25792815
1711. Indian J Psychiatry. 2017 Jan-Mar;59(1):69-76. doi:

10.4103/psychiatry.IndianJPsychiatry_24_17.
Treatment compliance and noncompliance in psychoses.
Rao KN(1), George J(1), Sudarshan CY(1), Begum S(1).
Author information:
(1)Department of Psychiatry, JJM Medical College, Davangere, Karnataka, India.
BACKGROUND: Compliance or noncompliance with treatment significantly influences

course and outcome of psychiatric disorders. While noncompliance has been
extensively researched, compliance has received less attention. The current study
was conducted to elicit reasons for compliance and noncompliance in patients
having psychoses attending psychiatric clinics.
MATERIALS AND METHODS: A total of 196 compliant and 150 noncompliant patients
were interviewed using self-designed tools to elicit sociodemographic data,
details of illness, and treatment. Factors contributing to compliance and
noncompliance were grouped under illness-related, clinician-related,
medication-related, family-related, and economic-related domains and compared.
RESULTS: Compliance was significantly more in females and middle- and
high-socioeconomic status patients. They had less substance use, high physical
comorbidity, high attendance in the outpatient department, and better remission.
Clinician-related, family-related, and medication-related domains were
contributing more to compliance whereas illness-related and economic-related
domains seemed to have more bearing on noncompliance.
CONCLUSIONS: Compliance and noncompliance are determined multidimensionally.
Domains related to clinician, family, and medications have to be reinforced to
enhance compliance. Illness-related and economic domains have to be resolved to
reduce noncompliance.
DOI: 10.4103/psychiatry.IndianJPsychiatry_24_17
PMCID: PMC5419016
PMID: 28529363
1712. Transl Psychiatry. 2017 Apr 25;7(4):e1108. doi: 10.1038/tp.2017.71.
Biobehavioral effects of baclofen in anxious alcohol-dependent individuals: a

randomized, double-blind, placebo-controlled, laboratory study.
Farokhnia M(1), Schwandt ML(2), Lee MR(1), Bollinger JW(1), Farinelli LA(1),
Amodio JP(1), Sewell L(2), Lionetti TA(3), Spero DE(3), Leggio L(1)(4).
Author information:
(1)Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology,
National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug
Abuse, National Institutes of Health, Bethesda, MD, USA.
(2)Office of the Clinical Director, National Institute on Alcohol Abuse and
Alcoholism, National Institutes of Health, Bethesda, MD, USA.
(3)Clinical Center Nursing Department, National Institutes of Health, Bethesda,
MD, USA.
(4)Center for Alcohol and Addiction Studies, Department of Behavioral and Social
Sciences, Brown University, Providence, RI, USA.
Baclofen has been suggested as a potential pharmacotherapy for alcohol use

disorder, but the clinical data are conflicting. Here we investigated the
biobehavioral effects of baclofen in a sample of anxious alcohol-dependent
individuals. This was a randomized, double-blind, placebo-controlled, human
laboratory study in non-treatment seeking alcohol-dependent individuals with high
trait anxiety (N=34). Participants received baclofen (30 mg per day) or placebo
for at least 8 days, then performed an experimental session consisting of alcohol
cue-reactivity followed by alcohol administration procedure (alcohol priming,
then alcohol self-administration). Total amount of alcohol self-administered was
the primary outcome; alcohol craving, subjective/physiological responses and
mood/anxiety symptoms were also evaluated. There was no significant medication
effect on the total amount of alcohol consumed during the alcohol
self-administration (P=0.76). Baclofen blunted the positive association between
maximum breath alcohol concentration during priming and the amount of alcohol
consumption (significant interaction, P=0.03). Ratings of feeling intoxicated
were significantly higher in the baclofen group after consuming the priming drink
(P=0.006). During the self-administration session, baclofen significantly
increased ratings of feeling high (P=0.01) and intoxicated (P=0.01). A
significant reduction in heart rate (P<0.001) and a trend-level increase in
diastolic blood pressure (P=0.06) were also detected in the baclofen group during
the alcohol laboratory session. In conclusion, baclofen was shown to affect
subjective and physiological responses to alcohol drinking in anxious
alcohol-dependent individuals. These results do not support an anti-craving or
anti-reinforcing effect of baclofen, but rather suggest that baclofen may act as
a substitution medication for alcohol use disorder.
DOI: 10.1038/tp.2017.71
PMCID: PMC5416708
1713. Behav Sci (Basel). 2017 Sep 15;7(3). pii: E62. doi: 10.3390/bs7030062.
A Systematic Review: Family Support Integrated with Diabetes Self-Management

among Uncontrolled Type II Diabetes Mellitus Patients.
Pamungkas RA(1)(2), Chamroonsawasdi K(3), Vatanasomboon P(4).
Author information:
(1)Department of Family Health, Mahidol University, Bangkok 10400, Thailand.
adirian491@yahoo.com.
(2)Department of Nursing, College of Health, Mega Rezky Makassar, Makassar 90245,
Indonesia. adirian491@yahoo.com.
(3)Department of Family Health, Mahidol University, Bangkok 10400, Thailand.
kanittha.cha@mahidol.ac.th.
(4)Department of Health Education and Behavioral Science, Mahidol University,
Bangkok 10400, Thailand. paranee.vat@mahidol.ac.th.
The rate of type-2 diabetes mellitus (T2D) is dramatically increasing worldwide.

Continuing diabetes mellitus (DM) care needs effective self-management education
and support for both patients and family members. This study aimed to review and
describe the impacts of diabetes mellitus self-management education (DSME) that
involve family members on patient outcomes related to patient health behaviors
and perceived self-efficacy on self-management such as medication adherence,
blood glucose monitoring, diet and exercise changes, health outcomes including
psychological well-being and self-efficacy, and physiological markers including
body mass index, level of blood pressure, cholesterol level and glycemic control.
Three databases, PubMed, CINAHL, and Scopus were reviewed for relevant articles.
The search terms were "type 2 diabetes," "self-management," "diabetes
self-management education (DSME)," "family support," "social support," and
"uncontrolled glycaemia." Joanna Briggs Institute (JBI) guidelines were used to
determine which studies to include in the review. Details of the family support
components of DSME intervention and the impacts of these interventions had on
improving the health outcomes patients with uncontrolled glycaemia patients. A
total of 22 intervention studies were identified. These studies involved
different DSME strategies, different components of family support provided, and
different health outcomes to be measured among T2D patients. Overall, family
support had a positive impact on healthy diet, increased perceived support,
higher self-efficacy, improved psychological well-being and better glycemic
control. This systematic review found evidence that DSME with family support
improved self-management behaviors and health outcomes among uncontrolled
glycaemia T2D patients. The findings suggest DSME models that include family
engagement can be a useful direction for improving diabetes care.
DOI: 10.3390/bs7030062
PMCID: PMC5618070
PMID: 28914815
Conflict of interest statement: We declare no conflict of interest in this

manuscript. The funding sponsors also had no role in the writing of the
manuscript or the decision to publish this manuscript.
1714. Pain Med. 2015 Apr;16(4):706-14. doi: 10.1111/pme.12701. Epub 2015 Feb 3.
Pain self-management in HIV-infected individuals with chronic pain: a qualitative

study.
Merlin JS(1), Walcott M, Kerns R, Bair MJ, Burgio KL, Turan JM.
Author information:
(1)Division of Infectious Diseases, Department of Medicine, University of Alabama
at Birmingham, Birmingham, Alabama; Division of Gerontology, Geriatrics, and
Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA.
OBJECTIVE: Chronic pain in individuals with HIV is a common, impairing condition.

Behavioral interventions for chronic pain specifically tailored to this
population have yet to be developed. We assert that understanding self-management
strategies already used by persons living with these conditions is an essential
first step, and is the objective of this investigation.
DESIGN: We conducted a thematic analysis of qualitative data from 25 in-depth
interviews with individuals with HIV and chronic pain.
RESULTS: The primary pain self-management strategies articulated by participants
were: physical activity; cognitive and spiritual strategies; spending time with
family and friends and social support; avoidance of physical/social activity;
medication-centric pain management; and substance use.
CONCLUSIONS: Some of these strategies may be viewed as beneficial and overlap
with known HIV self-management strategies (cognitive strategies), whereas others
may have negative health consequences (substance use). Interventions that
incorporate healthy self-management strategies may be particularly effective in
improving both HIV and pain outcomes.
DOI: 10.1111/pme.12701
PMCID: PMC4390451
1715. Health Expect. 2015 Oct;18(5):1270-81. doi: 10.1111/hex.12101. Epub 2013 Jun
20.
Pharmacist intervention in improving hypertension-related knowledge, treatment

medication adherence and health-related quality of life: a non-clinical
Saleem F(1), Hassali MA(2), Shafie AA(1), Ul Haq N(1), Farooqui M(3), Aljadhay
H(4), Ahmad FU(5).
Author information:
Sciences, Universiti Sains Malaysia, Penang, Malaysia.
(2)School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang,
Malaysia.
(3)Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Penang, Malaysia.
(4)College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
(5)Discipline of Physiology, School of Pharmaceutical Sciences, Universiti Sains
Malaysia, Penang, Malaysia.
OBJECTIVE: The study evaluated whether a pharmaceutical care intervention can

result in better understanding about hypertension, increase medication adherence
to antihypertensive therapy and improve overall health-related quality of life.
METHODS: A non-clinical randomized control trial was conducted whereby
participants received an educational intervention through hospital pharmacists.
Hypertension knowledge, medication adherence and health-related quality of life
were measured by means of self-administered questionnaires. Descriptive
statistics were used to describe the demographic and disease characteristics of
the patients. Inferential statistics were used for inter- and intragroup
comparisons. SPSS 17 was used for data analysis.
RESULTS: Three hundred and eighty-five hypertensive patients were randomly
assigned (192 in the control group and 193 in the intervention group) to the
study. No significant differences were observed in either group for age, gender,
income, locality, education, occupation or duration of disease. There was,
however, a significant increase in the participants' levels of knowledge about
hypertension and medication adherence among the interventional group after
completing the intervention. Significantly lower systolic and diastolic blood
pressure levels were also observed among the interventional group after
completion of the intervention. The interventional group, however, reported
decreased yet significant health-related quality of life at the end of the
interventional programme.
CONCLUSION: Pharmacist intervention can significantly increase disease-related
knowledge, blood pressure control and medication adherence in patients with
hypertension. However, further research is needed to address the decreased
health-related quality of life after completion of the study.
DOI: 10.1111/hex.12101
PMCID: PMC5060860
Assessing oral medication adherence among patients with type 2 diabetes mellitus
treated with polytherapy in a developed Asian community: a cross-sectional study.
Lee CS(1), Tan JHM(1), Sankari U(1), Koh YLE(1), Tan NC(1)(2).
Author information:
(1)SingHealth Polyclinics, Singapore, Singapore.
(2)Duke-NUS Medical School, Singapore, Singapore.
OBJECTIVES: The disease burden of type 2 diabetes mellitus (T2DM) is rising due
to suboptimal glycaemic control leading to vascular complications. Medication
adherence (MA) directly influences glycaemic control and clinical consequences.
This study aimed to assess the MA of patients with T2DM and identify associated
factors.
DESIGN: Analysis of data from a cross-sectional survey and electronic medical
records.
SETTING: Primary care outpatient clinic in Singapore.
PARTICIPANTS: Adult patients with T2DM.
MAIN OUTCOME MEASURES: MA to each prescribed oral hypoglycaemic agent (OHA) was
measured using the five-question Medication Adherence Report Scale (MARS-5). Low
MA is defined as a MARS-R score of <25. Demographic data, clinical
characteristics and investigation results were collected to identify factors that
are associated with low MA.
RESULTS: The study population comprised 382 patients with a slight female
predominance (53.4%) and a mean±SD age of 62.0±10.4 years. 57.1% of the patients
had low MA to at least one OHA. Univariate analysis showed that patients who were
younger, of Chinese ethnicity, married or widowed, self-administering their
medications or taking fewer (four or less) daily medications tended to have low
MA to OHA. Logistic regression revealed that younger age (OR 0.97; 95% CI 0.95
to0.99), Chinese ethnicity (OR 2.80; 95% CI 1.53 to5.15) and poorer glycaemic
control (HbA1c level) (OR 1.27; 95% CI 1.06 to1.51) were associated with low MA
to OHA.
CONCLUSIONS: Younger patients with T2DM and of Chinese ethnicity were susceptible
to low MA to OHA, which was associated with poorer glycaemic control. Polytherapy
was not associated with low MA.
DOI: 10.1136/bmjopen-2017-016317
PMCID: PMC5640112
1717. Prev Med Rep. 2015 Dec 29;3:132-4. doi: 10.1016/j.pmedr.2015.12.011.

eCollection
2016 Jun.
Survival effects of physical activity on mortality among persons with liver

disease.
Loprinzi PD(1), VanWagner LB(2).
Author information:
(1)Jackson Heart Study Vanguard Center of Oxford, Center for Health Behavior
Research, Department of Health, Exercise Science and Recreation Management, The
University of Mississippi, University, MS 38677, United States.
(2)Division of Gastroenterology & Hepatology and Department of Preventive
Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611,
United States.
Physical activity is protective of premature mortality and those with liver

disease are at an increased risk of early mortality. It is thus plausible to
suggest that physical activity may have survival benefits among those with liver
disease, but this has yet to be investigated. In a national sample, we examine
the prospective association of objectively-measured physical activity on
all-cause mortality among those with liver disease. Data from the 2003-2006
National Health and Nutrition Examination Survey (with follow-up through 2011)
were evaluated (analyzed in 2015). Physical activity was assessed via
accelerometry over 7 days. Liver disease was assessed via self-report of
physician diagnosis. Covariates included age, gender, race-ethnicity, serum
cotinine, income-to-poverty ratio, C-reactive protein, cholesterol medication
use, blood pressure medication use, alcohol behavior, self-reported liver disease
status, serum alanine aminotransferase (ALT), serum gamma-glutamyltransferase
(GGT) and comorbid illness. The sample included 162 adults who self-reported a
physician-diagnosis of liver disease. The unweighted median follow-up period was
80.0 months (IQR = 68-91; SD = 18.0). In the sample, 12,815 person-months
occurred with a mortality incidence rate of 1.09 deaths per 1000 person-months.
After adjustments, for every 10 min/day increase in moderate-to-vigorous physical
activity (MVPA), participants had an 89% reduced risk of all-cause mortality
(HRadjusted = 0.11; 95% CI: 0.02-0.47; P = 0.004). There was no evidence of
moderation by alcohol behavior, ALT, GGT or Hepatitis C virus status. These
findings demonstrate that modest increases in MVPA may have survival benefits
among those with a self-reported liver condition.
DOI: 10.1016/j.pmedr.2015.12.011
PMCID: PMC4733094
PMID: 26844199
1718. Clinics (Sao Paulo). 2017 Dec;72(12):743-749. doi:

10.6061/clinics/2017(12)05.
Depression and adherence to antiretroviral treatment in HIV-positive men in São

Paulo, the largest city in South America: Social and psychological implications.
Moraes RP(1), Casseb J(1)(2).
Author information:
(1)Ambulatorio de Imunodeficiencias Secundarias, Departamento de Dermatologia,
Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao
Paulo, Sao Paulo, SP, BR.
(2)Instituto de Medicina Tropical de Sao Paulo, Sao Paulo, SP, BR.
OBJECTIVES: The aim of the present study was to investigate the prevalence of
depression and adherence to antiretroviral treatment in two groups of
individuals: men who have sex with men (MSM) and men who have sex with women
(MSW).
METHODS: Two hundred and sixteen participants (MSM=116; MSW=100) who visited the
Clinics Hospital of the School of the Medicine of the University of São Paulo
completed two independent surveys (the BECK Depression Inventory and an adherence
self-declared questionnaire) to evaluate their depression status and adherence to
antiretroviral treatment, respectively.
RESULTS: The study highlighted a positive relationship between depression and low
adherence to Highly Active Antiretroviral Therapy in these patients regardless of
age and sexual orientation. In addition, MSM subjects were two times more prone
than MSW subjects to develop depression symptoms. White or mixed race men showed
7.6 times greater adherence to treatment than black men. The probability of
complete adherence to treatment was 3.8 times higher in non-depressed subjects
than in depressed subjects regardless of their ethnicity. The chance of
developing depression was 4.17 times higher for an individual with non-adherent
behavior than for an adherent individual.
CONCLUSIONS: Individuals with low adherence rates have proportionally higher
depression rates. Depressed men tend to show less adherence to treatment. Black
but not mixed race or white men show less adherence to Highly Active
Antiretroviral Therapy and have a greater chance of developing depression, which
directly interferes with adherence. The chances of developing depression are four
times greater for a patient with non-adherent behavior than for a patient with
adherent behavior.
DOI: 10.6061/clinics/2017(12)05
PMCID: PMC5738567
1719. Cien Saude Colet. 2018 May;23(5):1611-1620. doi:

10.1590/1413-81232018235.17112016.
Factors associated with negative self-rated health in menopausal women.

publisher]
Silva VH(1), Rocha JSB(1), Caldeira AP(2).
Author information:
(1)Faculdades Integradas Pitágoras. Av. Profa. Aida Mainartina Paraiso 80,
Ibituruna. 39408-007 Montes Claros MG Brasil. vitorhipolito@bol.com.br.
(2)Departamento de Saúde da Mulher e da Criança, Universidade Estadual de Montes
Claros. Montes Claros MG Brasil.
The scope of this study was to investigate the prevalence and factors associated
with negative self-rated health in menopausal women registered with the Family
Health Strategy in a Brazilian urban center. It is a cross-sectional study with a
random sample of menopausal women. A validated instrument addressing
sociodemographic and behavioral data related to self-rated health status was
used. The association between the variables studied and negative self-rated
health was assessed by bivariate analysis followed by Poisson regression with
robust variance, in a hierarchical model. The prevalence of negative self-rated
health among the population studied was 41.6%, among 761 women. Among women aged
52-65 years old, 49.2% had negative self-rated health. Age corresponding to
post-menopause, education up to eight years of study, having a partner, not
having a formal job, current tobacco use and physical inactivity were associated
with negative self-rated health. The presence of menopausal symptoms, overweight
and obesity, the current use of medication and the presence of chronic diseases
were also associated with negative self-rated health in the final model. The
associations observed point to the need for health promotion activities aimed at
menopausal women.
Publisher: O objetivo do estudo foi investigar a prevalência e os fatores

associados à autopercepção negativa de saúde em mulheres climatéricas cadastradas
na Estratégia Saúde da Família em um centro urbano brasileiro. Pesquisa
transversal, com amostra aleatória de mulheres climatéricas. Foi utilizado um
instrumento validado abordando dados sociodemográficos, comportamentais,
relacionados ao estado e à autopercepção de saúde. A associação entre as
variáveis estudadas e à autopercepção negativa de saúde foi verificada por
análise bivariada seguida de regressão de Poisson, com variância robusta, em
modelo hierarquizado. A prevalência de autopercepção negativa de saúde na
população estudada foi de 41,6%, em 761 mulheres. Entre as mulheres de 52 a 65
anos, 49,2% apresentaram autopercepção negativa de saúde. Idade correspondente à
pós-menopausa, escolaridade até oito anos de estudo, ter um companheiro, não ter
um trabalho formal, uso atual do tabaco e sedentarismo foram associados à
autopercepção negativa de saúde. A presença de sintomas climatéricos, sobrepeso e
obesidade, o uso atual de medicamentos e a presença de doenças crônicas também se
mostraram associados no modelo final. As associações observadas apontam para a
necessidade de ações de promoção de saúde voltadas às mulheres climatéricas.
DOI: 10.1590/1413-81232018235.17112016
1720. Chron Respir Dis. 2017 Nov;14(4):407-419. doi: 10.1177/1479972316660977. Epub

2016 Aug 10.
Living with asthma and chronic obstructive airways disease: Using technology to
support self-management - An overview.
Morrison D(1), Mair FS(1), Yardley L(2), Kirby S(2), Thomas M(3).
Author information:
(1)1 General Practice and Primary Care, Institute of Health and Wellbeing,
University of Glasgow, Glasgow, UK.
(2)2 Department of Psychology, University of Southampton, Highfield, Southampton,
UK.
(3)3 Primary Care Research, Aldermoor Health Centre, University of Southampton,
Aldermoor Close, Southampton, UK.
Long-term respiratory conditions such as asthma and chronic obstructive pulmonary

disease (COPD) are common, and cause high levels of morbidity and mortality.
Supporting self-management is advocated for both asthma and increasingly so for
COPD, and there is growing interest in the potential role of a range of new
technologies, such as smartphone apps, the web or telehealth to facilitate and
promote self-management in these conditions. Treatment goals for both asthma and
COPD include aiming to control symptoms, maintain activities, achieve the best
possible quality of life and minimize risks of exacerbation. To do this, health
professionals should be (a) helping patients to recognize deteriorating symptoms
and act appropriately; (b) promoting adherence to maintenance therapy; (c)
promoting a regular review where triggers can be established, and strategies for
managing such triggers discussed; and (d) promoting healthy lifestyles and
positive self-management of symptoms. In particular, low uptake of asthma action
plans is a modifiable contributor to morbidity and possibly also to mortality in
those with asthma and should be addressed as a priority. Using technology to
support self-management is an evolving strategy that shows promise. This review
provides an overview of self-management support and discusses how newer
technologies may help patients and health professionals to meet key treatment
goals.
DOI: 10.1177/1479972316660977
PMCID: PMC5729728
1721. Asian Nurs Res (Korean Soc Nurs Sci). 2015 Dec;9(4):291-7. doi:
10.1016/j.anr.2015.07.005. Epub 2015 Oct 22.
Risk Factor-tailored Small Group Education for Patients with First-time Acute
Coronary Syndrome.
Hwang SY(1), Kim JS(2).
Author information:
(1)College of Nursing, Hanynag University, Seoul, South Korea. Electronic
address: seon9772@hanyang.ac.kr.
(2)College of Nursing, Gachon University, Incheon, South Korea.
PURPOSE: The purpose of this study was to evaluate the effects of a risk
factor-tailored small group education on anxiety and depressive symptoms,
self-efficacy and self-care compliance in patients with first-time acute coronary
syndrome (ACS) for 12-month follow-up.
METHODS: A quasi-experimental pretest and post-test design was used. Patients
were recruited from a national university hospital from 2010 to 2011 in Korea.
The group education consisted of a 60-minute long video developed using
multimedia contents including voice-recorded texts, flash animation, and video
clips, with nurses' dialogue. The intervention group (n = 34) participated in
group education using the multimedia video in a small group of patients with
similar risk factors, and received periodic telephone counseling and text
messages. The control group (n = 40) received usual care and counseling upon
request.
RESULTS: Depressive symptoms decreased, and self-efficacy and self-care
compliance in the areas of medication, exercise, and healthy diet practice
significantly increased in patients in the intervention group, compared with
those in the control group.
CONCLUSIONS: Risk factor-tailored small group education and periodic text message
were an effective strategy for decreasing depression, and increasing
self-efficacy and long-term compliance with lifestyle changes in patients with
first-time ACS. We suggested that risk factor-tailored small group education need
to be given for first-time ACS patients for psychological support and behavioral
change in clinical practice. It is also comparable to individual approach to
encourage psychological and behavioral change.
DOI: 10.1016/j.anr.2015.07.005
Cardiovascular risk outcome and program evaluation of a cluster randomised

controlled trial of a community-based, lay peer led program for people with
diabetes.
Riddell MA(1), Dunbar JA(2), Absetz P(3), Wolfe R(4), Li H(4)(5), Brand M(4),
Aziz Z(4)(6), Oldenburg B(4)(6); Australasian Peers for Progress Diabetes Project
Investigators.
Collaborators: Oldenburg B, Dunbar J, Reddy P, Hagger V, Johnson G, de Courten M,

Wolfe R, Carter R, Absetz P, Zaini A.
Author information:
(1)Department of Epidemiology and Preventive Medicine, Faculty of Medicine
Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial
Road, Melbourne, Victoria, 3004, Australia. Michaela.riddell@monash.edu.
(2)Deakin Population Health Strategic Research Centre, Deakin University,
(3)School of Health Sciences, University of Tampere, Tampere, Finland.
(4)Department of Epidemiology and Preventive Medicine, Faculty of Medicine
Nursing and Health Science, Monash University, The Alfred Centre, 99 Commercial
Road, Melbourne, Victoria, 3004, Australia.
(5)Institute of Chronic Disease Control, Beijing Centers for Disease Control and
Prevention, Beijing, People's Republic of China.
(6)Melbourne School of Population and Global Health, University of Melbourne,
BACKGROUND: The 2013 Global Burden of Disease Study demonstrated the increasing
burden of diabetes and the challenge it poses to the health systems of all
countries. The chronic and complex nature of diabetes requires active
self-management by patients in addition to clinical management in order to
achieve optimal glycaemic control and appropriate use of available clinical
services. This study is an evaluation of a "real world" peer support program
aimed at improving the control and management of type 2 diabetes (T2DM) in
Australia.
METHODS: The trial used a randomised cluster design with a peer support
intervention and routine care control arms and 12-month follow up. Participants
in both arms received a standardised session of self-management education at
baseline. The intervention program comprised monthly community-based group
meetings over 12 months led by trained peer supporters and active encouragement
to use primary health care and other community resources and supports related to
diabetes. Clinical, behavioural and other measures were collected at baseline, 6
and 12 months. The primary outcome was the predicted 5 year cardiovascular
disease risk using the United Kingdom Prospective Diabetes Study (UKPDS) Risk
Equation at 12 months. Secondary outcomes included clinical measures, quality of
life, measures of support, psychosocial functioning and lifestyle measures.
RESULTS: Eleven of 12 planned groups were successfully implemented in the
intervention arm. Both the usual care and the intervention arms demonstrated a
small reduction in 5 year UKPDS risk and the mean values for biochemical and
anthropometric outcomes were close to target at 12 months. There were some small
positive changes in self-management behaviours.
CONCLUSIONS: The positive changes in self-management behaviours among
intervention participants were not sufficient to reduce cardiovascular risk,
possibly because approximately half of the study participants already had quite
well controlled T2DM at baseline. Future research needs to address how to enhance
community based programs so that they reach and benefit those most in need of
resources and supports to improve metabolic control and associated clinical
outcomes.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR)
ACTRN12609000469213 . Registered 16 June 2009.
DOI: 10.1186/s12889-016-3538-3
PMCID: PMC4995663
1723. Transl Stroke Res. 2017 Feb;8(1):77-82. doi: 10.1007/s12975-016-0481-7. Epub
2016
Jul 9.
Interactive Voice Response-An Innovative Approach to Post-Stroke Depression

Self-Management Support.
Skolarus LE(1)(2), Piette JD(3)(4)(5), Pfeiffer PN(6)(7), Williams LS(7)(8),

Mackey J(9), Hughes R(10), Morgenstern LB(10).
Author information:
(1)Department of Neurology, Stroke Program, University of Michigan, Ann Arbor,
MI, USA. lerusche@umich.edu.
(2)University of Michigan Medical Center, 1500 East Medical Center Drive
SPC#5855, Ann Arbor, MI, 48109-5855, USA. lerusche@umich.edu.
(3)Ann Arbor Department of Veterans Affairs Center for Clinical Management
Research, Ann Arbor, MI, USA.
(4)School of Public Health, University of Michigan, Ann Arbor, MI, USA.
(5)School of Medicine, University of Michigan, Ann Arbor, MI, USA.
(6)Psychiatry, University of Michigan, Ann Arbor, MI, USA.
(7)VA HSR&D Center for Health Information and Communication, Indianapolis, IN,
USA.
(8)Regenstrief Institute, Inc., Indianapolis, IN, USA.
(9)Department of Neurology, Indiana University School of Medicine, Indianapolis,
IN, USA.
(10)Department of Neurology, Stroke Program, University of Michigan, Ann Arbor,
MI, USA.
Automated interactive voice response (IVR) call systems can provide systematic
monitoring and self-management support to depressed patients, but it is unknown
if stroke patients are able and willing to engage in IVR interactions. We sought
to assess the feasibility and acceptability of IVR as an adjunct to post-stroke
depression follow-up care. The CarePartner program is a mobile health program
designed to optimize depression self-management, facilitate social support from a
caregiver, and strengthen connections between stroke survivors and primary care
providers (PCPs). Ischemic stroke patients and an informal caregiver, if
available, were recruited during the patient's acute stroke hospitalization or
follow-up appointment. The CarePartner program was activated in patients with
depressive symptoms during their stroke hospitalization or follow-up. The 3-month
intervention consisted of weekly IVR calls monitoring both depressive symptoms
and medication adherence along with tailored suggestions for depressive symptom
self-management. After each completed IVR call, informal caregivers were
automatically updated, and, if needed, the subject's PCP was notified. Of the 56
stroke patients who enrolled, depressive symptoms were identified in 13 (23 %)
subjects. Subjects completed 74 % of the weekly IVR assessments. A total of six
subjects did not complete the outcome assessment, including two non-study-related
deaths. PCPs were notified five times, including two times for suicidal ideation
and three times for medication non-adherence. Stroke patients with depressive
symptoms were able to engage in an IVR call system. Future studies are needed to
explore the efficacy of an IVR approach for post-stroke self-management and
monitoring of stroke-related outcomes.
DOI: 10.1007/s12975-016-0481-7
PMCID: PMC5507192
1724. Iran J Psychiatry. 2017 Apr;12(2):142-146.
The Potential Role of Naltrexone in Borderline Personality Disorder.
Moghaddas A(1), Dianatkhah M(2), Ghaffari S(3), Ghaeli P(4).
Author information:
(1)Department of Clinical Pharmacy, Faculty of Pharmacy, Isfahan University of
Medical Sciences, Tehran, Iran.
(3)Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of
Medical Sciences, Tabriz, Iran.
(4)Psychiatry and Psychology Research Center, Roozbeh Hospital and Faculty of
Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Objective: Management of borderline personality disorder (BPD) is a difficult

challenge due to the complex features of this disorder. This article reviews the
use of naltrexone in the treatment of BPD. Method: Published articles and
clinical trials were searched in Google Scholar, MedLine, ELSEVIER, and Cochrane
database of systematic reviews abstracts in English language between 1990 and
2017. Results: Naltrexone (NTX), a nonspecific competitive opiate antagonist, has
been noted to be helpful in controlling self-injurious behavior (SIB) and
dissociative symptoms in patients with BPD. Conclusion: Further studies should be
conducted on the effects of naltrexone to confirm the role of this medication in
the treatment of BPD.
PMCID: PMC5483240
PMID: 28659987
1725. Ann Intensive Care. 2017 Dec;7(1):1. doi: 10.1186/s13613-016-0221-x. Epub

2017
Jan 3.
Patients with preexisting psychiatric disorders admitted to ICU: a descriptive

and retrospective cohort study.
Gacouin A(1)(2)(3), Maamar A(4)(5)(6), Fillatre P(4)(5)(6), Sylvestre E(7)(8)(9),

Dolan M(10), Le Tulzo Y(4)(5)(6), Tadié JM(4)(5)(6).
Author information:
(1)Service des Maladies Infectieuses et Réanimation Médicale, Maladies
Infectieuses et Réanimation Médicale, CHU Rennes, 35033, Rennes, France.
arnaud.gacouin@chu-rennes.fr.
(2)Faculté de Médecine, Biosit, Université Rennes 1, 35043, Rennes, France.
arnaud.gacouin@chu-rennes.fr.
(3)Inserm-CIC-1414, Faculté de Médecine, Université Rennes 1, IFR 140, 35033,
Rennes, France. arnaud.gacouin@chu-rennes.fr.
(4)Service des Maladies Infectieuses et Réanimation Médicale, Maladies
Infectieuses et Réanimation Médicale, CHU Rennes, 35033, Rennes, France.
(5)Faculté de Médecine, Biosit, Université Rennes 1, 35043, Rennes, France.
(6)Inserm-CIC-1414, Faculté de Médecine, Université Rennes 1, IFR 140, 35033,
Rennes, France.
(7)Département d'information médicale, CHU Rennes, 35033, Rennes, France.
(8)INSERM, U1099, 35000, Rennes, France.
(9)LTSI, Université de Rennes 1, 35000, Rennes, France.
(10)Département de psychiatrie, Centre Hospitalier Guillaume Regnier, CHU Rennes,
35703, Rennes, France.
BACKGROUND: While the psychiatric disorders are conditions frequently encountered

in hospitalized patients, there are little or no data regarding the
characteristics and short- and long-term outcomes in patients with preexisting
psychiatric disorders in ICU. Such assessment may provide the opportunity to
determine the respective impact on mortality in the ICU and after ICU discharge
with reasons for admission, including modalities of self-harm, of underlying
psychiatric disorders and prior psychoactive medications.
METHODS: ICU and 1-year survival analysis performed on a retrospective cohort of
patients with preexisting psychiatric disorders admitted from 2000 through 2013
in a 21-bed polyvalent ICU in a university hospital.
RESULTS: Among the 1751 patients of the cohort, 1280 (73%) were admitted after
deliberate self-harm. Psychiatric diagnoses were: schizophrenia, n = 97 (6%);
non-schizophrenia psychotic disorder, n = 237 (13%); depression disorder,
n = 1058 (60%), bipolar disorder, n = 172 (10%), and anxiety disorder, n = 187
(11%). ICU mortality rate was significantly lower in patients admitted after
self-harm than in patients admitted for other reasons than self-harm [38/1288
patients (3%) vs. 53/463 patients (11%), respectively, p < 0.0001]. Compared with
patients admitted for deliberate self-poisoning with psychoactive medications,
patients admitted for self-harm by hanging, drowning, jumping from buildings, or
corrosive chemicals ingestion had a significantly higher ICU mortality rate. In
the ICU, SAPS II score [adjusted odds ratio (OR) 1.061, 95% CI 1.041-1.079,
p < 0.0001], use of vasopressors (adjusted OR 7.40, 95% CI 2.94-18.51,
p < 0.001), out-of-hospital cardiac arrest (adjusted OR 14.70, 95% CI 3.86-38.51,
p < 0.001), and self-harm by hanging, drowning, jumping from buildings, or
corrosive chemicals ingestion (adjusted OR 11.49, 95% CI 3.76-35.71, p < 0.001)
were independently associated with mortality. After ICU discharge SAPS II score
[adjusted hazard ratio (HR) 1.023, 95% CI 1.010-1.036, p < 0.01], age (adjusted
HR 1.030, 95% CI 1.016-1.044, p < 0.0001), admission for respiratory failure
(adjusted HR 2.23, 95% CI 1.19-4.57, p = 0.01), and shock (adjusted HR 3.72, 95%
CI 1.97-6.62, p < 0.001) were independently associated with long-term mortality.
Neither psychiatric diagnoses nor psychoactive medications received before
admission to the ICU were independently associated with mortality.
CONCLUSIONS: The study provides data on the short- and long-term outcomes of
patients with prepsychiatric disorders admitted to the ICU that may guide
decisions when considering ICU admission and discharge in these patients.
DOI: 10.1186/s13613-016-0221-x
PMCID: PMC5209316
PMID: 28050894
1726. Prim Care Companion CNS Disord. 2018 Nov 1;20(6). pii: 18m02340. doi:
10.4088/PCC.18m02340.
Factors That Impact Treatment Decisions: Results From an Online Survey of

Individuals With Bipolar and Unipolar Depression.
Rosenblat JD(1), Simon GE(2)(3), Sachs GS(2), Deetz I(2), Doederlein A(2),
DePeralta D(2), Dean MM(2), McIntyre RS(4)(1)(2).
Author information:
(1)Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University
Health Network, University of Toronto, Toronto, Ontario, Canada.
(2)Depression and Bipolar Support Alliance, Chicago, Illinois, USA.
(3)Kaiser Permanente Washington Health Research Insitute, Seattle, Washington,
USA.
(4)Mood Disorders Psychopharmacology Unit, University Health Network, University
of Toronto, 399 Bathurst St, MP 9-325, Toronto, ON M5T 2S8, Canada.
roger.mcintyre@uhn.ca.
Objective: To identify patient-reported factors that influence medication

treatment decisions among individuals with bipolar and unipolar depression.
Methods: The Depression and Bipolar Support Alliance (DBSA) conducted an online
survey February 2016 to April 2016 asking participants about factors that
influence treatment decisions (eg, starting and stopping specific medications).
Results: In total, 896 participants completed the survey (49.9% unipolar
depression [n = 447] and 50.1% bipolar depression [n = 449]). The majority of
respondents reported several previous medication trials. The most frequently
reported factors impacting treatment decisions were side effects, doctor
recommendations, cost, and how quickly the treatment will begin to work. The most
common reason for changing treatments was ineffectiveness in the unipolar
depression group and side effects in the bipolar depression group. Weight gain
was the side effect that most commonly led respondents to discontinue a
medication. When respondents currently using medications versus respondents not
using medications were compared, doctor recommendations were more likely to be
influential for those taking medications (P < .0001). Conversely, cost (P = .008)
and impact on pregnancy/lactation (P = .045) were more likely to impact treatment
decisions in participants not currently taking medications. Current medication
use was associated with increased rates of perceived treatment effectiveness (P <
.0001).
Conclusions: Side effects, doctor recommendations, cost, and rapidity of
antidepressant effects were determined to be particularly important factors in
making treatment decisions, with doctor recommendations being more influential
for medication users and cost being more influential for participants not using
medications. These findings highlight the importance of patient-centered factors
in adjudicating treatment decisions.
© Copyright 2018 Physicians Postgraduate Press, Inc.
DOI: 10.4088/PCC.18m02340
1727. J Clin Periodontol. 2016 Jul;43(7):566-71. doi: 10.1111/jcpe.12553. Epub 2016

May
19.
Relationship between periodontal disease and asthma among overweight/obese

adults.
Rivera R(1), Andriankaja OM(2), Perez CM(3), Joshipura K(2).
Author information:
(1)College of Business, University of Puerto Rico, Mayaguez, Puerto Rico.
(2)School of Dental Medicine, Medical Science Campus, University of Puerto Rico,
Medical Science Campus, San Juan, Puerto Rico.
(3)School of Public Health, University of Puerto Rico, Medical Science Campus,
San Juan, Puerto Rico.
AIM: To assess the relationship between oral health and asthma.

METHODS: Data from 1315 overweight or obese individuals, aged 40-65 years were
used. Asthma was self-reported, whereas periodontitis, bleeding on probing (BOP)
and plaque index were determined by clinical examinations.
RESULTS: Using logistic regression adjusting for gender, smoking status, age,
body mass index, family history of asthma and income level, revealed that the
odds ratio (OR) of asthma for a participant with severe periodontitis was 0.44
(95% confidence interval: 0.27, 0.70) that of a participant with none/mild
periodontitis. On the other hand, proportion of BOP sites and plaque index were
not statistically significant. For a participant with severe periodontitis, the
OR of taking asthma medication was 0.20 (95% confidence interval: 0.09, 0.43)
that of a participant with none/mild periodontitis. Moreover, proportion of BOP
sites was statistically associated with use of asthma medication, whereas plaque
index still remained non-significant.
CONCLUSION: Participants with severe periodontitis were less likely to have
asthma. Stronger evidence of an inverse association was found when using asthma
medication as outcome.
DOI: 10.1111/jcpe.12553
PMCID: PMC4900929
1728. Br J Clin Pharmacol. 2015 Dec;80(6):1289-302. doi: 10.1111/bcp.12734. Epub

2015
Oct 28.
Oral antineoplastic agents: how do we care about adherence?
Barillet M(1), Prevost V(2)(3)(4), Joly F(2)(3)(4), Clarisse B(4).
Author information:
(1)Centre Hospitalier J Monod, rue Eugène Garnier BP 219, 61104, Flers cedex.
(2)Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186,
14032, Caen Cedex 05.
(3)INSERM U1086, Cancers et Préventions, Avenue de la Côte de Nacre, F-14000,
Caen.
(4)Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du
Général Harris, 14000, Caen, France.
AIMS: Oral therapies, including hormone-based or targeted therapies, have

recently taken an increasing place in cancer treatment. In this context, a state
of the art of the available studies dealing with the adherence of adult patients
to oral anticancer treatment is warranted. The purpose of this review is to
address (i) the association between assessment methods and measured adherence,
(ii) the putative factors related to adherence and (iii) new ways of improving
adherence to oral cancer therapies.
METHODS: We conducted a literature-based narrative review of studies obtained
from Pubmed using medical subject heading terms and free-text terms combining
concepts related to oral anticancer medication and adherence.
RESULTS: The analysis is based on 48 studies published since 1990, mostly
assessing hormone-based therapy in breast cancer and targeted therapies in
chronic myeloid leukaemia. Various methods of adherence were reported including
self-report, medication measurement or combinations of methods. Adherence rates
were found to vary from 14% to 100%. Beside patient related-factors, adherence
rate discrepancies were found to be dependent on the method used. Furthermore,
there was no consensual definition of adherence even regarding the same methods,
some of them tolerating a period of interruption during the treatment period.
Finally, several studies addressing persistence found a progressive decrease in
adherence with time.
CONCLUSION: Adherence to novel oral therapies is a major issue and further
research is warranted to standardize adherence assessment in clinical studies
better and to define better the most appropriate approaches to improve long term
adherence in oncology practice.
DOI: 10.1111/bcp.12734
PMCID: PMC4693496
1729. Transl Behav Med. 2014 Dec;4(4):398-406. doi: 10.1007/s13142-014-0277-9.
Effects of chronic disease self-management programs for participants with higher

depression scores: secondary analyses of an on-line and a small-group program.
Ritter PL(1), Ory MG(2), Laurent DD(1), Lorig K(1).
Author information:
(1)Stanford Patient Education Research Center, School of Medicine, Stanford
University, 1000 Welch Road Rd., Suite 204, Palo Alto, CA 94304 USA.
(2)Health Science Center, Texas A&M University, College Station, TX USA.
Depression often accompanies chronic illness. Study aims included determining (1)
the level of current depression (Patient Health Questionnaire (PHQ)-8 ≥ 10) for
two sets of Chronic Disease Self-Management Programs (CDSMP) participants; (2) if
depression or other outcomes improved for those with PHQ-8 ≥ 10; and (3) if
outcomes differed for participants with or without depression. This study
utilized longitudinal secondary data analysis of depression cohorts (PHQ-8 ≥ 10)
from two independent translational implementations of the CDSMP, small-group
(N = 175) and Internet-based (N = 110). At baseline, 27 and 55 % of the two
samples had PHQ-8 10 or greater. This decreased to 16 and 37 % by 12 months
(p < 0.001). Both depressed and non-depressed cohorts demonstrated improvements
in most 12-month outcomes (pain, fatigue, activity limitations, and medication
adherence). The CDSMP was associated with long-term improvements in depression
regardless of delivery mode or location, and the programs appeared beneficial for
participants with and without depression.
DOI: 10.1007/s13142-014-0277-9
PMCID: PMC4286546
PMID: 25584089

eCollection 2017.
Effect of caregivers' expressed emotion on the care burden and rehospitalization

rate of schizophrenia.
Wang X(1), Chen Q(2), Yang M(1).
Author information:
(1)Xiangya School of Nursing.
(2)Nursing Department, Second Xiangya Hospital, Central South University,
Changsha, Hunan, People's Republic of China.
BACKGROUND: This study assessed the effect of expressed emotion (EE) among
caregivers of schizophrenia patients on their care burden and the illness
rehospitalization rate.
SUBJECTS AND METHODS: A total of 64 schizophrenia patients hospitalized for the
first time and their key caregivers were recruited. The Chinese version of the
Camberwell Family Interview (CFI-CV) was used to evaluate the EE of the key
caregivers. A family burden questionnaire was used to evaluate the care burden.
The patients' rehospitalization rate and medication compliance were evaluated by
the self-designated criteria. The data collection was carried out at the first
meeting in the hospital, at 6 months and 12 months after hospital discharge by
using the same instruments.
RESULTS: The subjective stress burden and subjective demand burden scores were
higher in caregivers before and after discharge with statistical difference
between the various observation time points (P<0.05). Significant differences
were observed in the rehospitalization rate between patients with high medication
adherence and low medication adherence at 12 months (P<0.01) and between patients
with high expressed emotion (HEE) and low expressed emotion (LEE; P<0.05). The
rehospitalization rate in patients with HEE caregivers was higher than that in
those with LEE caregivers. The subjective stress burden scores were statistically
significant between HEE and LEE caregivers (P<0.05).
CONCLUSION: HEE is a predictor of rehospitalization rate in schizophrenic
patients. The burdens of care scores are high in caregivers of schizophrenic
patients. The caregivers with HEE have a high score in burden of care compared
with those with LEE.
DOI: 10.2147/PPA.S143873
PMCID: PMC5593414
PMID: 28919723

1731. Psychiatr Danub. 2017 Jun;29(2):214-217.
The PsyLOG mobile application: development of a tool for the assessment and
monitoring of side effects of psychotropic medication.
Kuzman MR(1), Andlauer O, Burmeister K, Dvoracek B, Lencer R, Koelkebeck K, Nawka

A, Riese F.
Author information:
(1)Department of Psychiatry, Zagreb University Hospital Centre, Kispaticeva 12,
10000 Zagreb, Croatia, mrojnic@gmail.com.
Mobile health interventions are regarded as affordable and accessible tools that
can enhance standard psychiatric care. As part of the mHealth Psycho-Educational
Intervention Versus Antipsychotic-Induced Side Effects (mPIVAS) project
(www.psylog.eu), we developed the mobile application "PsyLOG" based on mobile
"smartphone" technology to monitor antipsychotic-induced side effects. The aim of
this paper is to describe the rationale and development of the PsyLOG and its
clinical use. The PsyLOG application runs on smartphones with Android operating
system. The application is currently available in seven languages (Croatian,
Czech, English, French, German, Japanese and Serbian). It consists of several
categories: "My Drug Effects", "My Life Styles", "My Charts", "My Medication",
"My Strategies", "My Supporters", "Settings" and "About". The main category "My
Drug Effects" includes a list of 30 side effects with the possibility to add
three additional side effects. Side effects are each accompanied by an
appropriate description and the possibility to rate its severity on a visual
analogue scale from 0-100%. The PsyLOG application is intended to enhance the
link between patients and mental health professionals, serving as a tool that
more objectively monitors side-effects over certain periods of time. To the best
of our knowledge, no such applications have so far been developed for patients
taking antipsychotic medication or for their therapists.
1732. J Chiropr Educ. 2016 Mar;30(1):25-9. doi: 10.7899/JCE-15-2. Epub 2015 Aug 4.
Community-based free clinics: opportunities for interprofessional collaboration,

health promotion, and complex care management.
Kaeser MA, Hawk C, Anderson ML, Reinhardt R.
OBJECTIVE: Free or outreach clinics offer students the opportunity to work with
diverse patient populations. The objective of this study was to describe the
demographics and clinical characteristics of a sample of chiropractic patients at
a free community-based clinic to assess clinical and educational opportunities
for students to work with diverse populations, collaborate with other professions
and practice health promotion through patient education.
METHODS: This was a prospective, descriptive cross-sectional study conducted over
2 months. Data on demographics, health status, and health risks were collected
from patients and their interns.
RESULTS: Of the 158 patients, 50.6% were women and 50.6% African-American, while
only 20.9% were employed full-time. Of the 24.7% tobacco users, 48.7% expressed
interest in cessation. Of 80.0% overweight or obese patients, 48.8% expressed
interest in weight loss. By self-report, 16.5% were diabetic, 10.1% took
hypertension medication, 36.7% used prescription pain medication (9.4% opiate
use), 33.5% used nonprescription pain medication, and 9.4% were under the care of
a mental health professional.
CONCLUSION: This patient population is demographically diverse. A high proportion
of patients who used tobacco, or were overweight or obese expressed interest in
information on those topics. A substantial proportion reported being under care
with a mental health professional. This clinic provides opportunities for
students to work with diverse populations, collaborate with other professions,
and practice health promotion.
DOI: 10.7899/JCE-15-2
PMCID: PMC4770992
PMID: 26241702
1733. J Clin Gastroenterol. 2015 Jan;49(1):76-83. doi:

10.1097/MCG.0000000000000055.
Self-efficacy and adherence to antiviral treatment for chronic hepatitis C.
Bonner JE(1), Esserman DA, Golin CE, Evon DM.
Author information:
(1)Departments of *Medicine, Division of Gastroenterology and Hepatology
†Medicine ‡Biostatistics, Gillings School of Public Health §Division of General
Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill,
NC.
GOALS: To investigate the role of self-efficacy (SE) during hepatitis C virus

(HCV) treatment.
BACKGROUND: Adherence to chronic HCV treatment is critical. SE is an important
predictor of medication adherence in a number of chronic disease populations and
medication regimens, but its role during HCV treatment remains unknown.
STUDY: Data from the prospective Virahep-C study were analyzed to examine
relationships between SE and patient-driven deviations (ie, missed doses measured
using electronic pill caps, and nonpersistence) from adherence to HCV antiviral
treatment. SE was measured using the 17-item HCV Treatment Self-Efficacy scale.
This measure provides a global estimate of a patient's confidence to undergo and
adhere to HCV treatment, and can estimate SE in 4 underlying domains:
communication SE (ie, confidence to communicate with health care provider),
physical coping SE (ie, confidence to cope with physical side effects),
psychological coping SE (ie, confidence to cope with psychiatric side effects),
and treatment adherence SE (ie, confidence to take all medications as prescribed
and attend doctor visits). Generalized estimating equations and Cox proportional
hazards models were used to assess associations between SE and missed doses and
nonpersistence, respectively.
RESULTS: SE was associated with being in a relationship, educated, privately
insured, and less depressed. Higher communication SE at TW24 reduced the risk of
missed doses between TW24 and TW48. Higher baseline treatment adherence SE
reduced the likelihood of nonpersistence between baseline and TW24.
CONCLUSIONS: SE's relationship to HCV treatment adherence has promising clinical
and research implications.
DOI: 10.1097/MCG.0000000000000055
PMCID: PMC4062612
1734. Nicotine Tob Res. 2016 May;18(5):906-12. doi: 10.1093/ntr/ntv205. Epub 2015
Sep
21.
Understanding Pregnant Smokers' Adherence to Nicotine Replacement Therapy During

a Quit Attempt: A Qualitative Study.
Bowker K(1), Campbell KA(2), Coleman T(2), Lewis S(3), Naughton F(4), Cooper
S(2).
Author information:
(1)Division of Primary Care, University of Nottingham, Nottingham, United
Kingdom; Katharine.bowker@nottingham.ac.uk.
(2)Division of Primary Care, University of Nottingham, Nottingham, United
Kingdom;
(3)Division of Epidemiology and Public Health, Nottingham City Hospital,
Nottingham, United Kingdom;
(4)Behavioural Science Group, Institute of Public Health, University of
Cambridge, Cambridge, United Kingdom.
BACKGROUND: Pregnant smokers may be offered nicotine replacement therapy (NRT)

alongside behavioral support to assist with a quit attempt. Yet trials of NRT
have found adherence to be low among pregnant women, and this has made it
difficult to determine the efficacy of NRT. The aim of this study is to
understand the experience of pregnant women who use NRT but discontinue this
early or do not use the medication as recommended.
METHODS: Semi-structured telephone interviews were conducted with 14 pregnant
smokers who had recently been prescribed NRT, but self-reported poor NRT
adherence or discontinuing treatment prematurely. Data were transcribed and
analyzed using inductive thematic analysis
RESULTS: There were four main themes identified; expectations of NRT, experience
of using NRT, safety concerns and experience of using e-cigarettes. Some women
intentionally used NRT to substitute a proportion of their cigarette intake and
smoked alongside. Most women smoked while using NRT. Women who underutilized NRT
did so as they experienced side effects, or were concerned that using NRT instead
of smoking could actually increase their nicotine exposure and potential for
increased nicotine dependence or fetal harm. Most women spoke about the use of
e-cigarettes as a smoking cessation method but only a few had actually
experienced using them during pregnancy.
CONCLUSION: Many women underused NRT but simultaneously smoked. Challenging
negative perceptions about NRT and educating women further about the risks of
smoking may encourage them to use NRT products as recommended.
IMPLICATIONS: These findings add to the research surrounding the efficacy of NRT
during pregnancy by providing insight into how pregnant women use NRT during a
quit attempt and how this may influence adherence. It may assist health
professionals to support pregnant smokers by increasing their understanding about
the differing ways in which women use NRT and help them address concerns women
may have about the safety of NRT.
DOI: 10.1093/ntr/ntv205
PMCID: PMC5942617
1735. J Clin Hypertens (Greenwich). 2016 Sep;18(9):871-7. doi: 10.1111/jch.12775.

Epub
2016 Jan 22.
Predictors of Uncontrolled Blood Pressure in Treated Hypertensive Individuals:

First Population-Based Study in Lebanon.
Farah R(1)(2), Zeidan RK(3), Chahine MN(4), Asmar R(4), Chahine R(5), Salameh
P(6)(7), Pathak A(8), Hosseini H(9)(10).
Author information:
(1)Doctoral School of Life and Health Sciences, Paris-Est University, Creteil,
France. rita.farah@univ-paris-est.fr.
(2)EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est,
Creteil, France. rita.farah@univ-paris-est.fr.
(3)Doctoral School of Biology Health and Biotechnologies, Toulouse III
University, Toulouse, France.
(4)Foundation-Medical Research Institutes, F-MRI®, Beirut, Lebanon.
(5)Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.
(6)School of Pharmacy, Lebanese American University, Byblos, Lebanon.
(7)Laboratory of Clinical and Epidemiology Research, Faculty of Pharmacy,
Lebanese University, Hadath, Lebanon.
(8)Department of Cardiovascular Medicine, Hypertension, Risk Factors and Heart
Failure Unit, Clinique Pasteur, Toulouse, France.
(9)EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est,
Creteil, France.
(10)Department of Neurology, Henri Mondor Hospital AP-HP, Creteil, France.
Arterial hypertension is a leading risk factor for cardiovascular disease and

stroke. This study aimed to assess the predictors of uncontrolled systolic and
diastolic blood pressure (BP) in Lebanon among treated hypertensive individuals.
The authors included 562 participants 40 years and older. The potential
predictors included sociodemographic characteristics, self-reported health
information, and medication adherence. Prevalence of uncontrolled systolic and
diastolic BP reached 43.1% and 24.9%, respectively. Independent predictors of
uncontrolled systolic BP were older age, male sex, and low and medium medication
adherence level. Predictors of uncontrolled diastolic BP were younger age,
obesity, and low medication adherence level. Married individuals and patients
taking statins had better diastolic BP control. Uncontrolled BP is a major public
health problem in Lebanon. The authors identified low adherence as a major
modifiable risk factor for systolic and diastolic BP control and obesity as a
major modifiable risk factor for diastolic BP control.
DOI: 10.1111/jch.12775
1736. J Health Med Econ. 2018;4(2). pii: 7. doi: 10.21767/2471-9927.100040.
Change in Insurance Status and Cost-related Medication Non-adherence among Older

U.S. Adults with Diabetes from 2010 to 2014.
Zhang JX(1), Bhaumik D(2), Huang ES(1), Meltzer DO(1)(3)(2).
Author information:
(1)Department of Medicine, The University of Chicago, Chicago, IL.
(2)Harris School of Public Policy, The University of Chicago, Chicago, IL.
(3)Department of Economics, The University of Chicago, Chicago, IL.
Objective: Cost-related medication non-adherence (CRN) is a persistent challenge

in health care in the U.S. Insurance coverage is a key determinant of access to
medical care. We seek to examine the CRN rates among the older diabetes adult
population in the U.S. from 2010 to 2014 when the major provisions of the
Affordable Care Act came into force.
Research Design and Method: Data from the 2010 and 2014 Health and Retirement
Study (HRS) were used for this study. CRN is identified if a respondent indicated
taking less medication than was prescribed because of the cost, while diabetes is
self-reported. We assessed the change in CRN rates by insurance status using
multivariable logistic regression analysis.
Results: A total of 4,741 and 4,505 diabetes adults aged 50 or older in 2010 and
2014 were included in the analyses, representing 18.8 million and 19.1 million
older adults with diabetes respectively. Overall, the percentage of dual-eligible
diabetes patients increased from 8% to 10% and the uninsured decreased from 6% to
4% based on weighted population estimates. The CRN rates decreased from 27% to
21% and from 12% to 10% for those between 50 and 64, and 65 or older,
respectively from 2010 to 2014. Race (African American) became a less significant
factor for variations in CRN rates in 2014 (p=0.24).
Conclusions: There is an encouraging reduction in CRN rates after implementation
of the ACA. However, CRN rates among diabetes patients between 50 and 65 of age
remained high.
DOI: 10.21767/2471-9927.100040
PMCID: PMC6322665
PMID: 30627691
Conflict of interest statement: Conflicts of Interest: The authors have no

conflicts of interest. Zhang has an ownership interest in Chicago MedInfo Group,
LLC.
1737. BMC Geriatr. 2017 Jul 28;17(1):166. doi: 10.1186/s12877-017-0567-4.
"Visually impaired elderly patient ingests pill desiccant, leading to acute

hypoxic respiratory failure requiring intubation".
Gerstein W(1), Liu Z(2).
Author information:
(1)Department of Internal Medicine, New Mexico VA Health Care Service, 1501 San
Pedro Ave, SE, Albuquerque, NM, 87108, USA. wgerstein@gmail.com.
(2)Department of Internal Medicine Residency Program, University of New Mexico, 1
University of New Mexico, Albuquerque, NM, 87131-0001, USA.
BACKGROUND: A significant percentage of elderly patients suffer from both

polypharmacy and visual impairment. This combination can increase the risk of an
adverse event related to medication. This case highlights an unusual, but
potentially deadly, medication adverse event.
CASE PRESENTATION: A 77-year-old male, visually impaired, ingested a pill
desiccant, believing it was the ampicillin/sulbactam tablet he was prescribed for
an infected diabetic foot ulcer. He presented to the emergency room with
inability to swallow, and imaging revealed the pill desiccant lodged in his upper
esophagus. He developed respiratory distress due to aspiration of secretions,
necessitating intubation both to protect his airway and for an
esophagogastroduodenoscopy (EGD). During EGD the desiccant was pushed into the
stomach due to an inability to remove it without causing harm. Patient
self-extubated the following day and per family and patient's wishes was not
re-intubated. The patient suffered no further complications directly related to
the desiccant, but he died several days later from respiratory failure.
CONCLUSIONS: This case highlights a concerning medication patient safety issue
for visually impaired geriatric patients.
DOI: 10.1186/s12877-017-0567-4
PMCID: PMC5534102
1738. Med Clin North Am. 2017 Jan;101(1):229-245. doi: 10.1016/j.mcna.2016.08.005.
Adherence to Antihypertensive Therapy.
Peacock E(1), Krousel-Wood M(2).
Author information:
(1)Department of Medicine, Tulane University School of Medicine, 1430 Tulane
Avenue, New Orleans, LA 70112, USA.
(2)Department of Medicine, Tulane University School of Medicine, 1430 Tulane
Avenue, New Orleans, LA 70112, USA; Department of Epidemiology, Tulane University
School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA
70112, USA; Center for Health Research, Ochsner Clinic Foundation, 1514 Jefferson
Highway, New Orleans, LA 70121, USA. Electronic address: mawood@tulane.edu.
Adherence to antihypertensive medication remains a key modifiable factor in the

management of hypertension. The multidimensional nature of adherence and blood
pressure (BP) control call for multicomponent, patient-centered interventions to
improve adherence. Promising strategies to improve antihypertensive medication
adherence and BP control include regimen simplification, reduction of
out-of-pocket costs, use of allied health professionals for intervention
delivery, and self-monitoring of BP. Research to understand the effects of
technology-mediated interventions, mechanisms underlying adherence behavior, and
sex-race differences in determinants of low adherence and intervention
effectiveness may enhance patient-specific approaches to improve adherence and
disease control.
Copyright Â© 2016 Elsevier Inc. All rights reserved.
DOI: 10.1016/j.mcna.2016.08.005
PMCID: PMC5156530
1739. Medicine (Baltimore). 2018 Dec;97(50):e13632. doi:

10.1097/MD.0000000000013632.
Increased self-care activities and glycemic control rate in relation to health

education via Wechat among diabetes patients: A randomized clinical trial.
Dong Y(1), Wang P(2), Dai Z(1), Liu K(1), Jin Y(1), Li A(1), Wang S(1), Zheng
J(1).
Author information:
(1)Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou,
Henan.
(2)Department of Internal Medicine, The Second Affiliated Hospital of Hainan
Medical University, Hainan Medical University, Haikou, Hainan, China.
BACKGROUND: Health education has been considered as the effectiveness method to

increase the self-care skills of diabetes patients. However, limited studies to
investigate the association of health education via Wechat platform on increased
the basic self-care skills and glycemic control rate in patients with type 2
diabetes.
METHODS: A total number of 120 type 2 diabetes patients were randomized into
intervention (health education by Wechat platform plus usual care) and the
control group (usual care). Biochemical parameters including fasting plasma
glucose (FPG), 2-hour plasma glucose (2hPG), glycosylated hemoglobin A1c (HbA1c)
were measured among the 2 groups at baseline 6-month and 12-month. Diabetes
Management Self-Efficacy (SE) Scale was completed at baseline 6-month and
12-month.
RESULTS: Significant difference of HbA1c concentration and SE were found between
intervention and control groups at 6-month and 12-month (P <.05). The effect of
groups and health education duration times was found on reduced HbA1c
concentration and increased the total score of SE (P <.05). No significant
difference of FPG and 2hPG concentrations were found between intervention and
control groups at 6 months and 12 months (P >.05).
CONCLUSION: Health education of diabetic individuals via Wechat platform in
conjunction with conventional diabetes treatment could improve glycemic control
and positively influence other aspects of diabetes self-care skills.
DOI: 10.1097/MD.0000000000013632
PMCID: PMC6319995
1740. J Pediatr Psychol. 2015 Jan-Feb;40(1):75-84. doi: 10.1093/jpepsy/jst093. Epub

2013 Dec 23.
Electronic monitoring of medication adherence in early maintenance phase

treatment for pediatric leukemia and lymphoma: identifying patterns of
nonadherence.
Rohan JM(1), Drotar D(2), Alderfer M(3), Donewar CW(3), Ewing L(3), Katz ER(3),
Muriel A(3).
Author information:
(1)Department of Psychology, University of Cincinnati, USA, Center for Adherence
and Self-Management, Cincinnati Children's Hospital Medical Center, USA, The
Cancer Center, Children's Hospital of Philadelphia, USA, Department of
Psychiatry, Children's Hospital Medical Center, USA, Department of Psychiatry,
Western Psychiatric Institute and Clinic, USA, Division of Hematology-Oncology
and Blood & Marrow Transplant, Children's Hospital Los Angeles, USA, and
Adolescent Psychiatry & Pediatric Psychiatry, Dana-Farber/Children's Hospital
Cancer Center, USA Department of Psychology, University of Cincinnati, USA,
Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical
Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA,
Department of Psychiatry, Children's Hospital Medical Center, USA, Department of
Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of
Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los
Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry,
Dana-Farber/Children's Hospital Cancer Center, USA rohanjenm@gmail.com.
Cancer Center, USA Department of Psychology, University of Cincinnati, USA,
Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical
Center, USA, The Cancer Center, Children's Hospital of Philadelphia, USA,
Department of Psychiatry, Children's Hospital Medical Center, USA, Department of
Psychiatry, Western Psychiatric Institute and Clinic, USA, Division of
Hematology-Oncology and Blood & Marrow Transplant, Children's Hospital Los
Angeles, USA, and Adolescent Psychiatry & Pediatric Psychiatry,
Dana-Farber/Children's Hospital Cancer Center, USA.
Cancer Center, USA.
OBJECTIVE: To describe patterns of treatment adherence to early maintenance phase

therapy for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL).
METHODS: Using an objective observational method (electronic monitoring),
adherence was examined for 139 patients aged 7-19 years diagnosed with ALL or LBL
across 6 centers.
RESULTS: The mean adherence percentage was 86.2%. Adherence rates declined over
the 1-month of follow-up to 83%. 3 linear trajectories of 6-mercaptopurine
adherence were identified: (1) exemplary adherence (n = 99): Averaging nearly
100%; (2) deteriorating (n = 23): Adherence decreased from 100 to 60%; and (3)
chronically poor adherence (n = 9): Averaging 40%.
CONCLUSIONS: Adherence promotion interventions might be tailored to subgroups of
patients who demonstrated problematic patterns of treatment adherence that could
place them at risk for relapse. This research demonstrates the importance of
using objective real-time measures of medication adherence for measuring and
documenting adherence patterns.
DOI: 10.1093/jpepsy/jst093
PMCID: PMC4288299

Self-reported and actual involvement of community pharmacists in patient

counseling: a cross-sectional and simulated patient study in Gondar, Ethiopia.
Surur AS(1), Getachew E(2), Teressa E(3), Hailemeskel B(4), Getaw NS(5), Erku
DA(6).
Author information:
(1)BPharm, MSc. Assistant Professor. Department of Pharmaceutical Chemistry,
School of Pharmacy, College of Medicine and Health Sciences, University of
Gondar. Gondar (Ethiopia). lowerurexpect@gmail.com.
(2)BPharm. Assistant Lecturer. Department of Pharmacology, School of Pharmacy,
College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
eyobagetachew12@gmail.com.
(3)BPharm. Assistant Lecturer. Department of clinical pharmacy, School of
Pharmacy, College of Medicine and Health Sciences, University of Gondar. Gondar
(Ethiopia). ebsateressa@gmail.com.
(4)MS, PharmD, RPh. Associate Professor and Director of Drug Information
Services. School of Pharmacy, College of Pharmacy, Nursing, and Allied Health
Sciences, Howard University. Washington, DC (United States).
bhailemeskel@howard.edu.
(5)BPharm, MSc. Senior Lecturer. Department of Pharmaceutical Chemistry, School
of Pharmacy, College of Medicine and Health Sciences, University of Gondar.
Gondar (Ethiopia). nurahmeds10@gmail.com.
(6)B.Pharm. Lecturer. Department of Pharmacy Practice, School of Pharmacy,
College of Medicine and Health Sciences, University of Gondar. Gondar (Ethiopia).
staymotivated015@gmail.com.
BACKGROUND: Community pharmacists play a crucial role in reducing medication

related health problems and improving the patient's overall wellbeing. Evidence
suggests that community pharmacist led counseling services result in a better
clinical and self-reported outcome, including a higher level of satisfaction and
quality of life.
OBJECTIVE: This study aims to document self-reported and actual levels of
community pharmacists' involvement in the provision of patient counseling and
barriers that limit their involvement in such services.
METHODS: Simulated patient visits and a cross-sectional survey of community
pharmacists were employed in Gondar town, Ethiopia between March 15 and May 15,
2016 to observe actual counseling practices and to assess their reported
counseling practices respectively. Four different scenarios were developed for
the simulated patient visit. A well designed questionnaire and an assessment form
were used for the survey and simulated patient visit.
RESULTS: In the cross-sectional survey, 84 pharmacists were approached and 78
agreed to participate (92.8 % response rate). Of the respondents, 96.1%
agreed/strongly agreed that patient counseling is important and 69.3% strongly
agreed that patient counseling should be a professional duty. The most frequent
information provided to patients were dosing schedule of drugs, how to take
medication, and drug-food interaction. Majority of community pharmacists either
strongly agreed (42.1%) or agreed (51.3%) that patients are comfortable towards
their counseling practice. A total of 48 simulated visits were conducted and a
medicine was dispensed in all visits. In all four scenarios, dosage schedule
(100%), how to take medication (97.6%) and drug-food interaction (69.1%) were the
most common type of information provided while what to do when dose is missed
(100%), contraindication (95.2%) and the importance of compliance or adherence
(92.9%) were the most commonly ignored types of information.
CONCLUSIONS: The present study emphasizes the existing gap in self-reported and
actual counseling practices by community pharmacist in Gondar town, Ethiopia.
Hence, the ministry of health, local health policy makers and other stakeholders
should collaborate to design interventions to improve community pharmacists'
dispensing and counseling practice.
DOI: 10.18549/PharmPract.2017.01.890
PMCID: PMC5386626
PMID: 28503225
Conflict of interest statement: CONFLICT OF INTEREST None.
1742. BMC Health Serv Res. 2018 Apr 6;18(1):254. doi: 10.1186/s12913-018-3071-4.
Language-concordant automated telephone queries to assess medication adherence in

a diverse population: a cross-sectional analysis of convergent validity with
pharmacy claims.
Ratanawongsa N(1), Quan J(2), Handley MA(2)(3), Sarkar U(2), Schillinger D(2).
Author information:
(1)General Internal Medicine and UCSF Center for Vulnerable Populations at San
Francisco General Hospital and Trauma Center, University of California, 1001
Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA.
Neda.ratanawongsa@ucsf.edu.
(2)General Internal Medicine and UCSF Center for Vulnerable Populations at San
Francisco General Hospital and Trauma Center, University of California, 1001
Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA.
(3)Department of Epidemiology and Biostatistics, Division of Preventive Medicine
and Public Health, University of California, 1001 Potrero Avenue, Box 1364, San
Francisco, CA, 94143, USA.
BACKGROUND: Clinicians have difficulty accurately assessing medication

non-adherence within chronic disease care settings. Health information technology
(HIT) could offer novel tools to assess medication adherence in diverse
populations outside of usual health care settings. In a multilingual urban safety
net population, we examined the validity of assessing adherence using automated
telephone self-management (ATSM) queries, when compared with non-adherence using
continuous medication gap (CMG) on pharmacy claims. We hypothesized that patients
reporting greater days of missed pills to ATSM queries would have higher rates of
non-adherence as measured by CMG, and that ATSM adherence assessments would
perform as well as structured interview assessments.
METHODS: As part of an ATSM-facilitated diabetes self-management program,
low-income health plan members typed numeric responses to rotating weekly ATSM
queries: "In the last 7 days, how many days did you MISS taking your …" diabetes,
blood pressure, or cholesterol pill. Research assistants asked similar questions
in computer-assisted structured telephone interviews. We measured continuous
medication gap (CMG) by claims over 12 preceding months. To evaluate convergent
validity, we compared rates of optimal adherence (CMG ≤ 20%) across respondents
reporting 0, 1, and ≥ 2 missed pill days on ATSM and on structured interview.
RESULTS: Among 210 participants, 46% had limited health literacy, 57% spoke
Cantonese, and 19% Spanish. ATSM respondents reported ≥1 missed day for diabetes
(33%), blood pressure (19%), and cholesterol (36%) pills. Interview respondents
reported ≥1 missed day for diabetes (28%), blood pressure (21%), and cholesterol
(26%) pills. Optimal adherence rates by CMG were lower among ATSM respondents
reporting more missed days for blood pressure (p = 0.02) and cholesterol
(p < 0.01); by interview, differences were significant for cholesterol
(p = 0.01).
CONCLUSIONS: Language-concordant ATSM demonstrated modest potential for assessing
adherence. Studies should evaluate HIT assessments of medication beliefs and
concerns in diverse populations.
TRIAL REGISTRATION: NCT00683020 , registered May 21, 2008.
DOI: 10.1186/s12913-018-3071-4
PMCID: PMC5889590
1743. Breathe (Sheff). 2016 Dec;12(4):310-317. doi: 10.1183/20734735.014716.
Asthma in intellectual disability: are we managing our patients appropriately?
Davis S(1).
Author information:
(1)Faculty of Pharmacy and Woolcock Institute of Medical Research, University of
Sydney, Sydney, New South Wales, Australia.
People with intellectual disability are a vulnerable group of people with asthma
that has, to date, largely been ignored in the medical literature. Although
guidelines for medication management for people with intellectual disability
suggest asthma is treated as for other populations, there are special
considerations that should be taken into account when managing asthma in this
group. Due to their cognitive impairment as well as comorbidities, they are
likely to require support with asthma self-management, including inhaler use.
Their varying degrees of autonomy mean that there is often a need to provide
education and information to both the person and their caregivers.EDUCATIONAL
AIMS: To understand general principles of health of people with intellectual
disability and how this affects the healthcare professional's approach to asthma
management.To understand how intellectual disability affects cognition, autonomy
and communication, and therefore the ability of a person to self-manage asthma.To
recognise ways of mitigating respiratory disease risk in people with intellectual
disability.To describe ways for healthcare professionals to support people with
intellectual disability and their caregivers in asthma management.
DOI: 10.1183/20734735.014716
PMCID: PMC5297950
PMID: 28210318
Conflict of interest statement: Conflict of interest None declared.
1744. Respir Med. 2017 Feb;123:150. doi: 10.1016/j.rmed.2016.11.013.
"Evaluation of chronic obstructive pulmonary disease (COPD) and reduced ejection

fraction heart failure (HFrEF) discharge medication prescribing: Is drug therapy
concordant with national guidelines associated with a reduction in 30-day
readmissions?" [Respir. Med. 119 (October 2016) 135-140].
Richardson A(1), Tolley E(2), Hartmann J(3), Reedus J(3), Bowlin B(3), Finch
C(4), Sands CW(5), Self T(4).
Author information:
(1)Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA;
College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN,
USA. Electronic address: arichardson@chsu.org.
(2)Department of Preventive Medicine, University of Tennessee Health Science
Center, Memphis, TN, USA.
(3)Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA.
(4)Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA;
College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN,
USA.
(5)College of Medicine, University of Tennessee Health Science Center, Memphis,
TN, USA; Hospitalist, Methodist University Hospital, Memphis, TN, USA.
Erratum for
Respir Med. 2016 Oct;119:135-140.
DOI: 10.1016/j.rmed.2016.11.013
PMID: 27916482
Theory-based self-management intervention to improve adolescents' asthma control:

a cluster randomised controlled trial protocol.
Harris K(1), Mosler G(1), Grigg J(1).
Author information:
(1)Centre for Genomics and Child Health, Queen Mary University of London, London,
UK.
INTRODUCTION: Asthma-related morbidity and mortality in the UK is higher than

elsewhere in Europe. Although the reasons for this are largely unclear, one
explanation could be a higher prevalence of poorly controlled asthma in the UK.
Findings from our earlier study found that, in a sample of 766 children with
asthma, 45.7% had poorly controlled asthma. Our earlier study also showed that
adherence to inhaled corticosteroids was low. Subsequent focus groups identified
concerns regarding embarrassment and bullying as barriers to adherence, as well
as forgetfulness and incorrect medication beliefs. Following this, a school-based
self-management intervention has been developed, aimed to improve asthma control
and self-management behaviours.
METHODS AND ANALYSIS: The theory-based cluster randomised controlled trial tests
an intervention comprising two components: (1) a theatre workshop for all
children in years 7 and 8, and (2) self-management workshops for children with
asthma. The COM-B model was used to guide the development of the intervention.
Questionnaire data will be collected in schools at baseline, immediately post
intervention, and 3, 6 and 12 months post intervention. The data collected at
6 months will measure the effect of the intervention against the baseline data.
The primary outcome will be asthma control, measured using the Asthma Control
Test. All the data will be analysed quantitatively using generalised linear and
non-linear mixed effects models.
ETHICS AND DISSEMINATION: Ethical approval was obtained by the Queen Mary
University of London Ethics Committee on 12 April 2018. Regular meetings will be
held with key patient and public stakeholders to plan the key messages from this
research. Key messages from the study will also be tweeted via the project
twitter account (@SchoolsAsthma). The findings of the study will be submitted for
presentation at conferences, as well as written into a manuscript.
TRIAL REGISTRATION NUMBER: MGU0400.

DOI: 10.1136/bmjopen-2018-025867
PMCID: PMC6500249
PMID: 31015270
1746. Clin Psychol Sci. 2017 Jan;5(1):174-181. doi: 10.1177/2167702616654898. Epub

2016
Oct 19.
Negative Self-Referential Processing Predicts the Recurrence of Major Depressive

Episodes.
LeMoult J(1), Kircanski K(1), Prasad G(2), Gotlib IH(1).
Author information:
(1)Stanford University.
(2)University of Southern California.
Most individuals who develop Major Depressive Disorder (MDD) will experience a
recurrent depressive episode; we know little, however, about cognitive mechanisms
that increase the likelihood of recurrence. In the current study we examined
whether negatively biased self-referential processing, negative life events,
baseline depressive symptoms, and psychotropic medication use predicted the onset
of a subsequent depressive episode in a longitudinal study of women with a
history of recurrent MDD. Higher levels of depressive symptoms at baseline
predicted experiencing a greater number of negative life events which, in turn,
tended to predict recurrence of depression. Importantly, after accounting for
other associations, negatively biased self-referential processing contributed
unique variance to the likelihood of experiencing a depressive episode over the
next three years. Thus, negatively biased self-referential processing appears to
be a significant risk factor for the recurrence of depressive episodes and may be
an important target for interventions aimed at preventing future episodes.
DOI: 10.1177/2167702616654898
PMCID: PMC5341388
PMID: 28286705
1747. BMC Neurol. 2017 Jun 17;17(1):114. doi: 10.1186/s12883-017-0893-3.
A systematic review and narrative synthesis of group self-management

interventions for adults with epilepsy.
Smith A(1), McKinlay A(2), Wojewodka G(2), Ridsdale L(3).
Author information:
(1)GKT School of Medicine, King's College London, London, SE1 1UL, UK.
(2)Institute of Psychiatry, Psychology & Neuroscience, Academic Neuroscience
Centre, King's College London, PO Box 57, London, SE5 8AF, UK.
(3)Institute of Psychiatry, Psychology & Neuroscience, Academic Neuroscience
Centre, King's College London, PO Box 57, London, SE5 8AF, UK.
leone.ridsdale@kcl.ac.uk.
BACKGROUND: Epilepsy is a serious and costly long-term condition that negatively

affects quality of life, especially if seizures persist on medication. Studies
show that people with epilepsy (PWE) want to learn more about the condition and
some educational self-management courses have been trialled internationally. The
objectives of this review were to evaluate research and summarise results on
group self-management interventions for PWE.
METHODS: We searched Medline and PsycINFO for results published in English
between 1995 and 2015. Only studies evaluating face-to-face, group interventions
for adults with epilepsy were included. Heterogeneity in study outcomes prevented
the carrying out of a meta-analysis; however, a Cochrane style review was
undertaken.
RESULTS: We found eleven studies, nine of which were randomised controlled
trials. There were variable standards of methodological reporting with some risk
of bias. Seven of the studies used quality of life as an outcome, with four
finding statistically significant improvements in mean total score. Two found an
improvement in outcome subscales. One study included some additional
semi-qualitative data.
CONCLUSIONS: We identified promising trends in the trials reviewed. In
particular, there were significant improvements in quality of life scales and
seizure frequency in many of the interventions. However, considerable
heterogeneity of interventions and outcomes made comparison between the studies
difficult. Courses that included psychological interventions and others that had
a high number of sessions showed more effect than short educational courses.
Furthermore, the evidence was predominantly from pilot studies with small sample
sizes and short follow-up duration. Further research is needed to better evaluate
the role of group self-management interventions in outpatient epilepsy
management.
DOI: 10.1186/s12883-017-0893-3
PMCID: PMC5474294
1748. J Assoc Nurses AIDS Care. 2016 Jul-Aug;27(4):468-75. doi:

10.1016/j.jana.2016.03.002. Epub 2016 Mar 23.
The Impact of Mental Wellness on HIV Self-Management.
Webel AR, Sattar A, Schreiner N, Kinley B, Moore SM, Salata RA.
As people living with HIV age, they face increasing self-management work related
to HIV infection plus the prevention and mitigation of multiple chronic health
conditions, including daily health practices (i.e., physical activity,
nutrition), engaging in a supportive community, and accepting the chronicity of
HIV. Our purpose was to describe the relationship between HIV self-management
practices and mental wellness (depressive symptoms, perceived stress).
Ninety-three adult people living with HIV on antiretroviral therapy were enrolled
and completed a survey. We used descriptive statistics to summarize variables,
and Spearman rank correlation and quantile regression to study associations
between variables. Participants' average age was 48.6 years, 56% were male, and
87% were African American. Daily self-management practices were associated with
depressive symptoms (r = -0.19; p ≤ .01) and perceived stress (r = -0.14;
p = .06); engaging with a supportive community and accepting the chronicity of
HIV were not associated with mental wellness (all p > .05).
Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc.

DOI: 10.1016/j.jana.2016.03.002
PMCID: PMC4903919
1749. Acta Paediatr. 2019 Feb;108(2):333-338. doi: 10.1111/apa.14471. Epub 2018 Jul
10.
Self-efficacy did not predict the outcome of the transition to adult care
in adolescents with inflammatory bowel disease.
van den Brink G(1), van Gaalen MAC(1), Zijlstra M(2), de Ridder L(1), van der
Woude CJ(3), Escher JC(1).
Author information:
(1)Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's
Hospital, Rotterdam, The Netherlands.
(2)Department of Paediatric Gastroenterology, Wilhelmina Children's Hospital,
University Medical Center Utrecht, Utrecht, The Netherlands.
(3)Department of Gastroenterology, Erasmus MC, Rotterdam, The Netherlands.
AIM: It can be difficult for adolescents with inflammatory bowel disease (IBD) to
make the transition from paediatric to adult care. We studied the outcomes of
this process and defined what constituted a successful transition.
METHODS: In 2008, 50 adolescents who attended our IBD transition clinic completed
IBD-yourself, a self-efficacy questionnaire that we had previously developed and
validated. We approached the subjects in 2014, two to six years after they
transferred to adult care, and 35 agreed to take part in the current study. The
outcome of transition was assessed by our newly developed Transition Yourself
Score. In addition, the relationship between self-efficacy and the outcome of the
transition was measured.
RESULTS: The mean age of the patients was 21.8 years, and 69% suffered from
Crohn's disease. The transition process was successful in 63% of cases,
moderately successful in 31% and failed in 6%. A successful transition was
associated with effective use of medication and clinical remission at the time of
transfer, but could not be predicted by self-efficacy. The Transition Yourself
Score will be validated in future studies.
CONCLUSION: Nearly two-thirds (63%) of the adolescents who attended the IBD
transition clinic had a successful transition to adult care.
©2018 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf
of Foundation Acta Paediatrica.
DOI: 10.1111/apa.14471
PMCID: PMC6585705
PMID: 29926962
1750. Frontline Gastroenterol. 2017 Oct;8(4):272-278. doi:

10.1136/flgastro-2017-100807. Epub 2017 Mar 29.
Implementing a self-management strategy in inflammatory bowel disease (IBD):

patient perceptions, clinical outcomes and the impact on service.
Squires SI(1), Boal AJ(1), Lamont S(1), Naismith GD(1).
Author information:
(1)C/O Gastroenterology Department, Royal Alexandra and Vale of Leven Hospitals,
Paisley, UK.
INTRODUCTION: Patient self-management and its service integration is not a new

concept but it may be a key component in the long-term sustainability of
inflammatory bowel disease (IBD) service provision, when considering growing
disease prevalence and limited resources.
METHODS: The IBD team at the Royal Alexandra and Vale of Leven Hospitals in the
Clyde Valley region developed a self-management tool, called the 'flare card'.
Patients were asked to complete a questionnaire which reflected their opinion on
its viability as a self-management intervention. In addition, its utility in
terms of service use over a 10-month period in 2016 was compared with a similar
cohort of patients over 10 months in 2015.
RESULTS: Patients overall felt that the 'flare card' was a viable self-management
tool. Positive feedback identified that the intervention could help them aid
control over their IBD, improve medication adherence, reduce symptoms and
reflected a feeling of patient-centred IBD care. The comparison between 2015 and
2016 service use revealed a significant reduction in IBD and non-IBD service
usage, Steroid prescribing and unscheduled IBD care in the flare card supported
cohort.
CONCLUSIONS: IBD services must continue to adapt to changes within the National
Health Service bearing in mind long-term sustainability and continued care
provision. The 'flare card' goes further in an attempt to optimise Crohn's
disease and ulcerative colitis management by harmonising clinician evaluation and
patient's self-initiation of therapy and investigation.
DOI: 10.1136/flgastro-2017-100807
PMCID: PMC5641849
PMID: 29067153

eCollection 2015.
Urban and suburban differences in hypertension trends and self-care: three

population-based cross-sectional studies from 2005-2011.
Li G(1), Hu H(2), Dong Z(1), Xie J(1), Zhou Y(1).
Author information:
(1)Institute of Chronic Diseases Control and Prevention, Beijing Center for
Diseases Control and Prevention, Beijing, China.
(2)Lab of Exercise Epidemiology, Graduate School of Sport Sciences, Waseda
University, Saitama, Japan.
OBJECTIVES: This study aimed to compare hypertension trends in the urban and
suburban population, and to examine the use of several self-care behaviors among
patients who were aware of their hypertension.
METHODS: We examined the data from three cross-sectional adult populations
obtained in 2005, 2008, and 2011, in Beijing.
RESULTS: Our analyses indicated that from 2005 to 2011 the standardized rate of
hypertension increased from 31.9% to 36.0% (P <0.001) among urban adults, and was
relatively stable (40.8% -40.2%) among suburban adults (P = 0.02). About 10% of
the patients reported having taken measures to control their weight for
hypertension management. As compared to the other patients, the female patients
in the urban areas reported the highest rate of regular BP measurement (52.6%).
In addition, the patients who reported taking medication regularly increased
among the males and females. Most of the women reported nonsmoking (≥95%) and
alcohol abstinence (≥90%). The trend of nonsmoking decreased among the urban
males. In contrast, the prevalence of nonsmoking increased among the suburban
males, though the trend was not statistically significant (P = 0.055). Further,
the patient-reported alcohol abstinence was found to exhibit a decreasing trend
among the males.
CONCLUSIONS: We observed an increase in the hypertension prevalence from 2005 to
2011. The rates remained higher for suburban adults than for urban adults.
Females generally had better self-care ability as compared to male patients.
Further research is needed to promote self-care behaviors in hypertensive
patients, especially for male patients.
PMCID: PMC4322055
1752. Prz Menopauzalny. 2019 Apr;18(1):15-22. doi: 10.5114/pm.2019.84152. Epub 2019

Apr
9.
Genitourinary syndrome of menopause: effects on related factors, quality of life,

and self-care power.
Karakoç H(1), Uçtu AK(2), Özerdoğan N(3).
Author information:
(1)Department of Midwifery, College of Health Science, KTO Karatay University,
Konya, Turkey.
(2)Department of Midwifery, College of Health Science, Bozok University, Yozgat,
Turkey.
(3)Department of Midwifery, Faculty of Health Science, Eskişehir Osmangazi
University, Eskişehir, Turkey.
Introduction: This study aimed to determine the effects of genitourinary syndrome

of menopause on related factors, quality of life, and self-care power.
Material and methods: This case-control epidemiological study included 300
postmenopausal women aged 48-60 years who were divided into two groups: the case
group (141) with genitourinary syndrome and the control group (159) without
genitourinary syndrome. Data were evaluated by chi-square and t-tests in
independent groups and logistic regression analysis.
Results: The incidence of genitourinary syndrome of menopause was 0.61 times
higher in women with a lower educational level than in those with a high
educational level, 0.44 times higher in those with chronic disease than in those
without, 2.54 times higher in those who continuously used medication than in
those who did not, and 2.45 times higher in those with urinary incontinence than
in those without. The mean Self-Care Power Scale score was significantly higher
in the control group (101.52 ±21.50) than in the case group (83.96 ±25.64). The
mean Menopause-Specific Quality of Life Scale score was significantly higher in
the case group (65.52 ±33.47) than in the control group (37.06 ±25.81).
Conclusions: Low educational level, chronic disease, urinary incontinence, and
continuous drug use are associated with genitourinary syndrome of menopause,
which negatively affects the quality of life and self-care power in women.
DOI: 10.5114/pm.2019.84152
PMCID: PMC6528038
PMID: 31114453
Conflict of interest statement: The authors report no conflict of interest.
1753. Eur Respir J. 2018 Jan 31;51(2). pii: 1701509. doi: 10.1183/13993003.01509-
2017.
Print 2018 Feb.
First trimester fetal size and prescribed asthma medication at 15 years of age.
Turner S(1), Fielding S(2), Devereux G(3).
Author information:
(1)Child Health, University of Aberdeen, Aberdeen, UK s.w.turner@abdn.ac.uk.
(2)Medical Statistics Team, Institute of Applied Health Sciences, University of
Aberdeen, Aberdeen, UK.
(3)Child Health, University of Aberdeen, Aberdeen, UK.
There is increasing evidence that antenatal factors predispose to childhood

asthma. We tested the hypothesis that reduced first trimester fetal size is
associated with increased risk for asthma at 15 years of age.Fetal size in the
first and second trimester was ascertained by ultrasound scan. The primary
outcome of being dispensed one or more asthma medications by the family doctor in
the year before the 15th birthday was determined from routinely acquired
dispensing data.Dispensing data were available for 1699 (88% of the original
cohort) participants at 15 years of age and questionnaire data for 750 (39%).
Each reduction in z-score for first trimester size was associated with increased
odds for dispensed asthma medication at 15 years of age (OR 1.26, 95% CI
1.03-1.54) and self-reported use of asthma medications (OR 1.55, 95% CI
1.16-2.08). Overall, first and second trimester size and forced expiratory volume
in 1 s at ages 5, 10 and 15 years were reduced for those dispensed asthma
medications compared with those not dispensed asthma medications
(p=0.003).Antenatal factors that are active by the first trimester may contribute
to respiratory well-being throughout childhood. Dropout from a birth cohort study
can overestimate of the magnitude of any true association.
Copyright ©ERS 2018.
DOI: 10.1183/13993003.01509-2017
Conflict of interest statement: Conflict of interest: None declared.
1754. Rev Bras Enferm. 2015 Jan-Feb;68(1):103-8, 111-6. doi:

10.1590/0034-7167.2015680115p.
Adherence to foot self-care in diabetes mellitus patients.
Rezende Neta DS(1), da Silva AR(2), da Silva GR(1).
Author information:
(1)Programa de Pós-Graduação em Enfermagem, Universidade Federal do Piauí,
Teresina, PI, Brasil.
(2)Programa de Pós-Graduação em Ciências e Saúde, Universidade Federal do Piauí,
Picos, PI, Brasil.
OBJECTIVE: To analyze the self-care of patients with type 2 diabetes mellitus in

the Family Health Strategy in Teresina-PI.
METHOD: Search cross selected by simple random sampling, 331 people with diabetes
mellitus. Data collection took place from August to December 2012 with the use of
Self-Care Activities Questionnaire with Diabetes and structured instrument for
recording information socioeconomic and guidance received by the professional
nurse.
RESULTS: The data revealed that patients have poor adherence to blood glucose
monitoring, the physical exercise and foot care, but with good adherence to the
medication. Only 38.7% of the sample examined the feet of fi ve to seven days a
week. Statistically significant association between self-care activities with
their feet and orientations of nurses (p < 0,05).
CONCLUSION: That there is need to raise awareness with regard to the development
of skills for self-care.
DOI: 10.1590/0034-7167.2015680115p
1755. J Acquir Immune Defic Syndr. 2017 Jun 1;75(2):203-210. doi:

10.1097/QAI.0000000000001371.
Predictors and Impact of Self-Reported Suboptimal Effort on Estimates of

Prevalence of HIV-Associated Neurocognitive Disorders.
Levine AJ(1), Martin E, Sacktor N, Munro C, Becker J; Multicenter AIDS Cohort

Study-Neuropsychology Working Group.
Author information:
(1)*Department of Neurology, David Geffen School of Medicine at the University of
California Los Angeles, Los Angeles, CA; †Department of Psychiatry, Rush
University Medical Center, Chicago, IL; ‡Department of Neurology, Johns Hopkins
University School of Medicine, Baltimore, MD; §Departments of Psychiatry and
Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; and
‖Departments of Psychiatry and Neurology, University of Pittsburgh, Pittsburgh,
PA.
BACKGROUND: Prevalence estimates of HIV-associated neurocognitive disorders

(HAND) may be inflated. Estimates are determined via cohort studies in which
participants may apply suboptimal effort on neurocognitive testing, thereby
inflating estimates. Additionally, fluctuating HAND severity over time may be
related to inconsistent effort. To address these hypotheses, we characterized
effort in the Multicenter AIDS Cohort Study.
METHODS: After neurocognitive testing, 935 participants (525 HIV- and 410 HIV+)
completed the visual analog effort scale (VAES), rating their effort from 0% to
100%. Those with <100% then indicated the reason(s) for suboptimal effort.
K-means cluster analysis established 3 groups: high (mean = 97%), moderate (79%),
and low effort (51%). Rates of HAND and other characteristics were compared
between the groups. Linear regression examined the predictors of VAES score. Data
from 57 participants who completed the VAES at 2 visits were analyzed to
characterize the longitudinal relationship between effort and HAND severity.
RESULTS: Fifty-two percent of participants reported suboptimal effort (<100%),
with no difference between serostatus groups. Common reasons included "tired"
(43%) and "distracted" (36%). The lowest effort group had greater asymptomatic
neurocognitive impairment and minor neurocognitive disorder diagnosis (25% and
33%) as compared with the moderate (23% and 15%) and the high (12% and 9%) effort
groups. Predictors of suboptimal effort were self-reported memory impairment,
African American race, and cocaine use. Change in effort between baseline and
follow-up correlated with change in HAND severity.
CONCLUSIONS: Suboptimal effort seems to inflate estimated HAND prevalence and
explain fluctuation of severity over time. A simple modification of study
protocols to optimize effort is indicated by the results.
DOI: 10.1097/QAI.0000000000001371
PMCID: PMC5429190
Effect of directly observed antiretroviral therapy compared to self-administered

antiretroviral therapy on adherence and virological outcomes among HIV-infected
prisoners: a randomized controlled pilot study.
White BL(1), Golin CE, Grodensky CA, Kiziah CN, Richardson A, Hudgens MG, Wohl
DA, Kaplan AH.
Author information:
(1)Department of Medicine, School of Medicine, University of North Carolina
School of Medicine, 130 Mason Farm Road, Chapel Hill, NC, 27284, USA,
bls@med.unc.edu.
The effect of directly observed therapy (DOT) versus self-administered therapy

(SAT) on antiretroviral (ART) adherence and virological outcomes in prison has
never been assessed in a randomized, controlled trial. Prisoners were randomized
to receive ART by DOT or SAT. The primary outcome was medication adherence
[percent of ART doses measured by the medication event monitoring system (MEMS)
and pill counts] at the end of 24 weeks. The changes in the plasma viral loads
from baseline and proportion of participants virological suppressed (<400
copies/mL) at the end of 24 weeks were assessed. Sixty-six percent (90/136) of
eligible prisoners declined participation. Participants in the DOT arm (n = 20)
had higher viral loads than participants in the SAT (n = 23) arm (p = 0.23).
Participants, with complete data at 24 weeks, were analyzed as randomized. There
were no significant differences in median ART adherence between the DOT (n = 16,
99% MEMS [IQR 93.9, 100], 97.1 % pill count [IQR 95.1, 99.3]) and SAT (n = 21,
98.3 % MEMS [IQR 96.0, 100], 98.5 % pill count [95.8, 100]) arms (p = 0.82 MEMS,
p = 0.40 Pill Count) at 24 weeks. Participants in the DOT arm had a greater
reduction in viral load of approximately -1 log 10 copies/mL [IQR -1.75, -0.05]
compared to -0.05 [IQR -0.45, 0.51] in the SAT arm (p value = 0.02) at 24 weeks.
The proportion of participants achieving virological suppression in the DOT vs
SAT arms was not statistically different at 24 weeks (53 % vs 32 %, p = 0.21).
These findings suggest that DOT ART programs in prison settings may not offer any
additional benefit on adherence than SAT programs.
DOI: 10.1007/s10461-014-0850-8
PMCID: PMC4303492
1757. Seizure. 2017 Aug;50:153-159. doi: 10.1016/j.seizure.2017.06.012. Epub 2017

Jun
20.
Anxiety and depression in people with epilepsy: The contribution of metacognitive

beliefs.
Fisher PL(1), Noble AJ(2).
Author information:
(1)Psychological Sciences, University of Liverpool, Liverpool, United Kingdom;
Nidaros DPS, Division of Psychiatry, St. Olavs University Hospital, Trondheim,
Norway. Electronic address: peter.fisher@liverpool.ac.uk.
(2)Psychological Sciences, University of Liverpool, Liverpool, United Kingdom.
PURPOSE: Anxiety and depressive disorders frequently occur in people with

epilepsy (PWE). An information processing model of psychopathology, the
Self-Regulatory Executive Function (S-REF) model specifies that maladaptive
metacognitive beliefs and processes play a fundamental role in the development
and maintenance of anxiety and depression. This study explored whether
metacognitive beliefs would explain additional variance in anxiety and depression
after accounting for demographics, physical and/or psychiatric illnesses,
epilepsy characteristics and medication issues. The mediational relationships
between metacognitive beliefs, worry and anxiety and depression, predicted by the
metacognitive model were also explored, METHODS: Three hundred and forty-nine PWE
participated in an online survey and completed self-report questionnaires
measuring anxiety, depression, metacognitive beliefs and worry. Participants also
provided information on epilepsy characteristics, demographics, comorbid physical
and/or psychiatric illnesses, number of, and perceived side effects of,
anti-epileptic medication.
RESULTS: Regression analysis showed that metacognitive beliefs were associated
with symptoms of anxiety, depression, and explained additional variance in these
outcomes after accounting for the control variables. Furthermore, the fundamental
tenet of the metacognitive model was supported; the relationship between negative
metacognitive beliefs about uncontrollability and danger of worry and anxious and
depressive symptoms was partially mediated by worry.
CONCLUSION: This is the first study to demonstrate that metacognitive beliefs and
processes contribute to anxiety and depression beyond variables often associated
with emotional distress in PWE. Further research is required to test if
modification of metacognitive beliefs and processes using metacognitive therapy
would effectively alleviate anxiety and depression in PWE.

rights reserved.
DOI: 10.1016/j.seizure.2017.06.012
1758. BMJ Support Palliat Care. 2016 Sep;6(3):263-75. doi:

10.1136/bmjspcare-2015-000958. Epub 2016 May 5.
How can we help family carers manage pain medicines for patients with advanced
cancer? A systematic review of intervention studies.
Latter S(1), Hopkinson JB(2), Richardson A(3), Hughes JA(1), Lowson E(1), Edwards
D(2).
Author information:
(2)School of Healthcare Sciences, Cardiff University, Cardiff, Wales, UK.
(3)Faculty of Health Sciences, University of Southampton, Southampton, UK
Department of Cancer Care, University Hospital Southampton NHS Foundation Trust,
Southampton, UK.
BACKGROUND: Family carers play a significant role in managing pain and associated
medicines for people with advanced cancer. Research indicates that carers often
feel inadequately prepared for the tasks involved, which may impact on carers'
and patients' emotional state as well as the achievement of optimal pain control.
However, little is known about effective methods of supporting family carers with
cancer pain medicines.
AIMS: To systematically identify and review studies of interventions to help
carers manage medicines for pain in advanced cancer. To identify implications for
practice and research.
METHOD: A systematic literature search of databases (MEDLINE, CINAHL, PsycINFO
and AMED) was carried out to identify studies of pain medication management
interventions that involved family carers of patients with advanced cancer, and
reported specific outcomes for family carers. Patient pain outcomes were also
sought. Studies were quality appraised; key aspects of study design,
interventions and outcomes were compared and a narrative synthesis of findings
developed.
RESULTS: 8 studies were included; all had significant methodological limitations.
The majority reported improvements in family carer knowledge and/or self-efficacy
for managing pain medicines; no effect on patient pain outcomes; and no adverse
effects. It was not possible to discern any association between particular
intervention characteristics and family carer outcomes.
CONCLUSIONS: Current evidence is limited, but overall suggests face-to-face
educational interventions supported by written and/or other resources have
potential to improve carers' knowledge and self-efficacy for pain management.
Further research is needed to identify how best to help family carers manage pain
medicines for patients with advanced cancer.
DOI: 10.1136/bmjspcare-2015-000958
PMCID: PMC5013162
1759. Neurosci Lett. 2015 Nov 16;609:142-6. doi: 10.1016/j.neulet.2015.10.046. Epub

2015 Oct 21.
Experience of negative emotions in Parkinson's disease: An fMRI investigation.
Schienle A(1), Ille R(2), Wabnegger A(2).
Author information:
(1)Clinical Psychology, University of Graz, BioTechMed, Graz, Austria. Electronic
address: Anne.schienle@uni-graz.at.
(2)Clinical Psychology, University of Graz, BioTechMed, Graz, Austria.
OBJECTIVE: Amygdala abnormalities have been discussed as a possible mechanism

underlying reduced reactivity to negative stimuli in Parkinson's disease (PD).
METHODS: The present investigation used functional magnetic resonance imaging
(fMRI) in order to test this hypothesis. We compared brain activation of 17
nondepressed and nondemented PD patients with 22 healthy controls during the
elicitation of negative affective states. The patients suffered from moderate
motor symptoms for an average of 75 months and had stopped their antiparkinson
medication 10-12h prior to the fMRI testing. All participants were shown images
which depicted disgusting, fear-relevant and neutral contents and they answered
self-report scales for the assessment of disgust proneness and trait anxiety.
RESULTS: Both groups did not differ from each other in affective state and trait
ratings. In line with the self-report, the fMRI data showed similar activation
(including the amygdala) in both groups during disgust and fear elicitation.
CONCLUSION: This fMRI investigation found no indication of diminished disgust and
fear experience in PD.
SIGNIFICANCE: Previously reported affective processing deficits in PD might be
due to insufficiently controlled confounding variables (medication, depression,
cognitive impairment).
Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights
reserved.
DOI: 10.1016/j.neulet.2015.10.046
PMCID: PMC4681091
1760. Am Fam Physician. 2015 Jul 1;92(1):27-34.
Management of Blood Glucose with Noninsulin Therapies in Type 2 Diabetes.
George CM(1), Brujin LL(1), Will K(2), Howard-Thompson A(1).
Author information:
(1)University of Tennessee Health Science Center, Memphis, TN, USA.
(2)Texas Tech University Health Sciences Center, Abilene, TX, USA.
A comprehensive, collaborative approach is necessary for optimal treatment of

patients with type 2 diabetes mellitus. Treatment guidelines focus on nutrition,
exercise, and pharmacologic therapies to prevent and manage complications.
Patients with prediabetes or new-onset diabetes should receive individualized
medical nutrition therapy, preferably from a registered dietitian, as needed to
achieve treatment goals. Patients should be treated initially with metformin
because it is the only medication shown in randomized controlled trials to reduce
mortality and complications. Additional medications such as sulfonylureas,
dipeptidyl-peptidase-4 inhibitors, thiazolidinediones, and glucagon-like
peptide-1 receptor agonists should be added as needed in a patient-centered
fashion. However, there is no evidence that any of these medications reduce the
risk of diabetes-related complications, cardiovascular mortality, or all-cause
mortality. There is insufficient evidence on which combination of hypoglycemic
agents best improves health outcomes before escalating to insulin therapy. The
American Diabetes Association recommends an A1C goal of less than 7% for many
nonpregnant adults, with the option of a less stringent goal of less than 8% for
patients with short life expectancy, cardiovascular risk factors, or
long-standing diabetes. Randomized trials in middle-aged patients with
cardiovascular risk factors have shown no mortality benefit and in some cases
increased mortality with more stringent A1C targets.
1761. J Psychiatr Res. 2018 Sep;104:100-107. doi: 10.1016/j.jpsychires.2018.06.019.

Epub 2018 Jun 30.
Predictors of severe relapse in pregnant women with psychotic or bipolar

disorders.
Taylor CL(1), Broadbent M(2), Khondoker M(3), Stewart RJ(4), Howard LM(5).
Author information:
(1)Section of Women's Mental Health, Health Service and Population Research
Department, Institute of Psychiatry, King's College London, UK. Electronic
address: clare.l.taylor@kcl.ac.uk.
(2)South London and Maudsley NHS Foundation Trust, London, UK. Electronic
address: matthew.broadbent@kcl.ac.uk.
(3)University of East Anglia, Norwich Medical School, Norwich Research Park,
Norwich, UK. Electronic address: m.khondoker@uea.ac.uk.
(4)Psychological Medicine Department, Institute of Psychiatry, King's College
London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
Electronic address: robert.stewart@kcl.ac.uk.
(5)Section of Women's Mental Health, Health Service and Population Research
Department, Institute of Psychiatry, King's College London, UK; South London and
Maudsley NHS Foundation Trust, London, UK. Electronic address:
louise.howard@kcl.ac.uk.
Pregnancy in women with severe mental illness is associated with adverse outcomes
for mother and infant. There are limited data on prevalence and predictors of
relapse in pregnancy. A historical cohort study using anonymised comprehensive
electronic health records from secondary mental health care linked with national
maternity data was carried out. Women with a history of serious mental illness
who were pregnant (2007-2011), and in remission at the start of pregnancy, were
studied; severe relapse was defined as admission to acute care or self-harm.
Predictors of relapse were analysed using random effects logistic regression to
account for repeated measures in women with more than one pregnancy in the study
period. In 454 pregnancies (389 women) there were 58 (24%) relapses in women with
non-affective psychoses and 25 (12%) in women with affective psychotic or bipolar
disorders. Independent predictors of relapse included non-affective psychosis
(adjusted OR = 2.03; 95% CI = 1.16-3.54), number of recent admissions (1.37;
1.03-1.84), recent self-harm (2.24; 1.15-4.34), substance use (2.15; 1.13-4.08),
smoking (2.52; 1.26-5.02) and non-white ethnicity (black ethnicity: 2.37;
1.23-4.57, mixed/other ethnicity: 2.94; 1.32-6.56). Women on no regular
medication throughout first trimester were also at greater risk of relapse in
pregnancy (1.99; 1.05-3.75). There was no interaction between severity of illness
and medication status as relapse predictors. Therefore, women with non-affective
psychosis and higher number of recent acute admissions are at significant risk of
severe relapse in pregnancy. Continuation of medication in women with severe
mental illness who become pregnant may be protective.
DOI: 10.1016/j.jpsychires.2018.06.019
PMID: 30015264
1762. Diabetes Educ. 2015 Feb;41(1):136-46. doi: 10.1177/0145721714561031. Epub

2014
Dec 8.
A randomized controlled trial to provide adherence information and motivational

interviewing to improve diabetes and lipid control.
Pladevall M(1)(2), Divine G(3), Wells KE(3), Resnicow K(4), Williams LK(1)(5).
Author information:
(1)Center for Health Policy and Health Services Research, Henry Ford Health
System, Detroit, Michigan (Dr Pladevall, Dr Williams)
(2)Research Triangle Institute Health Solutions, Barcelona, Spain (Dr Pladevall)
(3)Department of Public Health Sciences, Henry Ford Health System, Detroit,
Michigan (Dr Divine, Ms Wells)
(4)Center for Health Communications Research, University of Michigan, Ann Arbor,
Michigan (Dr Resnicow)
(5)Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan
(Dr Williams)
Comment in
Diabetes Educ. 2015 Oct;41(5):625-6.
PURPOSE: The purpose of this study was to assess whether providing medication
adherence information with or without motivational interviewing improves diabetes
and lipid control.
METHODS: Study participants were adult members of a health system in southeast
Michigan, were using both oral diabetes and lipid-lowering medications, and had
glycated hemoglobin (A1C) or low-density lipoprotein cholesterol (LDL-C) levels
not at goal. Participants were randomly assigned to receive usual care (UC), n =
567; have medication adherence information (AI) provided to their physician, n =
569; or have AI and receive motivational interviewing (MI) though trained staff
(AI + MI), n = 556. Primary outcomes were A1C and LDL-C levels at 18 months post
randomization.
RESULTS: Primary outcomes were not significantly different between patients in
the AI or AI + MI study arms when compared with UC. Similarly, neither oral
diabetes nor lipid-lowering medication adherence was significantly different
between groups. Patient participation in the AI + MI arm was low and limit the
interpretation of the study results, but post hoc analysis of the AI + MI study
arm showed that the number of MI sessions received was positively associated with
only oral diabetes medication adherence.
CONCLUSION: Neither AI nor MI significantly improved diabetes and lipid control
when compared with UC. Moreover, patient participation appeared to be a
particular barrier for MI.
DOI: 10.1177/0145721714561031
PMCID: PMC4722813
1763. Nicotine Tob Res. 2014 Nov;16(11):1463-9. doi: 10.1093/ntr/ntu099. Epub 2014
Jun
20.
Early quit days among methadone-maintained smokers in a smoking cessation trial.
de Dios MA(1), Anderson BJ(2), Caviness CM(2), Stein MD(3).
Author information:
(1)Department of Health Disparities Research, University of Texas MD Anderson
Cancer Center, Houston, TX; made@mdanderson.org.
(2)Butler Hospital, Providence, RI;
(3)Butler Hospital, Providence, RI; Department of Medicine, Warren Alpert Medical
School, Brown University, Providence, RI; Department of Health Services, Policy,
and Practice, Warren Alpert Medical School, Brown University, Providence, RI.
INTRODUCTION: Methadone maintenance treatment (MMT) patients have an exceedingly

high prevalence of tobacco use, and interventions that have been specifically
developed for this vulnerable subpopulation have struggled to attain even modest
rates of cessation. A significant barrier has been an inability to initiate a
quit attempt early in the treatment process and adherence to treatment.
METHODS: This study examined the extent to which self-efficacy, medication
adherence, and other demographic and smoking variables predicted an early quit
day in a sample of MMT smokers (n = 315) enrolled in a smoking cessation
pharmacotherapy trial. Using logistic regression, we estimated the association of
having an early quit day-24hr without smoking during the first month of
treatment.
RESULTS: Only 35.2% of participants reported a successful early quit day. The
likelihood of an early quit day increased significantly (odds ratio [OR] = 1.39,
95% CI = 1.04-1.86, p < .05) with education level and if a quit attempt was made
in the past year (OR = 2.27, 95% CI = 1.33-3.87, p < .01). Compared to the
placebo arm, those randomized to either nicotine replacement therapy (OR = 3.25,
95% CI = 1.30-8.10, p < .01) or varenicline (OR = 3.16, 95% CI = 1.26-7.92) were
significantly more likely to have an early quit day. The likelihood of an early
quit day was also positively associated with adherence to the medication protocol
(OR = 2.05, 95% CI = 1.52-2.76).
CONCLUSIONS: Difficulty in achieving an early quit attempt may help explain the
very low cessation rates found in studies of MMT smokers.
DOI: 10.1093/ntr/ntu099
PMCID: PMC4271088
1764. BMC Pregnancy Childbirth. 2018 Nov 20;18(1):450. doi: 10.1186/s12884-018-

2081-x.
First trimester medication use in pregnancy in Cameroon: a multi-hospital survey.
Leke AZ(1)(2), Dolk H(3), Loane M(3), Casson K(3), Maboh NM(4), Maeya SE(4),
Ndumbe LD(4), Nyenti PB(4), Armstrong O(4), Etiendem D(4).
Author information:
(1)Department of Nursing, School of Health Sciences, Biaka University Institute
of Buea-Cameroon, PO BOX 77, Buea, Cameroon. zawuol@gmail.com.
(2)Office of the Deputy Vice Chancellor i/c Research/Cooperation/Quality, Biaka
Universit Institute of Buea, PO Box 77-SWR, Buea, Cameroon. zawuol@gmail.com.
(3)Centre for Maternal, Fetal and Infant Research, Institute for Nursing and
Health Research, Ulster University, Shore Rd Newtownabbey, BT370QB, Ulster,
Ireland.
(4)Department of Nursing, School of Health Sciences, Biaka University Institute
of Buea-Cameroon, PO BOX 77, Buea, Cameroon.
BACKGROUND: There is a paucity of epidemiological data on medication use in

pregnancy in Cameroon.
METHODS: Between March and August 2015, 795 pregnant women attending 8 urban and
12 rural hospitals in Cameroon for antenatal (ANC) or other care were interviewed
on first trimester medication use using structured questionnaires. Multivariate
logistic regression was used to analyse the association of 18 sociodemographic
factors with medication use.
RESULTS: A total of 582 (73.2%) women took at least one orthodox (Western)
medication during the first trimester, 543 (68.3%) women a non-pregnancy related
orthodox medication, and 336 (42.3%)women a pregnancy related orthodox
medication. 44% of the women took anti-infectives including antimalarials (33.6%)
and antibiotics (20.8%).The other most common medications were analgesics (48.8%)
and antianaemias (38.6%). Sulfadoxine/pyrimethamine, contraindicated in the first
trimester of pregnancy, was the most commonly used antimalarial(13% of
women).0.2% of women reported antiretroviral use. Almost 80% of all orthodox
medications consumed by women were purchased from the hospital. 12.8% of the
women self-prescribed. Health unit and early gestational age at ANC booking were
consistent determinants of prescribing of non-pregnancy related, pregnancy
related and anti-infective medications. Illness and opinion on the safety of
orthodox medications were determinants of the use of non-pregnancy related
medications and anti-infectives. Age and parity were associated only with
non-pregnancy related medications.
CONCLUSION: This study has confirmed the observations of studies across Africa
indicating the increasing use of medications during pregnancy. This is an
indication that access to medicine is improving and more emphasis now must be
placed on medication safety systems targeting pregnant women, especially during
the first trimester when the risk of teratogenicity is highest.
DOI: 10.1186/s12884-018-2081-x
PMCID: PMC6245902
1765. J Parkinsons Dis. 2016 Apr 2;6(2):383-92. doi: 10.3233/JPD-150765.
Development and Validation of the Parkinson's Disease Medication Beliefs Scale

(PD-Rx).
Fleisher JE(1), Dahodwala NA(2), Xie SX(3), Mayo M(2), Weintraub D(2), Chodosh
J(4), Shea JA(5).
Author information:
(1)The Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders,
New York University School of Medicine, Departments of Neurology and Population
Health, New York, NY, USA.
(2)University of Pennsylvania Perelman School of Medicine, Department of
Neurology, Philadelphia, PA, USA.
Biostatistics and Epidemiology., Philadelphia, PA, USA.
(4)New York University School of Medicine, Division of Geriatric Medicine and
Palliative Care, Department of Medicine, New York, NY, USA.
Medicine, Philadelphia, PA, USA.
BACKGROUND: Medication non-adherence is common in Parkinson's disease (PD) and is

associated with increased disability and healthcare costs. Individuals' beliefs
regarding their medical conditions and treatments impact medication adherence.
While instruments exist to measure patients' beliefs about medications in
general, no such tool exists for PD.
OBJECTIVES: Create an instrument eliciting medication beliefs of persons with PD;
identify demographic and clinical characteristics associated with beliefs; and
examine whether beliefs are associated with dopaminergic therapy adherence.
METHODS: We developed the Parkinson's Disease Medication Beliefs Scale (PD-Rx) in
four phases: focus groups of patients and caregivers to generate items, scale
development, expert and patient revision of items, and a cross-sectional
validation sample (n = 75). Adherence was calculated using two approaches
incorporating self-reported medication lists.
RESULTS: The PD-Rx consists of 11 items covering benefits and risks of PD
pharmacotherapies. The scale covers motor improvement, current adverse effects,
and future concerns. Higher scores indicate more positive beliefs. Internal
consistency was acceptable (Cronbach's alpha = 0.67). Test-retest reliability was
0.47. Quality of life was associated with PD-Rx scores, and lower scores were
associated with non-adherence.
CONCLUSIONS: Negative beliefs about PD treatments are associated with lower
quality of life and may be related to medication non-adherence. Further study of
any causal relationship between beliefs and medication non-adherence in PD will
inform the design of future patient-centered interventions to improve adherence.
DOI: 10.3233/JPD-150765
PMCID: PMC4884139
1766. Respir Care. 2014 Nov;59(11):1731-46. doi: 10.4187/respcare.02990. Epub 2014
Jul
15.
Adherence of subjects with cystic fibrosis to their home program: a systematic

review.
O'Donohoe R(1), Fullen BM(2).
Author information:
(1)School of Public Health, Physiotherapy and Population Science, Health Science
Centre, University College Dublin, Dublin, Ireland.
(2)School of Public Health, Physiotherapy and Population Science, Health Science
Centre, University College Dublin, Dublin, Ireland. brona.fullen@ucd.ie.
BACKGROUND: The management of cystic fibrosis (CF) includes adherence to a home

management program (airway clearance, medication, nutritional advice, and
exercise). This has led to an increase in life expectancy, although the benefits
depend greatly on a patient's level of adherence to daily treatments at home. To
date, no systematic review has established adherence rates to all World Health
Organization guidelines in the home setting; hence, this review was undertaken.
METHODS: The review comprised 3 phases. A methodological assessment of databases
(Embase, CINAHL, PsychINFO, PEDro, PubMed, Cochrane Central Register of
Controlled Trials) identified potentially relevant papers. These papers were
screened for inclusion criteria by 2 independent reviewers, data were extracted,
and the internal validity was rated using a valid and reliable scale. Results
were categorized into 4 themes: medication, nutrition, airway clearance
techniques, and exercise.
RESULTS: The search generated a total of 26 papers, 24 of which were rated as
being poor quality. Adherence to a treatment program for CF patients is generally
low (from 22% for nutritional guidelines to 130% for oral antibiotics), and it
varies greatly depending on the type of treatment and the method of assessment
employed (objective tool vs self-reported questionnaires).
CONCLUSIONS: Consensus on how to measure adherence is lacking, and the quality of
studies addressing adherence in this population is generally poor. Overall,
studies using self-reported measures yielded higher adherence scores than those
that used objective measures, suggesting that current efforts to improve methods
of adherence are appropriate. The prevalence of non-adherence remains unclear due
to these limitations.
1767. BMC Geriatr. 2018 Oct 5;18(1):238. doi: 10.1186/s12877-018-0926-9.
Potentially inappropriate medication use among hypertensive older

African-American adults.
Bazargan M(1)(2), Smith JL(3), King EO(3)(4).
Author information:
(1)Charles R. Drew University of Medicine and Science, 1731 East 120th Street,
Los Angeles, CA, 90005, USA. mobazarg@cdrewu.edu.
(2)University of California, Los Angeles, USA. mobazarg@cdrewu.edu.
(3)Charles R. Drew University of Medicine and Science, 1731 East 120th Street,
Los Angeles, CA, 90005, USA.
(4)University of California, Los Angeles, USA.
BACKGROUND: Inappropriate use of medications, particularly among minority older

adults with co-morbidity, remains a major public health concern. The American
Geriatrics Society (AGS) reports that Potentially Inappropriate Medication (PIM)
continues to be prescribed for older adults, despite evidence of poor outcomes.
The main objective of this study was to examine the prevalence of PIM use among
underserved non-institutionalized hypertensive older African-American adults.
Furthermore, this study examines potential correlations between PIM use and the
number and type of chronic conditions.
METHODS: This cross-sectional study is comprised of a convenience sample of 193
hypertensive non-institutionalized African-American adults, aged 65 years and
older recruited from several senior housing units located in underserved areas of
South Los Angeles. The updated 2015 AGS Beers Criteria was used to identify
participants using PIMs.
RESULTS: Almost one out of two participants had inappropriate medication use.
While the average number of PIMs taken was 0.87 drugs, the range was from one to
seven medications. Almost 23% of PIMs were due to drugs with potential drug-drug
interactions. The most common PIM was the use of proton pump inhibitors (PPI) and
Central Nervous System (CNS) active agents. Nearly 56% of PIMs potentially
increased the risk of falls and fall-associated bone fractures. The use of PIMs
was significantly higher among participants who reported a higher number of
chronic conditions. Nearly 70% of participants with PIM use reported suffering
from chronic pain.
CONCLUSIONS: The major reason for high levels of polypharmacy, PIMs, and drug
interactions is that patients suffer from multiple chronic conditions. But it may
not be possible or necessary to treat all chronic conditions. Therefore, the
goals of care should be explicitly reviewed with the patient in order to
determine which of the many chronic conditions has the greatest impact on the
life goals and/or functional priorities of the patient. Those drugs that have a
limited impact on the patient's functional priorities and that may cause harmful
drug-drug interactions can be reduced or eliminated, while the remaining
medications can focus on the most important functional priorities of the patient.
DOI: 10.1186/s12877-018-0926-9
PMCID: PMC6173851
1768. JMIR Res Protoc. 2017 Jul 18;6(7):e134. doi: 10.2196/resprot.7327.
Comparing Mobile Health Strategies to Improve Medication Adherence for Veterans

With Coronary Heart Disease (Mobile4Meds): Protocol for a Mixed-Methods Study.
Park LG(1), Collins EG(2), Shim JK(3), Whooley MA(4).
Author information:
(1)Department of Veterans Affairs, Community Health Systems, University of
California, San Francisco, San Francisco, CA, United States.
(2)Edward Hines Jr., VA Hospital, Department of Biobehavioral Health Science,
University of Illinois at Chicago, Chicago, IL, United States.
(3)University of California, San Francisco, Social and Behavioral Sciences, San
Francisco, CA, United States.
(4)Department of Veterans Affairs, Department of Medicine, Epidemiology and
Biostatistics, University of California, San Francisco, San Francisco, CA, United
States.
BACKGROUND: Adherence to antiplatelet medications is critical to prevent life

threatening complications (ie, stent thrombosis) after percutaneous coronary
interventions (PCIs), yet rates of nonadherence range from 21-57% by 12 months.
Mobile interventions delivered via text messaging or mobile apps represent a
practical and inexpensive strategy to promote behavior change and enhance
OBJECTIVE: The Mobile4Meds study seeks to determine whether text messaging or a
mobile app, compared with an educational website control provided to all
Veterans, can improve adherence to antiplatelet therapy among patients following
acute coronary syndrome (ACS) or PCI. The three aims of the study are to: (1)
determine preferences for content and frequency of text messaging to promote
medication adherence through focus groups; (2) identify the most patient-centered
app that promotes adherence, through a content analysis of all commercially
available apps for medication adherence and focus groups centered on usability;
and (3) compare adherence to antiplatelet medications in Veterans after ACS/PCI
via a randomized clinical trial (RCT).
METHODS: We will utilize a mixed-methods design that uses focus groups to achieve
the first and second aims (N=32). Patients will be followed for 12 months after
being randomly assigned to one of three arms: (1) customized text messaging, (2)
mobile app, or (3) website-control groups (N=225). Medication adherence will be
measured with electronic monitoring devices, pharmacy records, and self-reports.
RESULTS: Enrollment for the focus groups is currently in progress. We expect to
enroll patients for the RCT in the beginning of 2018.
CONCLUSIONS: Determining the efficacy of mobile technology using a
Veteran-designed protocol to promote medication adherence will have a significant
impact on Veteran health and public health, particularly for individuals with
chronic diseases that require strict medication adherence.
TRIAL REGISTRATION: ClinicalTrials.gov NCT03022669.
©Linda G Park, Eileen G Collins, Janet K Shim, Mary A Whooley. Originally

published in JMIR Research Protocols (http://www.researchprotocols.org),
18.07.2017.
PMCID: PMC5539386
PMID: 28720557
1769. Respir Med. 2017 Feb;123:110-115. doi: 10.1016/j.rmed.2016.12.012. Epub 2016

Dec
21.
How many instructions are required to correct inhalation errors in patients with
asthma and chronic obstructive pulmonary disease?
Takaku Y(1), Kurashima K(2), Ohta C(2), Ishiguro T(2), Kagiyama N(2), Yanagisawa
T(2), Takayanagi N(2).
Author information:
(1)Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory
Center, Itai, 1696, Kumagaya city, Saitama, Japan. Electronic address:
takaku.yotaro@pref.saitama.lg.jp.
(2)Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory
Center, Itai, 1696, Kumagaya city, Saitama, Japan.
In the treatment of asthma and chronic obstructive pulmonary disease (COPD),

errors in handling and wrong techniques in using inhalation devices are
associated with poor disease control. The aim of this study was to evaluate the
number of instructions that are necessary to minimize errors in using pressurized
metered-dose inhaler (pMDI), soft mist inhaler (SMI), and dry powder inhaler
(DPI). Among 216 patients with asthma (n = 135) and COPD (n = 81), we studied 245
cases that used different types of inhalation devices. After initial guidance,
145 of 245 cases (59%) made at least one error that could affect efficacy. For
every device, at least three instructions were required to achieve entirely no
errors or less than 10% errors in total. The most common error on the use of pMDI
was device handling, whereas that of DPI was inhalation manner. Both errors were
associated with low peak flow rate. In both patients with asthma and in patients
with COPD, the most common error was inhalation manner. We concluded that it is
necessary to repeat at least three times of instructions to achieve effective
inhalation skills in both asthma and COPD patients.
DOI: 10.1016/j.rmed.2016.12.012
1770. Asian Nurs Res (Korean Soc Nurs Sci). 2014 Dec;8(4):274-81. doi:
10.1016/j.anr.2014.10.001. Epub 2014 Oct 28.
Case management for medical aid beneficiaries in Korea: findings from

case-control study.
Shin HS(1), Oh JJ(2).
Author information:
(1)Department of Nursing, Dankook University, Chungnam, South Korea.
(2)Department of Nursing, Dankook University, Chungnam, South Korea. Electronic
address: jinjoo@dankook.ac.kr.
PURPOSE: This study was to evaluate effects of case management provided for 7
months for medical aid in Korea.
METHODS: This study was a retrospective comparative study using secondary data
analysis. Data from two pre-existing survey were reanalyzed. The data were
collected through door to-door interviews using the structured questionnaire. For
the medical service use, claims data from the Korea National Health Insurance
Corporation was used. Subjects were 73 in the intervention group and 118 in the
control group.
RESULTS: There was no significant change in the intervention group in self-care
ability (p = .296), medication adherence (p = .194) or quality of life (p = .903)
compared to those of the control group. For hospital visiting days, it appeared
to decrease in the intervention group (p = .038) but with no significant
difference from that of the control group (p = .157). Neither were there
significant differences in medical expenditures (p = .605).
CONCLUSION: Although the effect of case management in this study appeared
extremely limited, the short intervention period and characteristics of the
medical aid beneficiaries and the limit of controlling only the demand side were
discussed as factors to be considered. Nurses have been carrying out professional
roles in case management in Korea. However more efforts are needed to develop
case management as an area for nursing specialization.
DOI: 10.1016/j.anr.2014.10.001
1771. AIDS Care. 2018 Jun;30(6):688-695. doi: 10.1080/09540121.2017.1394434. Epub

2017
Oct 25.
Mindfulness instruction for HIV-infected youth: a randomized controlled trial.
Webb L(1), Perry-Parrish C(2), Ellen J(3), Sibinga E(3).
Author information:
(1)a Department of Mental Health , Johns Hopkins Bloomberg School of Public
Health , Baltimore , MD , USA.
(2)b Child and Adolescent Psychiatry , Johns Hopkins School of Medicine ,
Baltimore , MD , USA.
(3)c Pediatrics , Johns Hopkins School of Medicine , Baltimore , MD , USA.
HIV-infected youth experience many stressors, including stress related to their

illness, which can negatively impact their mental and physical health. Therefore,
there is a significant need to identify potentially effective interventions to
improve stress management, coping, and self-regulation. The object of the study
was to assess the effect of a mindfulness-based stress reduction (MBSR) program
compared to an active control group on psychological symptoms and HIV disease
management in youth utilizing a randomized controlled trial. Seventy-two
HIV-infected adolescents, ages 14-22 (mean age 18.71 years), were enrolled from
two urban clinics and randomized to MBSR or an active control. Data were
collected on mindfulness, stress, self-regulation, psychological symptoms,
medication adherence, and cognitive flexibility at baseline, post-program, and
3-month follow-up. CD4+ T lymphocyte and HIV viral load (HIV VL) counts were also
pulled from medical records. HIV-infected youth in the MBSR group reported higher
levels of mindfulness (P = .03), problem-solving coping (P = .03), and life
satisfaction (P = .047), and lower aggression (P = .002) than those in the
control group at the 3-month follow-up. At post-program, MBSR participants had
higher cognitive accuracy when faced with negative emotion stimuli (P = .02).
Also, those in the MBSR study arm were more likely to have or maintain reductions
in HIV VL at 3-month follow-up than those in the control group (P = .04). In our
sample, MBSR instruction proved beneficial for important psychological and
HIV-disease outcomes, even when compared with an active control condition. Lower
HIV VL levels suggest improved HIV disease control, possibly due to higher levels
of HIV medication adherence, which is of great significance in both HIV treatment
and prevention. Additional research is needed to explore further the role of MBSR
for improving the psychological and physical health of HIV-positive youth.
DOI: 10.1080/09540121.2017.1394434
PMCID: PMC5987527
1772. J Diabetes Sci Technol. 2016 Jun 28;10(4):959-66. doi:

10.1177/1932296816633721.
Print 2016 Jul.
Pen Devices for Insulin Self-Administration Compared With Needle and Vial:
Systematic Review of the Literature and Meta-Analysis.
Lasalvia P(1), Barahona-Correa JE(1), Romero-Alvernia DM(1), Gil-Tamayo S(1),

Castañeda-Cardona C(2), Bayona JG(1), Triana JJ(1), Laserna AF(1), Mejía-Torres
M(1), Restrepo-Jimenez P(1), Jimenez-Zapata J(1), Rosselli D(3).
Author information:
(1)Pontificia Universidad Javeriana, Medical School, Bogota, Colombia.
(2)Pontificia Universidad Javeriana, Medical School, Bogota, Colombia
NeuroEconomix SAS, Bogota, Colombia.
(3)Pontificia Universidad Javeriana, Medical School, Bogota, Colombia
diego.rosselli@gmail.com.
OBJECTIVES: Pen devices offer advantages compared with vial and syringe (VaS).
The purpose of this article was to evaluate efficacy of pen devices compared to
VaS.
METHODS: A systematic review of literature was performed in 8 different
databases. References were independently screened and selected. Primary
observational or experimental studies comparing pen devices with VaS for insulin
administrations were included. Studies on specific populations were excluded.
Risk of bias was evaluated using appropriate tools. Data on glycosylated
hemoglobin (HbA1c), hypoglycemia, adherence, persistence, patient preference, and
quality of life (QOL) were collected. Meta-analysis was performed when
appropriate. Heterogeneity and risk of publication bias were evaluated.
Otherwise, descriptive analyses of the available data was done.
RESULTS: In all, 10 348 articles were screened. A total of 17 studies were
finally selected: 7 experimental and 10 analytical. The populations of the
included articles were mainly composed of adults with type 2 diabetes mellitus.
Important risk of bias was found in all of the articles, particularly
experimental studies. Meta-analyses were performed for HbA1c, hypoglycemia,
adherence and persistence. Pen device showed better results in mean HbA1c change,
patients with hypoglycemia, adherence and persistence compared to VaS. No
difference was observed in number of patients achieving <7% HbA1c. Preference
studies showed a tendency favoring pen devices, however nonvalidated tools were
used. One QoL study showed improvements in some subscales of SF-36.
CONCLUSIONS: There is evidence that pen devices offer benefits in clinical and,
less clearly, patient-reported outcomes compared to VaS for insulin
administration. However, these results should be taken with caution.
DOI: 10.1177/1932296816633721
1773. BMC Res Notes. 2017 Jan 3;10(1):9. doi: 10.1186/s13104-016-2332-8.
"They're younger… it's harder." Primary providers' perspectives on hypertension

management in young adults: a multicenter qualitative study.
Johnson HM(1)(2), Warner RC(3), Bartels CM(4)(5), LaMantia JN(6)(4).
Author information:
(1)Division of Cardiovascular Medicine, Department of Medicine, University of
Wisconsin School of Medicine and Public Health, H4/512 CSC, MC 3248, 600 Highland
Avenue, Madison, WI, 53792, USA. hm2@medicine.wisc.edu.
(2)Health Innovation Program, University of Wisconsin School of Medicine and
Public Health, 800 University Bay Drive, Suite 210, Box 9445, Madison, WI, 53705,
USA. hm2@medicine.wisc.edu.
(3)Department of Counselor Education and Counseling Psychology, Marquette
University, Schroeder Health & Education Complex, 561 N 15th Street, Room 151A,
Milwaukee, WI, 53233, USA.
(4)Health Innovation Program, University of Wisconsin School of Medicine and
Public Health, 800 University Bay Drive, Suite 210, Box 9445, Madison, WI, 53705,
USA.
(5)Division of Rheumatology, Department of Medicine, University of Wisconsin
School of Medicine and Public Health, 4132 MFCB, Mail Code 2281, 1685 Highland
Avenue, Madison, WI, 53705, USA.
(6)Division of Cardiovascular Medicine, Department of Medicine, University of
Wisconsin School of Medicine and Public Health, H4/512 CSC, MC 3248, 600 Highland
Avenue, Madison, WI, 53792, USA.
BACKGROUND: Young adults (18-39 year-olds) have the lowest hypertension control
rates among adults with hypertension in the United States. Unique barriers to
hypertension management in young adults with primary care access compared to
older adults have not been evaluated. Understanding these differences will inform
the development of hypertension interventions tailored to young adults. The goals
of this multicenter study were to explore primary care providers' perspectives on
barriers to diagnosing, treating, and controlling hypertension among young adults
with regular primary care.
METHODS: Primary care providers (physicians and advanced practice providers)
actively managing young adults with uncontrolled hypertension were recruited by
the Wisconsin Research & Education Network (WREN), a statewide practice-based
research network. Semi-structured qualitative interviews were conducted in three
diverse Midwestern clinical practices (academic, rural, and urban clinics) using
a semi-structured interview guide, and content analysis was performed.
RESULTS: Primary care providers identified unique barriers across standard
hypertension healthcare delivery practices for young adults. Altered
self-identity, greater blood pressure variability, and unintended consequences of
medication initiation were critical hypertension control barriers among young
adults. Gender differences among young adults were also noted as barriers to
hypertension follow-up and antihypertensive medication initiation.
CONCLUSIONS: Tailored interventions addressing the unique barriers of young
adults are needed to improve population hypertension control. Augmenting
traditional clinic structure to support the "health identity" of young adults and
self-management skills are promising next steps to improve hypertension
healthcare delivery.
DOI: 10.1186/s13104-016-2332-8
PMCID: PMC5217565
1774. BMC Public Health. 2018 Jul 4;18(1):825. doi: 10.1186/s12889-018-5731-z.
Medication adherence to antiretroviral therapy among newly treated people living

with HIV.
Yu Y(1), Luo D(2), Chen X(3), Huang Z(4), Wang M(5), Xiao S(1).
Author information:
(1)Department of Social Medicine and Health Management, Xiangya School of Public
Health, Central South University, Changsha, 410078, China.
(2)Department of Social Medicine and Health Management, Xiangya School of Public
Health, Central South University, Changsha, 410078, China.
luodan_csu_2011@126.com.
(3)Hunan Provincial Center for Disease Prevention and Control, Changsha, China.
(4)Changsha Center for Disease Prevention and Control, Changsha, China.
(5)HIV/AIDS Research Institute, The First Hospital of Changsha, Changsha, China.
BACKGROUND: Free antiretroviral therapy has been implemented in China since 2004,
but adherence to antiretroviral therapy among people living with HIV is
suboptimal. The effectiveness of antiretroviral therapy is subject to medication
adherence, which decreases with prolonged treatment times. The aim of this study
was to investigate medication adherence and related factors among people living
with HIV with newly initiated antiretroviral therapy.
METHODS: This observational study was conducted in consecutive samples of people
living with HIV who had newly initiated antiretroviral therapy. Participants were
recruited between March 1, 2013, and August 31, 2014, from the local Center for
Disease Control and Prevention and Infectious Disease hospital in a capital city
in central China. A standard set of questionnaires was adopted, including the
Community Programs for Clinical Research on AIDS Antiretroviral Medications and
Self-Report Questionnaire (CPCRA), the Patient Health Questionnaire-9 (PHQ-9) and
the 7-item Generalized Anxiety Disorder Scale (GAD-7). T-test, Chi square test
and multivariate logistic regression analysis with backward stepwise were
performed to explore factors that might influence medication adherence.
RESULTS: Of the 207 participants, 85.5% of the participants (177/207) were
categorized with good adherence, and 14.5% (30/207) with poor adherence. The
multivariate logistic regression analyses showed that participants with positive
depression (OR = 5.95, 95% CI: 2.34-15.11) and without disclosure of their HIV
status to others (OR = 2.62, 95% CI: 1.06-6.50) were more susceptible to poor
adherence.
CONCLUSIONS: One-sixth of the participants reported suboptimal medication
adherence within the first 6 months. Factors associated with poor adherence
included non-disclosure of their HIV status, had positive depression. Tailored
interventions, such as effective psychological coping strategies, should be
implemented for people living with HIV with newly initiated antiretroviral
therapy to improve their medication adherence.
DOI: 10.1186/s12889-018-5731-z
PMCID: PMC6030792
1775. Nat Commun. 2019 Apr 23;10(1):1891. doi: 10.1038/s41467-019-09572-5.
Genome-wide association study of medication-use and associated disease in the UK

Biobank.
Wu Y(1), Byrne EM(1), Zheng Z(1)(2), Kemper KE(1), Yengo L(1), Mallett AJ(1)(3),
Yang J(1)(2)(4), Visscher PM(5)(6), Wray NR(7)(8).
Author information:
(1)Institute for Molecular Bioscience, The University of Queensland, Brisbane,
QLD, 4072, Australia.
(2)Institute for Advanced Research, Wenzhou Medical University, 325027, Wenzhou,
Zhejiang, China.
(3)Department of Renal Medicine, Royal Brisbane and Women's Hospital, Herston,
QLD, 4029, Australia.
(4)Queensland Brain Institute, The University of Queensland, Brisbane, QLD, 4072,
Australia.
QLD, 4072, Australia. peter.visscher@uq.edu.au.
Australia. peter.visscher@uq.edu.au.
QLD, 4072, Australia. naomi.wray@uq.edu.au.
Australia. naomi.wray@uq.edu.au.
Genome-wide association studies (GWASs) of medication use may contribute to

understanding of disease etiology, could generate new leads relevant for drug
discovery and can be used to quantify future risk of medication taking. Here, we
conduct GWASs of self-reported medication use from 23 medication categories in
approximately 320,000 individuals from the UK Biobank. A total of 505 independent
genetic loci that meet stringent criteria (P < 10-8/23) for statistical
significance are identified. We investigate the implications of these GWAS
findings in relation to biological mechanism, potential drug target
identification and genetic risk stratification of disease. Amongst the
medication-associated genes are 16 known therapeutic-effect target genes for
medications from 9 categories. Two of the medication classes studied are for
disorders that have not previously been subject to large GWAS (hypothyroidism and
gastro-oesophageal reflux disease).
DOI: 10.1038/s41467-019-09572-5
PMCID: PMC6478889
1776. Int J Emerg Med. 2018 May 30;11(1):30. doi: 10.1186/s12245-018-0187-6.
Elevated blood pressure and illness beliefs: a cross-sectional study of emergency

department patients in Jamaica.
Wilson TT(1)(2), Williams-Johnson J(3)(4), Gossel-Williams M(5)(6), Goldberg

EM(7)(8), Wilks R(6)(9), Dasgupta S(3)(4), Gordon-Strachan GM(6), Williams
EW(3)(4), Levy PD(10)(11).
Author information:
(1)Alpert School of Medicine, Brown University, Emergency Medicine, Rhode Island
Hospital, 55 Claverick St. #2, Providence, RI, 02903, USA.
taneisha_wilson@brown.edu.
(2)University Emergency Medicine Foundation, Kingston, Jamaica.
taneisha_wilson@brown.edu.
(3)University Hospital, University of the West Indies, Mona, Kingston, Jamaica.
(4)The University Hospital of the West Indies, Mona, Kingston, West Indies,
Jamaica.
(5)Department of Basic Medical Sciences, University of the West Indies, Mona,
Kingston, Jamaica.
(6)The University of the West Indies, Mona, Kingston, West Indies, Jamaica.
(7)Alpert School of Medicine, Brown University, Emergency Medicine, Rhode Island
Hospital, 55 Claverick St. #2, Providence, RI, 02903, USA.
(8)University Emergency Medicine Foundation, Kingston, Jamaica.
(9)Tropical Medicine Research Institute, University of the West Indies, Mona,
Kingston, Jamaica.
(10)Department of Emergency Medicine, Wayne State University, Detroit, MI, USA.
(11)Emergency Medicine, 6G4 University Health Center, Detroit, MI, 48201, USA.
BACKGROUND: Elevated blood pressure (BP) is common among emergency department

(ED) patients. While some data exist on the association between ED BP and
hypertension (HTN) in the USA, little is known about this relationship in
Afro-Caribbean nations. The aim of the study was to evaluate the relationship
between elevated systolic BP in the ED and a previous diagnosis of HTN,
accounting for potential factors that could contribute to poor HTN control among
those with a previous diagnosis: socioeconomic status, health-seeking behavior,
underlying HTN illness beliefs, medication adherence, and perceived adherence
self-efficacy.
METHODS: This was a cross-sectional survey over 6 weeks, from November 19 through
December 30, 2014. Those surveyed were non-critically ill or injured adult ED
patients (≥ 18 years) presenting to an Afro-Caribbean hospital. Descriptive
statistics were derived for study patients as a whole, by HTN history and by
presenting BP subgroup (with systolic BP ≥ 140 mmHg considered elevated). Data
between groups were compared using chi-square and t tests, where appropriate.
RESULTS: A total of 307 patients were included: 145 (47.2%) had a prior history
of HTN, 126 (41.4%) had elevated BP, and 89 (61.4%) of those presenting with
elevated blood pressure had a previous diagnosis of HTN. Those with less formal
education were significantly more likely to present with elevated BP (52.1 vs.
28.8% for those with some high school and 19.2% for those with a college
education; p = 0.001). Among those with a history of HTN, only 56 (30.9%) had a
normal presenting BP. Those with a history of HTN and normal ED presenting BP
were no different from patients with elevated BP when comparing the in duration
of HTN, medication compliance, location of usual follow-up care, and HTN-specific
illness beliefs.
CONCLUSIONS: In this single-center study, two out of every five Jamaican ED
patients had elevated presenting BP, the majority of whom had a previous
diagnosis of HTN. Among those with a history of HTN, 60% had an elevated
presenting BP. The ED can be an important location to identify patients with
chronic disease in need of greater disease-specific education. Further studies
should evaluate if brief interventions provided by ED medical staff improve HTN
control in this patient population.
DOI: 10.1186/s12245-018-0187-6
PMCID: PMC5976560
PMID: 29846823
1777. JMIR Med Inform. 2016 Feb 8;4(1):e4. doi: 10.2196/medinform.4739.
Integration of Provider, Pharmacy, and Patient-Reported Data to Improve

Medication Adherence for Type 2 Diabetes: A Controlled Before-After Pilot Study.
Dixon BE(1), Alzeer AH, Phillips EO, Marrero DG.
Author information:
(1)Indiana University Richard M. Fairbanks School of Public Health, Department of
Epidemiology, Indianapolis, IN, United States. bedixon@regenstrief.org.
BACKGROUND: Patients with diabetes often have poor adherence to using medications
as prescribed. The reasons why, however, are not well understood. Furthermore,
most health care delivery processes do not routinely assess medication adherence
or the factors that contribute to poor adherence.
OBJECTIVE: The objective of the study was to assess the feasibility of an
integrated informatics approach to aggregating and displaying clinically relevant
data with the potential to identify issues that may interfere with appropriate
medication utilization and facilitate patient-provider communication during
clinical encounters about strategies to improve medication use.
METHODS: We developed a clinical dashboard within an electronic health record
(EHR) system that uses data from three sources: the medical record, pharmacy
claims, and a patient portal. Next, we implemented the dashboard into three
community health centers. Health care providers (n=15) and patients with diabetes
(n=96) were enrolled in a before-after pilot to test the system's impact on
medication adherence and clinical outcomes. To measure adherence, we calculated
the proportion of days covered using pharmacy claims. Demographic, laboratory,
and visit data from the EHR were analyzed using pairwise t tests. Perceived
barriers to adherence were self-reported by patients. Providers were surveyed
about their use and perceptions of the clinical dashboard.
RESULTS: Adherence significantly and meaningfully improved (improvements ranged
from 6%-20%) consistently across diabetes as well as cardiovascular drug classes.
Clinical outcomes, including HbA1c, blood pressure, lipid control, and emergency
department utilization remained unchanged. Only a quarter of patients (n=24)
logged into the patient portal and completed psychosocial questionnaires about
their barriers to taking medications.
CONCLUSIONS: Integrated approaches using advanced EHR, clinical decision support,
and patient-controlled technologies show promise for improving appropriate
medication use and supporting better management of chronic conditions. Future
research and development is necessary to design, implement, and integrate the
myriad of EHR and clinical decision support systems as well as patient-focused
information systems into routine care and patient processes that together support
health and well-being.
DOI: 10.2196/medinform.4739
PMCID: PMC4763113
PMID: 26858218
Congestive heart failure adherence redesign trial: a pilot study.
Mangla A(1), Doukky R(2), Powell LH(3), Avery E(3), Richardson D(4), Calvin JE
Jr(5).
Author information:
(1)Department of Preventive Medicine, Rush University Medical Center, Chicago,
Illinois, USA Department of Internal Medicine, OSF St. Francis Medical Center,
Peoria, Illinois, USA.
Illinois, USA Division of Cardiology, John H. Stroger, Jr. Hospital of Cook
County, Chicago, Illinois, USA Division of Cardiology, Rush University Medical
Center, Chicago, Illinois, USA.
Illinois, USA.
Illinois, USA Department of Mathematics, Lake Forest College, Lake Forest,
Illinois, USA.
(5)Department of Medicine, University of Western Ontario, London, Ontario,
Canada.
OBJECTIVE: Heart failure (HF) continues to be a leading cause of hospital

admissions, particularly in underserved patients. We hypothesised that providing
individualised self-management support to patients and feedback on use of
evidence-based HF therapies (EBT) to physicians could lead to improvements in
care and decrease hospitalisations. To assess the feasibility of conducting a
larger trial testing the efficacy of this dual-level intervention, we conducted
the Congestive Heart failure Adherence Redesign Trial Pilot (CHART-P), a
proof-of-concept, quasi-experimental, feasibility pilot study.
SETTING: A large tertiary care medical centre in Chicago.
PARTICIPANTS: Low-income patients (<US$30,000/year) hospitalised for exacerbation
of systolic HF (ejection fraction ≤50%) and their physicians. Twenty physicians
and 33 patients were enrolled, of whom 23 patients completed the study.
INTERVENTIONS: Physicians received HF guidelines and periodic individualised
feedback on their adherence to EBT. Patients received HF education, support and
self-management training for diet and medication adherence by a trained nurse
through 11 interactive sessions over a 4-month period. Evaluations were conducted
pre-enrolment and 1 month postintervention completion.
OUTCOME MEASURES: Feasibility was assessed by the ability to deliver intervention
to patients and physicians. Exploratory outcomes included changes in medication
and sodium intake for patients and adherence to EBT for physicians.
RESULTS: Eighty-seven per cent and 82% of patients received >80% of interventions
at 1 month and by study completion, respectively. Median sodium intake declined
(3.5 vs 2.0 g; p<0.01). There was no statistically significant change in
medication adherence based on electronic pill cap monitoring or the Morisky
Medication Adherence Scale (MMAS); however, there was a trend towards improved
adherence based on MMAS. All physicians received timely intervention.
CONCLUSIONS: This pilot study demonstrated that the protocol was feasible. It
provided important insights about the need for intervention and the difficulties
in treating patients with a variety of psychosocial problems that undercut their
effective care.
DOI: 10.1136/bmjopen-2014-006542
PMCID: PMC4256535

eCollection 2016.
Impact of Socioeconomic Inequality on Access, Adherence, and Outcomes of

Antiretroviral Treatment Services for People Living with HIV/AIDS in Vietnam.
Tran BX(1)(2), Hwang J(3), Nguyen LH(4), Nguyen AT(5), Latkin NR(2), Tran NK(6),
Minh Thuc VT(7), Nguyen HL(5), Phan HT(8), Le HT(1), Tran TD(9), Latkin CA(2).
Author information:
(1)Institute for Preventive Medicine and Public Health, Hanoi Medical University,
Hanoi, Vietnam.
(2)Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United
States of America.
(3)Department of Health Promotion, Daegu University, Gyeongsan, Republic of
Korea.
(4)School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
(5)Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
(6)Woolcock Medical Research Institute, Hanoi, Vietnam.
(7)Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi,
Vietnam.
(8)Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
(9)Department of Hepatobiliary Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam.
BACKGROUND: Ensuring an equal benefit across different patient groups is

necessary while scaling up free-of-charge antiretroviral treatment (ART)
services. This study aimed to measure the disparity in access, adherence, and
outcomes of ART in Vietnam and the effects of socioeconomic status (SES)
characteristics on the levels of inequality.
METHODS: A cross-sectional study was conducted in 1133 PLWH in Vietnam. ART
access, adherence, and treatment outcomes were self-reported using a structured
questionnaire. Wealth-related inequality was calculated using a concentration
index, and a decomposition analysis was used to determine the contribution of
each SES variable to inequality in access, adherence, and outcomes of ART.
RESULTS: Based on SES, minor inequality was found in ART access and adherence
while there was considerable inequality in ART outcomes. Poor people were more
likely to start treatment early, while rich people had better adherence and
overall treatment outcomes. Decomposition revealed that occupation and education
played important roles in inequality in ART access, adherence, and treatment
outcomes.
CONCLUSION: The findings suggested that health services should be integrated into
the ART regimen. Furthermore, occupational orientation and training courses
should be provided to reduce inequality in ART access, adherence, and treatment
outcomes.
PMCID: PMC5179124

interests exist.
1780. Diabetes Metab Syndr Obes. 2018 Jul 20;11:367-374. doi: 10.2147/DMSO.S170253.
eCollection 2018.
Migraine in adults with diabetes; is there an association? Results of a

López-de-Andrés A(1), Luis Del Barrio J(1), Hernández-Barrera V(1), de

Miguel-Díez J(2), Jimenez-Trujillo I(1), Martinez-Huedo MA(3), Jimenez-García
R(1).
Author information:
(1)Preventive Medicine and Public Health Teaching and Research Unit, Health
Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain,
rodrigo.jimenez@urjc.es.
(2)Respiratory Department, Hospital General Universitario Gregorio Marañón,
Madrid, Spain.
(3)Preventive Medicine and Public Health Department, Teaching and Research Unit,
University Hospital La Paz, Madrid, Spain.
Aims: To investigate the association between migraine and diabetes mellitus while
controlling for several socio-demographic characteristics, comorbidities, and
lifestyle variables. We also aimed to identify which of these variables are
associated with migraine among diabetics.
Patients and methods: We conducted a cross-sectional study using data taken from
the European Health Interview Surveys for Spain conducted in 2009/10 (n=22,188)
and 2014 (n=22,842). We selected those subjects ≥40 years of age. Diabetes status
was self-reported. One non-diabetic control was matched by the year of survey,
age, and sex for each diabetic case. The presence of migraine was defined as the
affirmative answer to both of the following questions: "Have you suffered
migraine or frequent headaches over the last 12 months?" and "Has your physician
confirmed the diagnosis?". Independent variables included demographic and
socio-economic characteristics, health status variables, lifestyle, and pain
characteristics.
Results: The prevalence of migraine was significantly higher among those
suffering from diabetes (14.9% vs. 13.0%; p=0.021). The multivariable analysis
showed that diabetes was not associated with a higher risk of migraine (adjusted
OR 1.06; 95%CI 0.89-1.25). Among diabetic subjects, female sex, suffering
concomitant mental disorders, respiratory disorders, neck pain, and low back pain
were variables associated with suffering from migraine.
Conclusion: We found no significant differences in the prevalence of migraine
between diabetics and non-diabetic age- and sex-matched controls after
controlling for possible confounders.
DOI: 10.2147/DMSO.S170253
PMCID: PMC6056164
PMID: 30050314

1781. EGEMS (Wash DC). 2016 Jul 12;4(1):1258. doi: 10.13063/2327-9214.1258.
eCollection
2016.
Applying Sequential Analytic Methods to Self-Reported Information to Anticipate

Care Needs.
Bayliss EA(1), Powers JD(2), Ellis JL(2), Barrow JC(2), Strobel M(3), Beck A(2).
Author information:
(1)Kaiser Permanente Colorado Institute for Health Research; Department of Family
Medicine, University of Colorado School of Medicine.
(2)Kaiser Permanente Colorado Institute for Health Research.
(3)Kaiser Permanente Colorado, Department of Complete Health Solutions.
PURPOSE: Identifying care needs for newly enrolled or newly insured individuals
is important under the Affordable Care Act. Systematically collected
patient-reported information can potentially identify subgroups with specific
care needs prior to service use.
METHODS: We conducted a retrospective cohort investigation of 6,047 individuals
who completed a 10-question needs assessment upon initial enrollment in Kaiser
Permanente Colorado (KPCO), a not-for-profit integrated delivery system, through
the Colorado State Individual Exchange. We used responses from the Brief Health
Questionnaire (BHQ), to develop a predictive model for cost for receiving care in
the top 25 percent, then applied cluster analytic techniques to identify
different high-cost subpopulations. Per-member, per-month cost was measured from
6 to 12 months following BHQ response.
RESULTS: BHQ responses significantly predictive of high-cost care included
self-reported health status, functional limitations, medication use, presence of
0-4 chronic conditions, self-reported emergency department (ED) use during the
prior year, and lack of prior insurance. Age, gender, and deductible-based
insurance product were also predictive. The largest possible range of predicted
probabilities of being in the top 25 percent of cost was 3.5 percent to 96.4
percent. Within the top cost quartile, examples of potentially actionable
clusters of patients included those with high morbidity, prior utilization,
depression risk and financial constraints; those with high morbidity, previously
uninsured individuals with few financial constraints; and relatively healthy,
previously insured individuals with medication needs.
CONCLUSIONS: Applying sequential predictive modeling and cluster analytic
techniques to patient-reported information can identify subgroups of individuals
within heterogeneous populations who may benefit from specific interventions to
optimize initial care delivery.
DOI: 10.13063/2327-9214.1258
PMCID: PMC4975568
PMID: 27563684
1782. Chronic Illn. 2016 Mar;12(1):29-40. doi: 10.1177/1742395315601415. Epub 2015

Aug
18.
Informational needs of liver transplant recipients during a two-year

posttransplant period.
Ko D(1), Lee I(2), Muehrer RJ(3).
Author information:
(1)School of Nursing, University of Wisconsin-Madison, Madison, USA
dko4@wisc.edu.
(2)College of Nursing, Seoul National University, Seoul, South Korea.
(3)School of Nursing, University of Wisconsin-Madison, Madison, USA Department of
Medicine, Section of Nephrology, University of Wisconsin-Madison School of
Medicine and Public Health, Madison, USA.
OBJECTIVES: To describe the informational needs of liver transplant (LTx)

recipients, examine potential differences in informational needs by
sociodemographic and clinical variables, and examine informational needs at
various time points posttransplant.
METHODS: A descriptive, cross-sectional design was used. Informational needs were
assessed by the Informational Needs Questionnaire-liver, a new questionnaire
developed to include LTx recipients' perspectives. To examine informational needs
at different posttransplant time points, participants were classified into four
groups (0-1, 2-4, 5-9, and 10-24 months).
RESULTS: Participants (159) who were married, single, had higher education, or
higher monthly incomes had significantly greater informational needs.
Informational needs regarding disease and physical and emotional management
remained high after transplant. Four subscales (medication, wound management,
diet, and daily and social activities) indicated informational needs were
different across time. Participants 2-4 months posttransplant had higher
informational needs regarding wound management and daily and social activities.
Participants 5-9 months posttransplant had the highest informational needs
regarding medication and diet.
DISCUSSION: Findings indicate informational needs vary among LTx recipients at
different posttransplant time points. Marital status, education, and monthly
income can influence informational needs.
CONCLUSION: Healthcare providers should tailor information given to LTx
recipients based on informational needs. Longitudinal studies are needed to
confirm changing patterns of informational needs.
DOI: 10.1177/1742395315601415
PMCID: PMC5027924
1783. Prim Care Companion CNS Disord. 2014 Nov 13;16(6). doi: 10.4088/PCC.14m01692.
eCollection 2014.
A cross-sectional survey of childhood trauma and compliance with general health

care among adult primary care outpatients.
Sansone RA(1), Jordan Bohinc R(1), Wiederman MW(1).
Author information:
(1)Departments of Psychiatry (Dr Sansone) and Internal Medicine (Drs Sansone and
Bohinc), Wright State University School of Medicine, Dayton, Ohio; Department of
Psychiatry Education, Kettering Medical Center, Kettering, Ohio (Dr Sansone); and
Department of Psychology, Columbia College, Columbia, South Carolina (Dr
Wiederman).
OBJECTIVE: Beyond the examination of medication compliance among individuals with

substance abuse or human immunodeficiency virus (HIV)/acquired immunodeficiency
syndrome (AIDS), few studies have examined relationships between childhood trauma
and health care compliance in adulthood-the focus of the present study.
METHOD: Using a cross-sectional approach and a self-report survey methodology, we
examined 5 types of childhood trauma (ie, witnessing violence, physical neglect,
emotional abuse, physical abuse, sexual abuse) in relationship to 4 measures of
general health care compliance (ie, self-rated general conscientiousness with
medical treatment; 5 items pertaining to general health care compliance such as
scheduling regular dental checkups, timely arrival for doctor's appointments, and
timely completion of laboratory work; 2 medication compliance items; and the
Medical Outcomes Study general adherence score) among a sample of adult primary
care outpatients (N = 272). Data were collected in March 2014.
RESULTS: According to findings, some health care adherence variables demonstrated
relationships with the summed childhood trauma score, whereas others did not. It
could be interpreted that the more subjective health care compliance variables
(eg, self-rated conscientiousness with regard to medical treatment) demonstrated
no relationship with a summed childhood trauma score, whereas the more objective
health care compliance variables (eg, frequency of regular dental checkups,
ability to remember to take all medications, Medical Outcomes Study general
adherence score) did demonstrate statistically significant relationships with a
summed childhood trauma score (most at P < .01).
CONCLUSIONS: Patients with histories of childhood trauma demonstrate some
deficits with health care compliance in comparison to those without childhood
trauma. One interpretation is that the mistreated appear to believe that they are
fairly compliant with health care treatment, but objective variables appear to
suggest otherwise.
DOI: 10.4088/PCC.14m01692
PMCID: PMC4374826
PMID: 25834767
1784. HIV Med. 2015 Aug;16(7):393-402. doi: 10.1111/hiv.12223. Epub 2015 Jan 14.
Factors associated with risk of depression and relevant predictors of screening

for depression in clinical practice: a cross-sectional study among HIV-infected
individuals in Denmark.
Slot M(1), Sodemann M(1), Gabel C(2), Holmskov J(3), Laursen T(2), Rodkjaer L(2).
Author information:
(1)Department of Infectious Diseases, Odense University Hospital, Odense,
Denmark.
(2)Department of Infectious Diseases, Aarhus University Hospital, Aarhus,
Denmark.
(3)Department of Psychiatric Diseases, Odense University Hospital, Odense,
Denmark.
OBJECTIVES: Depression and psychiatric disorders are frequent among HIV-infected

individuals. The aim of this study was to determine the prevalence of depression
and describe the psychiatric history of HIV-infected individuals in an
out-patient clinic in Denmark and to identify factors of clinical importance that
may be used to identify patients at risk of depression.
METHODS: In 2013, 212 HIV-infected patients were included in a questionnaire
study. We used the Beck Depression Inventory II (BDI-II) to assess the prevalence
and severity of depressive symptoms. Patients with a BDI-II score ≥ 20 were
offered a clinical evaluation by a consultant psychiatrist. Logistic regression
was used to determine predictors associated with risk of depression.
RESULTS: Symptoms of depression (BDI-II score ≥ 14) were observed in 75 patients
(35%), and symptoms of moderate to major depression (BDI-II score ≥ 20) in 55
patients (26%). There was also a high prevalence of co-occurring mental illness.
In a multivariate model, self-reported stress, self-reported perception that HIV
infection affects all aspects of life, self-reported poor health, not being
satisfied with one's current life situation, previous alcohol abuse, nonadherence
to antiretroviral therapy and previously having sought help because of
psychological problems were independently associated with risk of depression.
CONCLUSIONS: Symptoms of depression and co-occurring mental illness are
under-diagnosed and under-treated among HIV-infected individuals. We recommend
that screening of depression should be conducted regularly to provide a full
psychiatric profile to decrease the risk of depression and improve adherence and
quality of life in this population.
© 2015 British HIV Association.
DOI: 10.1111/hiv.12223
1785. Nurs Res. 2017 Sep/Oct;66(5):337-349. doi: 10.1097/NNR.0000000000000240.
Facilitated Nurse Medication-Related Event Reporting to Improve Medication

Management Quality and Safety in Intensive Care Units.
Xu J(1), Reale C, Slagle JM, Anders S, Shotwell MS, Dresselhaus T, Weinger MB.
Author information:
(1)Jie Xu, PhD, is Research Instructor, Department of Anesthesiology, School of
Medicine, Vanderbilt University, and The Center for Research and Innovation in
Systems Safety, Vanderbilt University Medical Center, Nashville, Tennessee.
Carrie Reale, RN-BC, MSN, is Informatics Nurse Specialist, Center for Research
and Innovation in Systems Safety, Vanderbilt University Medical Center,
Nashville, Tennessee. Jason M. Slagle, PhD, is Associate Professor of
Anesthesiology; and Shilo Anders, PhD, is Assistant Professor of Anesthesiology,
School of Medicine, Vanderbilt University, and The Center for Research and
Innovation in Systems Safety, Vanderbilt University Medical Center, Nashville,
Tennessee. Matthew S. Shotwell, PhD, is Assistant Professor of Anesthesiology and
Biostatistics School of Medicine, Vanderbilt University, and The Center for
Research and Innovation in Systems Safety, Vanderbilt University Medical Center,
Nashville, Tennessee. Timothy Dresselhaus, MD, MPH, is Chief of Primary Care
Service, VA San Diego Healthcare System, and Clinical Professor, Department of
Medicine, University of California, San Diego. Matthew B. Weinger, MD, is
Professor and Vice Chair of Anesthesiology, Professor of Biomedical Informatics
and Medical Education, Norman Ty Smith Chair in Patient Safety and Medical
Simulation, School of Medicine, Vanderbilt University; Director, The Center for
Research and Innovation in Systems Safety, Vanderbilt University Medical Center;
and Senior Physician Scientist, Geriatric Research Education and Clinical Center,
VA Tennessee Valley Healthcare System, Nashville, Tennessee.
BACKGROUND: Medication safety presents an ongoing challenge for nurses working in

complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's
medication management-especially medication-related events (MREs)-provides an
approach to analyze and improve medication safety and quality.
OBJECTIVES: The goal of this study was to explore the utility of facilitated MRE
reporting in identifying system deficiencies and the relationship between MREs
and nurses' work in the ICUs.
METHODS: We conducted 124 structured 4-hour observations of nurses in three
different ICUs. Each observation included measurement of nurse's moment-to-moment
activity and self-reports of workload and negative mood. The observer then
obtained MRE reports from the nurse using a structured tool. The MREs were
analyzed by three experts.
RESULTS: MREs were reported in 35% of observations. The 60 total MREs included
four medication errors and seven adverse drug events. Of the 49 remaining MREs,
65% were associated with negative patient impact. Task/process deficiencies were
the most common contributory factor for MREs. MRE occurrence was correlated with
increased total task volume. MREs also correlated with increased workload,
especially during night shifts.
DISCUSSION: Most of these MREs would not be captured by traditional event
reporting systems. Facilitated MRE reporting provides a robust information source
about potential breakdowns in medication management safety and opportunities for
system improvement.
DOI: 10.1097/NNR.0000000000000240
PMCID: PMC5679090
1786. Int J Geriatr Psychiatry. 2016 Oct;31(10):1097-104. doi: 10.1002/gps.4550.

Epub
2016 Jul 21.
Mental health treatment preferences and challenges of living with multimorbidity

from the veteran perspective.
DiNapoli EA(1)(2), Cinna C(3)(4), Whiteman KL(5)(6)(7), Fox L(3), Appelt

CJ(3)(4)(8), Kasckow J(9)(10)(11).
Author information:
(1)VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA
Pittsburgh Healthcare System, Pittsburgh, PA, USA. Elizabeth.Dinapoli2@va.gov.
(2)Department of Psychiatry, University of Pittsburgh School of Medicine,
Pittsburgh, PA, USA. Elizabeth.Dinapoli2@va.gov.
(3)VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA
Pittsburgh Healthcare System, Pittsburgh, PA, USA.
(4)Graduate Center for Social and Public Policy, Duquesne University, Pittsburgh,
PA, USA.
(5)Dartmouth Centers for Health and Aging, Lebanon, NH, USA.
(6)CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
(7)Department of Psychiatry, Geisel School of Medicine at Dartmouth, Pittsburgh,
PA, USA.
(8)Department of Sociology, Duquesne University, Pittsburgh, PA, USA.
(9)Western Psychiatric Institute and Clinic, University of Pittsburgh Medical
Center, Pittsburgh, PA, USA.
(10)MIRECC and Behavioral Health, VA Pittsburgh Healthcare System, Pittsburgh,
PA, USA.
(11)VA Pittsburgh Center for Health and Equity Promotion, Pittsburgh, PA, USA.
OBJECTIVE: To explore middle-aged and older veterans' current disease-management

practices, mental health treatment preferences, and challenges of living with
multiple chronic health conditions (i.e., multimorbidity).
METHODS: Semi-structured qualitative interviews and self-report measures were
collected from 28 middle-aged and older (50 years of age or older) veterans with
multimorbidity.
RESULTS: Our sample of veterans with multimorbidity was, on average, mildly
depressed and anxious with elevated stress and disability. Veterans acknowledged
the interaction of physical and emotional symptoms, which caused greater
difficulty with health care management and daily functioning. Veterans had many
concerns regarding their physical and emotional health conditions, such as
continued disease progression and the addition of other emotional and physical
health complications. Veterans also identified specific self-care approaches for
disease management (e.g., medication, healthy lifestyle practices, and
psychological stress management techniques), as well as barriers to engaging in
care (e.g., money, transportation, and stigma). Participants preferred a
combination of medication, psychotherapy, and healthy lifestyle practices for
mental health treatment. The majority of participants (88.5%) agreed that these
mental health treatments would be beneficial to integrate into disease management
for older veterans with multimorbidity. Lastly, veterans provided an array of
recommendations for improving Veteran's Administration services and reducing
mental health stigma.
CONCLUSIONS: These findings provide support for patient-centered approaches and
integrated mental and physical health self-management in the Veteran's
Administration for middle-aged and older veterans with multiple chronic
conditions. Copyright © 2016 John Wiley & Sons, Ltd.
DOI: 10.1002/gps.4550
PMCID: PMC5839102
1787. J Clin Hypertens (Greenwich). 2015 Mar;17(3):172-82. doi: 10.1111/jch.12476.

Epub
2015 Feb 3.
Prevalence of taking actions to control blood pressure among adults with

self-reported hypertension in 18 states and the District of Columbia, 2009.
Ayala C(1), Fang J, Yuan K.
Author information:
Prevention, Atlanta, GA.
The authors used 2009 Behavioral Risk Factor Surveillance System data to assess
the prevalence of taking actions to control hypertension among adults with
self-reported hypertension. Differences by descriptive characteristics (sex, age,
race/ethnicity, access to health care, medication adherence), presence of other
health risk factors (overweight/obesity, smoking, heavy drinking, inadequate
fruit/vegetable intake, and physical inactivity), and comorbidities (diabetes,
high cholesterol, coronary heart disease, and stroke) were compared. The
prevalence of hypertension was 29.6%, and 75.0% of these patients reported taking
antihypertensive medications, 73.1% changed eating habits, 72.8% decreased the
use of salt, 78.8% reduced alcohol consumption, and 69.9% increased their
physical activity. Overall, 87.2% reported taking two or more actions to reduce
blood pressure. Patients taking antihypertensive medications were more likely to
take two or more actions than their counterparts (90.6% vs 79.4%, P<.01). Those
with at least one other health risk factor were 1.85 times as likely to take two
or more actions as their counterparts (95% confidence interval, 1.18-2.92 times).
More than 80% of hypertensive adults reported taking two or more actions to
control blood pressure. The prevalence of taking actions differed significantly
by descriptive characteristics, the presence health risk factors, and
comorbidities.
Published 2015. This article is a U.S. Government work and is in the public
domain in the USA.
DOI: 10.1111/jch.12476
PMCID: PMC6223011
1788. Pediatr Transplant. 2016 Feb;20(1):130-40. doi: 10.1111/petr.12639.
Development and field testing of Teen Pocket PATH(®), a mobile health application
to improve medication adherence in adolescent solid organ recipients.
Shellmer DA(1)(2), Dew MA(3), Mazariegos G(1)(2), DeVito Dabbs A(4).
Author information:
(1)Department of Pediatric Transplant Surgery, School of Medicine University of
(2)Hillman Center for Pediatric Transplantation, The Children's Hospital of
Pittsburgh of UPMC, Pittsburgh, PA, USA.
(3)Departments of Psychiatry, Psychology, Epidemiology and Biostatistics, School
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
(4)Department of Acute and Tertiary Care, School of Nursing, University of
Comment in
Pediatr Transplant. 2016 Feb;20(1):11-2.
Applying principles of user-centered design, we iteratively developed and tested

the prototype of TPP, an mHealth application to promote medication adherence and
enhance communication about medication management between adolescents and primary
caregivers. A purposive sample of seven adolescent solid organ transplant
recipients who were ≥ one yr post-transplant and their primary caregivers
participated. Participants completed up to three face-to-face laboratory
usability sessions, a 6-week field test, and a debriefing session. Primary
caregivers participated in an additional usability telephone session.
Participants completed usability and satisfaction measures. Sample included liver
(n = 4), heart (n = 2), and lung (n = 1) recipients aged 11-18 yr (57% were
female, 86% were Caucasian), and nine primary caregivers aged 42-61 yr (88.9%
were parents, 88% were female, 88% were Caucasian). Ninety percent of the
adolescents endorsed the graphs or logs of missed/late medication dosing as
useful and 100% endorsed the remaining features (e.g., medication list, dose time
reminders/warnings) as useful. All adolescents expressed interest in using TPP
for monitoring medications and satisfaction with the automatic messaging between
adolescent and caregiver versions of the application. Adolescents unanimously
found TPP easy to use. TPP shows promise as an mHealth adherence tool.
DOI: 10.1111/petr.12639
PMCID: PMC5499533

eCollection 2019.
Feasibility and outcomes of a multi-function mobile health approach for the

schizophrenia spectrum: App4Independence (A4i).
Kidd SA(1), Feldcamp L(2), Adler A(3), Kaleis L(3), Wang W(1), Vichnevetski K(2),
McKenzie K(1), Voineskos A(1).
Author information:
(1)University of Toronto, Department of Psychiatry, Toronto, Canada.
(2)Centre for Addiction and Mental Health, Toronto, Canada.
(3)MEMOTEXT, Toronto, Ontario, Canada.
Relative to the large investments in mobile health (mHealth) strategies for

mental illnesses such as anxiety and depression, the development of technology to
facilitate illness self-management for people with schizophrenia spectrum
illnesses is limited. This situation falls out of step with the opportunity
mHealth represents for providing inexpensive and accessible self-care resources
and the routine use of mobile technologies by people with schizophrenia.
Accordingly, the focus of this study was upon the feasibility of a
schizophrenia-focused mobile application: App4Independence (A4i). A4i is a
multi-feature app that uses feed, scheduling, and text-based functions
co-designed with service users to enhance illness self-management. This study was
completed in a large urban Canadian centre and employed pre-post assessments over
a 1-month period that examined medication adherence, personal recovery, and
psychiatric symptomatology. App use metrics were assessed as was qualitative
feedback through semi-structured interview. Findings are reported in line with
the World Health Organization mHealth Evidence and Assessment (mERA) checklist.
Among the 38 individuals with a primary psychosis who participated, there was no
research attrition and classic retention on the app was 52.5%. Significant
improvement was observed in some psychiatric symptom domains with small-medium
effects. Significant change in recovery engagement and medication adherence were
not observed after controlling for multiple comparisons. Those who interacted
with the app more frequently were more depressed and had higher hostility and
interpersonal sensitivity at baseline. Satisfaction with the app was high and
qualitative feedback provided insights regarding feature enhancements. This
research suggested that A4i is feasible in terms of outcome and process
indicators and is a technology that is ready to move on to clinical trial and
validation testing. This study contributes to the small but emergent body of work
investigating digital health approaches in severe mental illness populations.
PMCID: PMC6629069
PMID: 31306439
Conflict of interest statement: The authors have read the journal’s policy and
the authors of this manuscript have the following competing interests: AA and LK
are paid employees of MEMOTEXT. AA is also a principal of MEMOTEXT. SK and AA
have interests in the company App4Independence (A4i), a digital health engagement
platform to support people living with schizophrenia, which will house the
aforementioned app. MEMOTEXT holds 50% equity interest in A4i Inc. SK is a paid
employee of CAMH. CAMH holds a 35% equity interest in A4i Inc. The authors would
like to declare the following patents/patent applications associated with this
research: US 16/109,394, CDN 3,015,178, and AUS 2018220089; filed for “Tool For
Identifying Occurrence of Acute Incident Symptomatic of Mental Condition or
Disorder” filed August 22/23; 2018. This does not alter our adherence to all the
PLOS ONE policies on sharing data and materials. This does not alter our
adherence to PLOS ONE policies on sharing data and materials.
1790. Public Health Rev. 2018 Oct 1;39:29. doi: 10.1186/s40985-018-0105-8.

eCollection
2018.
The Community Health Experience Model-value generation from person-centered

health transaction network.
Lantos Z(1), Simon J(2).

Author information:
(1)Corvinus University of Budapest and Jill Health Guide ApS, Copenhagen,
Denmark.
(2)2Corvinus University of Budapest, Fövam ter 8, Budapest, 1093 Hungary.
Background: Network society is creating new opportunities for value generation in

all areas of our lives: new collaborative methods and tools are increasingly
available for use by closely connected individuals and organizations. The
stakeholders of the health ecosystem are potential winners of this networking
process as a consequence of the increase in knowledge about health value
generation supported by teamwork and collaborative approaches in this field.
Case Presentation: In this paper, we focus on the transactional nature of health
value generation networks. First, we analyze the transactions in the networks. We
then propose a design structure-the Community Health Experience Model-for
effective person-centered health value generation networks. In the second phase
of the work, we describe how the system design of the complete transaction
network was tested in a real-life pilot environment focusing on fall prevention
in individuals with osteoporosis.As a result of the network-based collaborative
service approach, fall risk decreased by 11.8% and the number of falls decreased
by 4.5% within 3 months. Regarding the major health experience outcomes,
self-evaluated condition-specific health literacy improved from 7.85 to 8.26 (an
improvement of 0.41), while self-evaluated condition-specific self-management
capability changed from 7.25 to 8.06 (0.81 improvement).
Conclusions: In conclusion, the proposed Community Health Experience Model is a
novel and promising approach to designing the structure of more effective and
efficient health services and collaborative networks.
Publisher: A hálózatos társadalom életünk minden területén új lehetőségeket kínál

az értékteremtésre az internet által is szorosan összekötött egyének és
szervezetek számára. Az egészség-ökoszisztéma szereplői és érintettjei valószínű
nyertesei ennek a hálózatosodásnak az egyre gyarapodó tudásunknak köszönhetően,
amely az egészségérték csapatmunkában és együttműködéssel történő megteremtéséhez
kötődik.Munkánkban az egészségértéket megteremtő hálózat tranzakcióinak
sajátosságaira összpontosítottunk. Először elemeztük az egészséget megteremtő
hálózatokra jellemző tranzakciókat, majd leírtuk a hatékony egyénközpontú
egészségérték-teremtő hálózatokra javasolt működési struktúrát, a Közösségi
Egészségélmény Modellt. Az elvégzett munka második szakaszában a teljes
tranzakciós hálózati rendszer-designját teszteltük valós életbeli körülmények
között, csontritkulásos egyének esésmegelőzésére összpontosítva.A hálózatos
együttműködéseken alapuló szolgáltatásstruktúra eredményeként az eséskockázat
11,8%-kal csökkent, míg az esések száma 4,5%-kal csökkent három hónap alatt. A
két kiemelten vizsgált egészségélmény mutató, az önértékeléssel mért
egészségműveltség tízfokozatú skálán 7,85-ről 8,26-ra nőtt (0,41 növekedés), míg
az önértékeléssel mért állapotspecifikus önmenedzsment képesség 7,25-ről 8,06-ra
(0,81 növekedés).Az eredmények alapján a Közösségi Egészségélmény Modell ígéretes
új megközelítést nyújt a hatékonyabb és hatásosabb egészségszolgáltatások és
együttműködő hálózatok megtervezéséhez.
DOI: 10.1186/s40985-018-0105-8
PMCID: PMC6166292
PMID: 30288335
Conflict of interest statement: The National Scientific and Ethical Committee of

the Medical Research Council approved the pilot and all participants filled out
and signed the appropriate informed consent form.Written informed consent was
obtained from the patient for publication of this case report and any
accompanying images. A copy of the written consent is available for review by the
Editor-in-Chief of this journal.The authors declare that they have no competing
interests.Springer Nature remains neutral with regard to jurisdictional claims in
eCollection 2017.
Associations of health status with subsequent blood donor behavior-An alternative

perspective on the Healthy Donor Effect from Donor InSight.
van den Hurk K(1), Zalpuri S(1), Prinsze FJ(1), Merz EM(1)(2), de Kort
WLAM(1)(3).
Author information:
(1)Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands.
(2)Department of Sociology, VU University, Amsterdam, The Netherlands.
(3)Department of Public Health, Academic Medical Center, Amsterdam, The
Netherlands.
INTRODUCTION: In donor health research, the 'Healthy Donor Effect' (HDE) often
biases study results and hampers their interpretation. This refers to the fact
that donors are a selected 'healthier' subset of a population due to both donor
selection procedures and self-selection. Donors with long versus short donor
careers, or with high versus low donation intensities are often compared to avoid
this HDE, but underlying health differences might also cause these differences in
behaviour. Our aim was to estimate to what extent a donor´s perceived health
status associates with donation cessation and intensity.
METHODS: All active whole blood donors participating in Donor InSight (2007-2009;
11,107 male; 12,616 female) were included in this prospective cohort study. We
performed Cox survival and Poisson regression analyses to assess whether
self-reported health status, medication use, disease diagnosed by a physician and
recently having consulted a general practitioner (GP) or specialist were
associated with (time to) donation cessation and donation intensity.
RESULTS: At the end of 2013, 44% of the donors in this study had stopped
donating. Donors in self-rated good health had a 15% lower risk to stop donating
compared to donors in perceived poorer health. Medication use, disease diagnoses
and consulting a GP were associated with a 20-40% increased risk to stop donating
and a lower donation intensity, when adjusting for age, number of donations and
new donor status. Both men and women reporting good health made on average 10%
more donations.
CONCLUSION: Donors with a "good" health status were less likely to stop donating
blood and tended to donate blood more often than donors with perceived poorer
health status. This implies that the HDE is an important source of selection bias
in studies on donor health and this includes studies where comparisons within
donors are made. This HDE should be adjusted for appropriately when assessing
health effects of donation and donors' health status may provide estimates of
future donation behavior.
PMCID: PMC5648214
1792. Mult Scler Relat Disord. 2014 Nov;3(6):689-95.
Treatment adherence and transitioning youth in pediatric multiple sclerosis.
Lulu S(1), Julian L, Shapiro E, Hudson K, Waubant E.
Author information:
(1)University of California, San Francisco, CA, UnitedStates
BACKGROUND: Transitioning youth with multiple sclerosis (MS) represent a
vulnerable group to potentially poor outcomes. It is unknown how pediatric MS
patients transition into adult care.
OBJECTIVES: To describe self-management skills that include adherence to
disease-modifying therapies, quality of life measures, illness perception,
transition readiness and healthcare skills assessments in patients with pediatric
MS and associations with clinical and cognitive outcomes.
METHODS: This is a prospective cross-sectional study at the pediatric MS center
and transitional MS clinic at the University of California, San Francisco.
Patients and one of their parents completed validated surveys for self-management
skills. Non-adherence is defined as not taking their medication more than 20% of
the time in the past 1 month. Wilcoxin matched-pairs rank test and McNemar's
tests were used for comparison of patient and parent responses. Univariate and
multivariate regression models were used for analyses adjusting for disease
duration and socio-economic status.
RESULTS: Thirty patients were enrolled with a mean (+/-SD) age of 15.8
years+/-2.8, 53% was female and 47% Hispanic. The rate of non-adherence was 37%.
The most common reason for non-adherence was forgetting to take their medication
reported in 50% of patients. In adjusted regression models, higher EDSS was
associated with a lower score on patient's quality of life (13 points decrease,
95% CI 6–18, p<0.0001), and lower healthcare skills (15 points decrease, 95%
CI5–26, p=0.006). Four points increase in Symbol Digit Modalities Test score was
associated a 0.1 increase in transition readiness score (95% CI0.07–0.2, p=0.001)
and 3.9 points increase in health care skills scores (95% CI 1.7–6, p=0.008).
DOI: 10.1016/j.msard.2014.09.088
PMCID: PMC4361811
1793. J Clin Epidemiol. 2016 Dec;80:34-42. doi: 10.1016/j.jclinepi.2016.08.001.

Epub
2016 Aug 13.
Self-management interventions: Proposal and validation of a new operational

definition.
Jonkman NH(1), Schuurmans MJ(2), Jaarsma T(3), Shortridge-Baggett LM(4), Hoes

AW(5), Trappenburg JC(2).
Author information:
(1)Department of Rehabilitation, Nursing Science and Sports, University Medical
Center Utrecht, HP W01.121, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
Electronic address: n.h.jonkman@vu.nl.
(2)Department of Rehabilitation, Nursing Science and Sports, University Medical
Center Utrecht, HP W01.121, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
(3)Department of Social and Welfare Studies, Linköping University, Linköping,
Sweden.
(4)Lienhard School of Nursing, College of Health Professions, Pace University,
New York, NY, USA.
(5)Julius Center for Health Sciences and Primary Care, University Medical Center
Utrecht, Utrecht, The Netherlands.
OBJECTIVES: Systematic reviews on complex interventions like self-management

interventions often do not explicitly state an operational definition of the
intervention studied, which may impact the review's conclusions. This study aimed
to propose an operational definition of self-management interventions and
determine its discriminative performance compared with other operational
definitions.
STUDY DESIGN AND SETTING: Systematic review of definitions of self-management
interventions and consensus meetings with self-management research experts and
practitioners.
RESULTS: Self-management interventions were defined as interventions that aim to
equip patients with skills to actively participate and take responsibility in the
management of their chronic condition in order to function optimally through at
least knowledge acquisition and a combination of at least two of the following:
stimulation of independent sign/symptom monitoring, medication management,
enhancing problem-solving and decision-making skills for medical treatment
management, and changing their physical activity, dietary, and/or smoking
behavior. This definition substantially reduced the number of selected studies
(255 of 750). In two preliminary expert meetings (n = 6), the proposed definition
was identifiable for self-management research experts and practitioners (80% and
60% agreement, respectively).
CONCLUSION: Future systematic reviews must carefully consider the operational
definition of the intervention studied because the definition influences the
selection of studies on which conclusions and recommendations for clinical
practice are based.
DOI: 10.1016/j.jclinepi.2016.08.001
1794. Adv Ther. 2016 Jan;33(1):82-95. doi: 10.1007/s12325-015-0278-1. Epub 2016 Jan
21.
Validation of the Greek Version of the Diabetes Management Self-Efficacy Scale

(GR-DMSES).
Fappa E(1), Efthymiou V(2), Landis G(2), Rentoumis A(3), Doupis J(4).
Author information:
(1)Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
(2)Center for Adolescent Medicine, First Department of Pediatrics, University of
Athens Medical School, Aghia Sophia Children's Hospital, Athens, Greece.
(3)Health Services Researcher, Vidavo Health Telematics, Thessaloníki, Greece.
(4)Iatriko Paleou Falirou Medical Center Division of Diabetes, Athens, Greece.
John.Doupis@joslin.harvard.edu.
INTRODUCTION: Self-efficacy has been found to have a direct relation with

self-care in diabetes. Several tools have been developed and used for evaluating
self-efficacy of diabetic patients, the most widely used being the Diabetes
Management Self-Efficacy Scale (DMSES). The aim of the present study was to
translate, culturally adapt, and validate the Greek DMSES (GR-DMSES) in order for
it to be used in the ATTICA pilot study of the SmartCare EU-funded project.
METHODS: Using standard procedures, the original version of DMSES was translated
and culturally adapted into Greek. Content validity was assessed by an expert
panel with the calculation of a content validity index of the overall scale. Α
convenient sample was recruited to complete the questionnaire. Psychometric
testing of the produced instrument included internal consistency test (Cronbach's
alpha), construct validity (factor analysis), and stability (intraclass
correlation coefficient).
RESULTS: One hundred and sixteen patients, aged 36-86 years, with type 2 diabetes
(T2D) participated in the study. There were no items excluded from the original
scale after the content validity procedure. The coefficient Cronbach's alpha for
the internal consistency was 0.93 and the intraclass correlation coefficient for
the stability with a 5-week time interval was 0.87 (P < 0.001). Factor analysis
yielded four factors related to diet, medical therapy, medication and feet check,
and physical activity.
CONCLUSION: The findings supported that the GR-DMSES was reliable and valid in
measuring self-efficacy related to diabetes self-management, thus providing a
quick and easy-to-use tool for health professionals dealing with Greek adults
with T2D.
DOI: 10.1007/s12325-015-0278-1
PMCID: PMC4735230
1795. Implement Sci. 2015 May 19;10:70. doi: 10.1186/s13012-015-0260-y.
Implementation of an audit with feedback knowledge translation intervention to

promote medication error reporting in health care: a protocol.
Hutchinson AM(1)(2)(3), Sales AE(4)(5), Brotto V(6), Bucknall TK(7)(8)(9).
Author information:
(1)School of Nursing and Midwifery, Deakin University, Melbourne, VIC, Australia.
alison.hutchinson@deakin.edu.au.
(2)Centre for Quality and Patient Safety Research, Deakin University, Melbourne,
VIC, Australia. alison.hutchinson@deakin.edu.au.
(3)Monash Health, Melbourne, VIC, Australia. alison.hutchinson@deakin.edu.au.
(4)Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann
Arbor, MI, USA. salesann@umich.edu.
(5)School of Nursing, University of Michigan, Ann Arbor, MI, USA.
salesann@umich.edu.
vanessa.brotto@deakin.edu.au.
tracey.bucknall@deakin.edu.au.
(8)Centre for Quality and Patient Safety Research, Deakin University, Melbourne,
VIC, Australia. tracey.bucknall@deakin.edu.au.
(9)Alfred Health, Melbourne, VIC, Australia. tracey.bucknall@deakin.edu.au.
BACKGROUND: Health professionals strive to deliver high-quality care in an

inherently complex and error-prone environment. Underreporting of medical errors
challenges attempts to understand causative factors and impedes efforts to
implement preventive strategies. Audit with feedback is a knowledge translation
strategy that has potential to modify health professionals' medical error
reporting behaviour. However, evidence regarding which aspects of this complex,
multi-dimensional intervention work best is lacking. The aims of the Safe
Medication Audit Reporting Translation (SMART) study are to: 1. Implement and
refine a reporting mechanism to feed audit data on medication errors back to
nurses 2. Test the feedback reporting mechanism to determine its utility and
effect 3. Identify characteristics of organisational context associated with
error reporting in response to feedback
METHODS/DESIGN: A quasi-experimental design, incorporating two pairs of matched
wards at an acute care hospital, is used. Randomisation occurs at the ward level;
one ward from each pair is randomised to receive the intervention. A key
stakeholder reference group informs the design and delivery of the feedback
intervention. Nurses on the intervention wards receive the feedback intervention
(feedback of analysed audit data) on a quarterly basis for 12 months. Data for
the feedback intervention come from medication documentation point-prevalence
audits and weekly reports on routinely collected medication error data. Weekly
reports on these data are obtained for the control wards. A controlled
interrupted time series analysis is used to evaluate the effect of the feedback
intervention. Self-report data are also collected from nurses on all four wards
at baseline and at completion of the intervention to elicit their perceptions of
the work context. Additionally, following each feedback cycle, nurses on the
intervention wards are invited to complete a survey to evaluate the feedback and
to establish their intentions to change their reporting behaviour. To assess
sustainability of the intervention, at 6 months following completion of the
intervention a point-prevalence chart audit is undertaken and a report of
routinely collected medication errors for the previous 6 months is obtained. This
intervention will have wider application for delivery of feedback to promote
behaviour change for other areas of preventable error and adverse events.
DOI: 10.1186/s13012-015-0260-y
PMCID: PMC4443512
1796. BMJ Glob Health. 2019 Mar 19;4(2):e001285. doi: 10.1136/bmjgh-2018-001285.

eCollection 2019.
'Management of a spoiled identity': systematic review of interventions to address

self-stigma among people living with and affected by HIV.
Pantelic M(1)(2), Steinert JI(3), Park J(4), Mellors S(2), Murau F(2).
Author information:
(1)Department of Social Policy and Intervention, Oxford University, Oxford, UK.
(2)Frontline AIDS, Brighton, UK.
(3)Department of Economics, University of Goettingen, Goettingen, Germany.
(4)School of Experimental Medicine, University of British Columbia, Vancouver,
British Columbia, Canada.
Background: Self-stigma, also known as internalised stigma, is a global public

health threat because it keeps people from accessing HIV and other health
services. By hampering HIV testing, treatment and prevention, self-stigma can
compromise the sustainability of health interventions and have serious
epidemiological consequences. This review synthesised existing evidence of
interventions aiming to reduce self-stigma experienced by people living with HIV
and key populations affected by HIV in low-income and middle-income countries.
Methods: Studies were identified through bibliographic databases, grey literature
sites, study registries, back referencing and contacts with researchers, and
synthesised following Cochrane guidelines.
Results: Of 5880 potentially relevant titles, 20 studies were included in the
review. Represented in these studies were 9536 people (65% women) from Ethiopia,
India, Kenya, Lesotho, Malawi, Nepal, South Africa, Swaziland, Tanzania,
Thailand, Uganda and Vietnam. Seventeen of the studies recruited people living
with HIV (of which five focused specifically on pregnant women). The remaining
three studies focused on young men who have sex with men, female sex workers and
men who inject drugs. Studies were clustered into four categories based on the
socioecological level of risk or resilience that they targeted: (1) individual
level only, (2) individual and relational levels, (3) individual and structural
levels and (4) structural level only. Thirteen studies targeting structural risks
(with or without individual components) consistently produced significant
reductions in self-stigma. The remaining seven studies that did not include a
component to address structural risks produced mixed effects.
Conclusion: Structural interventions such as scale-up of antiretroviral
treatment, prevention of medication stockouts, social empowerment and economic
strengthening may help substantially reduce self-stigma among individuals. More
research is urgently needed to understand how to reduce self-stigma among young
people and key populations, as well as how to tackle intersectional self-stigma.
DOI: 10.1136/bmjgh-2018-001285
PMCID: PMC6441299
PMID: 30997170
1797. Psychopharmacology (Berl). 2016 Dec;233(23-24):3829-3848. Epub 2016 Oct 21.
Nicotine self-administration research: the legacy of Steven R. Goldberg and

implications for regulation, health policy, and research.
Henningfield JE(1)(2), Smith TT(3)(4), Kleykamp BA(5), Fant RV(5), Donny EC(6).
Author information:
(1)Pinney Associates, 4800 Montgomery Lane, Suite 400, Bethesda, MD, 20814, USA.
jhenning@pinneyassociates.com.
(2)Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University
School of Medicine, Baltimore, MD, USA. jhenning@pinneyassociates.com.
(3)University of Pittsburgh Cancer Institute, 4120 Sennott Square, 210 S. Bouquet
Street, Pittsburgh, PA, 15260, USA.
(4)Department of Epidemiology, Graduate School of Public Health, University of
Pittsburgh, 4120 Sennott Square, 210 S. Bouquet Street, Pittsburgh, PA, 15260,
USA.
(5)Pinney Associates, 4800 Montgomery Lane, Suite 400, Bethesda, MD, 20814, USA.
(6)Department of Psychology, University of Pittsburgh, 210 S. Bouquet Street,
Pittsburgh, PA, 15260, USA.
BACKGROUND AND RATIONALE: Steven R. Goldberg was a pioneering behavioral

pharmacologist whose intravenous drug self-administration studies advanced the
understanding of conditioned stimuli and schedules of reinforcement as
determinants of pattern and persistence of drug-seeking behavior, and in
particular, the importance of nicotine in tobacco use. His passing in 2014 led to
invitations to contribute articles to psychopharmacology dedicated to his work.
OBJECTIVES: The objectives of this review are to summarize and put into
historical perspective Goldberg's contributions to elucidate the reinforcing
effects of nicotine and to summarize the implications of his research for
medication development, tobacco regulation, and potential tobacco control policy
options. This includes a review of intravenous nicotine self-administration
research from the 1960s to 2016.
RESULTS: Goldberg's application of behavioral pharmacology methods to investigate
nicotine reinforcement and the influence of schedule of reinforcement and
conditioned stimuli on nicotine administration contributed to the conclusions of
the US National Institute on Drug Abuse, and the Surgeon General, that nicotine
met the criteria as a dependence-producing drug and cigarette smoking as a
prototypic drug dependency or "addiction." Equally important, this work has been
systematically extended to other species and applied to address a range of
factors relevant to tobacco use, medication development, regulation, and public
health policy.
CONCLUSIONS: Steven R. Goldberg was a pioneering scientist whose systematic
application of the science of behavioral pharmacology advanced the understanding
of tobacco and nicotine use and contributed to the scientific foundation for
tobacco product regulation and potential public health tobacco control policy
development.
DOI: 10.1007/s00213-016-4441-4
PMCID: PMC5588156

eCollection 2016.
Risk Factors for Non-Adherence to cART in Immigrants with HIV Living in the
Netherlands: Results from the ROtterdam ADherence (ROAD) Project.
Been SK(1), van de Vijver DA(2), Nieuwkerk PT(3), Brito I(1), Stutterheim SE(4),
Bos AE(4), Wolfers ME(5), Pogány K(6), Verbon A(1).
Author information:
(1)Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam,
The Netherlands.
(2)Department of Virology, Erasmus University Medical Centre, Rotterdam, The
Netherlands.
(3)Department of Medical Psychology, Academic Medical Centre, Amsterdam, The
Netherlands.
(4)Faculty of Psychology and Educational Sciences, Open University of the
Netherlands, Heerlen, the Netherlands.
(5)Municipal Public Health Service Rotterdam-Rijnmond, Infectious Disease Control
Division, Rotterdam, The Netherlands.
(6)Department of Internal Medicine, Maasstad Hospital, Rotterdam, The
Netherlands.
In the Netherlands, immigrant people living with HIV (PLWH) have poorer
psychological and treatment outcomes than Dutch PLWH. This cross-sectional field
study examined risk factors for non-adherence to combination Antiretroviral
Therapy (cART) among immigrant PLWH. First and second generation immigrant PLWH
attending outpatient clinics at two HIV-treatment centers in Rotterdam were
selected for this study. Socio-demographic and clinical characteristics for all
eligible participants were collected from an existing database. Trained
interviewers subsequently completed questionnaires together with consenting
participants (n = 352) to gather additional data on socio-demographic
characteristics, psychosocial variables, and self-reported adherence to cART.
Univariable and multivariable logistic regression analyses were conducted among
301 participants who had used cART ≥6 months prior to inclusion. Independent risk
factors for self-reported non-adherence were (I) not having attended formal
education or only primary school (OR = 3.25; 95% CI: 1.28-8.26, versus
University), (II) experiencing low levels of social support (OR = 2.56; 95% CI:
1.37-4.82), and (III) reporting low treatment adherence self-efficacy (OR = 2.99;
95% CI: 1.59-5.64). Additionally, HIV-RNA >50 copies/ml and internalized
HIV-related stigma were marginally associated (P<0.10) with non-adherence (OR =
2.53; 95% CI: 0.91-7.06 and OR = 1.82; 95% CI: 0.97-3.43). The findings that low
educational attainment, lack of social support, and low treatment adherence
self-efficacy are associated with non-adherence point to the need for tailored
supportive interventions. Establishing contact with peer immigrant PLWH who serve
as role models might be a successful intervention for this specific population.
PMCID: PMC5051866
Conflict of interest statement: The institution of AV and SKB has received an

unrestricted scientific grant from the Dutch Aids Fonds to perform the study.
This does not alter our adherence to PLOS ONE policies on sharing data and
materials.
1799. Asthma Res Pract. 2017 Nov 21;3:8. doi: 10.1186/s40733-017-0036-z.
eCollection
2017.
Identifying the hidden burden of allergic rhinitis (AR) in community pharmacy: a

global phenomenon.
Tan R(1), Cvetkovski B(1), Kritikos V(1), Price D(2)(3), Yan K(1)(4), Smith P(5),
Bosnic-Anticevich S(1)(6).
Author information:
(1)Quality Use of Respiratory Medicines Group, Woolcock Institute, University of
Sydney, Sydney, Australia.
(2)Academic Primary Care, University of Aberdeen, Aberdeen, UK.
(3)Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.
(4)Royal Prince Alfred Hospital, Sydney, Australia.
(5)Clinical Medicine, Griffith University, Southport, QLD Australia.
(6)Sydney Local Health District, Sydney, Australia.
Background: Patients with allergic rhinitis often trivialise their condition,

self-manage inappropriately, and would benefit from health care intervention. The
primary point of health care contact for these self-managing allergic rhinitis
patients is the community pharmacy. With the majority of allergic rhinitis
treatments being available for purchase over the counter, without health care
professional contact, we know little about how the patients self-manage. This
study aims to identify the burden of allergic rhinitis in the community pharmacy
and to identify key opportunity for intervention.
Methods: Pharmacy customers, who purchased nasal treatment in a community
pharmacy, were approached with a research-administered questionnaire that
collected data on medical history, symptoms and products purchased for the
treatment of nasal symptoms.
Results: Of the 296 participants, 69.9% self-managed with over-the-counter
medications; with 68% experiencing allergic rhinitis symptoms and only 44.3% of
this subgroup had a doctor's diagnosis. Nasal congestion (73.6%) was most
commonly experienced and oral antihistamines were most commonly purchased
(44.3%), indicating a pattern of suboptimal management. A third of participants
(36.5%) experienced moderate-severe symptoms, persistently, which impacted on
their daily living. Medication selection was mainly based on pharmacy customers'
perceptions of medication effectiveness (47.6%).
Conclusion: A majority of participants that self-selected over-the-counter
medications have symptoms consistent with allergic rhinitis, with almost half not
having received a diagnosis. Medication purchasing patterns suggest that
sub-optimal therapeutic decisions made by participants, even when they are
experiencing significant symptoms. This study uncovers the hidden burden of
allergic rhinitis in the community pharmacy and a missed opportunity to intervene
and refer if necessary. Patients need to be guided through appropriate treatment
as this study showed that many should be referred to a medical practitioner.
DOI: 10.1186/s40733-017-0036-z
PMCID: PMC5696909
PMID: 29201385
1800. J Diabetes Sci Technol. 2016 Aug 22;10(5):1161-8. doi:

10.1177/1932296816641433.
Print 2016 Sep.
Interferences and Limitations in Blood Glucose Self-Testing: An Overview of the

Current Knowledge.
Erbach M(1), Freckmann G(2), Hinzmann R(3), Kulzer B(4), Ziegler R(5), Heinemann
L(6), Schnell O(7).
Author information:
(1)Sciarc Institute, Baierbrunn, Germany.
(2)Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft
mbH, Ulm, Germany.
(3)Roche Diabetes Care GmbH, Mannheim, Germany.
(4)Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad
Mergentheim, Germany.
(5)Diabetes Clinic for Children and Adolescents, Muenster, Germany.
(6)Science & Co GmbH, Düsseldorf, Germany.
(7)Forschergruppe Diabetes e.V., Munich-Neuherberg, Germany
oliver.schnell@lrz.uni-muenchen.de.
In general, patients with diabetes performing self-monitoring of blood glucose

(SMBG) can strongly rely on the accuracy of measurement results. However, various
factors such as application errors, extreme environmental conditions, extreme
hematocrit values, or medication interferences may potentially falsify blood
glucose readings. Incorrect blood glucose readings may lead to treatment errors,
for example, incorrect insulin dosing. Therefore, the diabetes team as well as
the patients should be well informed about limitations in blood glucose testing.
The aim of this publication is to review the current knowledge on limitations and
interferences in blood glucose testing with the perspective of their clinical
relevance.
DOI: 10.1177/1932296816641433
PMCID: PMC5032951
Conflict of interest statement: The author(s) declared the following potential

conflicts of interest with respect to the research, authorship, and/or
publication of this article: RH is an employee of Roche Diabetes Care GmbH,
Mannheim, Germany. GF, BK, RZ, LH, and OS are members of national and
international advisory boards of Roche Diabetes Care GmbH, Mannheim, Germany
1801. NPJ Parkinsons Dis. 2017 Jan 9;3:2. doi: 10.1038/s41531-016-0003-z.

eCollection
2017.
Using a smartphone-based self-management platform to support medication adherence

and clinical consultation in Parkinson's disease.
Lakshminarayana R(1), Wang D(2), Burn D(3), Chaudhuri KR(4), Galtrey C(5), Guzman
NV(6), Hellman B(1), Ben James(1), Pal S(7), Stamford J(8), Steiger M(9), Stott
RW(6), Teo J(4), Barker RA(10), Wang E(11), Bloem BR(12), van der Eijk M(12),
Rochester L(3), Williams A(13).
Author information:
(1)uMotif Ltd, London, UK.
(2)Liverpool School of Tropical Medicine, Liverpool, UK.
(3)Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
(4)King's College Hospital NHS Foundation Trust, London, UK.
(5)St George's Healthcare Trust, London, UK.
(6)John van Geest Centre for Brain Repair, Cambridge, UK.
(7)NHS Forth Valley, Scotland, UK.
(8)Cure Parkinson's Trust, London, UK.
(9)The Walton Centre NHS Foundation Trust, Liverpool, UK.
(10)John van Geest Centre for Brain Repair & Cambridge University Hospitals NHS
Trust, Cambridge, UK.
(11)Queen Mary University of London, London, UK.
(12)Radboud University Medical Center, Nijmegen, The Netherlands.
(13)University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Erratum in
NPJ Parkinsons Dis. 2017 Nov 13;3:32.
The progressive nature of Parkinson's disease, its complex treatment regimens and
the high rates of comorbid conditions make self-management and treatment
adherence a challenge. Clinicians have limited face-to-face consultation time
with Parkinson's disease patients, making it difficult to comprehensively address
non-adherence. Here we share the results from a multi-centre (seven centres)
randomised controlled trial conducted in England and Scotland to assess the
impact of using a smartphone-based Parkinson's tracker app to promote patient
self-management, enhance treatment adherence and quality of clinical
consultation. Eligible Parkinson's disease patients were randomised using a 1:1
ratio according to a computer-generated random sequence, stratified by centre and
using blocks of variable size, to intervention Parkinson's Tracker App or control
(Treatment as Usual). Primary outcome was the self-reported score of adherence to
treatment (Morisky medication adherence scale -8) at 16 weeks. Secondary outcomes
were Quality of Life (Parkinson's disease questionnaire -39), quality of
consultation for Parkinson's disease patients (Patient-centred questionnaire for
Parkinson's disease), impact on non-motor symptoms (Non-motor symptoms
questionnaire), depression and anxiety (Hospital anxiety and depression scale)
and beliefs about medication (Beliefs about Medication Questionnaire) at 16
weeks. Primary and secondary endpoints were analysed using a generalised linear
model with treatment as the fixed effect and baseline measurement as the
covariate. 158 patients completed the study (Parkinson's tracker app = 68 and
TAU = 90). At 16 weeks Parkinson's tracker app significantly improved adherence,
compared to treatment as usual (mean difference: 0.39, 95%CI 0.04-0.74;
p = 0.0304) with no confounding effects of gender, number of comorbidities and
age. Among secondary outcomes, Parkinson's tracker app significantly improved
patients' perception of quality of consultation (0.15, 95% CI 0.03 to 0.27;
p = 0.0110). The change in non-motor symptoms was -0.82 (95% CI -1.75 to 0.10;
p = 0.0822). 72% of participants in the Parkinson's tracker app group continued
to use and engage with the application throughout the 16-week trial period. The
Parkinson's tracker app can be an effective and novel way of enhancing
self-reported medication adherence and quality of clinical consultation by
supporting self-management in Parkinson's disease in patients owning smartphones.
Further work is recommended to determine whether the benefits of the intervention
are maintained beyond the 16 week study period.
DOI: 10.1038/s41531-016-0003-z
PMCID: PMC5460235
PMID: 28649602
1802. J Diabetes Res. 2017;2017:7589184. doi: 10.1155/2017/7589184. Epub 2017 Feb

9.
Medication Adherence Mediates the Association between Type D Personality and High
HbA1c Level in Chinese Patients with Type 2 Diabetes Mellitus: A Six-Month
Follow-Up Study.
Li X(1), Gao M(2), Zhang S(2), Xu H(3), Zhou H(2), Wang X(2), Qu Z(2), Guo J(4),
Zhang W(2), Tian D(2).
Author information:
Beijing Normal University, Beijing 100875, China; Clinics of Cadre, Department of
Outpatient, General Hospital of the People's Liberation Army (301 Hospital),
Beijing 100853, China.
Beijing Normal University, Beijing 100875, China.
(3)Department of Public Health Sciences, University of Rochester School of
Medicine & Dentistry, Rochester, NY 14642, USA.
(4)Department of Sociology, Huazhong University of Science and Technology, Wuhan,
Hubei 430074, China.
Aims. To examine the association between Type D personality and HbA1c level and
to explore the mediating role of medication adherence between them in patients
with type 2 diabetes mellitus (T2DM). Methods. 330 patients went on to complete a
self-report measure of medication adherence and the HbA1c tests. Chi-square test,
T test, Ordinary Least Square Regression (OLS), and Recentered Influence Function
Regression (RIF) were employed. Results. Patients with Type D personality had
significantly higher HbA1c value (P < 0.01). When Type D personality was
operationalized as a categorical variable, SI was associated with HbA1c (P <
0.01). When NA, SI, and their interaction term were entered into regression, all
of them were no longer associated with HbA1c level (P > 0.1). On the other hand,
when Type D personality was operationalized as a continuous variable, only SI
trait was associated with HbA1c level (P < 0.01). When NA, SI, and NA × SI term
together were entered into regression, only SI was not related to HbA1c level.
Furthermore, medication adherence had a significant mediation effect between Type
D personality and HbA1c, accounting for 54.43% of the total effect. Conclusion.
Type D personality was associated with HbA1c in direct and indirect ways, and
medication adherence acted as a mediator role.
DOI: 10.1155/2017/7589184
PMCID: PMC5322451
interests.

eCollection 2016.
Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences

Matter to Different Patients.
Wouters H(1), Van Dijk L(2), Geers HC(3), Winters NA(3), Van Geffen EC(3),
Stiggelbout AM(4), Bouvy ML(3).
Author information:
(1)Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care,
Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural
Sciences, University of Groningen, Groningen, The Netherlands.
(2)NIVEL, Netherlands Institute for Health Services Research, Utrecht, The
Netherlands.
(3)Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute
for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The
Netherlands.
(4)Department of Medical Decision Making, Leiden University Medical Center,
Leiden, The Netherlands.
BACKGROUND: Non-adherence to statins is substantial and is associated with

numerous perceptions and experiences. However, time limits in clinical practice
constrain in depth explorations of these perceptions and experiences.
OBJECTIVES: To propose and examine a strategy aimed at an efficient assessment of
a wide array of perceptions and experiences regarding the efficacy, side effects,
and practical problems of statins. Furthermore, to assess associations between
this wide array of experiences and perceptions and non-adherence and to examine
whether patients' 'perceived self-efficacy' moderated these associations.
METHODS: Patients were recruited through community pharmacies. A wide array of
specific patient perceptions and experiences was efficiently assessed using the
electronic Tailored Medicine Inventory that allows people to skip irrelevant
questions. Adherence was measured through self-report and pharmacy refill data.
RESULTS: Of the two-hundred twenty-nine patients who participated (mean age 63.9,
standard deviation 10.2), 40%-70% doubted the necessity of or lacked knowledge
about the efficacy of statins, 20%-35% of the patients were worried about joint
and muscle side effects or had experienced these, and 23% had encountered
practical problems regarding information about statins, intake of tablets, the
package, or the blister. Experiencing more practical problems was associated with
increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13-2.10, P <
0.01), whereas worrying about side effects was associated with increased
intentional non-adherence (Odds ratio 1.90, 95%CI:1.17-3.08, P < 0.01). Higher
'perceived self-efficacy' did not moderate these associations.
CONCLUSIONS: Insight into patients' specific barriers with regard to appropriate
statin use may reveal personal reasons for being non-adherent. The Tailored
Medicine Inventory is a promising tool to devise individualized intervention
strategies aimed at improving adherence by the clinician-patient alliance.
PMCID: PMC4726652
1804. SAGE Open Med. 2018 Dec 24;6:2050312118821119. doi: 10.1177/2050312118821119.

eCollection 2018.
Patient expectations of hypertension and diabetes medication: Excessive focus on

short-term benefits.
Gibson DS(1), Nathan AG(1), Quinn MT(1), Laiteerapong N(1).
Author information:
(1)Section of General Internal Medicine, Department of Medicine, The University
of Chicago Medicine, Chicago, IL, USA.
Objectives: The objectives of this study are to assess patient perspectives on

their perceived benefits of hypertension and diabetes medications and determine
associations between perceived benefits and demographics, adherence, and disease
control.
Methods: We interviewed 60 adults with type 2 diabetes and hypertension on oral
medications. Participants were asked what benefits they expected from taking
their medications. Transcripts were analyzed using a modified template approach.
Benefits were categorized into short-term, long-term, or misconceptions (e.g.
"medications cure diabetes"). Associations between perceived benefits and
demographics, adherence, hemoglobin A1c, and blood pressure were analyzed.
Results: In general, participants had relatively high self-reported medication
adherence and well-controlled disease. All participants identified benefits of
their hypertension medications; however, only 85% identified benefits of their
diabetes medications. Half described only short-term benefits (e.g. lower blood
sugar) (48%); almost one-third described both short- and long-term benefits (e.g.
prevent complications) (30% and 28%, respectively). In multivariate analysis,
participants with higher comorbidity were more likely to name long-term benefits
of hypertension medications (odds ratio 13.3 (1.8-97.8), p = 0.01).
Discussion: Participants perceived short-term benefits of hypertension and
diabetes medications more often than long-term benefits; participants with higher
comorbidity identified more long-term benefits. Further studies are warranted to
determine whether additional education on long-term benefits may improve
adherence.
DOI: 10.1177/2050312118821119
PMCID: PMC6305947
PMID: 30627434

1805. Prim Health Care Res Dev. 2019 Jan;20:e4. doi: 10.1017/S1463423618000324.
Epub
2018 May 31.
The long and winding road: the journey taken by headache sufferers in search of
help.
Davies PTG(1), Lane RJM(2), Astbury T(1), Fontebasso M(3), Murphy J(3), Matharu
M(4).
Author information:
(1)1Department of Neurology,Northampton General Hospital,Billing
Road,Northampton,UK.
(2)4Department of Neurology,Ashford Hospital,Middlesex,UK.
(3)5York Headache Clinic (York District Hospital),York,UK.
(4)6The London Headache Group,National Hospital for Neurology and
Neurosurgery,Queen Square,London,UK.
AimTo outline the pathways a cohort of first attendees to our headache clinics
had taken over the years in search of explanations and treatment for their
headaches. To establish a greater awareness of the shortcomings and failures in
their medical journey in the hope that better headache management will emerge in
primary care. BACKGROUND: At first attendance in primary care most headache
sufferers will not receive a firm diagnosis. Treatments provided are often
ineffective and so many patients embark on a somewhat random self-made journey
searching for a remedy. If they reach a Headache Clinic the most common diagnoses
are 'chronic migraine' and 'medication overuse headache'. They are either no
better or worse than when their headaches first started despite their efforts.
METHOD: We undertook a prospective questionnaire-based study of over 200 patients
on first attendance at each of our headache clinics, three based in District
General Hospitals and one in a tertiary referral centre. We documented the
patients' headache characteristics, the 'burden' of their headaches, functional
handicap and the financial costs incurred seeking help before referral. We also
documented what our patients understood about their headache disorder and the
treatments previously tried.FindingsMost patients had not been given a formal
diagnosis in primary care and many remained unconvinced of the benign nature of
their headache problem and wanted further investigations. A few had sought help
from headache charities. Many had unrealistic attitudes to their problem and
medication overuse was rife. A few patients had been offered triptans in primary
care. Key deficiencies in the primary care management of these patients included
failure to provide a formal headache diagnosis, inadequate understanding of the
nature and mechanism of headaches and failure to follow a resilient management
strategy. We provide a more effective management pathway in primary care.
DOI: 10.1017/S1463423618000324
PMCID: PMC6476391
1806. Sci Rep. 2016 Aug 18;6:31598. doi: 10.1038/srep31598.
Validation of the Medication Adherence Rating Scale in homeless patients with

schizophrenia: Results from the French Housing First experience.
Zemmour K(1)(2), Tinland A(1)(2), Boucekine M(1), Girard V(1)(2), Loubière S(1),
Resseguier N(1), Fond G(3), Auquier P(1)(4), Boyer L(1)(4); French Housing First
Study Group.
Collaborators: Apostolidis T, Birmes P, Bossetti T, Bouloudnine R, Combes B,

Debieve J, Falissard B, Greacen T, Laval C, Lancon C, Le Cardinal P, Mantovani J,
Moreau D, Naudin J, Rhunter P, Videau B.
Author information:
(1)Aix-Marseille Univ., EA 3279 Research Unit, 13385 Marseille, France.
(2)Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille,
France.
(3)Université Paris-Est Créteil, Pôle de psychiatrie des hôpitaux universitaires
H Mondor, INSERM U955, Eq Psychiatrie Génétique, Fondation FondaMental Fondation
de coopération scientifique en santé mentale, Pole de Psychiatrie, Hôpital A.
Chenevier, 40 rue de Mesly, Créteil, F-94010, France.
(4)Department of Public Health, University Hospital, Marseille, France.
The Medication Adherence Rating Scale (MARS) is one of the most widely used
measurements of adherence in schizophrenia (SZ), but there is no available data
regarding its psychometric properties in homeless SZ patients (HSZ). The aim of
this study was therefore to assess the psychometric properties of the MARS in a
large multicenter sample of HSZ subjects. This multi-centre prospective study was
conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse.
Three hundred and fifty-three patients were included. The 3-factor structure of
the MARS was confirmed using confirmatory factor analysis: RMSEA = 0.045,
CFI = 0.98, TLI = 0.97 and WRMR = 0.76. The unidimensionality of each factor was
supported by the satisfactory INFIT statistics. Item internal consistencies were
all higher than 0.20 and the Kuder-Richardson were higher than to 0.6, except for
factor 2, which was closed to 0.5. Significant associations with symptoms,
functioning and quality of life showed satisfactory external validity. The
acceptability was satisfactory with missing data lower than 5% for each
dimension. The MARS is a short self-administered instrument with acceptable
psychometric properties in homeless SZ patients that yields interesting
information about medication adherence.
DOI: 10.1038/srep31598
PMCID: PMC4989491
1807. Curationis. 2015 May 29;38(1). doi: 10.4102/curationis.v38i1.1255.

Adherence to antiretroviral treatment by adults in a rural area of Botswana.
Ehlers VJ(1), Tshisuyi ET.
Author information:
(1)Department of Health Studies, University of South Africa. ehlersjh@mweb.co.za.
BACKGROUND: As antiretroviral therapy (ART) is becoming increasingly available to

people in developing countries, ART adherence challenges assume ever greater
significance. Often underlying treatment failure is the fact that suboptimal
adherence to ART is the strongest predictor of failure to achieve viral
suppression below the level of detection.
OBJECTIVES: The study's main objective was to identify factors affecting ART
adherence levels, as well as the impact on immunologic and virologic responses in
adult patients in one rural district in Botswana.
METHODS: A cross-sectional quantitative survey, was used. Structured interviews
were conducted with 300 ART patients between November 2011 and February 2012.
Data were analysed, then presented in charts, graphs and frequency tables.
RESULTS: The prevalence of non-adherence to ART was 14.0%. Motivators of good
adherence included disclosure of HIV-positive status to more than one person,
frequent adherence counselling, self-efficacy for adherence to ART, positive
interactions between patients and healthcare providers; and using adherence
partners. Barriers to adherence were forgetfulness, transportation costs to and
from the clinic, time away from work and side-effects. There was a strong
positive correlation between adherence, CD4 counts and viral load. Adherence was
closely tied to immunologic and virologic improvements. Respondents with poor
adherence were likely to have unsuppressed viral loads (OR 12.98, 95% CI 4.9-34).
CONCLUSION: Adherence to ART is closely tied to virologic, immunologic, and
clinical outcomes. Increases in adherence levels resulted in significant
improvements in these outcomes. Near perfect adherence, however, is required to
maximise the likelihood of long-term clinical success, which could pose
challenges to many ART patients, especially in resource-limited rural settings.
DOI: 10.4102/curationis.v38i1.1255
PMCID: PMC6091787
1808. BMC Complement Altern Med. 2019 Jan 15;19(1):17. doi: 10.1186/s12906-019-
2431-x.
Self-management strategies amongst Australian women with endometriosis: a

national online survey.
Armour M(1), Sinclair J(2), Chalmers KJ(3), Smith CA(2).
Author information:
(1)NICM Health Research Institute, Western Sydney University, Building 5,
Campbelltown Campus, Locked Bag 1797, Penrith, Sydney, NSW, 2751, Australia.
m.armour@westernsydney.edu.au.
(2)NICM Health Research Institute, Western Sydney University, Building 5,
Campbelltown Campus, Locked Bag 1797, Penrith, Sydney, NSW, 2751, Australia.
(3)School of Science and Health, Western Sydney University, Sydney, Australia.
BACKGROUND: Endometriosis has a significant negative impact on the lives of

women, and current medical treatments often do not give sufficient pain relief or
have intolerable side effects for many women. The majority of women with primary
dysmenorrhea use self-management strategies (including self-care techniques or
lifestyle choices) to help manage period related symptoms, but little is known
about self-management in women with endometriosis. The aim of this survey was to
determine the prevalence of use, safety, and self-rated effectiveness of common
forms of self-management.
METHODS: A cross-sectional online survey was distributed via social media using
endometriosis support and advocacy groups in Australia between October and
December 2017. Women were eligible to answer the survey if they were 18-45, lived
in Australia, and had a confirmed diagnosis of endometriosis. Survey questions
covered the types of self-management used, improvements in symptoms or reduction
in medication, and safety.
RESULTS: Four hundred and eighty-four valid responses were received.
Self-management strategies, consisting of self-care or lifestyle choices, were
very common (76%) amongst women with endometriosis. The most common forms used
were heat (70%), rest (68%), and meditation or breathing exercises (47%).
Cannabis, heat, hemp/CBD oil, and dietary changes were the most highly rated in
terms of self-reported effectiveness in pain reduction (with mean effectiveness
of 7.6, 6.52, 6.33, and 6.39, respectively, on a 10-point scale). Physical
interventions such as yoga/Pilates, stretching, and exercise were rated as being
less effective. Adverse events were common, especially with using alcohol (53.8%)
and exercise (34.2%).
CONCLUSIONS: Self-management was very commonly used by women with endometriosis
and form an important part of self-management. Women using cannabis reported the
highest self-rated effectiveness. Women with endometriosis have unique needs
compared to women with primary dysmenorrhea, and therefore any self-management
strategies, especially those that are physical in nature, need to be considered
in light of the potential for 'flare ups'.
DOI: 10.1186/s12906-019-2431-x
PMCID: PMC6332532
1809. Br J Health Psychol. 2019 May;24(2):357-380. doi: 10.1111/bjhp.12357. Epub

2019
Mar 1.
Adherence to medication in adults with Cystic Fibrosis: An investigation using

objective adherence data and the Theoretical Domains Framework.
Arden MA(1), Drabble S(2), O'Cathain A(2), Hutchings M(3), Wildman M(2)(3).
Author information:
(1)Centre for Behavioural Science and Applied Psychology (CeBSAP), Sheffield
Hallam University, UK.
(2)School of Health and Related Research (ScHARR), University of Sheffield, UK.
(3)Sheffield Adult CF Centre, Northern General Hospital, Sheffield, UK.
OBJECTIVES: Adherence to nebulizer treatment in adults with Cystic Fibrosis (CF)

is poor, and interventions are needed. This research aimed to identify the
factors affecting nebulizer adherence using the Theoretical Domains Framework
(TDF) and to compare these for participants with different levels of adherence.
DESIGN: Data-prompted interviews using the TDF.
METHODS: Eighteen semi-structured interviews were conducted with adults with CF
during which objectively measured adherence data were discussed. Framework
analysis was used to code the data into TDF domains, and inductive qualitative
content analysis was used to code different beliefs and experiences. Aspects of
the TDF that differed between participants with different adherence levels were
explored.
RESULTS: Factors influencing adherence to treatment included all 14 domains of
the TDF, 10 of which appeared to vary by adherence level: Skills; Memory and
decision-making; and Behavioural regulation; Environmental context and resources;
Social influences; Beliefs about consequences; Beliefs about capability;
Reinforcement; Social role and identify; Intentions; Optimism; and Emotions.
CONCLUSIONS: This study is the first to use objectively measured adherence data
in a data-prompted interview using the TDF framework to systematically assess the
full range of factors potentially influencing adherence. The results highlighted
that interventions need to consider issues of capability, opportunity, and
motivation. Interventions that challenge dysfunctional beliefs about adherence
and which support the development of routines or habits and problem-solving may
be particularly useful for adults with CF. Statement of contribution What is
already known? Adherence to medication in adults with cystic fibrosis is poor.
Previous research has identified a range of contributing factors in relation to
subjective reports of adherence. There is a wide discrepancy between
self-reported adherence and objectively measured adherence. What this study adds
A data-prompted interview using objectively measured adherence data enabled the
systematic assessment of potential factors that could be targeted in an
intervention to increase adherence. There were some differences in the factors
that were identified by high and low adherers. There is not one-size fits all
intervention for adherence to medication in cystic fibrosis.
© 2019 The Authors. British Journal of Health Psychology published by John Wiley
& Sons Ltd on behalf of British Psychological Society.
DOI: 10.1111/bjhp.12357
PMCID: PMC6519271

10.1016/j.drugalcdep.2016.02.020. Epub 2016 Feb 23.
Effects of fixed or self-titrated dosages of Sativex on cannabis withdrawal and

cravings.
Trigo JM(1), Lagzdins D(1), Rehm J(2), Selby P(3), Gamaleddin I(4), Fischer B(5),
Barnes AJ(6), Huestis MA(6), Le Foll B(7).
Author information:
(1)Translational Addiction Research Laboratory, Campbell Family Mental Health
Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto,
Canada.
(2)Social and Epidemiological Research Department, CAMH, Toronto, Canada;
Addiction Policy, Dalla Lana School of Public Health, University of Toronto,
Toronto, Canada; Institute of Medical Science, University of Toronto, Faculty of
Medicine, Toronto, Canada; Department of Psychiatry, University of Toronto,
Canada; Institute of Clinical Psychology and Psychotherapy & Center of Clinical
Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden,
Dresden, Germany.
(3)Department of Psychiatry, University of Toronto, Canada; Addictions Division,
CAMH, Toronto, Canada; Department of Family and Community Medicine, University of
Toronto, Canada.
Canada; Department of Medical Sciences, Institute of Environmental Studies and
Research, Ain Shams University, Cairo, Egypt; Directorate of Poison Control
Centres, MOH, Riyadh, Saudi Arabia.
(5)Social and Epidemiological Research Department, CAMH, Toronto, Canada;
Department of Psychiatry, University of Toronto, Canada; Centre for Applied
Research in Mental Health & Addiction, Faculty of Health Sciences, Simon Fraser
University, Vancouver, Canada.
(6)Chemistry and Drug Metabolism, National Institute on Drug Abuse (NIDA),
National Institutes of Health (NIH), Baltimore, USA.
Canada; Addictions Division, CAMH, Toronto, Canada. Electronic address:
bernard.lefoll@camh.ca.
BACKGROUND: There is currently no pharmacological treatment approved for cannabis

dependence. In this proof of concept study, we assessed the feasibility/effects
of fixed and self-titrated dosages of Sativex (1:1, Δ(9)-tetrahydrocannabinol
(THC)/cannabidiol (CBD)) on craving and withdrawal from cannabis among nine
community-recruited cannabis-dependent subjects.
METHODS: Participants underwent an 8-week double-blind placebo-controlled trial
(an ABACADAE design), with four smoke as usual conditions (SAU) (A) separated by
four cannabis abstinence conditions (B-E), with administration of either
self-titrated/fixed doses of placebo or Sativex (up to 108 mg THC/100 mg CBD).
The order of medication administration during abstinence conditions was
randomized and counterbalanced. Withdrawal symptoms and craving were assessed
using the Cannabis Withdrawal Scale (CWS), Marijuana Withdrawal Checklist (MWC)
and Marijuana Craving Questionnaire (MCQ). Medication use was assessed during the
study by means of self-reports, vial weight control, toxicology and metabolite
analysis. Cannabis use was assessed by means of self-reports.
RESULTS: High fixed doses of Sativex were well tolerated and significantly
reduced cannabis withdrawal during abstinence, but not craving, as compared to
placebo. Self-titrated doses were lower and showed limited efficacy as compared
to high fixed doses. Participants reported a significantly lower "high" following
Sativex or placebo as compared to SAU conditions. Cannabis/medication use along
the study, as per self-reports, suggests compliance with the study conditions.
CONCLUSIONS: The results found in this proof of concept study warrant further
systematic exploration of Sativex as a treatment option for cannabis withdrawal
and dependence.
DOI: 10.1016/j.drugalcdep.2016.02.020
PMCID: PMC4878903
1811. Asian J Surg. 2019 Jul 25. pii: S1015-9584(19)30417-8. doi:

10.1016/j.asjsur.2019.07.011. [Epub ahead of print]
Improvement of medication adherence with simplified once-daily immunosuppressive

regimen in stable kidney transplant recipients: A prospective cohort study.
Oh CK(1), Bang JB(1), Kim SJ(2), Huh KH(3), Kim SJ(4), Jeon JS(5), Han SY(6), Cho
HR(7), Kwon YJ(8), Lee SH(9), Kim YS(3).
Author information:
(1)Department of Surgery, Ajou University School of Medicine, Suwon, South Korea.
(2)Department of Surgery, Samsung Medical Center, Seoul, South Korea.
(3)Department of Transplantation Surgery, Severance Hospital, Yonsei University
Health System, Seoul, South Korea.
(4)Department of Surgery, CHA University School of Medicine, Seongnam, South
Korea.
(5)Department of Nephrology, Soon Chun Hyang University Hospital, Seoul, South
Korea.
(6)Department of Internal Medicine, Ilsan Paik Hospital, Goyang, South Korea.
(7)Department of Surgery, Ulsan University Hospital, Ulsan, South Korea.
(8)Department of Nephrology and Hypertension, Korea University Guro Hospital,
Seoul, South Korea.
(9)Department of Surgery, Ajou University School of Medicine, Suwon, South Korea.
Electronic address: dltngudgs@aumc.ac.kr.
BACKGROUND: Many immunosuppressive drugs are prescribed as twice-daily dosing. A

simplified once-daily dosing of immunosuppressive drug regimen may improve
medication adherence. We investigated medication adherence of simplified
once-daily immunosuppressive regimen consisting of extended-release tacrolimus,
sirolimus, and corticosteroids along with the efficacy and safety of this
regimen.
METHODS: This study was a prospective, multicenter, controlled and cohort trial.
Stable kidney transplant recipients who had received transplantation at least 3
months before the study enrollment were eligible for the study. Participants were
required to fill-out the self-reported immunosuppressant therapy barrier scale
(ITBS) questionnaire before and after the conversion. Other clinical laboratory
parameters and adverse events were evaluated until 6 months post-conversion.
RESULTS: A total of 160 kidney recipients comprised the intention-to-treat
population. The mean total ITBS score was 19.5 ± 4.0 at pre-conversion and 6
months after converting, the mean total ITBS score was 16.6 ± 3.6 (p < 0.001).
Particularly, the ITBS scores of 4 questions related to the frequency of
medication dosing were significantly different between pre-conversion and
post-conversion. Only 1 patient (0.62%) was diagnosed as biopsy-confirmed acute
rejection in the study period. There was no significant change in the mean
estimated glomerular filtration rate after the conversion. Overall 95 patients
(59.4%) had an adverse event and 28 patients (17.5%) had a serious adverse event.
No graft loss and 1 death were reported.
CONCLUSION: Medication adherence after the conversion to the once-daily
immunosuppressive regimen was significantly improved with no additional risks of
efficacy failure or adverse events.
Copyright © 2019. Published by Elsevier Taiwan LLC.
DOI: 10.1016/j.asjsur.2019.07.011
PMID: 31353239
1812. Sci Rep. 2019 May 22;9(1):7734. doi: 10.1038/s41598-019-44002-y.
Improving medication adherence in adult kidney transplantation (IMAKT): A pilot

Low JK(1)(2), Manias E(3)(4)(5), Crawford K(6), Walker R(7)(8), Mulley WR(9)(10),
Toussaint ND(11)(12), Dooley M(13)(14), Kennedy E(9), Smith CL(15), Nalder M(16),
Yip D(11), Williams A(6).
Author information:
(1)Monash Nursing & Midwifery, Monash University, Clayton, Victoria, Australia.
jackee.low@gmail.com.
(2)School of Nursing and Midwifery, Centre for Quality and Patient Safety
Research, Deakin University, Burwood, Victoria, Australia. jackee.low@gmail.com.
(3)School of Nursing and Midwifery, Centre for Quality and Patient Safety
Research, Deakin University, Burwood, Victoria, Australia.
(4)The Royal Melbourne Hospital, Parkville, Victoria, Australia.
(5)Melbourne School of Health Sciences, The University of Melbourne, Parkville,
(6)Monash Nursing & Midwifery, Monash University, Clayton, Victoria, Australia.
(7)Department of Renal Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
(8)Department of Medicine, Monash University, Melbourne, Victoria, Australia.
(9)Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia.
(10)Centre for Inflammatory Diseases, Department of Medicine, Monash University,
Clayton, Victoria, Australia.
(11)Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria,
Australia.
(12)Department of Medicine, The University of Melbourne, Parkville, Victoria,
Australia.
(13)Alfred Health, Prahran, Victoria, Australia.
(14)Centre for Medicine Use and Safety, Monash University, Parkville, Victoria,
Australia.
(15)School of Public Health and Preventive Medicine, Monash University,
Melbourne, Victoria, Australia.
(16)Pharmacy Department, The Royal Melbourne Hospital, Parkville, Victoria,
Australia.
Resources to support long-term medication adherence in kidney transplantation are

limited. This study aimed to determine the efficacy of an intervention designed
for kidney transplant recipients to enhance medication adherence. A single-blind,
multi-site, 12-month pilot randomised controlled trial was conducted at all five
public hospitals providing adult kidney transplantation in Victoria, Australia.
Participants were recruited at 4 to 6 weeks post-transplantation. Thirty-five
participants were randomly assigned to a 3-month intervention, involving a
face-to-face meeting (a medication review and a consumer-centred video) and
health coaching every two weeks. Thirty-six were randomised to receive usual
care. All participants were followed for nine months post-intervention. There
were no differences in adherence between groups measured by Medication Event
Monitoring System (MEMS), however, it was underutilised by 42% of participants.
Based on the self-reported Basel Assessment of Adherence to Immunosuppressive
Medications Scale (BAASIS©) score, the percentage of adherent participants
decreased significantly between baseline and 3 to 12 months in the control group
(p-values < 0.001) whilst the percentage of adherent participants in the
intervention group remained constant over time. No group differences were
detected in other outcomes. Due to the complex medication regimen, developing and
testing a medication adherence intervention is difficult in kidney
transplantation.
DOI: 10.1038/s41598-019-44002-y
PMCID: PMC6531445
PMID: 31118485
1813. BMC Psychiatry. 2018 Sep 12;18(1):292. doi: 10.1186/s12888-018-1856-y.
Patient preferences concerning the efficacy and side-effect profile of

schizophrenia medications: a survey of patients living with schizophrenia.
Achtyes E(1), Simmons A(2), Skabeev A(2), Levy N(2), Jiang Y(2), Marcy P(3),
Weiden PJ(2).
Author information:
(1)Cherry Health and Michigan State University College of Human Medicine, Grand
Rapids, MI, USA. achtyes@msu.edu.
(2)Alkermes, Inc., Waltham, MA, USA.
(3)Vanguard Research Group, Northwell Health System, Manhasset, NY, USA.
BACKGROUND: Despite the availability of numerous antipsychotic medications, many

patients with schizophrenia continue to experience side effects that contribute
to the overall burden of the illness. The present survey of patients with
schizophrenia and schizoaffective disorder aimed to assess patient attitudes
toward antipsychotic treatment, and understand key factors about willingness to
try a new medication.
METHODS: A cross-sectional survey was administered to 250 patients with a primary
clinical diagnosis of a schizophrenia spectrum disorder across five outpatient
clinics in the United States. The survey included self-reported gender, age,
weight, and height, and questions about the importance of efficacy and side
effects on the decision to take a prescribed antipsychotic medication.
RESULTS: Patients rated efficacy and side effects as important attributes of
antipsychotic treatment, with 93.6% and 83.6% of patients listing these as "very"
or the "most" important factors in taking prescribed medication. A total of 87.6%
of respondents identified the ability to think more clearly as an important
property of their medication. Patients identified weight gain, physical
restlessness, and somnolence as important side effects of current treatments
("very" or "most" important by 61.6%, 60.8%, and 58.8%, respectively). When asked
about willingness to change antipsychotic medication, anticipated weight gain had
a negative influence on willingness to try the new treatment, with 22.0%
declining to try a medication that would lead to weight gain of 2.7-4.5 kg
(6-10 lb), 34.0% declining for anticipated weight gain of 5.0-9.1 kg (11-20 lb),
and 52.4% declining for anticipated weight gain greater than 9 kg (20 lbs).
CONCLUSION: Patients living with schizophrenia spectrum disorders are influenced
by many factors when considering whether to take their medication, including
efficacy and side effects. It is important for clinicians to assess specific
patient concerns to develop a comprehensive treatment plan that maximizes
adherence to the prescribed therapy.
DOI: 10.1186/s12888-018-1856-y
PMCID: PMC6142379
1814. J Med Internet Res. 2016 Jul 22;18(7):e202. doi: 10.2196/jmir.5813.
Health Care Applicability of a Patient-Centric Web Portal for Patients'

Medication Experience.
Hong SH(1), Lee W, AlRuthia Y.
Author information:
(1)College of Pharmacy, Seoul National University, Seoul, Republic Of Korea.
songhhong@snu.ac.kr.
BACKGROUND: With the advent of the patient-centered care paradigm, it is

important to examine what patients' reports of medication experience (PROME) mean
to patient care. PROME available through a Web portal provide information on
medication treatment options and outcomes from the patient's perspective.
Patients who find certain PROME compelling are likely to mention them at their
physician visit, triggering a discussion between the patient and the physician.
However, no studies have examined PROME's potential applicability to patient
care.
OBJECTIVE: This study aimed to examine older (≥50 years) adults' perceptions of
the health care applicability of a hypothetical PROME Web portal. Specifically,
this study investigated whether PROME would facilitate patient-physician
communication, and identified the preferred reporting items and the trusted
sponsors of such a PROME Web portal.
METHODS: We used a cross-sectional, self-administered, 5-point Likert scale
survey to examine participants' perceptions of a hypothetical PROME Web portal
that compared PROME for 5 common antihypertensive medications. Between August and
December 2013, we recruited 300 members of 7 seniors' centers in a metropolitan
area of a southeastern state of the United States to participate in the survey.
RESULTS: An overwhelming majority of study participants (243/300, 81.0%) had a
favorable perception of PROME's health care applicability. They were mostly
positive that PROME would facilitate patient-physician communication, except for
the perception that physicians would be upset by the mention of PROME (n=133,
44.3%). Further, 85.7% (n=257) of participants considered the PROME information
trustworthy, and 72.0% (n=216) were willing to participate by reporting their own
medication experiences. Study participants wanted the PROME Web portal to report
the number of reviews, star ratings, and individual comments concerning different
medication attributes such as side effects (224/809, 27.7%), cost (168/809,
20.8%), and effectiveness (153/809, 18.9%). Finally, the PROME Web portal
sponsorship was important to participants, with the most trusted sponsor being
academic institutions (120/400, 30.0%).
CONCLUSIONS: PROME, if well compiled through Web portals, have the potential to
facilitate patient-physician communication.
DOI: 10.2196/jmir.5813
PMCID: PMC4994927
1815. J Clin Diagn Res. 2016 Feb;10(2):OC22-6. doi: 10.7860/JCDR/2016/16053.7271.

Epub
2016 Feb 1.
Study the Impact of Diabetes Camps on Adherence to Medication and Glycaemic

Control in Uttarakhand.
Pathania M(1), Dutt HK(2), Gogoi JB(3), Rathaur V(4), Singh G(5), Singh P(6).
Author information:
(1)Associate Professor, Department of Medicine, VCSGGMS&RI , Srikot, Srinagar,
Uttarakhand, India .
(2)Assistant Professor, Department of Pharmacology, Kannur Medical College ,
Anjarakandy, Kannur, Kerala, India .
(3)Professor, Department of Biochemistry, VCSGGMS&RI , Srikot, Srinagar,
Uttrakhand, India .
(4)Associate Professor, Department of Pediatrics, Government Doon Medical college
, Dehradun, Uttrakhand, India .
(5)Assistant Professor, Statistics, Department of Community Medicine, Lala Lajpat
Rai Memorial Medical College and S.V.B.P. Hospital , Meerut, India .
(6)Assistant Professor, Department of Ophthalmology, VCSGGMS&RI , Srinagar,
Uttarakhand, India .
INTRODUCTION: Diabetes is a major public health problem which needs to be

addressed with outmost planning in resource poor settings. Good glycaemic control
and medication adherence patterns can play an important role in reducing disease
related complications thereby reducing morbidity and mortality among diabetics.
Disease specific camps can act as a stepping stone in providing limited care to
the patients.
AIM: The study was planned to study the impact of diabetes camp on glycaemic
control and adherence to antidiabetic medication among diabetic patients at a
Government Teaching Hospital, Srinagar, Garhwal, Uttarakhand, India.
MATERIALS AND METHODS: A cross-sectional study using a medication adherence
questionnaire collected from the patients participating in diabetic camps and
measuring their HbA1C levels before and after the camps along with spreading
awareness about the disease. Two diabetes awareness camps were organized, three
month apart and the participants were imparted knowledge about the disease. A
total of 50 patients with type 2 DM who had self reported history of diabetes and
were on some form of oral anti diabetics confirmed by their prescriptions. The
patients were called for monthly follow up in outpatient department. A six
question preformed questionnaire - the Girerd's instrument was used to assess the
level of adherence to the prescribed anti-diabetic drugs in 50 patients with type
2 diabetes mellitus, their HbA1C levels were estimated and the results were
analysed using standard statistical methods.
RESULTS: A total of 50 type 2 diabetic, 48 were studied comprising 23 (47.9%)
women and 25 (52.1%) men with a mean age of 57.43 years. The average duration of
diabetes among participants was 7.02 years. Poor medication adherence score was
recorded in 27 participants and only 7 participants had good adherence to
medication before the camp. After the camp, 19 participants had good adherence
and 7 had poor medication adherence scores. As a result of improved adherence,
improvement in glycaemic control was noticed by a decrease of 0.5 units in the
mean HbA1C value by the end of the study.
CONCLUSION: The results clearly showed that group intervention in the form of
camp combined with monthly follow-ups could improve adherence as well as
glycaemic control at a government teaching hospital in a resource poor setting.
This could also involve and encourage society as well as young trainees to
participate collectively in the care of diabetics.
DOI: 10.7860/JCDR/2016/16053.7271
PMCID: PMC4800563
PMID: 27042497
1816. Can J Psychiatry. 2015 Dec;60(12):556-63.
Nonmedical Use of Prescription Medication Among Adolescents Using Drugs in

Quebec.
Roy É(1), Nolin MA(2), Traoré I(3), Leclerc P(4), Vasiliadis HM(5).
Author information:
(1)Full Professor, Faculty of Medicine, Université de Sherbrooke, Sherbrooke,
Quebec; Researcher, Research Chair on Addiction, Université de Sherbrooke,
Sherbrooke, Quebec.
(2)Graduate Student, Clinical Sciences Program, Université de Sherbrooke,
Sherbrooke, Quebec.
(3)Research Assistant, Direction des statistiques de santé, Institut de la
statistique du Québec, Montreal, Quebec.
(4)Public Health Officer, Direction de santé publique de l'agence de la santé et
des services sociaux de Montréal, Montreal, Quebec.
(5)Associate Professor, Faculty of Medicine, Université de Sherbrooke,
Sherbrooke, Quebec; Researcher, Charles LeMoyne Hospital Research Centre,
Greenfield Park, Quebec.
OBJECTIVE: To determine the prevalence and factors associated with nonmedical use
of prescription medication (NMUPM) among adolescents who use drugs (ages 12 to 17
years) in Quebec.
METHOD: Secondary data analyses were carried out with data from a 6-month study,
namely, the 2010-2011 Quebec Health Survey of High School Students-a large-scale
survey that sought to gain a better understanding of the health and well-being of
young Quebecers in high school. Bivariate and multivariate logistic regression
analyses were conducted to study NMUPM among adolescents who use drugs, according
to sociodemographic characteristics, peer characteristics, health indicators
(anxiety, depression, or attention-deficit disorder [ADD] with or without
hyperactivity), self-competency, family environment, and substance use (alcohol
and drug use) factors.
RESULTS: Among adolescents who had used drugs in the previous 12 months, 5.4%
(95% CI 4.9% to 6.0%) reported NMUPM. Based on multivariate analyses, having an
ADD (adjusted odds ratio [AOR] 1.47; 95% CI 1.13 to 1.91), anxiety disorder (AOR
2.14; 95% CI 1.57 to 2.92), low self-esteem (AOR 1.62; 95% CI 1.26 to 2.08), low
self-control (AOR 1.95; 95% CI 1.55 to 2.45), low parental supervision (AOR 1.43;
95% CI 1.11 to 1.83), regular alcohol use (AOR 1.72; 95% CI 1.36 to 2.16), and
polysubstance use (AOR 4.09; 95% CI 3.06 to 5.48) were associated with increased
odds of reporting NMUPM.
CONCLUSIONS: The observed prevalence of NMUPM was lower than expected. However,
the associations noted with certain mental health disorders and regular or heavy
use of other psychoactive substances are troubling. Clinical implications are
discussed.
DOI: 10.1177/070674371506001206
PMCID: PMC4679164
1817. BMC Health Serv Res. 2017 Dec 27;17(1):845. doi: 10.1186/s12913-017-2794-y.
A systematic review of adherence in Indigenous Australians: an opportunity to

improve chronic condition management.
de Dassel JL(1), Ralph AP(2), Cass A(2).
Author information:
(1)Charles Darwin University, Ellengowan Dr, Casuarina, Darwin, NT, 0810,
Australia. Jess.dedassel@menzies.edu.au.
(2)Menzies School of Health Research, Bld 58, Royal Darwin Hospital Campus,
Rocklands Drive, Tiwi, Darwin, NT, 0811, Australia.
BACKGROUND: Indigenous Australians experience high rates of chronic conditions.

It is often asserted Indigenous Australians have low adherence to medication;
however there has not been a comprehensive examination of the evidence. This
systematic literature review presents data from studies of Indigenous Australians
on adherence rates and identifies supporting factors and impediments from the
perspective of health professionals and patients.
METHODS: Search strategies were used to identify literature in electronic
databases and websites. The following databases were searched: Scopus, Medline,
CINAHL Plus, PsycINFO, Academic Search Premier, Cochrane Library, Trove,
Indigenous Health infonet and Grey Lit.org . Articles in English, reporting
original data on adherence to long-term, self-administered medicines in
Australia's Indigenous populations were included. Data were extracted into a
standard template and a quality assessment was undertaken.
RESULTS: Forty-seven articles met inclusion criteria. Varied study methodologies
prevented the use of meta-analysis.
KEY FINDINGS: health professionals believe adherence is a significant problem for
Indigenous Australians; however, adherence rates are rarely measured. Health
professionals and patients often reported the same barriers and facilitators,
providing a framework for improvement.
CONCLUSIONS: There is no evidence that medication adherence amongst Indigenous
Australians is lower than for the general population. Nevertheless, the heavy
burden of morbidity and mortality faced by Indigenous Australians with chronic
conditions could be alleviated by enhancing medication adherence. Some evidence
supports strategies to improve adherence, including the use of dose
administration aids. This evidence should be used by clinicians when prescribing,
and to implement and evaluate programs using standard measures to quantify
adherence, to drive improvement in health outcomes.
DOI: 10.1186/s12913-017-2794-y
PMCID: PMC5745645
1818. Neurol Med Chir (Tokyo). 2017 Dec 15;57(12):634-640. doi:

10.2176/nmc.oa.2017-0108. Epub 2017 Oct 12.
Postoperative Headache after Undergoing Acoustic Neuroma Surgery via the

Retrosigmoid Approach.
Aihara N(1), Yamada H(1), Takahashi M(2), Inagaki A(2), Murakami S(2), Mase M(1).
Author information:
(1)Department of Neurosurgery, Nagoya City University Medical School.
(2)Department of Otorhinolaryngology, Nagoya City University Medical School.
To estimate the duration of postoperative headache after surgery for acoustic

neuroma and the effects of age, sex, tumor size, extent of tumor resection, type
of skin incision, surgical duration, hearing preservation, and postoperative
facial nerve palsy. This retrospective review analyzed clinical data from 97
patients who had undergone surgery for unilateral acoustic neuroma via the
retrosigmoid approach >1 year previously. We investigated whether patients had
headache at hospital discharge and during attendance at outpatient clinics. We
classified postoperative headache as grade 0 (no headache), 1 (tolerable headache
without medication), or 2 (headache requiring medication). The period of headache
was defined as the interval in days between surgery and achievement of grade 0.
The period of medication for headache was defined as the interval in days between
surgery and achievement of grade 0 or 1. Kaplan-Meier analysis revealed median
durations of medication and headache of 81 and 641 days, respectively. Headache
was cured significantly earlier in patients who underwent surgery using a C-type
skin incision (P < 0.001). Headache persisted significantly longer among patients
who underwent a shorter surgical procedure (P < 0.02). Multivariate analysis
confirmed the type of skin incision as a factor independently associated with
duration of postoperative headache. Postoperative headache was cured in the
majority of patients within about 2 years after surgery. The C-type skin incision
is likely beneficial for reducing the duration of postoperative headache,
although headache persisted in a small number of patients.
DOI: 10.2176/nmc.oa.2017-0108
PMCID: PMC5735226

Associations between patient factors and medication adherence: A Jordanian

experience.
Basheti IA(1), Hait SS(2), Qunaibi EA(3), Aburuz S(4), Bulatova N(5).
Author information:
(1)Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied
Sciences University , Amman ( Jordan ). dr_iman@asu.edu.jo.
(2)Department of Quality Assurance, Sanofi, Jeddah, ( Saudi Arabia ).
ssaqfelhait@hotmail.com.
(3)Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences
University . Amman ( Jordan ). eyadqunaibi@yahoo.com.
(4)Department of Biopharmaceutics & Clinical Pharmacy, University of Jordan .
Amman ( Jordan ). aburuz@gmail.com.
(5)Department of Biopharmaceutics & Clinical Pharmacy, University of Jordan .
Amman ( Jordan ). nboulatova@hotmail.com.
OBJECTIVE: To explore the effect of patient characteristics and health beliefs on

their medication adherence.
METHODS: Patients (n=167) with chronic conditions (mean age 58.9; SD=13.54, 53%
males) were recruited from March 2009- to March 2010 using a cross sectional
study design. Data collected included patients' demographics, medical conditions,
medications therapeutic regimen, frequency of physician visits and health
beliefs. Patient self-reported adherence to medications was assessed by the
researcher using a validated and published scale. Treatment related problems
(TRPs) were evaluated for each patient by competent clinical pharmacists.
Associations between patient characteristics/health beliefs with adherence were
explored.
RESULTS: About half of the patients (46.1%) were non-adherent. A significant
association was found between lower adherence and higher number of disease states
(p<0.001), higher number of medications (p=0.001), and higher number of
identified TRPs (p = 0.003). Patient adherence was positively affected by older
age, higher educational level, and higher number of physician visits per month,
while it was negatively affected by reporting difficulties with getting
prescription refills on time.
CONCLUSION: This study identified different factors that may negatively affect
adherence, including higher number of medications and disease states, higher
number of identified TRPs and inability to getting prescription refills on time.
Hence, more care needs to be provided to patients with complex therapeutic
regimens in order to enhance adherence.
DOI: 10.18549/PharmPract.2016.01.639
PMCID: PMC4800011
PMID: 27011772
Starting antidepressant use: a qualitative synthesis of UK and Australian data.
Anderson C(1), Kirkpatrick S(2), Ridge D(3), Kokanovic R(4), Tanner C(4).
Author information:
(1)School of Pharmacy, University Park, Nottingham, UK.
(2)Health Experiences Research Group, Nuffield Department of Primary Care Health
Sciences, University of Oxford, Oxford, UK.
(3)Deptartment of Psychology, University of Westminster, London, UK.
(4)School of Social Sciences, Monash University, Melbourne, Victoria, Australia.
OBJECTIVE: To explore people's experiences of starting antidepressant treatment.

DESIGN: Qualitative interpretive approach combining thematic analysis with
constant comparison. Relevant coding reports from the original studies (generated
using NVivo) relating to initial experiences of antidepressants were explored in
further detail, focusing on the ways in which participants discussed their
experiences of taking or being prescribed an antidepressant for the first time.
PARTICIPANTS: 108 men and women aged 22-84 who had taken antidepressants for
depression.
SETTING: Respondents recruited throughout the UK during 2003-2004 and 2008 and
2012-2013 and in Australia during 2010-2011.
RESULTS: People expressed a wide range of feelings about initiating
antidepressant use. People's attitudes towards starting antidepressant use were
shaped by stereotypes and stigmas related to perceived drug dependency and
potentially extreme side effects. Anxieties were expressed about starting use,
and about how long the antidepressant might begin to take effect, how much it
might help or hinder them, and about what to expect in the initial weeks. People
worried about the possibility of experiencing adverse effects and implications
for their senses of self. Where people felt they had not been given sufficient
time during their consultation information or support to take the medicines, the
uncertainty could be particularly unsettling and impact on their ongoing views on
and use of antidepressants as a viable treatment option.
CONCLUSIONS: Our paper is the first to explore in-depth patient existential
concerns about start of antidepressant use using multicountry data. People need
additional support when they make decisions about starting antidepressants.
Health professionals can use our findings to better understand and explore with
patients' their concerns before their patients start antidepressants. These
insights are key to supporting patients, many of whom feel intimidated by the
prospect of taking antidepressants, especially during the uncertain first few
weeks of treatment.
DOI: 10.1136/bmjopen-2015-008636
PMCID: PMC4710845

eCollection 2018.
What utility scores do mental health service users, healthcare professionals and
members of the general public attribute to different health states? A co-produced
mixed methods online survey.
Flood C(1), Barlow S(1), Simpson A(1), Burls A(2), Price A(3), Cartwright M(2),
Brini S(2); Service User and Carer Group Advising on Research (SUGAR) members.
Author information:
(1)Centre for Mental Health Research, School of Health Sciences, University of
London, London and East London NHS Foundation Trust, London, United Kingdom.
(2)Centre for Health Services Research, School of Health Sciences, University of
London, London, United Kingdom.
(3)Department of Continuing Education, University of Oxford, Oxford, United
Kingdom.
BACKGROUND: Utility scores are integral to health economics decision-making.

Typically, utility scores have not been scored or developed with mental health
service users. The aims of this study were to i) collaborate with service users
to develop descriptions of five mental health states (psychosis, depression,
eating disorder, medication side effects and self-harm); ii) explore feasibility
and acceptability of using scenario-based health states in an e-survey; iii)
evaluate which utility measures (standard gamble (SG), time trade off (TTO) and
rating scale (RS)) are preferred; and iv) determine how different participant
groups discriminate between the health scenarios and rank them.
DESIGN AND METHODS: This was a co-produced mixed methods cross-sectional online
survey. Utility scores were generated using the SG, TTO and RS methods;
difficulty of the completing each method, markers of acceptability and
participants' preference were also assessed.
RESULTS: A total of 119 participants (58%) fully completed the survey. For any
given health state, SG consistently generated higher utility scores compared to
RS and for some health states higher also than TTO (i.e. SG produces inflated
utility scores relative to RS and TTO). Results suggest that different utility
measures produce different evaluations of described health states. The TTO was
preferred by all participant groups over the SG. The three participant groups
scored four (of five) health scenarios comparably. Psychosis scored as the worst
health state to live with while medication side-effects were viewed more
positively than other scenarios (depression, eating disorders, self-harm) by all
participant groups. However, there was a difference in how the depression
scenario was scored, with service users giving depression a lower utility score
compared to other groups.
CONCLUSION: Mental health state scenarios used to generate utility scores can be
co-produced and are well received by a broad range of participants. Utility
valuations using SG, TTO and RS were feasible for use with service users, carers,
healthcare professionals and members of the general public. Future studies of
utility scores in psychiatry should aim to include mental health service users as
both co-investigators and respondents.
PMCID: PMC6198969

interests exist.
Benefits of Diabetes Self-Management for Health Plan Members: A 6-Month

Translation Study.
Lorig K(1), Ritter PL, Turner RM, English K, Laurent DD, Greenberg J.
Author information:
(1)Stanford School of Medicine, Stanford University, Palo Alto, CA, United
States.
BACKGROUND: Diabetes self-management education has been shown to be effective in

controlled trials. However, few programs that meet American Association of
Diabetes Educators standards have been translated into widespread practice.
OBJECTIVE: This study examined the translation of the evidence-based Better
Choices, Better Health-Diabetes program in both Internet and face-to-face
versions.
METHODS: We administered the Internet program nationally in the United States
(n=1010). We conducted face-to-face workshops in Atlanta, Georgia; Indianapolis,
Indiana; and St. Louis, Missouri (n=232). Self-report questionnaires collected
health indicator, health behavior, and health care utilization measures.
Questionnaires were administered on the Web or by mail. We determined hemoglobin
A1c (HbA1c) from blood samples collected via mailed kits. Paired t tests
determined whether changes between baseline and 6 months differed significantly
from no change. Subgroup analyses determined whether participants with specific
conditions benefited (high HbA1c, depression, hypoglycemia, nonadherence to
medication taking, and no aerobic exercise). We calculated the percentage of
participants with improvements of at least 0.4 effect size in at least one of the
5 above measures.
RESULTS: Of the 1242 participants, 884 provided 6-month follow-up questionnaires.
There were statistically significant improvements in 6 of 7 health indicators
(including HbA1c) and in 7 of 7 behaviors. For each of the 5 conditions, there
were significant improvements among those with the condition (effect sizes
0.59-1.1). A total of 662 (75.0%) of study participants improved at least 0.4
effect size in at least one criterion, and 327 (37.1%) improved in 2 or more.
CONCLUSIONS: The Diabetes Self-Management Program, offered in two modes, was
successfully disseminated to a heterogeneous national population of members of
either insured or administered health plans. Participants had small but
significant benefits in multiple measures. The program appears effective in
improving diabetes management.
DOI: 10.2196/jmir.5568
PMCID: PMC4950850
1823. Respir Med. 2016 Sep;118:58-64. doi: 10.1016/j.rmed.2016.07.012. Epub 2016

Jul
16.
Asthma control in patients treated with inhaled corticosteroids and long-acting

beta agonists: A population-based analysis in Germany.
Kondla A(1), Glaab T(1), Pedersini R(2), Lommatzsch M(3).
Author information:
(1)Boehringer Ingelheim Pharma GmbH & Co. KG, Medical Affairs Respiratory
Medicine, Ingelheim, Germany.
(2)Kantar Health, Epsom, Surrey, UK; RTI Health Solutions, Barcelona, Spain.
(3)University of Rostock, Department of Respiratory Medicine, Rostock, Germany.
Electronic address: marek.lommatzsch@med.uni-rostock.de.
BACKGROUND: The prevalence and the characteristics of poor asthma control among
adults treated with combinations of inhaled corticosteroids (ICS) and long-acting
beta-agonists (LABA) are not completely understood.
METHODS: Data from adult patients in Germany with self-reported asthma treated
with an ICS-LABA combination in the National Health and Wellness Survey (NHWS)
were analysed. Patients with well-controlled and not well-controlled asthma
according to the Asthma Control Test (ACT) score were compared, with respect to
socio-demographic characteristics, attitudes, adherence and outcomes.
RESULTS: Among the German patients with self-reported asthma (5.2% of the
respondents), 16.2% (382 patients) were treated with an ICS-LABA combination and
did not report concomitant chronic obstructive pulmonary disease, chronic
bronchitis or emphysema. In this subgroup, 55.8% had not well-controlled asthma
(ACT < 20). ICS-LABA treated patients with not well-controlled asthma were more
likely to report emergency visits (16.4% vs. 8.9%), missed more time from work
(absenteeism: 12.9% vs. 4.3%), were more impaired while at work (presenteeism:
29.0% vs. 14.9%) and were more likely to be women (69.0% vs. 57.4%), compared
with well-controlled patients. There were no significant differences in age, body
mass index, smoking, income, education or self-reported adherence between the two
groups, but different attitudes regarding the patient-physician relationship.
CONCLUSIONS: A substantial proportion of patients treated with ICS and LABA had
not well-controlled asthma. These patients did not differ from well-controlled
patients in terms of education or self-reported adherence, but in terms of their
attitudes regarding the patient-physician relationship.
DOI: 10.1016/j.rmed.2016.07.012
eCollection 2016.
Finding Meaning: HIV Self-Management and Wellbeing among People Taking

Antiretroviral Therapy in Uganda.
Russell S(1), Martin F(2), Zalwango F(3), Namukwaya S(3), Nalugya R(3), Muhumuza
R(3), Katongole J(3), Seeley J(3)(4).
Author information:
(1)School of International Development, University of East Anglia, Norwich
Research Park, Norwich, United Kingdom.
(2)External Research Associate, School of International Development, University
of East Anglia, Norwich, United Kingdom.
(3)Medical Research Council / Uganda Virus Research Institute, Uganda Research
Unit on AIDS, Entebbe, Uganda.
(4)London School of Hygiene and Tropical Medicine, London, United Kingdom.
The health of people living with HIV (PLWH) and the sustained success of
antiretroviral therapy (ART) programmes depends on PLWH's motivation and ability
to self-manage the condition over the long term, including adherence to drugs on
a daily basis. PLWH's self-management of HIV and their wellbeing are likely to be
interrelated. Successful self-management sustains wellbeing, and wellbeing is
likely to motivate continued self-management. Detailed research is lacking on
PLWH's self-management processes on ART in resource-limited settings. This paper
presents findings from a study of PLWH's self-management and wellbeing in Wakiso
District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected
at ART facilities run by the government and by The AIDS Support Organisation in
and around Entebbe. Two in-depth interviews were completed with each participant
over three or four visits. Many were struggling economically, however the
recovery of health and hope on ART had enhanced wellbeing and motivated
self-management. The majority were managing their condition well across three
broad domains of self-management. First, they had mobilised resources, notably
through good relationships with health workers. Advice and counselling had helped
them to reconceptualise their condition and situation more positively and see
hope for the future, motivating their work to self-manage. Many had also
developed a new network of support through contacts they had developed at the ART
clinic. Second, they had acquired knowledge and skills to manage their health, a
useful framework to manage their condition and to live their life. Third,
participants were psychologically adjusting to their condition and their new
'self': they saw HIV as a normal disease, were coping with stigma and had
regained self-esteem, and were finding meaning in life. Our study demonstrates
the centrality of social relationships and other non-medical aspects of wellbeing
for self-management which ART programmes might explore further and encourage.
PMCID: PMC4726730
1825. Neuropsychiatr Dis Treat. 2016 Aug 25;12:2131-42. doi: 10.2147/NDT.S113712.

eCollection 2016.
The use of the Psychiatric Electroencephalography Evaluation Registry (PEER) to

personalize pharmacotherapy.
Iosifescu DV(1), Neborsky RJ(2), Valuck RJ(3).

Author information:
(1)Adult Psychopharmacology Program, Psychiatry and Neuroscience, Icahn School of
Medicine at Mount Sinai, New York, NY, USA.
(2)School of Medicine, University of California, San Diego, CA, USA; University
of California, Los Angeles, CA, USA; Medical Corps, US Navy, USA.
(3)Pharmacy, Epidemiology, and Family Medicine, University of Colorado, Denver,
CO, USA; Center for Pharmaceutical Outcomes Research, University of Colorado,
Denver, CO, USA; Colorado Consortium for Prescription Drug Abuse Prevention,
Denver, CO, USA.
Comment in
Neuropsychiatr Dis Treat. 2017 Oct 04;13:2527-2530.
PURPOSE: This study aims to determine whether Psychiatric Electroencephalography

Evaluation Registry (PEER) Interactive (an objective, adjunctive tool based on a
comparison of a quantitative electroencephalogram to an existing registry of
patient outcomes) is more effective than the current standard of care in
treatment of subjects suffering from depression.
PATIENTS AND METHODS: This is an interim report of an ongoing, 2-year
prospective, randomized, double blind, controlled study to evaluate PEER
Interactive in guiding medication selection in subjects with a primary diagnosis
of depression vs standard treatment. Subjects in treatment at two military
hospitals were blinded as to study group assignment and their self-report symptom
ratings were also blinded. Quick Inventory of Depressive Symptomatology,
Self-Report (QIDS-SR16) depression scores were the primary efficacy endpoint. One
hundred and fifty subjects received a quantitative electroencephalography exam
and were randomized to either treatment as usual or PEER-informed
pharmacotherapy. Subjects in the control group were treated according to Veterans
Administration/Department of Defense Guidelines, the current standard of care. In
the experimental group, the attending physician received a PEER report ranking
the subject's likely clinical response to on-label medications.
RESULTS: In this post hoc interim analysis subjects were separated into Report
Followed and Report Not Followed groups - based on the concordance between their
subsequent treatment and PEER medication guidance. We thus evaluated the
predictive validity of PEER recommendations. We found significantly greater
improvements in depression scores (QIDS-SR16 P<0.03), reduction in suicidal
ideation (Concise Health Risk Tracking Scale-SR7 P<0.002), and post-traumatic
stress disorder (PTSD) score improvement (PTSD Checklist Military/Civilian
P<0.04) for subjects treated with PEER-recommended medications compared to those
who did not follow PEER recommendations.
CONCLUSION: This interim analysis suggests that an objective tool such as PEER
Interactive can help improve medication selection. Consistent with results of
earlier studies, it supports the hypothesis that PEER-guided treatment offers
distinct advantages over the current standard of care.
DOI: 10.2147/NDT.S113712
PMCID: PMC5003598
PMID: 27601908
1826. Arch Osteoporos. 2016;11:19. doi: 10.1007/s11657-016-0272-5. Epub 2016 Apr

29.
Patient-reported barriers to osteoporosis therapy.
Lindsay BR(1), Olufade T(2), Bauer J(3), Babrowicz J(3), Hahn R(3).
Author information:
(1)Center for Observational and Real-World Evidence, Merck & Co. Inc.,
Kenilworth, NJ, USA. Brianna_lindsay@merck.com.
(2)Center for Observational and Real-World Evidence, Merck & Co. Inc.,
Kenilworth, NJ, USA.
(3)Nielsen, New York, NY, USA.
We investigated reasons for non-treatment of osteoporosis and discontinuation of

osteoporosis therapy. Barriers to treatment include patients' preference for
alternative treatments and a fear of possible side effects. Side effects are a
common reason for treatment discontinuation, and they may be associated with a
lack of willingness to restart treatment.PURPOSE/INTRODUCTION: Osteoporosis
patients commonly cite treatment-related side effects, or the fear thereof, as a
reason for discontinuing or not initiating anti-osteoporosis medications. The
purpose of this study was to investigate, from the patient's perspective, reasons
for (i) non-treatment of osteoporosis and (ii) discontinuation of osteoporosis
therapy.
METHODS: This was an internet-based survey of postmenopausal women in the USA who
self-reported having been diagnosed with osteoporosis. Respondents were recruited
from consumer research panels and received nominal compensation.
RESULTS: Within the surveyed population (N = 1407), 581 patients were currently
being treated, 503 had never been treated, and 323 had previously been treated.
Among patients never treated for osteoporosis, the highest ranking reasons for
non-treatment were the use of alternative treatments such as over-the-counter
vitamins/supplements (57.5 % of respondents) and fear of side effects (43.9 %).
Among previously treated patients, frequent reasons for discontinuation included
the direction of the physician (41.2 % of respondents), concerns about long-term
safety (30.3 %), and the experience of side effects (29.8 %). When asked about
their willingness to restart their osteoporosis medication, previously treated
patients who were not willing (N = 104) to restart had a higher frequency of
experiencing side effects (44.2 versus 20.5 % of those willing; P < 0.001).
CONCLUSIONS: From the osteoporosis patient's perspective, barriers to
prescription treatment include a preference for alternative, non-prescription
treatments and a fear of possible side effects. Side effects are one of the most
common reasons for discontinuing osteoporosis medications, and they appear to be
associated with a lack of willingness to restart treatment.
DOI: 10.1007/s11657-016-0272-5
PMCID: PMC4851700
Conflict of interest statement: BRL is an employee of Merck & Co., Inc. TO was an
employee of Merck & Co., Inc. at the time of the study. J. Bauer, J. Babrowicz,
and RH are employees of Nielsen, which received funding from Merck & Co., Inc.
for the participation in the study. The study was funded by Merck & Co., Inc.
1827. Hypertension. 2019 Jun;73(6):1231-1239. doi:

10.1161/HYPERTENSIONAHA.118.12415.
Cost-Effectiveness of Telemonitoring and Self-Monitoring of Blood Pressure for

Antihypertensive Titration in Primary Care (TASMINH4).
Monahan M(1), Jowett S(1), Nickless A(2), Franssen M(2), Grant S(3), Greenfield
S(1), Hobbs FDR(2), Hodgkinson J(1), Mant J(4), McManus RJ(2).
Author information:
(1)From the Institute of Applied Health Research, University of Birmingham,
United Kingdom (M.M., S.J., S. Greenfield, J.H.).
United Kingdom (A.N., M.F., F.D.R.H., R.J.M.).
(3)Translational Health Sciences, University of Bristol, United Kingdom (S.
Grant).
(4)Department of Public Health and Primary Care, University of Cambridge, United
Kingdom (J.M.).
The use of self-monitoring of blood pressure, with or without telemonitoring, to

guide therapy decisions by physicians for patients with hypertension has been
recently demonstrated to reduce blood pressure compared with using clinic
monitoring (usual care). However, both the cost-effectiveness of these strategies
compared with usual care, and whether the additional benefit of telemonitoring
compared with self-monitoring alone could be considered value for money, are
unknown. This study assessed the cost-effectiveness of physician titration of
antihypertensive medication using self-monitored blood pressure, with or without
telemonitoring, to make hypertension treatment decisions in primary care compared
with usual care. A Markov patient-level simulation model was developed taking a
UK Health Service/Personal Social Services perspective. The model adopted a
lifetime time horizon with 6-month time cycles. At a willingness to pay of
£20 000 per quality-adjusted life year, self-monitoring plus telemonitoring was
the most cost-effective strategy (£17 424 per quality-adjusted life year gained)
compared with usual care or self-monitoring alone (posting the results to the
physician). However, deterministic sensitivity analysis showed that
self-monitoring alone became the most cost-effective option when changing key
assumptions around long-term effectiveness and time horizon. Overall,
probabilistic sensitivity analysis suggested that self-monitoring regardless of
transmission modality was likely to be cost-effective compared with usual care
(89% probability of cost-effectiveness at £20 000/quality-adjusted life year),
with high uncertainty as to whether telemonitoring or self-monitoring alone was
the most cost-effective option. Self-monitoring in clinical practice is
cost-effective and likely to lead to reduced cardiovascular mortality and
morbidity.
DOI: 10.1161/HYPERTENSIONAHA.118.12415
PMCID: PMC6510405
PMID: 31067190
1828. Osteoporos Int. 2019 Jun;30(6):1297-1305. doi: 10.1007/s00198-019-04872-4.

Epub
2019 Feb 25.
Extensive undertreatment of osteoporosis in older Swedish women.
Lorentzon M(1)(2), Nilsson AG(1), Johansson H(3), Kanis JA(3)(4), Mellström

D(1)(2), Sundh D(5)(6).
Author information:
(1)Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition,
Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
(2)Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
(3)Mary McKillop Health Institute, Australian Catholic University, Melbourne,
Australia.
(4)Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
(5)Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition,
Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
daniel.sundh@gu.se.
(6)Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
daniel.sundh@gu.se.
In a population-based study of older Swedish women, we investigated the
proportion of women treated with osteoporosis medication in relation to the
proportion of women eligible for treatment according to national guidelines. We
found that only a minority (22%) of those eligible for treatment were prescribed
osteoporosis medication.INTRODUCTION: Fracture rates increase markedly in old age
and the incidence of hip fracture in Swedish women is among the highest in the
world. Although effective pharmacological treatment is available, treatment rates
remain low. Limited data are available regarding treatment rates in relation to
fracture risk in a population-based setting in older women. Therefore, we aimed
to investigate the proportion of older women eligible for treatment according to
Swedish Osteoporosis Society (SvOS) guidelines.
METHODS: A population-based study was performed in Gothenburg in 3028 older women
(77.8 ± 1.6 years [mean ± SD]). Bone mineral density of the spine and hip was
measured with dual-energy X-ray absorptiometry. Clinical risk factors for
fracture and data regarding osteoporosis medication was collected with
self-administered questionnaires. Logistic regression was used to evaluate
whether the 10-year probability of sustaining a major osteoporotic fracture
(FRAX-score) or its components predicted treatment with osteoporosis medication.
RESULTS: For the 2983 women with complete data, 1107 (37%) women were eligible
for treatment using SvOS criteria. The proportion of these women receiving
treatment was 21.8%. For women eligible for treatment according to SvOS
guidelines, strong predictors for receiving osteoporosis medication were
glucocorticoid treatment (odds ratio (95% CI) 2.88 (1.80-4.59)) and prior
fracture (2.58 (1.84-3.61)).
CONCLUSION: This study demonstrates that a substantial proportion of older
Swedish women should be considered for osteoporosis medication given their high
fracture risk, but that only a minority receives treatment.
DOI: 10.1007/s00198-019-04872-4
PMCID: PMC6546648
PMID: 30805678
1829. J Prim Care Community Health. 2017 Oct;8(4):324-331. doi:

10.1177/2150131917701797. Epub 2017 Apr 5.
Improving Chronic Disease Outcomes Through Medication Therapy Management in

Federally Qualified Health Centers.
Rodis JL(1), Sevin A(1)(2), Awad MH(3), Porter B(1), Glasgow K(4), Hornbeck Fox
C(5), Pryor B(5).
Author information:
(1)1 The Ohio State University, Columbus, OH, USA.
(2)2 PrimaryOne Health, Columbus, OH, USA.
(3)3 AxessPointe Community Health Center/NEOMED, Akron, OH, USA.
(4)4 Health Partners of Western Ohio, Lima, OH, USA.
(5)5 Ohio Department of Health, Columbus, OH, USA.
INTRODUCTION: Appropriate management of chronic diseases, including proper use of

medications, can lead to better disease control, decrease disease-related
complications, and improve overall health. Pharmacists have been shown to
positively affect chronic disease outcomes through medication therapy management
(MTM). The primary objectives of this project are to increase the number of
patients with (1) A1c in control and (2) blood pressure in control; secondary
objectives are to (3) describe number and type of medication-related problems
identified and resolved by pharmacists providing MTM in Federally Qualified
Health Centers (FQHCs), (4) identify potential (pADEs) and actual adverse drug
events (ADEs), and refer patients to diabetes self-management education classes,
as needed.
METHODS: This multisite, prospective, descriptive pilot study engaged three FQHC
sites with distinct models of established pharmacist MTM services to care for
patients with uncontrolled diabetes and/or hypertension. Data were reported in
aggregate regarding primary and secondary outcomes.
RESULTS: As of December 2015, 706 patients were enrolled in the project. Of the
422 with uncontrolled diabetes, 52.84% (n = 223) had an A1c <9%; 72 patients
(17.06%) achieved an A1c between 8% and 9%, 19.19% (n = 81) of patients achieved
an A1c <8% and ≥7%, and 16.59% (n = 70) of patients achieved an A1c <7%. The
percentage of patients with blood pressure <140/90 mm Hg improved to 65.21%.
CONCLUSION: Pharmacist-provided MTM can improve chronic disease intermediate
outcomes for medically underserved patients in FQHCs.
DOI: 10.1177/2150131917701797
PMCID: PMC5932724
Validity of self-reported diabetes among middle-aged and older Chinese adults:

the China Health and Retirement Longitudinal Study.
Yuan X(1), Liu T(2), Wu L(3), Zou ZY(4), Li C(5).
Author information:
(1)Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research
Center, Baton Rouge, Louisiana, USA.
(2)Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia,
USA.
(3)Center for Clinical and Translational Sciences, Mayo Clinic, Rochester,
Minnesota, USA.
(4)Institute of Child and Adolescent Health, School of Public Health, Peking
University, Beijing, Beijing, China.
(5)Department of Epidemiology, Tulane University School of Public Health and
Tropical Medicine, New Orleans, Louisiana, USA.
BACKGROUND: Self-reported diabetes has been found to be valid to evaluate

people's diabetes status in the population of several countries. However, no such
study has been conducted to assess the validity of self-reported diabetes in the
Chinese population, the largest population with the highest rate of diabetes. The
aim of our study is to evaluate the validity of self-reported diabetes among the
middle-aged and older Chinese population.
METHODS: Data from 11 601 participants, aged ≥45, of the China Health and
Retirement Longitudinal Study (CHARLS) during 2011-2012, were analysed. Prevalent
self-reported diabetes was compared with reference definition defined by fasting
glucose, glycated haemoglobin and medication use. Sensitivity, specificity,
positive predicted value, negative predicted value and κ value were calculated
overall, by 5-year age groups, by education levels and by living areas.
RESULTS: The sensitivity of prevalent self-reported diabetes was 41.5%, and the
specificity was 98.6%. The sensitivity of self-reported diabetes increased with
education levels, and was much higher among urban residents than rural residents
(58.2% vs 35.0%). The specificity was above 98% among all age groups, in
different education levels, and in rural and urban areas. Self-reported diabetes
had substantial agreement with reference definition among participants with above
vocational school education or those living in urban areas (κ=0.658 and 0.646,
respectively).
CONCLUSIONS: Although the sensitivity of self-reported diabetes was poor among
middle-aged and older Chinese adults, the specificity and positive predictive
values were fairly good. Furthermore, self-reported diabetes performed well among
those with more than vocational school educations or those living in urban areas.
DOI: 10.1136/bmjopen-2014-006633
PMCID: PMC4401856
1831. J Cancer. 2019 Jun 2;10(14):3253-3258. doi: 10.7150/jca.30057. eCollection

2019.
Analysis of the perceptions and attitudes to participate in radical and

palliative clinical trials among Chinese lymphoma and head/neck cancer patients.
Kong QH(1)(2), Yang LP(1)(2), Lai YR(2)(3), Qin HY(2)(4), He LZ(2)(5), Liu
YS(1)(2), Li YE(2)(5), Chen XJ(2)(5), Qiu MZ(1)(2), Wang ZX(1)(2), Wang Y(1)(2).
Author information:
(1)Department of Medical Oncology, Sun Yat-Sen University Cancer Center,
Guangzhou 510060, China.
(2)Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in
South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou
510060, China.
(3)Department of Gynecological Oncology, Sun Yat-Sen University Cancer Center,
(4)Department of Nursing, Sun Yat-Sen University Cancer Center, Guangzhou 510060,
China.
(5)Department of Clinical Research, Sun Yat-Sen University Cancer Center,
Objective: The purpose of this prospective study was to investigate the

perceptions and attitudes to participate in radical and palliative clinical
trials among Chinese lymphoma and head/neck cancer patients. Patients and
Methods: A self-developed questionnaire was administered to hospitalized patients
in the Department of Medical Oncology in Sun Yat-Sen University Cancer Center
between 20 September 2014 and 20 September 2015. This study included lymphoma
patients who were enrolled into a radical treatment clinical trial, and head/neck
cancer patients participating in a palliative clinical trial. Results: There were
136 lymphoma patients and 87 head/neck cancer patients who completed and returned
the questionnaire. The questionnaire return rate was 100%. More than 90% of the
patients in both groups showed trust and acceptance for medical care personnel,
and more than 50% of the patients in both groups were in hope of trying new
medication, receiving free medication, and receiving new treatment at an earlier
rate. As compared with those in the radical trials, patients in the palliative
clinical trials were more likely to hope to try new medication (P<0.001) and
receive a new treatment at an earlier date (P=0.025), but less likely to hope to
receive free medication (P=0.047). Conclusions: This study reveals several shared
perceptions and needs of patients in both the radical (lymphoma) and palliative
(head/neck cancer) settings and explores the differences in patients' attitudes
between radical clinical trials and palliative clinical trials. These findings
may provide a basis for improving recruitment of patients for different types of
clinical trials and ensuring that patients have a better understanding of
clinical trials.
DOI: 10.7150/jca.30057
PMCID: PMC6603383
PMID: 31289597
Conflict of interest statement: Competing Interests: The authors have declared

that no competing interest exists.
1832. Medicina (Kaunas). 2019 May 18;55(5). pii: E163. doi:

10.3390/medicina55050163.
Medication Adherence and Its Association with Health Literacy and Performance in
Activities of Daily Livings among Elderly Hypertensive Patients in Islamabad,
Pakistan.
Saqlain M(1), Riaz A(2), Malik MN(3), Khan S(4), Ahmed A(5), Kamran S(6), Ali
H(7).
Author information:
(1)Department of Pharmacy, Quaid-I-Azam University, Islamabad 45320, Pakistan.
msaqlain@bs.qau.edu.pk.
(2)Cardiology Department, Pakistan Institute of Medical Sciences (PIMS),
Islamabad 44080, Pakistan. dr.asadriaz13@gmail.com.
(3)Cardiology Department, Pakistan Institute of Medical Sciences (PIMS),
Islamabad 44080, Pakistan. drnaeempims@gmail.com.
skhan@qau.edu.pk.
aliahmed@bs.qau.edu.pk.
kamran1978pk@yahoo.com.
h.ali@qau.edu.pk.
Background and Objective: Medication non-adherence is a preventable reason for

treatment failure, poor blood pressure control among hypertensive patients and
the geriatric population owing to poor physical activity is more vulnerable
strata. The objective of this study is to investigate medication adherence and
its associated factors among Pakistani geriatric hypertensive patients. Methods:
A cross-sectional survey-based study was conducted at the out-patient department
of the cardiac center from May 2018 to August 2018. A universal sampling
technique was used to approach patients and 262 eligible consented patients were
interviewed to collect information about socio-demographics, health, and
disease-related characteristics using a structured questionnaire. The Morisky
Levine Green test was used for the assessment of medication adherence. The
Barthel index and single item literacy screener (SILS) was used to measure
performance in activities of daily living and health literacy respectively.
Chi-square tests and multivariate binary logistic regression analysis were
performed to find factors by using SPSS version 20. Results: Of the total 262
participants, about 38.9% (n = 102) were scored 4 and considered adherent while
61.1% (n = 160) were considered as non-adherent. In logistic regression analysis,
self-reported moderate (OR = 3.538, p = 0.009) and good subjective health (OR =
4.249, p = 0.008), adequate health literacy (OR = 3.369, p < 0.001) and
independence in performing activities of daily living (OR = 2.968, p = 0.002)
were found to be independent predictors of medication adherence among older
hypertensive patients. Conclusion: Medication adherence among the older
hypertensive population in Pakistan is alarmingly low. This clearly requires
patient-centered interventions to overcome barriers and educating them about the
importance of adherence.
DOI: 10.3390/medicina55050163
PMCID: PMC6572440
PMID: 31109105
Conflict of interest statement: The authors have no relevant affiliations or

financial involvement with any organization or entity with a financial interest
in or financial conflict with the subject matter or materials discussed in the
manuscript. This includes employment, consultancies, honoraria, stock ownership
or options, expert testimony, grants or patents received or pending, or
royalties.

eCollection 2017.
Medication-related issues associated with adherence to long-term tyrosine kinase

inhibitors for controlling chronic myeloid leukemia: a qualitative study.
Tan BK(1)(2), Tan SB(3), Chen LC(4), Chang KM(5), Chua SS(1)(6), Balashanker
S(7), Kamarul Jaman HNB(5), Edmund SC(8), Bee PC(3).
Author information:
(1)Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala
Lumpur, Malaysia.
University, Kuala Lumpur, Malaysia.
(3)Department of Medicine, Faculty of Medicine, University of Malaya, Kuala
Lumpur, Malaysia.
(4)Division of Pharmacy and Optometry, School of Health Sciences, University of
Manchester, Manchester, UK.
(5)Department of Hematology, Ampang Hospital, Ampang, Selangor, Malaysia.
(6)School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's
University, Lakeside Campus, Subang, Selangor, Malaysia.
(7)School of Pharmacy, University of Nottingham Malaysia Campus, Semenyih,
Selangor, Malaysia.
(8)Clinical Research Center, Ampang Hospital, Ampang, Selangor, Malaysia.
PURPOSE: Poor adherence to tyrosine kinase inhibitors (TKIs) could compromise the
control of chronic myeloid leukemia (CML) and contributes to poorer survival.
Little is known about how medication-related issues affect CML patients'
adherence to TKI therapy in Malaysia. This qualitative study aimed to explore
these issues.
PATIENTS AND METHODS: Individual face-to-face, semistructured interviews were
conducted at the hematology outpatient clinics of two medical centers in Malaysia
from August 2015 to January 2016. CML patients aged ≥18 years who were prescribed
a TKI were invited to participate in the study. Interviews were audio-recorded,
transcribed verbatim, and thematically analyzed.
RESULTS: Four themes were identified from 18 interviews: 1) concerns about
adverse reactions to TKIs, 2) personal beliefs regarding the use of TKIs, 3)
mismanagement of TKIs in daily lives, and 4) financial burden in accessing
treatment. Participants skipped their TKIs due to ineffective emesis control
measures and perceived wastage of medication from vomiting. Participants also
modified their TKI therapy due to fear of potential harm from long-term use, and
stopped taking their TKIs based on belief in curative claims of traditional
medicines and misconception about therapeutic effects of TKIs. Difficulty in
integrating the dosing requirements of TKIs into daily lives led to unintentional
skipping of doses, as well as the risk of toxicities from inappropriate dosing
intervals or food interactions. Furthermore, financial constraints also resulted
in delayed initiation of TKIs, missed clinic appointments, and treatment
interruptions.
CONCLUSION: Malaysian CML patients encountered a range of medication-related
issues leading to a complex pattern of nonadherence to TKI therapy. Further
studies should investigate whether regular contact with patients to improve
understanding of treatment rationale, to elicit and address patients' concerns
about adverse reactions, and to empower patients with skills to self-manage their
medications might promote better adherence to TKIs and improve CML patients'
outcome.
DOI: 10.2147/PPA.S132894
PMCID: PMC5476765
PMID: 28652712

1834. Psychiatr Serv. 2016 Mar;67(3):342-5. doi: 10.1176/appi.ps.201500010. Epub

2015
Dec 15.
Adherence to Psychotropic and Nonpsychotropic Medication Among Patients With

Bipolar Disorder and General Medical Conditions.
Levin JB(1), Aebi ME(1), Tatsuoka C(1), Cassidy KA(1), Sajatovic M(1).
Author information:
(1)Dr. Levin and Dr. Sajatovic are with the Department of Psychiatry and Dr.
Tatsuoka is with the Department of Neurology, Case Western Reserve University
School of Medicine, Cleveland, Ohio (e-mail: jennifer.levin@uhhospitals.org ).
Dr. Levin, Dr. Tatsuoka, and Dr. Sajatovic are also with the Neurological and
Behavioral Outcomes Center, University Hospitals Case Medical Center, Cleveland,
where Ms. Aebi and Ms. Cassidy are with the Department of Psychiatry.
OBJECTIVE: This study assessed the relationship between nonadherence to

psychotropic and nonpsychotropic medications for 88 patients nonadherent to
medication treatment for bipolar disorder.
METHODS: This descriptive study was part of a clinical trial promoting medication
adherence. Nonadherence was defined as ≥ 20% of days with missed doses.
RESULTS: A majority of the sample was female and had type I bipolar disorder; 49%
had hypertension, 39% had hyperlipidemia, and 69% smoked; average body mass index
was 34, and 65% were obese. The median proportion of days with missed doses was
53.6% (interquartile ratio [IQR]=38.10%-73.40%) for psychotropic medications and
33.93% (IQR=13.81%-51.91%) for nonpsychotropic medications. There was a
significant difference between nonadherence to psychotropic and nonpsychotropic
medication for the past week (z=-4.11, p<.001) and past month (z=-4.19, p<.001).
More global psychopathology was associated with nonpsychotropic nonadherence.
CONCLUSIONS: Psychotropic adherence was worse than nonpsychotropic adherence, yet
both were poor. Improving adherence to cardiovascular medications is a reasonable
pathway to improve cardiovascular health in this population.
DOI: 10.1176/appi.ps.201500010
1835. BMC Res Notes. 2018 Jan 15;11(1):27. doi: 10.1186/s13104-018-3139-6.
Antihypertensive medication adherence and associated factors among adult

hypertensive patients at Jimma University Specialized Hospital, southwest
Ethiopia.
Asgedom SW(1), Atey TM(2), Desse TA(3).
Author information:
(1)School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle,
Ethiopia. s.weldegebreal@gmail.com.
(2)School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle,
Ethiopia.
(3)Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College
of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Erratum in
BMC Res Notes. 2018 Aug 16;11(1):592.
BACKGROUND: Adherence to antihypertensive medications is a key component to

control blood pressure levels. Poor adherence to these medications leads to the
development of hypertensive complications and increase risk of cardiovascular
events which in turn reduces the ultimate clinical outcome. The purpose of this
study was to assess antihypertensive medication adherence and associated factors
among adult hypertensive patients. A hospital-based cross-sectional study among
adult hypertensive patients was conducted at hypertensive follow-up clinic of
Jimma University Specialized Hospital from March 4, 2015 to April 3, 2015. A
simple random sampling technique was used to select the study participants from
the study population. The study patients were interviewed and their medical
charts were reviewed using a pretested structured questionnaire. Adherence was
assessed using Morisky Medication Adherence Scale-8 (MMAS-8) and MMAS-8 score
less than 6 was considered as non-adherent and MMAS-8 score was ≥ 6 was declared
as adherence. Factors associated with adherence were identified using binary and
multivariate logistic regression analysis. Crude odds ratio, adjusted odds ratio
(AOR) and 95% confidence interval of the odds ratio were calculated using SPSS
version 21. Variables with p-value less than 0.05 were assumed as statistically
significant factors.
RESULTS: Among 280 hypertensive patients, 61.8% of the study participants were
found to be adherent. More than half (53.2%) of the participants were males and
the mean age of the participants was 55.0 ± 12.7 years. Co-morbidity
(AOR = 0.083, 95% CI = 0.033-0.207, p < 0.001), alcohol intake (AOR = 0.011, 95%
CI = 0.002-0.079, p < 0.001), getting medications freely (AOR = 0.020, 95%
CI = 0.003-0.117, p < 0.001), and combination of antihypertensive medications
(AOR = 0.32, 95% CI = 0.144-0.712, p < 0.005) were inversely associated with
antihypertensive medication adherence.
CONCLUSION: The adherence level to the prescribed antihypertensive medications
was found to be sub-optimal according to the MMAS-8, and influenced by co
morbidity, alcohol intake, self-purchasing of the medications and combination of
antihypertensive medications.
DOI: 10.1186/s13104-018-3139-6
PMCID: PMC5769214
1836. Diabetes Technol Ther. 2017 Jan;19(1):9-17. doi: 10.1089/dia.2016.0294.
mHealth Intervention Elements and User Characteristics Determine Utility: A

Mixed-Methods Analysis.
Nelson LA(1)(2), Mulvaney SA(3)(4)(5), Johnson KB(4)(5), Osborn CY(6).

Author information:
(1)1 Department of Medicine, Vanderbilt University Medical Center , Nashville,
Tennessee.
(2)2 Center for Health Behavior and Health Education, Vanderbilt University
Medical Center , Nashville, Tennessee.
(3)3 School of Nursing, Vanderbilt University , Nashville, Tennessee.
(4)4 Department of Biomedical Informatics, Vanderbilt University Medical Center ,
Nashville, Tennessee.
(5)5 Department of Pediatrics, Vanderbilt University Medical Center , Nashville,
Tennessee.
(6)6 One Drop , New York, New York.
BACKGROUND: Mobile health (mHealth) interventions are improving the medication

adherence of adults with type 2 diabetes mellitus (T2DM), but few studies examine
how users experience these interventions. Therefore, we used a mixed-methods
approach to understand how T2DM users experience a text messaging and interactive
voice response (IVR)-delivered medication adherence intervention called MEssaging
for Diabetes (MED).
METHODS: Adults with T2DM used MED as part of a 3-month pilot study. MED sends
daily tailored text messages addressing adherence barriers, daily assessment text
messages asking about adherence, and weekly tailored IVR calls providing
adherence feedback, encouragement, and questions to facilitate problem solving.
Sixty participants completed feedback interviews. We used a mixed-methods
approach to understand their experience, examining associations between
participants' characteristics and their feedback.
RESULTS: Participants who completed feedback interviews were on average
50.0 ± 10.1 years old; 65% female, 62% non-white; 15% had less than a high school
education, 70% had annual incomes less than $20K; and average hemoglobin A1c was
8.0% ± 1.9%. Participants rated each intervention element favorably; common
reasons for MED's helpfulness included receiving novel information about diabetes
medications, emotional support, and reminders to take medication. People who were
younger and more recently diagnosed with T2DM had more favorable experiences
using MED. In general, users valued text messages more than IVR calls.
CONCLUSIONS: Consideration of the user experience is critical for developing
engaging mHealth interventions. User feedback reveals what mHealth elements have
the most value and why, which users to target, and how to optimize an
intervention's utility and appeal.
DOI: 10.1089/dia.2016.0294
PMCID: PMC5248539
Conflict of interest statement: Author Disclosure Statement No competing

financial interests exist.
1837. Clin Cardiol. 2016 Dec;39(12):721-727. doi: 10.1002/clc.22594.
Antianginal medications and long-term outcomes after elective catheterization in

patients with coronary artery disease.
Shen L(1)(2), Vavalle JP(2), Broderick S(3), Shaw LK(3), Douglas PS(3).
Author information:
(1)Shanghai Renji Hospital, School of Medicine, Shanghai Jiaotong University,
Shanghai, China.
(2)School of Medicine, University of North Carolina, Chapel Hill.
(3)The Duke Clinical Research Institute, Duke University Medical Center, Durham,
North Carolina.
BACKGROUND: Antianginal medications are a class I recommendation by the American
College of Cardiology/American Heart Association guidelines for stable ischemic
heart disease. We sought to better understand guidance in drug selection and
real-life outcomes of antianginal medication use.
HYPOTHESIS: In patients with stable ischemic heart disease, antianginal
medications lower mortality.
METHODS: We evaluated 5608 patients with obstructive coronary artery disease
(CAD) on elective cardiac catheterization with follow-up through
self-administered questionnaires. Patients were classified as being prescribed a
particular medication if they received that medication at index catheterization,
or within 3 months postcatheterization. The association between antianginal
medication use and outcomes was evaluated using Cox proportional hazards models.
RESULTS: Compared with the 11% not prescribed any antianginal medication,
patients prescribed antianginal medication were more likely to be older and
female; have a history of hypertension, diabetes mellitus, peripheral vascular
disease, or 3-vessel CAD; have lower adjusted mortality (hazard ratio [HR]: 0.75,
95% confidence interval [CI]: 0.63-0.89); and experience mortality or myocardial
infarction (HR: 0.83, 95% CI: 0.71-0.98). Compared with patients not taking
β-blockers (17%), those taking β-blockers had a lower risk of mortality (HR:
0.76, 95% CI: 0.66-0.88). Patients prescribed calcium channel blockers or
long-acting nitrates had a higher risk of mortality compared with nonusers (HR:
1.16, 95% CI: 1.04-1.29; HR: 1.20, 95% CI: 1.08-1.34; respectively).
CONCLUSIONS: Antianginal medications are not universally prescribed among
obstructive CAD patients; nonuse was associated with higher mortality. For CAD
patients with or without prior myocardial infarction, β-blockers were associated
with improved long-term survival.
DOI: 10.1002/clc.22594
PMCID: PMC6490842
1838. Int J Surg Case Rep. 2016;24:80-2. doi: 10.1016/j.ijscr.2016.05.014. Epub

2016
May 18.
Complex gunshot injury to the heart as a consequence of suicide attempt in a

schizophrenic patient.
Konecny J(1), Klvacek A(2), Simek M(2), Lonsky V(2), Santavy P(2).
Author information:
(1)Department of Cardiac Surgery, University Hospital, Olomouc, Czech Republic.
Electronic address: kkubik@seznam.cz.
(2)Department of Cardiac Surgery, University Hospital, Olomouc, Czech Republic.
INTRODUCTION: Self-inflicted gunshot injury to the heart is uncommon in Western

Europe countries. However it is considered to have a high mortality through
cardiac tamponade or exsanguination and concomitant chest or abdominal cavity
injury.
CASE PRESENTATION: We present a 39-year-old schizophrenic woman who attempted
suicide with the aid of a 6.35mm caliber handgun, after self-discontinuing of
antipsychotic treatment. Lower third of sternum, right heart atrium and ventricle
and inferior caval vein were hit by the bullet which consequently got lodged in
the right paravertebral muscle mass at the lower thoracic vertebral level. As she
was hemodynamically unstable due to hemopericardium and a huge right hemothorax,
she underwent emergent surgery. Heart and inferior vena caval injuries were
repaired on extracorporeal circulation. The postoperative course was uneventful
and she was transferred to a psychiatric facility on the 7th postoperative day.
One year after the surgery she is well, compliant to antipsychotic medications
and on periodic follow-up by psychiatrists.
CONCLUSION: This case represents management of complex self-inflicted gunshot
cardiac injury in a schizophrenic patient who discontinued antipsychotic
medication. Liaison between themedical rescue service and high level trauma
center essentially reduced injury-to-surgery time. Complex heart injury was
successfully repaired on extracorporeal circulation.
DOI: 10.1016/j.ijscr.2016.05.014
PMCID: PMC4885112
PMID: 27232290
1839. SSM Popul Health. 2017 Nov 12;4:37-44. doi: 10.1016/j.ssmph.2017.11.002.

Becoming a 'pharmaceutical person': Medication use trajectories from age 26 to 38

in a representative birth cohort from Dunedin, New Zealand.
Ballantyne PJ(1)(2), Norris P(3), Parachuru VP(4), Thomson WM(4).
Author information:
(1)Department of Sociology, Trent University, 1600 West Bank Drive, Peterborough,
Canada, K9L 0G2.
(2)Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.
(3)School of Pharmacy, University of Otago, Room 505a, Fifth Floor, Dunedin 9054,
New Zealand.
(4)School of Dentistry, University of Otago, PO Box 56, Dunedin, New Zealand.
Despite the abundance of medications available for human consumption, and

frequent concerns about increasing medicalization or pharmaceuticalization of
everyday life, there is little research investigating medicines-use in young and
middle-aged populations and discussing the implications of young people using
increasing numbers of medicines and becoming pharmaceutical users over time. We
use data from a New Zealand longitudinal study to examine changes in
self-reported medication use by a complete birth cohort of young adults. Details
of medications taken during the previous two weeks at age 38 are compared to
similar data collected at ages 32 and 26, and by gender. Major drug categories
are examined. General use profiles and medicine-types are considered in light of
our interest in understanding the formation of the young and middle-aging
'pharmaceutical person' - where one's embodied experience is frequently and
normally mediated by pharmaceutical interventions having documented benefit/risk
outcomes.
DOI: 10.1016/j.ssmph.2017.11.002
PMCID: PMC5769117
PMID: 29349271
1840. Neuropsychiatr Dis Treat. 2016 Apr 18;12:833-41. doi: 10.2147/NDT.S80881.

eCollection 2016.
Novel pharmacologic treatment in acute binge eating disorder - role of

lisdexamfetamine.
Guerdjikova AI(1), Mori N(1), Casuto LS(1), McElroy SL(1).
Author information:
(1)Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry and
Behavioral Neuroscience, University of Cincinnati College of Medicine,
Binge eating disorder (BED) is the most common eating disorder and an important
public health problem. It is characterized by recurrent episodes of excessive
food consumption accompanied by a sense of loss of control over the binge eating
behavior without the inappropriate compensatory weight loss behaviors of bulimia
nervosa. BED affects both sexes and all age groups and is associated with medical
and psychiatric comorbidities. Until recently, self-help and psychotherapy were
the primary treatment options for patients with BED. In early 2015,
lisdexamfetamine dimesylate, a prodrug stimulant marketed for attention deficit
hyperactive disorder, was the first pharmacologic agent to be approved by the US
Food and Drug Administration for the treatment of moderate or severe BED in
adults. This article summarizes BED clinical presentation, and discusses the
pharmacokinetic profile, efficacy, and safety of lisdexamfetamine dimesylate in
the treatment of BED in adults.
DOI: 10.2147/NDT.S80881
PMCID: PMC4841437
PMID: 27143885
1841. Health Lit Res Pract. 2018 Jan 23;2(1):e1-e14. doi: 10.3928/24748307-
20171227-01.
eCollection 2018 Jan.
A Linguistic Analysis of Health Literacy Demands of Chronic Kidney Disease

Patient Education Materials.
Morony S, Webster AC, Buchbinder R, Kirkendall S, McCaffery KJ, Clerehan R.
Background: Instruments to assess the quality and comprehensibility of printed

patient education materials may lack proper consideration of how readers derive
meaning from text. The Evaluative Linguistic Framework (ELF) considers how
factors that influence readers' expectations about health care texts also affect
their ability to understand them. The ELF has demonstrated value in improving the
quality of patient materials about medication, consent, and self-reported
questionnaires, but has not yet been used to evaluate a corpus of patient
education materials about chronic disease self-management.
Objective: This study sought to apply the ELF to examine specific elements of
printed self-management patient education materials for chronic kidney disease
(CKD) not captured by other tools.
Methods: From a previously published systematic review, we identified 14 patient
education materials (eight self-management, six diet and nutrition) for people
with CKD. We used the ELF to identify the different ways the text could be
structured, its intended purpose, the relationship established between reader and
writer, presence of signposting, its complexity and technicality of language, and
factual content.
Key Results: Our analysis identified nine possible structural units, of which
"introducing the problem" and "instructing the reader to self-manage" were common
to all materials. However, there was no consistency or common sequence to these
units of text. The intended readership and aims of the author(s) were not always
clear; many materials made assumptions about what the reader knew, the language
was often complex and dense, and the meta-discourse was sometimes distracting.
Conclusions: Our analysis suggests CKD document developers can benefit from a
theoretically grounded linguistic tool that focuses on the intended audience and
their specific needs. The ELF identified structural units of text, aligned with
rhetorical elements that can be uniformly applied for developing self-management
education materials for CKD, and provided checks for language complexity. Further
work can determine its usefulness for other (e.g., electronic) formats and other
chronic diseases. [HLRP: Health Literacy Research and Practice.
2018;2(1):e1-e14.].
Plain Language Summary: Helping patients make meaning from information about
their condition is a key goal of health care organizations. We analyzed chronic
kidney disease patient education materials on self-management using the
Evaluative Linguistic Framework. The purpose and intended audience were
frequently unclear. We identified nine structural units of text that may assist
information providers to plan and structure content.
DOI: 10.3928/24748307-20171227-01
PMCID: PMC6608909
PMID: 31294272
1842. J Gen Fam Med. 2017 Apr 4;18(2):52-55. doi: 10.1002/jgf2.39. eCollection 2017
Apr.
Travel medicine: Part 1-The basics.
Kamata K(1), Birrer RB(2), Tokuda Y(3).
Author information:
(1)Department of Medicine JCHO Tokyo Joto Hospital Kotoku Tokyo Japan.
(2)Department of Emergency Medicine Cornell University School of Medicine New
York NY USA.
(3)Japan Community Healthcare Association (JCHO) Tokyo Japan.
International travels for tourism and business purposes continue to increase

annually, while the global terrorism and the risk of lethal viral infections are
currently real concerns. It is important that primary care physicians assess
travel risk and adequately prepare the prospective traveler for trips.
Appropriate vaccines should be administered and an emergency self-kit
recommended. Patient should be educated about safe travel habits and a posttravel
follow-up process established. Further, traveling healthcare professionals may be
called upon to assist an ill patient at any time during their journey. In these
2-part special articles, we provide a practical brief summary of up-to-date
travel medicine basics for primary care physicians.
DOI: 10.1002/jgf2.39
PMCID: PMC5689387
PMID: 29263991
1843. Rev Soc Bras Med Trop. 2016 Apr;49(2):248-51. doi: 10.1590/0037-8682-0275-
2015.
Factors associated with non-adherence to the treatment of vivax malaria in a

rural community from the Brazilian Amazon Basin.
Almeida ED(1), Vieira JL(1).
Author information:
(1)Faculdade de Farmácia, Universidade Federal do Pará, Belém, Pará, Brazil.
INTRODUCTION We investigated the association between demographic and behavioral
factors and non-adherence to antimalarial therapy. METHODS A demographic
questionnaire and 5-item self-reported questionnaire regarding non-adherence were
completed by 135 patients after treatment for Plasmodium vivax. RESULTS Treatment
interruption, but not demographic factors, was significantly associated with
non-adherence to therapy. The likelihood of non-adherence was 5.16 times higher
when the patients felt better than when they felt worse. The relative risk of
parasitic resurgence was 3.04 times higher in non-adherent patients. CONCLUSIONS
Treatment interruption is significantly associated with treatment adherence.
DOI: 10.1590/0037-8682-0275-2015
1844. Prim Care Companion CNS Disord. 2015 Jul 30;17(4). doi: 10.4088/PCC.14m01760.
eCollection 2015.
Reducing Adverse Polypharmacy in Patients With Borderline Personality Disorder:

An Empirical Case Study.
Madan A(1), Oldham JM(1), Gonzalez S(1), Fowler JC(1).
Author information:
(1)The Menninger Clinic and Menninger Department of Psychiatry and Behavioral
Sciences, Baylor College of Medicine, Houston, Texas.
OBJECTIVE: Polypharmacy is common and especially challenging in the context of

borderline personality disorder in light of impulsivity and self-harm associated
with the disorder, risk of adverse drug-drug interactions, and financial burden.
Reduction in polypharmacy could be conceptualized as a high priority in the
treatment of borderline personality disorder. This case aims to demonstrate that
potential.
METHOD: This case report presents outcomes data for an individual with borderline
personality disorder during the course of an extended psychiatric
hospitalization. Symptomatic change is based on the Patient Health Questionnaire
Somatic, Anxiety, and Depression Symptoms scales and World Health Organization
5-Item Well-Being Index. Change in polypharmacy is presented both in terms of
absolute number and complexity of the medication regimen. Clinical outcomes data
are provided at 2, 12, and 24 weeks postdischarge.
RESULTS: During a 56-day hospitalization, the patient demonstrated clinical
improvement across clinical domains-all occurred within the context of reduced
number (43%) and complexity (40%) of her medication regimen. Symptomatic
improvement was sustained up to 6 months postdischarge.
CONCLUSIONS: Despite good intentions, polypharmacy can be associated with
iatrogenic harm and contribute to functional impairment, especially in the
context of borderline personality disorder, in which symptomatic fluctuations are
part of the illness itself. A reduction in the patient's high-risk polypharmacy
during treatment represents a noteworthy treatment outcome in and of itself.
Additional measures of medication risk and liability have the potential to become
markers of clinical effectiveness.
DOI: 10.4088/PCC.14m01760
PMCID: PMC4664564
PMID: 26693036
1845. Fam Med. 2015 Jan;47(1):22-30.

Association of reproductive health training on intention to provide services
after residency: the family physician resident survey.
Romero D(1), Maldonado L, Fuentes L, Prine L.
Author information:
(1)CUNY School of Public Health, Hunter College, New York, NY.
BACKGROUND AND OBJECTIVES: High rates of unintended pregnancy and need for
reproductive health services (RHS), including abortion, require continued efforts
to train medical professionals and increase availability of these services. With
US approval 12 years ago of Mifepristone, a medication abortion pill, abortion
services are additionally amenable to primary care. Family physicians are a
logical group to focus on given that they provide the bulk of primary care.
METHODS: We analyzed data from an annual survey (2007--2010) of third-year family
medicine residents (n=284, response rate=48%--64%) in programs offering abortion
training to examine the association between such training and self-reported
competence and intentions to provide RHS (with a particular focus on abortion)
upon graduation from residency.
RESULTS: The majority of residents (75% in most cases) were trained in each of
the RHS we asked about; relatively fewer trained in implant insertion (39%),
electric vacuum aspiration (EVA) (58%), and manual vacuum aspiration (MVA) (69%).
Perceived competence on the part of the graduating residents ranged from high
levels in pregnancy options counseling (89%) and IUD insertion (85%) to lows in
ultrasound and EVA (both 34%). Bivariate analysis revealed significant
associations between number of procedures performed and future intentions to
provide them. The association between competence and intentions persisted for all
procedures in multivariate analysis, adjusting for number of procedures. Further,
the total number of abortions performed during residency increased the odds of
intending to provide MVA and medication abortion by 3% and 2%, respectively.
CONCLUSIONS: Findings support augmenting training in RHS for family medicine
residents, given that almost half (45%) of those trained intended to provide
abortions. The volume of training should be increased so more residents feel
competent, particularly in light of the fact that combined exposure to different
abortion procedures has a cumulative impact on intention to provide MVA and
medication abortion.
1846. Am J Prev Med. 2016 Oct;51(4):597-608. doi: 10.1016/j.amepre.2016.04.005.
A Post-Discharge Smoking-Cessation Intervention for Hospital Patients: Helping

Hand 2 Randomized Clinical Trial.
Rigotti NA(1), Tindle HA(2), Regan S(3), Levy DE(4), Chang Y(5), Carpenter KM(6),
Park ER(7), Kelley JH(8), Streck JM(9), Reid ZZ(8), Ylioja T(10), Reyen M(11),
Singer DE(5).
Author information:
(1)Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston,
Massachusetts; Division of General Internal Medicine, Department of Medicine,
Massachusetts General Hospital, Boston, Massachusetts; Mongan Institute for
Health Policy, Massachusetts General Hospital and Partners HealthCare, Boston,
Massachusetts; Department of Medicine, Harvard Medical School, Boston,
Massachusetts. Electronic address: nrigotti@partners.org.
(2)Department of Medicine, Vanderbilt University School of Medicine, Nashville,
Tennessee.
Massachusetts; Division of General Internal Medicine, Department of Medicine,
Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine,
Harvard Medical School, Boston, Massachusetts.
Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital
and Partners HealthCare, Boston, Massachusetts; Department of Medicine, Harvard
Medical School, Boston, Massachusetts.
(5)Division of General Internal Medicine, Department of Medicine, Massachusetts
General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical
School, Boston, Massachusetts.
(6)Alere Wellbeing, Inc., Seattle, Washington.
and Partners HealthCare, Boston, Massachusetts; Department of Psychiatry, Harvard
Medical School, Boston, Massachusetts.
and Partners HealthCare, Boston, Massachusetts.
(9)Department of Psychological Science, University of Vermont, Burlington,
Vermont.
(10)Department of Medicine, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania.
(11)Tobacco Research and Treatment Center, Massachusetts General Hospital,
Boston, Massachusetts; Division of General Internal Medicine, Department of
Medicine, Massachusetts General Hospital, Boston, Massachusetts.
INTRODUCTION: Hospitalization provides an opportunity for smokers to quit, but

tobacco-cessation interventions started in hospital must continue after discharge
to be effective. This study aimed to improve the scalability of a proven
effective post-discharge intervention by incorporating referral to a telephone
quitline, a nationally available cessation resource.
STUDY DESIGN: A three-site RCT compared Sustained Care, a post-discharge
tobacco-cessation intervention, with Standard Care among hospitalized adult
smokers who wanted to quit smoking and received in-hospital tobacco-cessation
counseling.
SETTING/PARTICIPANTS: A total of 1,357 daily smokers admitted to three hospitals
were enrolled from December 2012 to July 2014.
INTERVENTION: Sustained Care started at discharge and included automated
interactive voice response telephone calls and the patient's choice of cessation
medication for 3 months. Each automated call advised cessation, supported
medication adherence, and triaged smokers seeking additional counseling or
medication support directly to a telephone quitline. Standard Care provided only
medication and counseling recommendations at discharge.
MAIN OUTCOME MEASURES: Biochemically confirmed past 7-day tobacco abstinence 6
months after discharge (primary outcome) and self-reported tobacco abstinence and
tobacco-cessation treatment use at 1, 3, and 6 months and overall (0-6 months).
Analyses were done in 2015-2016.
RESULTS: Smokers offered Sustained Care (n=680), versus those offered Standard
Care (n=677), did not have greater biochemically confirmed abstinence at 6 months
(17% vs 16%, p=0.58). However, the Sustained Care group reported more
tobacco-cessation counseling and medication use at each follow-up and higher
rates of self-reported past 7-day tobacco abstinence at 1 month (43% vs 32%,
p<0.0001) and 3 months (37% vs 30%, p=0.008). At 6 months, the difference
narrowed (31% vs 27%, p=0.09). Overall, the intervention increased self-reported
7-day abstinence over the 6-month follow-up (relative risk, 1.25; 95% CI=1.10,
1.40; p=0.0006).
CONCLUSIONS: A 3-month post-discharge smoking-cessation intervention for
hospitalized smokers who wanted to quit did not increase confirmed tobacco
abstinence at 6 months but did increase self-reported abstinence during the
treatment period (3 months). Real-time linkage of interactive voice response
calls to a quitline, done in this trial to increase scalability of a previously
proven cessation intervention, demonstrated short-term promise but did not
sustain long-term intervention effectiveness.
TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov
NCT01714323.
Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier

DOI: 10.1016/j.amepre.2016.04.005
PMCID: PMC5031242
Assessing Medicare Part D claim completeness using medication self-reports: the

role of veteran status and Generic Drug Discount Programs.
Zhou L(1), Stearns SC, Thudium EM, Alburikan KA, Rodgers JE.
Author information:
(1)*Lineberger Comprehensive Cancer Center †Gillings School of Global Public
Health ‡UNC Eshelman School of Pharmacy, The University of North Carolina at
Chapel Hill, Chapel Hill, NC.
OBJECTIVE: Medicare Part D claims are commonly used for research, but missing
claims could compromise their validity. This study assessed 2 possible causes of
missing claims: veteran status and Generic Drug Discount Programs (GDDP).
MATERIALS AND METHODS: We merged medication self-reports from telephone
interviews in the Atherosclerosis Risk in Communities (ARIC) Study with Part D
claims for 6 medications (3 were commonly in GDDP in 2009). Merged records (4468)
were available for 2905 ARIC participants enrolled in Part D. Multinomial logit
regression provided estimates of the association of concordance (self-report and
Part D, self-report only, or Part D only) with veteran and GDDP status,
controlling for participant sociodemographics.
RESULTS: Sample participants were 74±5 years of age, 68% white and 63% female;
19% were male veterans. Compared with females, male veterans were 11% [95%
confidence interval (CI), 7%-16%] less likely to have matched medications in
self-report and Part D and 11% (95% CI, 7%-16%) more likely to have self-report
only. Records for GDDP versus non-GDDP medications were 4% (95% CI, 1%-7%) more
likely to be in self-report and Part D and 3% (95% CI, 1%-5%) less likely to be
in Part D only, with no difference in self-report only.
CONCLUSIONS: Part D claims were more likely to be missing for veterans, but
claims for medications commonly available through GDDP were more likely to match
with self-reports. Although researchers should be aware of the possibility of
missing claims, GDDP status was associated with a higher rather than lower
likelihood of claims being complete in 2009.
DOI: 10.1097/MLR.0000000000000341
PMCID: PMC4646610
1848. Scientifica (Cairo). 2016;2016:9183272. doi: 10.1155/2016/9183272. Epub 2016

Mar
28.
Review on the Eyedrop Self-Instillation Techniques and Factors Affecting These
Techniques in Glaucoma Patients.
Kayikcioglu O(1), Bilgin S(2), Uyar M(2).
Author information:
(1)Department of Ophthalmology, Hafsa Sultan Hospital, Celal Bayar University,
Faculty of Medicine, Manisa, Turkey.
(2)Department of Ophthalmology, Sifa University Faculty of Medicine, 35410 Izmir,
Turkey.
Objective. This study aims to evaluate eyedrop self-installation techniques and

factors affecting these techniques in glaucoma patients. Methods. Researchers
directly observed eyedrop instillation procedures of 66 glaucoma patients.
Contact with periocular tissues and instillation onto ocular surface or
conjunctival fornices were considered. Correlations of instillation patterns with
patient characteristics including age, gender, intraocular pressure, cup-to-disc
ratio, visual field loss, and total intake of glaucoma medication and handgrip
strength score were searched. Results. The average handgrip strength in the
instillation without periocular contact group was 66.4 ± 19.7 kg, while the
average handgrip strength score was 55.9 ± 20.9 kg in the instillation with
contact group. The difference between the two groups was statistically
significant (p = 0.039). No statistically significant correlation was found
between handgrip strength and the mean number of glaucoma medications, c/d,
intraocular pressure (p > 0.05). Also there was no significant relation between
mean handgrip strength score and the severity of the visual field defect (p =
0.191). Conclusion. Patients especially with severe glaucomatous damage should be
adequately instructed about the proper techniques for self-instillation of
eyedrops and motivated to use a proper technique. Also, it is possible to suggest
that patients with a higher handgrip strength, indicating the well-being of
general health, may be doing better in properly instilling glaucoma eyedrops.
DOI: 10.1155/2016/9183272
PMCID: PMC4826945
PMID: 27119046
1849. Adv Ther. 2019 Jan;36(1):118-130. doi: 10.1007/s12325-018-0828-4. Epub 2018

Dec
7.
Bridging the Gap Between Self-Reported and Claims-Derived Adherence Measures for
Basal Insulin Among Patients with Type 2 Diabetes Mellitus.
Stephenson JJ(1), Bae JP(2), Raval AD(3), Kern DM(4).
Author information:
(1)HealthCore, Inc., Wilmington, DE, USA. jstephenson@healthcore.com.
(2)Eli Lilly and Company, Indianapolis, IN, USA.
(3)Merck & Co., Inc., Kenilworth, NJ, USA.
(4)Janssen Research & Development, Titusville, NJ, USA.
INTRODUCTION: Complex or personalized insulin regimens challenge traditional

adherence measures. Our objective was to develop an improved basal insulin (BI)
adherence measure using both patient-reported and administrative claims data,
resulting in a more complete measure.
METHODS: Patients' self-reported BI utilization over the previous 12 months was
linked with their claims data for the same period. Hybrid medication possession
ratio (MPR) was derived by calculating expected days of insulin supply [total
dispensed insulin units from claims over 12 months divided by self-reported total
daily dose (TDD)]. The hybrid MPR was compared against traditional claims-based
MPR, adjusted claims-based MPR, and patient-reported MPR. For all MPR measures,
the adherence threshold was ≥ 0.8. A logistic model was used to predict
non-adherence per hybrid MPR. The predicted model-based MPR was compared with
existing measures in a larger cohort.
RESULTS: The study sample consisted of 296 patients. TDD derived from claims was
higher than self-reported TDD [77.9 (71.8) vs. 57.7 (38.3)], implying average
dispensed insulin would last longer than claims-based days supply.
Correspondingly, hybrid and MPRs adjusted for package size (56% and 71%,
respectively) were higher than claims-based MPR (50%). Age, total claims-based
days supply, retinopathy, adjusted MPR-based adherence, and non-insulin
injectable use were key predictors of hybrid MPR-based adherence. Applying the
claims-based prediction model to a larger cohort to test validity showed high
correlations with predicted and adjusted MPR-based adherence.
CONCLUSIONS: Traditional claims-based MPR underestimated adherence while adjusted
MPR overestimated adherence when self-reported total daily dose was taken as
benchmark insulin dose. The predicted model may help identify patients with poor
basal insulin adherence. More research is needed to further confirm the findings.
FUNDING: Eli Lilly and Company, Indianapolis, IN, USA.
DOI: 10.1007/s12325-018-0828-4
PMCID: PMC6318230
PMID: 30536142
1850. BMC Public Health. 2018 Sep 29;18(1):1148. doi: 10.1186/s12889-018-6050-0.
Self-management of diabetes in Sub-Saharan Africa: a systematic review.
Stephani V(1), Opoku D(2), Beran D(3).
Author information:
(1)Department of Health Care Management, Technical University of Berlin, Berlin,
Germany. victor.stephani@tu-berlin.de.
(2)Department of Health Care Management, Technical University of Berlin, Berlin,
Germany.
(3)Division of Tropical and Humanitarian Medicine, University of Geneva and
Geneva University Hospitals, Genève, Switzerland.
BACKGROUND: The prevalence of diabetes in sub-Saharan Africa has increased

rapidly over the last years. Self-management is a key element for the proper
management, but strategies are currently lacking in this context. This systematic
review aims to describe the level of self-management among persons living with
type 2 diabetes mellitus in sub-Saharan Africa.
METHOD: Relevant databases including PubMed, Web of Science and Google Scholar
were searched up to September 2016. Studies reporting self-management behavior of
people with type 2 diabetes mellitus and living in sub-Saharan Africa were
included.
RESULTS: A total of 550 abstracts and 109 full-text articles were assessed.
Forty-three studies, mainly observational, met the inclusion criteria. The
studies showed that patients rarely self-monitored their glucose levels, had low
frequency/duration of physical activity, moderately adhered to recommended
dietary and medication behavior, had poor level of knowledge regarding diabetes
related complications and sought traditional or herbal medicines beside of their
biomedical treatment. The analysis also revealed a lack of studies on
psychosocial aspects.
CONCLUSION: Except for the psychosocial area, there is a good amount of recent
studies on self-management behavior of type 2 diabetes mellitus sub-Saharan
Africa. These studies indicate that self-management in sub-Saharan Africa is poor
and therefore a serious threat to the health of individuals and the health
systems capacity.
DOI: 10.1186/s12889-018-6050-0
PMCID: PMC6162903
1851. J Diabetes Sci Technol. 2018 Jul;12(4):808-816. doi:

10.1177/1932296818754907.
Epub 2018 Feb 1.
An Analysis of Diabetes Mobile Applications Features Compared to AADE7™:

Addressing Self-Management Behaviors in People With Diabetes.
Ye Q(1), Khan U(2), Boren SA(1)(3), Simoes EJ(1)(3), Kim MS(1)(3).
Author information:
(1)1 University of Missouri Informatics Institute, University of Missouri,
Columbia, MO, USA.
(2)2 Department of Medicine, University of Missouri, Columbia, MO, USA.
(3)3 Department of Health Management and Informatics, University of Missouri,
Columbia, MO, USA.
BACKGROUND: Diabetes self-management (DSM) applications (apps) have been designed

to improve knowledge of diabetes and self-management behaviors. However, few
studies have systematically examined if diabetes apps followed the American
Association of Diabetes Educators (AADE) Self-Care Behaviors™ guidelines. The
purpose of this study was to compare the features of current DSM apps to the
AADE7™ guidelines.
METHODS: In two major app stores (iTunes and Google Play), we used three search
terms "diabetes," "blood sugar," and "glucose" to capture a wide range of
diabetes apps. Apps were excluded based on five exclusion criteria. A
multidisciplinary team analyzed and classified the features of each app based on
the AADE7™. We conducted interviews with six diabetes physicians and educators
for their opinions on the distribution of the features of DSM apps.
RESULTS: Out of 1050 apps retrieved, 173 apps were identified as eligible during
November 2015 and 137 apps during December 2017. We found an unbalanced DSM app
development trend based on AADE7™ guidelines. Many apps were designed to support
the behaviors of Healthy Eating (77%), Monitoring (76%), Taking Medication (58%),
and Being Active (45%). On the other hand, few apps explored the behaviors of
Problem Solving (31%), Healthy Coping (10%), and Reducing Risks (5%). From
interviews, we identified the main reasons why only a few apps support the
features related to Problem Solving, Healthy Coping, and Reducing Risks.
CONCLUSIONS: Future diabetes apps should attempt to incorporate features under
evidence-based guidelines such as AADE7™ to better support the self-management
behavior changes of people with diabetes.
DOI: 10.1177/1932296818754907
PMCID: PMC6134307
1852. BMC Womens Health. 2018 Feb 13;18(1):39. doi: 10.1186/s12905-018-0532-1.
Prevalence of dysmenorrhea among University students in Northern Ghana; its

impact and management strategies.
Ameade EPK(1), Amalba A(2), Mohammed BS(3).
Author information:
(1)Department of Pharmacology, School of Medicine and Health Sciences, University
for Development Studies, P.O.Box TL 1350, Tamale, Ghana. sokpesh@yahoo.com.
(2)Department of Health Professions Education and Innovative Learning, School of
Medicine and Health Sciences, University for Development Studies, Tamale, Ghana.
(3)Department of Pharmacology, School of Medicine and Health Sciences, University
for Development Studies, P.O.Box TL 1350, Tamale, Ghana.
BACKGROUND: The period of menstruation is an eventful one for a significant

number of post-pubescent females as they experience lower abdominal pains
referred to as dysmenorrhea. This study conducted among female students of the
Tamale campus of the University for Development Studies assessed the prevalence
of dysmenorrhea, its impact on the students and treatment methods applied.
METHODS: A cross-sectional study using a self-administered questionnaire was used
to obtain data from 293 randomly selected female students. Data was analyzed
using Graph Pad 5.01. Association between different variables was tested.
RESULTS: The prevalence rate of dysmenorrhea was 83.6% with more than half
describing their pain which lasts less than 3 days as moderate. This dysmenorrhea
during menstruation affects the daily activities of up to 61.2% of respondents.
Lower chronological age (χ2 = 8.28; df = 2; p = 0.016) and gynecological age
(χ2 = 10.09; df = 2; p = 0.006) were the factors that were significantly
associated with the presence of dysmenorrhea. Chronological and gynecological
ages, age at menarche, menstrual duration or flow level do not influence the
severity of dysmenorrhea but irregular menstrual flow is significantly associated
with severe dysmenorrhea (χ2 = 10.54; df = 2; p = 0.005). Only 16.3% ever
reported their dysmenorrhea to the hospital but increasing pain level is
significantly associated with respondents visiting a hospital (χ2 = 65.61;
df = 2; p < 0.0001) or use an allopathic medication (χ2 = 32.77; df = 2;
p < 0.0001). Paracetamol preparation was the most common medication used
notwithstanding the severity of the pain.
CONCLUSIONS: There is high prevalence of dysmenorrhea among the female students
of the Tamale campus of the University for Development studies which negatively
affects the daily activity of majority of them. Although, bed rest was the most
common treatment method practised, paracetamol preparation was the most common
allopathic drug used in self- management of their dysmenorrhea.
DOI: 10.1186/s12905-018-0532-1
PMCID: PMC5810012
Text Messaging to Improve Hypertension Medication Adherence in African Americans

From Primary Care and Emergency Department Settings: Results From Two Randomized
Feasibility Studies.
Buis L(1), Hirzel L(2), Dawood RM(3), Dawood KL(3), Nichols LP(1), Artinian
NT(2), Schwiebert L(4), Yarandi HN(2), Roberson DN(1), Plegue MA(1), Mango LC(3),
Levy PD(3).
Author information:
(1)Department of Family Medicine, University of Michigan, Ann Arbor, MI, United
States.
(2)College of Nursing, Wayne State University, Detroit, MI, United States.
(3)Department of Emergency Medicine, School of Medicine, Wayne State University,
Detroit, MI, United States.
(4)College of Engineering, Wayne State University, Detroit, MI, United States.
BACKGROUND: Hypertension (HTN) is an important problem in the United States, with

an estimated 78 million Americans aged 20 years and older suffering from this
condition. Health disparities related to HTN are common in the United States,
with African Americans suffering from greater prevalence of the condition than
whites, as well as greater severity, earlier onset, and more complications.
Medication adherence is an important component of HTN management, but adherence
is often poor, and simply forgetting to take medications is often cited as a
reason. Mobile health (mHealth) strategies have the potential to be a low-cost
and effective method for improving medication adherence that also has broad
reach.
OBJECTIVE: Our goal was to determine the feasibility, acceptability, and
preliminary clinical effectiveness of BPMED, an intervention designed to improve
medication adherence among African Americans with uncontrolled HTN, through fully
automated text messaging support.
METHODS: We conducted two parallel, unblinded randomized controlled pilot trials
with African-American patients who had uncontrolled HTN, recruited from primary
care and emergency department (ED) settings. In each trial, participants were
randomized to receive either usual care or the BPMED intervention for one month.
Data were collected in-person at baseline and one-month follow-up, assessing the
effect on medication adherence, systolic and diastolic blood pressure (SBP and
DBP), medication adherence self-efficacy, and participant satisfaction. Data for
both randomized controlled pilot trials were analyzed separately and combined.
RESULTS: A total of 58 primary care and 65 ED participants were recruited with
retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants
consistently showed numerically greater, yet nonsignificant, improvements in
measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD
1.5, P=.26), SBP (mean change -12.6, SD 24.0 vs mean change -11.3, SD 25.5 mm Hg,
P=.78), and DBP (mean change -4.9, SD 13.1 mm Hg vs mean change -3.3, SD 14.3 mm
Hg, P=.54). Control and BPMED participants had slight improvements to medication
adherence self-efficacy (mean change 0.8, SD 9.8 vs mean change 0.7, SD 7.0) with
no significant differences found between groups (P=.92). On linear regression
analysis, baseline SBP was the only predictor of SBP change; participants with
higher SBP at enrollment exhibited significantly greater improvements at
one-month follow-up (β=-0.63, P<.001). In total, 94% (51/54) of BPMED
participants agreed/strongly agreed that they were satisfied with the program,
regardless of pilot setting.
CONCLUSIONS: Use of text message reminders to improve medication adherence is a
feasible and acceptable approach among African Americans with uncontrolled HTN.
Although differences in actual medication adherence and blood pressure between
BPMED and usual care controls were not significant, patterns of improvement in
the BPMED condition suggest that text message medication reminders may have an
effect and fully powered investigations with longer-term follow-up are warranted.
TRIAL REGISTRATION: Clinicaltrials.gov NCT01465217;
http://www.webcitation.org/6V0tto0lZ).
©Lorraine Buis, Lindsey Hirzel, Rachelle M Dawood, Katee L Dawood, Lauren P

Nichols, Nancy T Artinian, Loren Schwiebert, Hossein N Yarandi, Dana N Roberson,
Melissa A Plegue, LynnMarie C Mango, Phillip D Levy. Originally published in JMIR
Mhealth and Uhealth (http://mhealth.jmir.org), 01.02.2017.
PMCID: PMC5311421
PMID: 28148474
1854. J Gen Intern Med. 2015 Oct;30(10):1538-46. doi: 10.1007/s11606-015-3288-4.
Epub
2015 Apr 28.
Different Measures, Different Outcomes? A Systematic Review of Performance-Based

versus Self-Reported Measures of Health Literacy and Numeracy.
Kiechle ES(1), Bailey SC(2), Hedlund LA(3), Viera AJ(1)(4)(5), Sheridan

SL(6)(7)(8)(9).
Author information:
(1)Program on Health Care and Prevention, Gillings School of Global Public
Health, University of North Carolina, Chapel Hill, NC, USA.
University of North Carolina, Chapel Hill, NC, USA.
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
(4)Department of Family Medicine, University of North Carolina, Chapel Hill, NC,
USA.
(5)Cecil G. Sheps Center for Health Services Research, University of North
Carolina, Chapel Hill, NC, USA.
(6)Program on Health Care and Prevention, Gillings School of Global Public
Health, University of North Carolina, Chapel Hill, NC, USA.
stacey_sheridan@med.unc.edu.
(7)Cecil G. Sheps Center for Health Services Research, University of North
Carolina, Chapel Hill, NC, USA. stacey_sheridan@med.unc.edu.
(8)Division of General Medicine and Clinical Epidemiology, Department of
Medicine, University of North Carolina, Chapel Hill, NC, USA.
stacey_sheridan@med.unc.edu.
(9)University of North Carolina at Chapel Hill, 5039 Old Clinic Building, CB
#7110, Chapel Hill, NC, 27599-7110, USA. stacey_sheridan@med.unc.edu.
Comment in
J Gen Intern Med. 2015 Oct;30(10):1537.
BACKGROUND: Health literacy (HL) and numeracy are measured by one of two methods:
performance on objective tests or self-report of one's skills. Whether results
from these methods differ in their relationship to health outcomes or use of
health services is unknown.
METHODS: We performed a systematic review to identify and evaluate articles that
measured both performance-based and self-reported HL or numeracy and examined
their relationship to health outcomes or health service use. To identify studies,
we started with an AHRQ-funded systematic review of HL and health outcomes. We
then looked for newer studies by searching MEDLINE from 1 February 2010 to 9
December 2014. We included English language studies meeting pre-specified
criteria. Two reviewers independently assessed abstracts and studies for
inclusion and graded study quality. One reviewer abstracted information from
included studies while a second checked content for accuracy.
RESULTS: We identified four "fair" quality studies that met inclusion criteria
for our review. Two studies measuring HL found no differences between
performance-based and self-reported HL for association with self-reported
outcomes (including diabetes, stroke, hypertension) or a physician-completed
rheumatoid arthritis disease activity score. However, HL measures were
differentially related to a patient-completed health assessment questionnaire and
to a patient's ability to interpret their prescription medication name and dose
from a medication bottle. Only one study measured numeracy and found no
difference between performance-based and self-reported measures of numeracy and
colorectal cancer (CRC) screening utilization. However, in a moderator analysis
from the same study, performance-based and self-reported numeracy were
differentially related to CRC screening utilization when stratified by certain
patient-provider communication behaviors (e.g., the chance to always ask
questions and get the support that is needed).
DISCUSSION: Most studies found no difference in the relationship between results
of performance-based and self-reported measures and outcomes. However, we
identified few studies using multiple instruments and/or objective outcomes.
DOI: 10.1007/s11606-015-3288-4
PMCID: PMC4579206
1855. Health Lit Res Pract. 2017 Oct;1(4):e192-e202. doi: 10.3928/24748307-

20170906-01.
Text Messaging May Engage and Benefit Adults with Type 2 Diabetes Regardless of
Health Literacy Status.
Bergner EM(1), Nelson LA(2), Rothman RL(3), Mayberry L(4).
Author information:
(1)Senior Research Specialist, Center for Health Behavior and Health Education,
Vanderbilt University Medical Center.
(2)Research Assistant Professor, Center for Health Behavior and Health Education,
(3)Professor of Medicine, and the Director, Center for Health Services Research,
(4)Assistant Professor, Department of Medicine, Center for Health Behavior and
Health Education, Vanderbilt University Medical Center.
Background: Technology-delivered interventions have the potential to improve

diabetes self-care and glycemic control among adults with type 2 diabetes (T2D).
However, patients who do not engage with interventions may not reap benefits, and
there is little evidence on how engagement with mobile health interventions
varies by health literacy status.
Objective: This study explored how patients with limited health literacy engaged
with and experienced Rapid Education/Encouragement and Communications for Health
(REACH), a text messaging intervention designed to support the self-care
adherence of disadvantaged patients with T2D. We recruited adults with T2D from
federally qualified health centers and used mixed methods to examine (1)
associations between users' health literacy status and their prior mobile phone
use and their engagement with REACH and (2) similarities and differences in
users' self-reported benefits by health literacy status.
Methods: Participants (N = 55) completed a survey, including measures of health
literacy and prior mobile phone use. For 2 weeks, participants experienced REACH,
which included daily text messages promoting self-care and asking about
medication adherence, and weekly text messages providing medication adherence
feedback. After 2 weeks, participants completed a semi-structured telephone
interview about their experiences.
Key Results: Participants with limited health literacy were less likely to have
used cell phones to access the Internet (48% vs. 90%, p = .001) or email (36% vs.
87%, p < .001), but equally as likely to have used text messaging and to respond
to REACH text messages (p = .12 and p = .40, respectively) compared to
participants with adequate health literacy. Participants responded to 93% of text
messages on average and reported benefits of the intervention, including
reminders and accountability, convenience and accessibility, and information and
motivation. Participants with limited health literacy described a unique benefit
of receiving social support from the intervention.
Conclusions: Text messaging interventions may engage and benefit patients with
T2D, regardless of health literacy status. Text messaging may have the potential
to reduce T2D health disparities related to limited health literacy.
DOI: 10.3928/24748307-20170906-01
PMCID: PMC5714586
PMID: 29214241
1856. Arthritis Care Res (Hoboken). 2018 Mar;70(3):343-352. doi: 10.1002/acr.23287.

Epub 2018 Feb 6.
Effects of a Web-Based Patient Decision Aid on Biologic and Small-Molecule Agents

for Rheumatoid Arthritis: Results From a Proof-of-Concept Study.
Li LC(1), Shaw CD(2), Lacaille D(1), Yacyshyn E(3), Jones CA(3), Koehn C(4),
Hoens AM(1), Geldman J(5), Sayre EC(5), Macdonald GG(1), Leese J(1), Bansback
N(1).
Author information:
(1)University of British Columbia, Vancouver, Canada, and Arthritis Research
Canada, Richmond, Canada.
(2)Simon Fraser University, Burnaby, Canada.
(3)University of Alberta, Edmonton, Canada.
(4)Arthritis Consumer Experts, Vancouver, Canada.
(5)Arthritis Research Canada, Richmond, Canada.
OBJECTIVE: To assess the extent to which ANSWER-2, an interactive online patient

decision aid, reduces patients' decisional conflict and improves their
medication-related knowledge and self-management capacity.
METHODS: We used a pre-post study design. Eligible participants had a diagnosis
of rheumatoid arthritis (RA), had been recommended to start using a biologic
agent or small-molecule agent or to switch to a new one, and had internet access.
Access to ANSWER-2 was provided immediately after enrollment. Outcome measures
included 1) the Decisional Conflict Scale (DCS), 2) the Medication Education
Impact Questionnaire (MeiQ), and 3) the Partners in Health Scale (PIHS). A paired
t-test was used to assess differences pre- and postintervention.
RESULTS: The majority of the 50 participants were women (n = 40), and the mean ±
SD age of participants was 49.6 ± 12.2 years. The median disease duration was 5
years (25th, 75th percentile: 2, 10 years). The mean ± SD DCS score was 45.9 ±
25.1 preintervention and 25.1 ± 21.8 postintervention (mean change of -21.2 of
100 [95% confidence interval (95% CI) -28.1, -14.4], P < 0.001). Before using
ANSWER-2, 20% of participants had a DCS score of <25, compared to 52% of
participants after the intervention. Similar results were observed in the PIHS
(mean ± SD 25.3 ± 14.8 preintervention and 20.4 ± 13.0 postintervention; mean
change of -3.7 of 88 [95% CI -6.3, -1.0], P = 0.009). Findings from the MeiQ were
mixed, with statistically significant differences found only in the
self-management subscales.
CONCLUSION: Patients' decisional conflict decreased and perceived self-management
capacity improved after using ANSWER-2. Future research comparing the
effectiveness of ANSWER-2 with that of educational material on biologic agents
will provide further insight into its value in RA management.
DOI: 10.1002/acr.23287
1857. Medicine (Baltimore). 2015 Nov;94(44):e1903. doi:

10.1097/MD.0000000000001903.
Treatment Outcomes From a Specialist Model for Treating Tobacco Use Disorder in a
Medical Center.
Burke MV(1), Ebbert JO, Schroeder DR, McFadden DD, Hays JT.
Author information:
(1)From the Nicotine Dependence Center, Department of Internal Medicine (MVB,
JOE, DDM, JTH) and Division of Biomedical Statistics and Informatics, Department
of Health Sciences Research, Mayo Clinic, Rochester, MN (DRS).
Cigarette smoking causes premature mortality and multiple morbidity; stop smoking
improves health. Higher rates of smoking cessation can be achieved through more
intensive treatment, consisting of medication and extended counseling of
patients, but there are challenges to integrating these interventions into
healthcare delivery systems. A care model using a master-level counselor trained
as a tobacco treatment specialist (TTS) to deliver behavioral intervention,
teamed with a supervising physician/prescriber, affords an opportunity to
integrate more intensive tobacco dependence treatment into hospitals, clinics,
and other medical systems. This article analyzes treatment outcomes and
predictors of abstinence for cigarette smokers being treated using the
TTS-physician team in a large outpatient clinic over a 7-year period.This is an
observational study of a large cohort of cigarette smokers treated for tobacco
dependence at a medical center. Patients referred by the primary healthcare team
for a TTS consult received a standard assessment and personalized treatment
planning guided by a workbook. Medication and behavioral plans were developed
collaboratively with each patient. Six months after the initial assessment, a
telephone call was made to ascertain a 7-day period of self-reported abstinence.
The univariate association of each baseline patient characteristic with
self-reported tobacco abstinence at 6 months was evaluated using the chi-squared
test. In addition, a multiple logistic regression analysis was performed with
self-reported tobacco abstinence as the dependent variable and all baseline
characteristics included as explanatory variables.Over a period of 7 years
(2005-2011), 6824 cigarette smokers who provided general research authorization
were seen for treatment. The 6-month self-reported abstinence rate was 28.1% (95%
confidence interval: 27.7-30.1). The patients most likely to report abstinence
were less dependent, more motivated to quit, and did not have a past year
diagnosis of depression or alcoholism.Predictable patient characteristics such as
level of dependence did predict abstinence, but all patient groups achieved
comparable abstinence outcomes. While this study has limitations inherent in a
single-center retrospective cohort study, it does suggest that the TTS model is
an effective way to integrate more intensive tobacco dependence treatment into
outpatient settings.
DOI: 10.1097/MD.0000000000001903
PMCID: PMC4915890
1858. P R Health Sci J. 2015 Mar;34(1):31-7.
Measuring health literacy among people living with HIV who attend a
community-based ambulatory clinic in Puerto Rico.
[No authors listed]
OBJECTIVE: Health literacy is an important area for interventions aimed at

reducing or eliminating the health disparities of people living with HIV (PLWH).
We sought to determine the level of functional health literacy (FHL) and its
association with medication adherence, symptoms, and their attendant management
strategies in PLWH.
METHODS: This was a cross-sectional study conducted with 200 adults from a
community-based ambulatory clinic in San Juan, Puerto Rico.
RESULTS: The mean age of the participants was 46.61. Almost half of all
participants (47%) had marginal or inadequate levels of health literacy (21.5%, n
= 23; 25.50%, n = 51, respectively). Educational level, being employed, annual
income, having children, incorrect self-reported CD4+T cell counts, were they
actually reported their viral loads, adherence to antiretroviral treatment (ART),
and use of self-care strategies for depression were significantly related to a
given individual's level of health literacy (p < 0.05). Significant interactions
were found between adherence and FHL (p = 0.0069). People with marginal health
literacy had a higher mean score (1.77 ± 937) on the adherence scale than did
those with inadequate literacy levels. After adjusting for age, education, and
the number of people per room at the participant's home, data showed that for
those who were 45 years of age or younger, there were significant differences (p
= 0.002) in the mean scores of the adherence scale between those with marginal
levels of health literacy and those who had inadequate levels of same (5.66 ±
1.84).
CONCLUSION: Findings from this study fill an existing gap in the important area
of health literacy among PLWH in Puerto Rico and highlight the importance of
conducting future research geared towards incorporating FHL as an essential
component in the management of adherence as well as in both symptoms and the
management of same in PLWH.
PMCID: PMC4394204
1859. Int J Bipolar Disord. 2017 Dec;5(1):16. doi: 10.1186/s40345-017-0081-9. Epub

2017
May 11.
Self-poisoning suicide deaths in people with bipolar disorder: characterizing a

subgroup and identifying treatment patterns.
Schaffer A(1)(2), Weinstock LM(3), Sinyor M(4)(5), Reis C(6), Goldstein BI(7)(8),
Yatham LN(9), Levitt AJ(4)(5).
Author information:
(1)Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook
Health Sciences Centre, 2075 Bayview Avenue, Room FG 52, Toronto, ON, M4N 3M5,
Canada. ayal.schaffer@sunnybrook.ca.
(2)Department of Psychiatry, University of Toronto, Toronto, Canada.
ayal.schaffer@sunnybrook.ca.
(3)Department of Psychiatry and Human Behavior, Brown University, Providence, RI,
USA.
(4)Department of Psychiatry, University of Toronto, Toronto, Canada.
(5)Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.
(6)Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook
Health Sciences Centre, 2075 Bayview Avenue, Room FG 52, Toronto, ON, M4N 3M5,
Canada.
(7)Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health
Sciences Centre, Toronto, Canada.
(8)Departments of Psychiatry and Pharmacology, University of Toronto, Toronto,
Canada.
(9)Department of Psychiatry, University of British Columbia, Vancouver, Canada.
OBJECTIVE: To characterize self-poisoning suicide deaths in BD compared to other
suicide decedents.
METHODS: Extracted coroner data from all suicide deaths (n = 3319) in Toronto,
Canada from 1998 to 2012. Analyses of demographics, clinical history, recent
stressors, and suicide details were conducted in 5 subgroups of suicide
decedents: BD self-poisoning, BD other methods, non-BD self-poisoning, non-BD
other methods, and unipolar depression self-poisoning. Toxicology results for
lethal and present substances were also compared between BD and non-BD
self-poisoning subgroups as well as between BD and unipolar depression
self-poisoning subgroups.
RESULTS: Among BD suicide decedents, self-poisoning was significantly associated
with female sex, past suicide attempts, and comorbid substance abuse. In both the
BD and non-BD self-poisoning groups, opioids were the most common class of lethal
medication. For both groups, benzodiazepines and antidepressants were the most
common medications present at time of death, and in 23% of the BD group, an
antidepressant was present without a mood stabilizer or antipsychotic. Only 31%
of the BD group had any mood stabilizer present, with carbamazepine being most
common. No antidepressant, mood stabilizer, or antipsychotic was present in 15.5%
of the BD group. Relative to unipolar depression self-poisoning group, the BD
self-poisoning group evidenced higher proportion of previous suicide attempt(s)
and psychiatry/ER visits in the previous week.
CONCLUSION: People with BD who die by suicide via self-poisoning comprise a
distinct but understudied group. The predominant absence of guideline-concordant
pharmacologic care comprises a crucial target for future policy and knowledge
translation efforts.
DOI: 10.1186/s40345-017-0081-9
PMCID: PMC5406320
PMID: 28332123
1860. Contemp Clin Trials. 2017 Nov;62:21-26. doi: 10.1016/j.cct.2017.08.013. Epub

2017
Aug 18.
Development and rationale for a multifactorial, randomized controlled trial to

test strategies to promote adherence to complex drug regimens among older adults.
Bailey SC(1), Wismer GA(2), Parker RM(3), Walton SM(4), Wood AJJ(5), Wallia A(6),
Brokenshire SA(7), Infanzon AC(7), Curtis LM(2), Kwasny MJ(8), Wolf MS(2).
Author information:
Pharmacy, University of North Carolina, Chapel Hill, NC, United States.
Electronic address: scbailey@unc.edu.
(2)Health Literacy and Learning Program, Division of General Internal Medicine &
Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL,
United States.
(3)Department of Medicine, Emory University School of Medicine, Atlanta, GA,
United States.
(4)Department of Pharmacy Systems Outcomes and Policy, College of Pharmacy,
University of Illinois at Chicago, Chicago, IL, United States.
(5)Department of Medicine, Division of Clinical Pharmacology, Vanderbilt
University School of Medicine, Nashville, TN, United States.
(6)Division of Endocrinology, Metabolism, and Molecular Medicine, Department of
Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL,
United States.
Pharmacy, University of North Carolina, Chapel Hill, NC, United States.
University, Chicago, IL, United States.
BACKGROUND: Patients with chronic conditions are often responsible for

self-managing complex, multi-drug regimens with minimal professional clinical
support. While numerous interventions to promote and support medication adherence
have been tested, most have had limited success or have been too
resource-intensive for real-world implementation.
OBJECTIVE: To compare the effectiveness of multiple low-cost, technology-enabled
strategies, alone and in combination, for promoting medication regimen adherence
among older adults.
METHODS: Older, English or Spanish-speaking patients on complex drug regimens
(N=1505) will be recruited from a community health system in Chicago, IL.
Enrolled patients will be randomized to one of four study arms, receiving either:
1) enhanced usual care alone; 2) daily medication reminders via SMS text
messages; 3) medication monitoring via a patient portal-based assessment; or 4)
both SMS text message reminders and portal-based medication monitoring. The
primary outcome of the study is medication adherence, which will be assessed via
multiple measures at baseline, 2months, and 6months. The effect of intervention
strategies on clinical markers (hemoglobin A1c, blood pressure, cholesterol
level), as well as intervention fidelity and the barriers and costs of
implementation will also be evaluated.
CONCLUSIONS: This randomized controlled trial will evaluate the impact of various
low-cost intervention strategies on adherence to complex medication regimens and
will explore barriers to implementation. If the studied intervention strategies
are shown to be effective, then these approaches could be effectively deployed
across a diverse range of clinical settings and patient populations.
CLINICAL TRIAL REGISTRATION: This trial is registered on
clinicaltrials.govNCT02820753.
DOI: 10.1016/j.cct.2017.08.013
PMCID: PMC5641260
1861. AIDS Care. 2018 Feb;30(2):150-159. doi: 10.1080/09540121.2017.1384532. Epub

2017
Oct 16.
Polypharmacy and risk of falls and fractures for patients with HIV infection and
substance dependence.
Kim TW(1), Walley AY(1), Ventura AS(1), Patts GJ(2), Heeren TC(3), Lerner GB(4),
Mauricio N(4), Saitz R(1)(5).
Author information:
(1)a Clinical Addiction Research and Education (CARE) Unit, Section of General
Internal Medicine, Boston Medical Center , Boston University School of Medicine ,
Boston , MA , USA.
(2)b Data Coordinating Center , Boston University School of Public Health ,
Boston , MA , USA.
(3)c Department of Biostatistics , Boston University School Public Health ,
Boston , MA , USA.
(4)d Boston University School of Medicine , Boston , MA , USA.
(5)e Department of Community Health Sciences , Boston University School of Public
Health , Boston , MA , USA.
Although people with HIV infection (PLWH) are at higher risk of polypharmacy and
substance use, there is limited knowledge about potential harms associated with
polypharmacy such as falls and fractures in this population. The study objective
was to determine whether polypharmacy, as measured by the number and type of
medication, is associated with falls and fractures among PLWH and DSM-IV
substance dependence in the past year or ever injection drug use (IDU). We
identified the number of medications by electronic medical record review in the
following categories: (i) systemically active, (ii) non-antiretroviral (non-ARV),
(iii) sedating, (iv) non-sedating as well as any opioid medication and any
non-opioid sedating medication. Outcomes were self-reported (1) fall/accident
requiring medical attention and (2) fracture in the previous year. Separate
logistic regression models were fitted for medications in each category and each
outcome. Among 250 participants, the odds of a fall requiring medical attention
were higher with each additional medication overall (odds ratio [OR] 1.12, 95%
Confidence Interval [CI] = 1.05, 1.18), each additional non-ARV medication (OR
1.13, 95%CI = 1.06, 1.20), each additional sedating medication (OR 1.36,
95%CI = 1.14, 1.62), and a non-opioid sedating medication (OR 2.89, 95%CI = 1.06,
7.85) but not with an additional non-sedating medication or opioid medication. In
receiver operating characteristic (ROC) curve analyses, optimal cutoffs for
predicting falls were: ≥8 overall and ≥2 sedating medications. Odds ratios for
fracture in the previous year were OR 1.05, 95%CI = 0.97, 1.13 for each
additional medication overall and OR 1.11, 95%CI = 0.89, 1.38 for each additional
sedating medication. In PLWH and substance dependence or ever IDU, a higher
number of medications was associated with greater odds of having a fall requiring
medical attention. The association appeared to be driven largely by sedating
medications. Future studies should determine if reducing such polypharmacy,
particularly sedating medications, lowers the risk of falls.
DOI: 10.1080/09540121.2017.1384532
PMCID: PMC5977400
1862. JMIR Res Protoc. 2018 May 28;7(5):e138. doi: 10.2196/resprot.9601.
Evaluating a Serious Gaming Electronic Medication Administration Record System

Among Nursing Students: Protocol for a Pragmatic Randomized Controlled Trial.
Booth R(1), Sinclair B(#)(1), McMurray J(2), Strudwick G(3), Watson G(4), Ladak
H(5), Zwarenstein M(6), McBride S(7), Chan R(1), Brennan L(1).
Author information:
(1)Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western
University, London, ON, Canada.
(2)Business Technology Management/Health Studies, Wilfrid Laurier University,
Waterloo, ON, Canada.
(3)Information Management Group, Centre for Addiction and Mental Health, Toronto,
ON, Canada.
(4)Teaching Support Centre, Western University, London, ON, Canada.
(5)Department of Medical Biophysics, Faculty of Engineering, Western University,
London, ON, Canada.
(6)Centre for Studies in Family Medicine, Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada.
(7)School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX,
United States.
BACKGROUND: Although electronic medication administration record systems have

been implemented in settings where nurses work, nursing students commonly lack
robust learning opportunities to practice the skills and workflow of digitalized
medication administration during their formative education. As a result, nursing
students' performance in administering medication facilitated by technology is
often poor. Serious gaming has been recommended as a possible intervention to
improve nursing students' performance with electronic medication administration
in nursing education.
OBJECTIVE: The objectives of this study are to examine whether the use of a
gamified electronic medication administration simulator (1) improves nursing
students' attention to medication administration safety within simulated
practice, (2) increases student self-efficacy and knowledge of the medication
administration process, and (3) improves motivational and cognitive processing
attributes related to student learning in a technology-enabled environment.
METHODS: This study comprised the development of a gamified electronic medication
administration record simulator and its evaluation in 2 phases. Phase 1 consists
of a prospective, pragmatic randomized controlled trial with second-year
baccalaureate nursing students at a Canadian university. Phase 2 consists of
qualitative focus group interviews with a cross-section of nursing student
participants.
RESULTS: The gamified medication administration simulator has been developed, and
data collection is currently under way.
CONCLUSIONS: If the gamified electronic medication administration simulator is
found to be effective, it could be used to support other health professional
simulated education and scaled more widely in nursing education programs.
https://clinicaltrials.gov/show/NCT03219151 (Archived by WebCite
at http://www.webcitation.org/6yjBROoDt).
REGISTERED REPORT IDENTIFIER: RR1-10.2196/9601.
©Richard Booth, Barbara Sinclair, Josephine McMurray, Gillian Strudwick, Gavan

Watson, Hanif Ladak, Merrick Zwarenstein, Susan McBride, Ryan Chan, Laura
Brennan. Originally published in JMIR Research Protocols
PMCID: PMC5996180
PMID: 29807885
1863. Environ Int. 2018 Oct;119:287-294. doi: 10.1016/j.envint.2018.06.034. Epub

2018
Jul 6.
Traffic noise, noise annoyance and psychotropic medication use.
Okokon EO(1), Yli-Tuomi T(2), Turunen AW(3), Tiittanen P(4), Juutilainen J(5),
Lanki T(6).
Author information:
(1)Department of Health Protection, THL - National Institute for Health and
Welfare, P.O. Box 95, FI-70701 Kuopio, Finland. Electronic address:
enembe.okokon@thl.fi.
tarja.yli-tuomi@thl.fi.
anu.turunen@thl.fi.
pekka.tiittanen@thl.fi.
(5)Department of Environmental Sciences, University of Eastern Finland,
Yliopistonranta 1, FI-70210 Kuopio, Finland. Electronic address:
jukka.juutilainen@uef.fi.
Welfare, P.O. Box 95, FI-70701 Kuopio, Finland; School of Medicine, University of
Eastern Finland, Yliopistonranta 1, FI-70210 Kuopio, Finland. Electronic address:
timo.lanki@thl.fi.
BACKGROUND: Road-traffic noise can induce stress, which may contribute to mental
health disorders. Mental health problems have not received much attention in
noise research. People perceive noise differently, which may affect the extent to
which noise contributes to poor mental health at the individual level. This paper
aims to assess the relationships between outdoor traffic noise and noise
annoyance and the use of psychotropic medication.
METHODS: We conducted a survey to assess noise annoyance and psychotropic
medication among residents of the Helsinki Capital Region of Finland. We also
assessed the associations of annoyance and road-traffic noise with sleep
disorders, anxiety and depression. Respondents were randomly sampled from the
Finnish Population registry, and data was collected using a self-administered
questionnaire. Outdoor traffic noise was modelled using the Nordic prediction
model. Associations between annoyance and modelled façade-noise levels with
mental health outcome indicators were assessed using a binary logistic regression
while controlling for socioeconomic, lifestyle and exposure-related factors.
RESULTS: A total of 7321 respondents returned completed questionnaires. Among the
study respondents, 15%, 7% and 7% used sleep medication, anxiolytic and
antidepressant medications, respectively, in the year preceding the study. Noise
annoyance was associated with anxiolytic drug use, OR = 1.41 (95% CI: 1.02-1.95),
but not with sedative or antidepressant use. There was suggestive association
between modelled noise at levels higher than 60 dB and anxiolytic or
antidepressant use. In respondents whose bedroom windows faced the street,
modelled noise was definitively associated with antidepressant use. Noise
sensitivity did not modify the effect of noise but was associated with an
increased use of psychotropic medication.
CONCLUSION: We observed suggestive associations between high levels of
road-traffic noise and psychotropic medication use. Noise sensitivity was
associated with psychotropic medication use.
DOI: 10.1016/j.envint.2018.06.034
1864. Diabetes Res Clin Pract. 2018 Aug;142:374-384. doi:

10.1016/j.diabres.2018.05.046. Epub 2018 Jun 4.
Assessing barriers to diabetes medication adherence using the

Information-Motivation-Behavioral skills model.
Nelson LA(1), Wallston KA(2), Kripalani S(3), LeStourgeon LM(1), Williamson

SE(1), Mayberry LS(4).
Author information:
USA; Center for Health Behavior and Health Education, Vanderbilt University
Medical Center, Nashville, TN, USA.
(2)School of Nursing, Vanderbilt University, Nashville, TN, USA; Center for
Health Services Research, Vanderbilt University Medical Center, Nashville, TN,
USA.
USA; Center for Clinical Quality and Implementation Research, Vanderbilt
University Medical Center, Nashville, TN, USA.
USA; Center for Health Behavior and Health Education, Vanderbilt University
Medical Center, Nashville, TN, USA; Center for Clinical Quality and
Implementation Research, Vanderbilt University Medical Center, Nashville, TN,
USA. Electronic address: lindsay.mayberry@vanderbilt.edu.
AIMS: Medication nonadherence is a prevalent and costly problem among patients

with type 2 diabetes. Applications of theory can inform and improve adherence
promotion interventions. We used a new assessment based on the
Information-Motivation-Behavioral skills (IMB) model of adherence to assess
patient-reported barriers and test the theoretical model.
METHODS: Participants (N = 237) completed a card sorting task to identify
barriers to adherence, a survey, and a hemoglobin A1c (HbA1c) test. We identified
the most commonly reported adherence barriers and examined associations between
patient characteristics and barriers mapped onto each of the IMB constructs. We
used structural equation modeling to test the IMB model and determine if barriers
as reported on this measure predict patients' self-reported diabetes medication
adherence and, in turn, HbA1c levels.
RESULTS: The most frequently reported barriers were forgetting doses, thinking
brand name medicine works better than generic medicine, not seeing immediate
benefit, and feeling burned out with taking diabetes medicine. Younger age and
lower health literacy were associated with higher barrier scores for all IMB
model constructs. Information and social motivation barriers affected adherence
via behavioral skills barriers (indirect effects -0.19, CI [-0.33, -0.09] and
-0.24, CI [-0.37, -0.14], respectively). The IMB barrier constructs explained 44%
of the variance in diabetes medication adherence which, in turn, was
significantly associated with and explained 8% of the variance in HbA1c (both
p < .001).
CONCLUSIONS: Results suggest this assessment task can identify patient-specific
barriers to diabetes medication adherence. Interventions targeting
patient-specific barriers using this assessment could improve adherence and
HbA1c.
DOI: 10.1016/j.diabres.2018.05.046
PMCID: PMC6083841
1865. Ann Intern Med. 2014 Nov 18;161(10 Suppl):S13-22. doi: 10.7326/M13-3012.
Comparison of community health worker-led diabetes medication decision-making

support for low-income Latino and African American adults with diabetes using
e-health tools versus print materials: a randomized, controlled trial.
Heisler M, Choi H, Palmisano G, Mase R, Richardson C, Fagerlin A, Montori VM,

Spencer M, An LC.
BACKGROUND: Health care centers serving low-income communities have scarce

resources to support medication decision making among patients with poorly
controlled diabetes.
OBJECTIVE: To compare outcomes between community health worker use of a tailored,
interactive, Web-based, tablet computer-delivered tool (iDecide) and use of print
educational materials.
DESIGN: Randomized, 2-group trial conducted from 2011 to 2013
(ClinicalTrials.gov: NCT01427660).
SETTING: Community health center in Detroit, Michigan, serving a Latino and
African American low-income population.
PARTICIPANTS: 188 adults with a hemoglobin A1c value greater than 7.5% (55%) or
those who reported questions, concerns, or difficulty taking diabetes
medications.
INTERVENTION: Participants were randomly assigned to receive a 1- to 2-hour
session with a community health worker who used iDecide or printed educational
materials and 2 follow-up calls.
MEASUREMENTS: Primary outcomes were changes in knowledge about antihyperglycemic
medications, patient-reported medication decisional conflict, and satisfaction
with antihyperglycemic medication information. Also examined were changes in
diabetes distress, self-efficacy, medication adherence, and hemoglobin A1c
values.
RESULTS: Ninety-four percent of participants completed 3-month follow-up. Both
groups improved across most measures. iDecide participants reported greater
improvements in satisfaction with medication information (helpfulness, P = 0.007;
clarity, P = 0.03) and in diabetes distress compared with the print materials
group (P < 0.001). The other outcomes did not differ between the groups.
LIMITATIONS: The study was conducted at 1 health center during a short period.
The community health workers were experienced in behavioral counseling, thereby
possibly mitigating the need for additional support tools.
CONCLUSION: Most outcomes were similarly improved among participants receiving
both types of decision-making support for diabetes medication. Longer-term
evaluations are necessary to determine whether the greater improvements in
satisfaction with medication information and diabetes distress achieved in the
iDecide group at 3 months translate into better longer-term diabetes outcomes.
PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality and National
Institute of Diabetes and Digestive and Kidney Diseases.
DOI: 10.7326/M13-3012
PMCID: PMC4391371
Pilot study to test the feasibility of a trial design and complex intervention on
PRIoritising MUltimedication in Multimorbidity in general practices
(PRIMUMpilot).
Muth C(1), Harder S(2), Uhlmann L(3), Rochon J(3), Fullerton B(1), Güthlin C(1),
Erler A(1), Beyer M(1), van den Akker M(4), Perera R(5), Knottnerus A(6),
Valderas JM(7), Gerlach FM(1), Haefeli WE(8).
Author information:
(1)Institute of General Practice, Johann Wolfgang Goethe University,
Frankfurt/Main, Germany.
(2)Institute for Clinical Pharmacology, Johann Wolfgang Goethe University
Hospital, Frankfurt/Main, Germany.
(3)Institute of Medical Biometry and Informatics, University of Heidelberg,
(4)Institute of General Practice, Johann Wolfgang Goethe University,
Frankfurt/Main, Germany Department of Family Medicine, School CAPHRI, Maastricht
University, Maastricht, The Netherlands Department of General Practice, KU
Leuven, Leuven, Belgium.
(5)Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
(6)Department of Family Medicine, School CAPHRI, Maastricht University,
Maastricht, The Netherlands.
(7)Health Services & Policy Research Group, School of Medicine, University of
Exeter, Exeter, UK.
(8)Department of Clinical Pharmacology and Pharmacoepidemiology, University of
Heidelberg, Heidelberg, Germany.
OBJECTIVE: To improve medication appropriateness and adherence in elderly

patients with multimorbidity, we developed a complex intervention involving
general practitioners (GPs) and their healthcare assistants (HCA). In accordance
with the Medical Research Council guidance on developing and evaluating complex
interventions, we prepared for the main study by testing the feasibility of the
intervention and study design in a cluster randomised pilot study.
SETTING: 20 general practices in Hesse, Germany.
PARTICIPANTS: 100 cognitively intact patients ≥65 years with ≥3 chronic
conditions, ≥5 chronic prescriptions and capable of participating in telephone
interviews; 94 patients completed the study.
INTERVENTION: The HCA conducted a checklist-based interview with patients on
medication-related problems and reconciled their medications. Assisted by a
computerised decision-support system (CDSS), the GPs discussed medication intake
with patients and adjusted their medication regimens. The control group continued
with usual care.
OUTCOME MEASURES: Feasibility of the intervention and required time were assessed
for GPs, HCAs and patients using mixed methods (questionnaires, interviews and
case vignettes after completion of the study). The feasibility of the study was
assessed concerning success of achieving recruitment targets, balancing cluster
sizes and minimising drop-out rates. Exploratory outcomes included the medication
appropriateness index (MAI), quality of life, functional status and
adherence-related measures. MAI was evaluated blinded to group assignment, and
intra-rater/inter-rater reliability was assessed for a subsample of
prescriptions.
RESULTS: 10 practices were randomised and analysed per group. GPs/HCAs were
satisfied with the interventions despite the time required (35/45 min/patient).
In case vignettes, GPs/HCAs needed help using the CDSS. The study made no
patients feel uneasy. Intra-rater/inter-rater reliability for MAI was excellent.
Inclusion criteria were challenging and potentially inadequate, and should
therefore be adjusted. Outcome measures on pain, functionality and self-reported
adherence were unfeasible due to frequent missing values, an incorrect manual or
potentially invalid results.
CONCLUSIONS: Intervention and trial design were feasible. The pilot study
revealed important limitations that influenced the design and conduct of the main
study, thus highlighting the value of piloting complex interventions.
TRIAL REGISTRATION NUMBER: ISRCTN99691973; Results.
DOI: 10.1136/bmjopen-2016-011613
PMCID: PMC4964238
1867. BMC Fam Pract. 2015 Jul 22;16:84. doi: 10.1186/s12875-015-0305-y.
Effect evaluation of an interprofessional medication therapy management approach

for multimorbid patients in primary care: a cluster-randomized controlled trial
in community care (WestGem study protocol).
Rose O(1)(2), Schaffert C(3), Czarnecki K(4), Mennemann HS(5), Waltering I(6),
Hamacher S(7), Felsch M(8), Herich L(9), Köberlein J(10).
Author information:
(1)Department of Clinical Pharmacy, University of Bonn, An der Immenburg 4,
53121, Bonn, Germany. rose@elefantenapo.de.
(2)Elefanten-Apotheke gegr 1575, Steinstr. 14, 48565, Steinfurt, Germany.
rose@elefantenapo.de.
(3)Centre of Health Care Management and Public Health, Schumpeter School of
Business and Economics, University of Wuppertal, Wuppertal, Germany.
Schaffert@wiwi.uni-wuppertal.de.
CzarneckiK@wiwi.uni-wuppertal.de.
(5)Muenster University of Applied Science, Robert-Koch-Str. 30, 48149, Muenster,
Germany. h.mennemann@fh-muenster.de.
(6)Department of Pharmacy, University of Muenster, Corrensstr. 48, 48149,
Muenster, Germany. waltering@pharmd.de.
(7)Institute of Medical Statistics, Informatics and Epidemiology, University of
Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
stefanie.hamacher@uni-koeln.de.
Cologne, Kerpener Str. 62, 50937, Cologne, Germany. moritz.felsch@uni-koeln.de.
Cologne, Kerpener Str. 62, 50937, Cologne, Germany. lena.herich@uni-koeln.de.
koeberlein@wiwi.uni-wuppertal.de.
BACKGROUND: Pharmaceutical practice worldwide is developing towards patient care.

Medication Review (MR) and Medication Therapy Management (MTM) are evolving as
the most prominent services in pharmaceutical care and have a strong potential to
provide a large benefit for patients and society. MTMs can only be performed in
an interprofessional, collaborative setting. Several international studies have
explored the effects of a MTM on the quality of therapy and costs. For Germany
the data is still deficient. This study aims to provide data on the effects of an
interprofessional MTM regarding quality of therapy, quality of life, costs and
cost-effectiveness.
METHOD/DESIGN: The study is designed as a cluster-randomized controlled trial in
primary care, involving 12 outpatient clinics (clusters) and 165 patients.
Primary care units are allocated to interventions using a Stepped Wedge Design.
All units are initially assigned to the control group. After a 6 month
observation period, general practitioners (GP) are randomly allocated to one of
three groups and the interprofessional medication therapy management approach is
implemented sequentially per each group with a lag of 3 months between. The
primary outcome is the change in the quality of therapy measured by the MAI
(Medication Appropriateness Index). Secondary outcomes include changes in the
number of drug related problems, medication complexity, changes in
drug-adherence, changes in health-status and function, quality of life, direct
costs and the incremental cost-effectiveness ratio. The acceptance of the
interprofessional Medication Therapy Management approach is assessed by
qualitative methods.
DISCUSSION: The patient interview and brown bag review are activities, typically
provided by the pharmacist. In this trial the patient is blinded to the
pharmacist. The strength of having the patient blinded to the pharmacists is to
exclude skepticism of the patient toward unknown pharmacies, which might be a
major confounder in a regional and community setting. A weakness is that some
patient related data might reach the pharmacists in a way, which might differ
from self-acquired data.
TRIAL REGISTRATION: Current controlled trials ISRCTN41595373 .
DOI: 10.1186/s12875-015-0305-y
PMCID: PMC4508809
1868. Bull Emerg Trauma. 2019 Apr;7(2):99-104. doi: 10.29252/beat-070202..
Size Estimation of Under-Reported Suicides and Suicide Attempts Using Network

Scale up Method.
Moradinazar M(1)(2), Najafi F(1), Baneshi MR(2), Haghdoost AA(2).
Author information:
(1)Research Center for Environmental Determinants of Health (ECEDH), Public
Health School, Kermanshah University of Medical Sciences, Kermanshah, Iran.
(2)Modeling in Health Research Center, Institute for Future Studies in Health,
Kerman University of Medical Science, Kerman, Iran.
Objective: To estimate (under reporting) UR of SDS (Suicide deaths) and SAS

(suicide attempts) in Kermanshah Province which is among provinces with high
suicide rate in Iran.
Methods: For estimating the size of UR suicide death registers, all cases of SAS
and suicide deaths were retrieved from forensic medicine and health centers.
Then, using network scale up method, a sample of 500 cases, aged 18 to 65 years,
were randomly selected from the general population on the basis of age - sex
proportion. To find the 95% confidence interval, bootstrap technique was used.
Results: The average coverage of SDS was 58.4%, the lowest and highest coverage
rate of SDS were attributed to self-immolation (34.2%) and hanging (81.2%),
respectively. The coverage rate of SAS for self-immolation and deliberate
self-poisoning were 82.4% and 77.2%, respectively. Size estimation of SAS by NSU
method revealed that deliberate self-poisoning with medication (61.7%), poisoning
with toxins and chemicals (20.6%), and self-immolation (7.7%) were the most
frequent methods of SAS.
Conclusion: Given the low coverage of suicide registers, all causes of death,
especially deaths classified as accident or deaths with undetermined category,
are required to be accurately registered. Investigations of causes of death,
correction of wrong codes, as well as interviews with survivors to give them
assurance can reduce the rate of suicide denial and result in increased accuracy
of death register coverage.
DOI: 10.29252/beat-070202.
PMCID: PMC6555204
PMID: 31198796
Conflict of interest statement: Authors have no conflicting interests to

disclose.
1869. Front Public Health. 2017 Oct 3;5:256. doi: 10.3389/fpubh.2017.00256.

eCollection
2017.
Clinic-Based Mobile Health Decision Support to Enhance Adult Epilepsy

Self-Management: An Intervention Mapping Approach.
Shegog R(1), Begley CE(1).

Author information:
(1)School of Public Health, University of Texas Health Science Center, Houston,
TX, United States.
INTRODUCTION: Epilepsy is a neurological disorder involving recurrent seizures.

It affects approximately 5 million people in the U.S. To optimize their quality
of life people with epilepsy are encouraged to engage in self-management (S-M)
behaviors. These include managing their treatment (e.g., adhering to anti-seizure
medication and clinical visit schedules), managing their seizures (e.g.,
responding to seizure episodes), managing their safety (e.g., monitoring and
avoiding environmental seizure triggers), and managing their co-morbid conditions
(e.g., anxiety, depression). The clinic-based Management Information Decision
Support Epilepsy Tool (MINDSET) is a decision-support system founded on theory
and empirical evidence. It is designed to increase awareness by adult patients
(≥18 years) and their health-care provider regarding the patient's epilepsy S-M
behaviors, facilitate communication during the clinic visit to prioritize S-M
goals and strategies commensurate with the patient's needs, and increase the
patient's self-efficacy to achieve those goals.
METHODS: The purpose of this paper is to describe the application of intervention
mapping (IM) to develop, implement, and formatively evaluate the clinic-based
MINDSET prototype and in developing implementation and evaluation plans.
Deliverables comprised a logic model of the problem (IM Step 1); matrices of
program objectives (IM Step 2); a program planning document comprising scope,
sequence, theory-based methods, and practical strategies (IM Step 3); a
functional MINDSET program prototype (IM Step 4); plans for implementation (IM
Step 5); and evaluation (IM Step 6). IM provided a logical and systematic
approach to developing and evaluating clinic-based decision support toward
epilepsy S-M.
DOI: 10.3389/fpubh.2017.00256
PMCID: PMC5632356
PMID: 29043247
1870. JMIR Res Protoc. 2017 Apr 20;6(4):e62. doi: 10.2196/resprot.6198.
Mobile Application to Promote Adherence to Oral Chemotherapy and Symptom

Management: A Protocol for Design and Development.
Fishbein JN(1), Nisotel LE(2), MacDonald JJ(3), Amoyal Pensak N(4), Jacobs
JM(5)(6), Flanagan C(7)(8), Jethwani K(7)(9), Greer JA(5)(6).
Author information:
(1)Department of Psychology and Neuroscience, University of Colorado Boulder,
Boulder, CO, United States.
(2)Department of Epidemiology, Harvard TH Chan School of Public Health, Boston,
MA, United States.
(3)Department of Psychology, University of California, Los Angeles, Los Angeles,
CA, United States.
(4)Anschutz Medical Campus, Department of Medicine, University of Colorado
Denver, Denver, CO, United States.
(5)Center for Psychiatric Oncology and Behavioral Sciences, Massachusetts General
Hospital and Harvard Medical School, Boston, MA, United States.
(6)Department of Psychiatry, Massachusetts General Hospital and Harvard Medical
School, Boston, MA, United States.
(7)Partners Connected Health, Partners HealthCare, Boston, MA, United States.
(8)Department of Global Health and Population, Harvard TH Chan School of Public
Health, Boston, MA, United States.
(9)Department of Dermatology, Massachusetts General Hospital and Harvard Medical
School, Boston, MA, United States.
BACKGROUND: Oral chemotherapy is increasingly used in place of traditional

intravenous chemotherapy to treat patients with cancer. While oral chemotherapy
includes benefits such as ease of administration, convenience, and minimization
of invasive infusions, patients receive less oversight, support, and symptom
monitoring from clinicians. Additionally, adherence is a well-documented
challenge for patients with cancer prescribed oral chemotherapy regimens. With
the ever-growing presence of smartphones and potential for efficacious behavioral
intervention technology, we created a mobile health intervention for medication
and symptom management.
OBJECTIVE: The objective of this study was to develop and evaluate the usability
and acceptability of a smartphone app to support adherence to oral chemotherapy
and symptom management in patients with cancer.
METHODS: We used a 5-step development model to create a comprehensive mobile app
with theoretically informed content. The research and technical development team
worked together to develop and iteratively test the app. In addition to the
research team, key stakeholders including patients and family members, oncology
clinicians, health care representatives, and practice administrators contributed
to the content refinement of the intervention. Patient and family members also
participated in alpha and beta testing of the final prototype to assess usability
and acceptability before we began the randomized controlled trial.
RESULTS: We incorporated app components based on the stakeholder feedback we
received in focus groups and alpha and beta testing. App components included
medication reminders, self-reporting of medication adherence and symptoms, an
education library including nutritional information, Fitbit integration, social
networking resources, and individually tailored symptom management feedback. We
are conducting a randomized controlled trial to determine the effectiveness of
the app in improving adherence to oral chemotherapy, quality of life, and burden
of symptoms and side effects. At every stage in this trial, we are engaging
stakeholders to solicit feedback on our progress and next steps.
CONCLUSIONS: To our knowledge, we are the first to describe the development of an
app designed for people taking oral chemotherapy. The app addresses many concerns
with oral chemotherapy, such as medication adherence and symptom management.
Soliciting feedback from stakeholders with broad perspectives and expertise
ensured that the app was acceptable and potentially beneficial for patients,
caregivers, and clinicians. In our development process, we instantiated 7 of the
8 best practices proposed in a recent review of mobile health app development.
Our process demonstrated the importance of effective communication between
research groups and technical teams, as well as meticulous planning of technical
specifications before development begins. Future efforts should consider
incorporating other proven strategies in software, such as gamification, to
bolster the impact of mobile health apps. Forthcoming results from our randomized
controlled trial will provide key data on the effectiveness of this app in
improving medication adherence and symptom management.
http://www.webcitation.org/6prj3xfKA).
©Joel Nathan Fishbein, Lauren Ellen Nisotel, James John MacDonald, Nicole Amoyal
Pensak, Jamie Michele Jacobs, Clare Flanagan, Kamal Jethwani, Joseph Andrew
Greer. Originally published in JMIR Research Protocols
PMCID: PMC5418526
PMID: 28428158
1871. Drug Saf. 2019 Jan;42(1):1-12. doi: 10.1007/s40264-018-0722-7.
Aim and Design of pREGnant, the Dutch Pregnancy Drug Register.
Vorstenbosch S(1), Te Winkel B(2), van Gelder MMHJ(3)(4), Kant A(2), Roeleveld
N(3), van Puijenbroek E(2)(5).
Author information:
(1)Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH,
's-Hertogenbosch, The Netherlands. s.vorstenbosch@lareb.nl.
(2)Netherlands Pharmacovigilance Centre Lareb, Goudsbloemvallei 7, 5237 MH,
's-Hertogenbosch, The Netherlands.
(3)Department for Health Evidence, Radboud Institute for Health Sciences, Radboud
University Medical Center, Nijmegen, The Netherlands.
(4)Radboud REshape Innovation Center, Radboud University Medical Center,
Nijmegen, The Netherlands.
(5)PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of
Pharmacy, University of Groningen, Groningen, The Netherlands.
Information on the safety of medication use during pregnancy and breastfeeding is

scarce, yet use of medication among pregnant and breastfeeding women is
widespread. The pREGnant, the Dutch Pregnancy Drug Register, was set up to obtain
insight into medication use among pregnant and breastfeeding women and potential
effects on maternal and fetal/infant health. The systematically documented, good
quality data on medication use during pregnancy and lactation in pREGnant will be
used in signal detection, epidemiologic studies and counseling of healthcare
providers and patients. The register has a prospective cohort design. The
population is derived from pregnant women throughout the Netherlands. Data
collection started in April 2014 and enrollment of women is continuous and is
characterized by a relative high proportion of women born in the Netherlands with
a high education compared with the general Dutch pregnant population. Data on
current pregnancy, obstetric history, maternal lifestyle, health and medication
use, delivery, and infant health are collected through web-based questionnaires
completed by the participating women (three times during pregnancy and three
times during the infant's first year of life). If permission is given, the
self-reported data can be complemented with information retrieved from Perined,
the perinatal registry of the Netherlands, and from obstetric and medical
records, and/or pharmacy records. Here, we provide detailed information on the
design of the pREGnant, the Dutch Pregnancy Drug Register, as well as descriptive
information on characteristics of the participants so far. Currently, steps are
being taken to implement the register on a large scale in the Netherlands.
DOI: 10.1007/s40264-018-0722-7
PMCID: PMC6373399
1872. Balkan Med J. 2017 Dec 1;34(6):540-545. doi: 10.4274/balkanmedj.2016.1461.
Adherence to Nucleoside/Nucleotide Analogue Treatment in Patients with Chronic

Hepatitis B.
Tütüncü EE(1), Güner R(2), Gürbüz Y(1), Kaya Kalem A(3), Öztürk B(1), Hasanoğlu
İ(3), Şencan İ(1), Taşyaran MA(2).
Author information:
(1)Department of Infectious Diseases and Clinical Microbiology, University of
Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara,
Turkey.
(2)Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım
Beyazıt University School of Medicine, Ankara, Turkey.
(3)Clinic of Infectious Diseases and Clinical Microbiology, Ankara Atatürk
Training and Research Hospital, Ankara, Turkey.
BACKGROUND: Adherence to medication is an important aspect of preventing drug

resistance and treatment failure in patients receiving nucleos(t)ide analogues
for chronic hepatitis B.
AIMS: To assess adherence to nucleoside/nucleotide analogues in chronic hepatitis
B treatment and to determine factors associated with non-adherence.
STUDY DESIGN: Cross-sectional study.
METHODS: The study enrolled 85 chronic hepatitis B patients who had been
receiving nucleoside/nucleotide analogues for ≥3 months. A questionnaire was
completed by patients themselves, and adherence was evaluated based on patients'
self-reporting. The use of at least 95% of the drugs in the previous month was
considered as adequate adherence.
RESULTS: Adherence was adequate in 82.4% of patients. Female gender (p=0.003),
unemployment (p=0.041) and lower monthly family income (p=0.001) were related to
lower adherence. Better adherence was significantly linked to adequate basic
knowledge regarding chronic hepatitis B (p=0.049), longer treatment duration than
12 months (p<0.001), previous use of other medications for chronic hepatitis B
(p=0.014) and regular follow-up by the same physician (p<0.001).
CONCLUSION: Counselling patients about their disease state and the consequences
of non-adherence is an important intervention for enhancing adherence. Naïve
patients should be followed up more frequently to reinforce adherence.
DOI: 10.4274/balkanmedj.2016.1461
PMCID: PMC5785659

eCollection 2016.
Psychometric properties of the Polish version of the eight-item Morisky

Medication Adherence Scale in hypertensive adults.
Jankowska-Polanska B(1), Uchmanowicz I(1), Chudiak A(1), Dudek K(2), Morisky

DE(3), Szymanska-Chabowska A(4).
Author information:
(1)Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical
(2)Department of Logistic and Transport Systems, Faculty of Mechanical
Engineering, Wroclaw University of Technology, Wroclaw, Poland.
(4)Department of Internal Medicine, Occupational Diseases and Hypertension,
Wroclaw Medical University, Wroclaw, Poland.
Low adherence to pharmacological treatment is often associated with poor blood

pressure control, but identification of nonadherent patients in outpatient
settings is difficult. The aim of the study was to translate and evaluate the
psychometric properties of the Polish version of the structured self-report
eight-item Morisky Medication Adherence Scale (MMAS-8) among patients with
hypertension. The study was conducted in a family doctor practice between January
and July 2015. After a standard "forward-backward" procedure to translate MMAS-8
into Polish, the questionnaire was administered to 160 patients with
hypertension. Reliability was tested using a measure of internal consistency
(Cronbach's α) and test-retest reliability. Validity was confirmed using known
group validity. Three levels of adherence were considered based on the following
scores: 0 to <6 (low); 6 to <8 (medium); and 8 (high). Complete questionnaires
were returned by 110 respondents (mean age: 60.7 years ±12.6; 54.6% were female).
The mean number of pills taken daily was 3.61±4.31. The mean adherence score was
6.42± 2.0. Moderate internal consistency was found (Cronbach's α=0.81), and
test-retest reliability was satisfactory (r=0.461-0.905; P<0.001).
Reproducibility expressed by Cohen's κ coefficient =0.61 was good. In
high-adherent patients, the percentage of well-controlled blood pressure was
higher than in low-adherent patients (33.3% vs 19.1%, χ (2)=0.87, P=0.648).
Psychometric evaluation of the Polish version of the MMAS-8 indicates that it is
a reliable and valid measure tool to detect nonadherent patients. The MMAS-8 may
be routinely used to support communication about the medication-taking behavior
in hypertensive patients.
DOI: 10.2147/PPA.S101904
PMCID: PMC5026177
PMID: 27672314
1874. BMC Geriatr. 2014 Nov 18;14:116. doi: 10.1186/1471-2318-14-116.
Opti-Med: the effectiveness of optimised clinical medication reviews in older

people with 'geriatric giants' in general practice; study protocol of a cluster
Willeboordse F(1), Hugtenburg JG, van Dijk L, Bosmans JE, de Vries OJ, Schellevis
FG, Elders PJ.
Author information:
(1)NIVEL, Netherlands Institute for Health Services Research, Po, Box 1568, 3500
BN, Utrecht, The Netherlands. f.willeboordse@vumc.nl.
BACKGROUND: Inappropriate drug use has been identified as one of the most
important problems affecting the quality of care in older people. Inappropriate
drug use may increase the risk of the occurrence of 'geriatric giants' such as
immobility, instability, incontinence and cognitive impairment. There are
indications that clinical medication reviews (CMR) can reduce inappropriate drug
use. However, CMRs have not yet been implemented at a large scale in primary
care. An innovative medication review program in primary care will be developed
which tackles the most important obstacles for a large scale implementation of
CMRs. The aim of this study is to assess whether this CMR program is (cost-)
effective compared with usual general practice care for older patients with
geriatric symptoms with regard to quality of life and geriatric symptoms.
METHODS: A cluster randomised controlled trial will be performed in 20 Dutch
general practices including 500 patients. Patients of 65 years and older are
eligible if they newly present with pre-specified geriatric symptoms in general
practice and chronic use of at least one prescribed drug. GP practices will be
stratified by practice size and randomly allocated to control (n = 10) or
intervention group (n = 10). The intervention consists of CMRs which will be
facilitated and prepared by an expert team consisting of a GP and a pharmacist.
Primary outcome measures are patient's quality of life and the presence of
self-reported geriatric symptoms during a follow-up period of 6 months. Secondary
outcomes are costs of healthcare utilisation, feasibility, number of drug related
problems, medication adherence and satisfaction with medication.
DISCUSSION: This study is expected to add evidence on the (cost-) effectiveness
of an optimally facilitated, prepared and structured CMR in comparison with usual
care in older patients who present a geriatric symptom to their GP. The strength
of this study is that it will be conducted in daily clinical practice. This
improves the possibilities to implement the CMRs in the primary care setting on a
large scale.
TRIAL REGISTRATION: Netherlands Trial register: NTR4264.
DOI: 10.1186/1471-2318-14-116
PMCID: PMC4240827
1875. J Clin Psychopharmacol. 2015 Feb;35(1):63-7. doi:

10.1097/JCP.0000000000000232.
Rates of psychotropic medication use reported by borderline patients and axis II

comparison subjects over 16 years of prospective follow-up.
Zanarini MC(1), Frankenburg FR, Bradford Reich D, Harned AL, Fitzmaurice GM.
Author information:
(1)From the *Department of Psychiatry, McLean Hospital, Belmont; †Department of
Psychiatry, Harvard Medical School; and ‡Department of Psychiatry, Boston
University School of Medicine, Boston, MA.
The purpose of this study was to assess the classes and types of psychotropic
medication reported by borderline patients and axis II comparison subjects over
16 years of prospective follow-up. Medication use was assessed at baseline using
a semistructured interview of proven reliability and validity as well as its
follow-up analog at 8 contiguous 2-year follow-up periods. A significantly higher
percentage of borderline patients than axis II comparison subjects reported
taking an antidepressant, an anxiolytic, an antipsychotic, and a mood stabilizer
over time. They also reported more commonly taking 7 of the 10 more specific
types of medication studied (ie, all but tricyclic antidepressants, monoamine
oxidase inhibitor antidepressants, and atypical antipsychotics). The rates over
time of taking antipsychotics and mood stabilizers were stable, whereas there was
a significant decline in the rates of antidepressants and anxiolytics from
baseline to 8-year follow-up (but not from 8- to 16-year follow-up) reported by
those in both study groups. In terms of specific medications, rates of atypical
antidepressants and anticonvulsants were the most stable. In contrast,
nonbenzodiazepine anxiolytics declined the most steadily over time, whereas rates
of atypical antipsychotics increased significantly over the 16 years of
prospective follow-up. Taken together, the results of this study suggest that a
substantial percentage of borderline patients continue to use the major classes
of medication over time. They also suggest that the declining rates of use tend
to stabilize less than a decade after index admission.
DOI: 10.1097/JCP.0000000000000232
PMCID: PMC4276426
1876. Int J Geriatr Psychiatry. 2015 Jun;30(6):580-6. doi: 10.1002/gps.4187. Epub

2014
Aug 12.
Older adults recently started on psychotropic medication: where are the symptoms?
Maust DT(1), Chen SH, Benson A, Mavandadi S, Streim JE, DiFilippo S, Snedden TM,
Oslin DW.
Author information:
(1)Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Center
for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI,
USA.
OBJECTIVE: The objective of this study is to understand the characteristics of

older adults on newly prescribed psychotropic medication with minimal psychiatric
symptoms.
METHODS: Naturalistic cohort study of non-institutionalized older adults in
Pennsylvania participating in the Pharmaceutical Assistance Contract for the
Elderly. Persons newly prescribed antidepressant or anxiolytic monotherapy or
combination therapy were contacted for clinical assessment by a telephone-based
behavioral health service. The initial assessment included standardized mental
health screening instruments and scales including the Blessed
Orientation-Memory-Concentration test, Patient Health Questionnaire-9,
Generalized Anxiety Disorder-7, and Medical Outcomes Survey (SF-12). In addition,
patients were asked for their understanding of the prescription indication.
RESULTS: Of the 254 participants who met minimal symptom criteria (Patient Health
Questionnaire-9 < 5 and Generalized Anxiety Disorder-7 < 5), women comprised
slightly more of the anxiolytic compared with antidepressant monotherapy group
(88.9% vs. 76.7%, p = 0.04). The most common self-reported reason for
prescription of an antidepressant or anxiolytic was depression or anxiety,
respectively, despite near-absence of these symptoms on clinical assessment.
Comparing monotherapy to combination therapy groups, those with combination
therapy were more likely to report a history of depression (12.6% vs. 1.8%, p <
0.001) and also report depression as the reason for the prescription (40.2% vs.
21.0%, p < 0.01).
CONCLUSIONS: In this sample of older adults on new psychotropic medication with
minimal psychiatric symptoms, there are few patient characteristics that
distinguish those on antidepressant versus anxiolytic monotherapy or those on
monotherapy versus combination therapy. While quality of care in late-life mental
health has focused on improving detection and treatment, there should be further
attention to low-symptom patients potentially receiving inappropriate
pharmacotherapy.
DOI: 10.1002/gps.4187
1877. Spinal Cord Ser Cases. 2017 Nov 30;3:17083. doi: 10.1038/s41394-017-0032-9.
eCollection 2017.
Neuropathic pain in a rehabilitation setting after spinal cord injury: an

interpretative phenomenological analysis of inpatients' experiences.
Hearn JH(1), Finlay KA(2), Fine PA(2), Cotter I(3).
Author information:
(1)1The University of Buckingham Medical School, Hunter Street, Buckingham, MK18
1EG UK.
(2)2The Department of Psychology, The University of Buckingham, Hunter Street,
Buckingham, MK18 1EG UK.
(3)3The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury,
HP21 8AL UK.
Study design: Qualitative, semi-structured interviews.

Objectives: Neuropathic pain (NP) can be psychologically and physically
debilitating, and is present in approximately half of the spinal cord injured
(SCI) population. However, under half of those with NP are adherent to pain
medication. Understanding the impact of NP during rehabilitation is required to
reduce long-term impact and to promote adherence to medication and
psychoeducation recommendations.
Setting: United Kingdom.
Methods: Five males and three females with SCI and chronic NP, resident in
rehabilitation wards at a specialist SCI center in the United Kingdom, took part.
Semi-structured interviews were conducted with participants less than 15 months
post-SCI (mean = 8.4 months). Verbatim transcripts were subject to interpretative
phenomenological analysis (IPA).
Results: Three super-ordinate themes were identified, mediating pain and
adherence: (1) the dichotomy of safety perceptions; (2) adherence despite
adversity; and (3) fighting the future. Analyses suggest that experience of the
rehabilitation setting and responsiveness of care shapes early distress.
Attitudes to medication and psychosocial adjustment are relevant to developing
expectations about pain management.
Conclusions: Enhancing self-efficacy, feelings of safety in hospital, and
encouraging the adoption of adaptive coping strategies may enhance psychosocial
and pain-related outcomes, and improve adherence to medication. Encouraging
adaptive responses to, and interpretation of, pain, through the use of
interventions such as coping effectiveness training, targeted cognitive
behavioral pain management, and acceptance-based interventions such as
mindfulness, is recommended in order to reduce long-term reliance on medication.
DOI: 10.1038/s41394-017-0032-9
PMCID: PMC5798930
PMID: 29423289
Conflict of interest statement: Compliance with ethical standardsThe authors

declare that they have no competing interests.
Quality of prescribing of antipsychotic medication for people with intellectual

disability under the care of UK mental health services: a cross-sectional audit
of clinical practice.
Paton C(1), Bhatti S(2), Purandare K(3), Roy A(4), Barnes T(5).
Author information:
(1)Oxleas NHS Foundation Trust, Dartford, UK.
(2)Royal College of Psychiatrists Centre for Quality Improvement, London, UK.
(3)Central and North East London Foundation Trust, London, UK.
(4)Coventry and Warwickshire Partnership Trust, Coventry, UK.
(5)Imperial College, London, UK.
OBJECTIVES: To determine the prevalence and quality of antipsychotic prescribing

for people with intellectual disability (ID).
DESIGN: A clinical audit of prescribing practice in the context of a quality
improvement programme. Practice standards for audit were derived from relevant,
evidence-based guidelines, including NICE. Data were mainly collected from the
clinical records, but to determine the clinical rationale for using antipsychotic
medication in individual cases, prescribers could also be directly questioned.
SETTINGS: 54 mental health services in the UK, which were predominantly NHS
Trusts.
PARTICIPANTS: Information on prescribing was collected for 5654 people with ID.
RESULTS: Almost two-thirds (64%) of the total sample was prescribed antipsychotic
medication, of whom almost half (49%) had a schizophrenia spectrum or affective
disorder diagnosis, while a further third (36%) exhibited behaviours recognised
by NICE as potentially legitimate targets for such treatment such as violence,
aggression or self-injury. With respect to screening for potential side effects
within the past year, 41% had a documented measure of body weight (range across
participating services 18-100%), 32% blood pressure (0-100%) and 37% blood
glucose and blood lipids (0-100%).
CONCLUSIONS: These data from mental health services across the UK suggest that
antipsychotic medications are not widely used outside of licensed and/or
evidence-based indications in people with ID. However, screening for side effects
in those patients on continuing antipsychotic medication was inconsistent across
the participating services and the possibility that a small number of these
services failed to meet basic standards of care cannot be excluded.
DOI: 10.1136/bmjopen-2016-013116
PMCID: PMC5168692
Conflict of interest statement: CP has participated in a neurosciences advisory

board in relation to neurodegenerative diseases for Eli Lilly. TREB has acted as
a member of scientific advisory boards for Sunovion and Otsuka/Lundbeck in
relation to antipsychotic medication.

eCollection 2016.
The interactive web-based program MSmonitor for self-management and

multidisciplinary care in multiple sclerosis: utilization and valuation by
patients.
Jongen PJ(1), Sinnige LG(2), van Geel BM(3), Verheul F(4), Verhagen WI(5), van
der Kruijk RA(6), Haverkamp R(7), Schrijver HM(8), Baart JC(9), Visser LH(10),
Arnoldus EP(11), Gilhuis HJ(12), Pop P(13), Booy M(14), Heerings M(15), Kool
A(16), van Noort E(16).
Author information:
(1)Department of Community and Occupational Medicine, University Medical Center
Groningen, University of Groningen, Groningen, the Netherlands; MS4 Research
Institute, Nijmegen, the Netherlands.
(2)Multiple Sclerosis Centre Leeuwarden, Medical Centre Leeuwarden, Leeuwarden,
the Netherlands.
(3)Department of Neurology, Medical Centre Alkmaar, Alkmaar, the Netherlands.
(4)Department of Neurology, Groene Hart Hospital, Gouda, the Netherlands.
(5)Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, the
Netherlands.
(6)Department of Neurology, Slingeland Hospital, Doetinchem, the Netherlands.
(7)Department of Neurology, Zuwe Hofpoort Hospital, Woerden, the Netherlands.
(8)Multiple Sclerosis Centre, Westfries Gasthuis, Hoorn, the Netherlands.
(9)Department of Neurology, Ziekenhuisgroep Twente, Almelo-Hengelo, the
Netherlands.
(10)Multiple Sclerosis Centre Midden Brabant, St Elisabeth Hospital, Tilburg, the
Netherlands.
(11)Multiple Sclerosis Centre Midden Brabant, Tweesteden Hospital, Delft, the
Netherlands.
(12)Department of Neurology, Reinier de Graaf Gasthuis, Delft, the Netherlands.
(13)Department of Neurology, Viecuri Medical Centre, Venlo-Venray, the
Netherlands.
(14)Multiple Sclerosis Centre, Amphia Hospital, Breda, the Netherlands.
(15)MH Advies en organisatiebureau, Assen, the Netherlands.
(16)Curavista bv, Geertruidenberg, the Netherlands.
BACKGROUND: MSmonitor is an interactive web-based program for self-management and

integrated, multidisciplinary care in multiple sclerosis.
METHODS: To assess the utilization and valuation by persons with multiple
sclerosis, we held an online survey among those who had used the program for at
least 1 year. We evaluated the utilization and meaningfulness of the program's
elements, perceived use of data by neurologists and nurses, and appreciation of
care, self-management, and satisfaction.
RESULTS: Fifty-five persons completed the questionnaire (estimated response rate
40%). The Multiple Sclerosis Impact Profile (MSIP), Medication and Adherence
Inventory, Activities Diary, and electronic consultation (e-consult) were used by
40%, 55%, 47%, and 44% of respondents and were considered meaningful by 83%, 81%,
54%, and 88%, respectively. During out-patient consultations, nurses reportedly
used the MSmonitor data three to six times more frequently than neurologists. As
to nursing care, more symptoms were dealt with (according to 54% of respondents),
symptoms were better discussed (69%), and the overall quality of care had
improved (60%) since the use of the program. As to neurological care, these
figures were 24%, 31%, and 27%, respectively. In 46% of the respondents, the
insight into their symptoms and disabilities had increased since the use of the
program; the MSIP, Activities Diary, and e-consult had contributed most to this
improvement. The overall satisfaction with the program was 3.5 out of 5, and 73%
of the respondents would recommend the program to other persons with multiple
sclerosis.
CONCLUSION: A survey among persons with multiple sclerosis using the MSmonitor
program showed that the MSIP, Medication and Adherence Inventory, Activities
Diary, and e-consult were frequently used and that the MSIP, Medication and
Adherence Inventory, and e-consult were appreciated the most. Moreover, the
quality of nursing care, but not so neurological care, had improved, which may
relate to nurses making more frequent use of the MSmonitor data than
neurologists.
DOI: 10.2147/PPA.S93786
PMCID: PMC4780403
PMID: 27042018

eCollection 2017.
Medication-related factors associated with health-related quality of life in

patients older than 65 years with polypharmacy.
Montiel-Luque A(1), Núñez-Montenegro AJ(2), Martín-Aurioles E(3), Canca-Sánchez

JC(4), Toro-Toro MC(5), González-Correa JA(6); Polipresact Research Group.
Author information:
(1)San Miguel Health Center, Costa del Sol Primary Healthcare District,
Andalusian Health Service, Málaga, Spain.
(2)North Málaga Health Area, Andalusian Health Service, Málaga, Spain.
(3)La Roca Health Center, Málaga-Guadalhorce Primary Healthcare District,
Andalusian Health Service, Málaga, Spain.
(4)Costa del Sol Health Agency, Andalusian Health Service, Marbella (Málaga),
Spain.
(5)Campillo Health Center, North Málaga Health Area, Andalusian Health Service,
Málaga, Spain.
(6)Department of Pharmacology, Biomedical Research Institute of Málaga.
University of Málaga, Málaga, Spain.
METHODS AND DESIGN: Objective: To describe the relationship between

medication-related factors and the health-related quality of life in patients
older than 65 years who use multiple medications (polypharmacy). Design:
Cross-sectional descriptive study. Setting: Primary care. Participants: Patients
older than 65 years who use multiple medications (n = 375). Measurements: The
main outcome measure was health-related quality of life according to the
EuroQol-5D instrument. Sociodemographic, clinical and medication-related
variables were recorded during home interviews.
RESULTS: Mean age was 74.72 ± 5.59 years, and 65.5% of our participants were
women. The global level of health-related quality of life according to the EQ-5D
visual analog scale was 59.25 ± 20.92. Of the five EuroQol dimensions,
anxiety/depression and pain were the most frequently reported, while mobility and
self-care were the dimensions with the greatest impact on self-reported quality
of life. Multivariate analysis indicated that functional independence was the
factor most strongly associated (β = 14.27 p < 0.001) with better health-related
quality of life, while illiteracy (β = -13.58 p < 0.001), depression (β = -10.13
p < 0.001), social risk (β = -7.23 p = 0.004) and using more than 10 medicines (β
= -4.85 p = 0.009) were strongly associated with a poorer health-related quality
of life.
CONCLUSIONS: Factors inherent within the patient such as functional incapacity,
cognitive impairment and social and emotional problems were the main constraints
to quality of life in our study population. The number of medicines taken was
negatively related with quality of life.
PMCID: PMC5293190

interests exist.
1881. Alcohol Clin Exp Res. 2018 Jul;42(7):1249-1259. doi: 10.1111/acer.13772. Epub
2018 Jun 9.
Opioid Misuse as a Predictor of Alcohol Treatment Outcomes in the COMBINE Study:

Mediation by Medication Adherence.
Witkiewitz K(1)(2), Votaw VR(1), Vowles KE(1), Kranzler HR(3).
Author information:
(1)Department of Psychology, University of New Mexico, Albuquerque, New Mexico.
(2)Center on Alcoholism, Substance Abuse, and Addictions, University of New
Mexico, Albuquerque, New Mexico.
(3)Center for Studies of Addiction, University of Pennsylvania Perelman School of
Medicine, Philadelphia, Pennsylvania.
BACKGROUND: Alcohol is often consumed with opioids and alcohol misuse interferes
with treatment for opioid use disorder (OUD). Drug misuse is associated with
worse alcohol use disorder (AUD) treatment outcomes, yet no studies have
investigated the role of opioid misuse in AUD treatment outcomes.
METHODS: We conducted secondary analyses of the medication conditions of the
COMBINE study (n = 1,226), a randomized clinical trial of medications
(acamprosate and/or naltrexone) and behavioral interventions (medication
management and/or behavioral intervention) for alcohol dependence. We examined
associations between baseline opioid misuse and the use of cannabis and other
drugs with time to first drinking day, time to first heavy drinking day, and the
frequency and intensity of drinking during treatment and 1 year following
treatment, based on latent profile analysis. Opioid misuse was defined as use of
illicit or prescription opioids without a prescription or not as directed in the
previous 6 months, in the absence of OUD. Self-reported cannabis and other drug
use were also examined. Seventy individuals (5.7%) met the opioid misuse
definition and 542 (44.2%) reported use of cannabis or other drugs without opioid
misuse. We also examined medication adherence as a potential mediator.
RESULTS: Baseline opioid misuse significantly predicted the time to first heavy
drinking day (OR = 1.38 [95% CI: 1.13, 1.64], p = 0.001) and a higher probability
of being in a heavier and more frequent drinking profile at the end of treatment
(OR = 2.90 [95% CI: 1.43, 5.90], p = 0.003), and at 1 year following treatment
(OR = 2.66 [95% CI: 1.26, 5.59], p = 0.01). Cannabis and other drug use also
predicted outcomes. Medication adherence partially mediated the association
between opioid misuse, cannabis use, other drug use, and treatment outcomes.
CONCLUSIONS: Opioid misuse and other drug use were associated with poorer AUD
treatment outcomes, which was partially mediated by medication adherence.
Clinicians and researchers should assess opioid misuse and other drug use in
patients undergoing AUD treatment.
DOI: 10.1111/acer.13772
PMCID: PMC6063524
PMID: 29873089
1882. J Pain Symptom Manage. 2015 Sep;50(3):381-6. doi:

The Quantitative Analgesic Questionnaire: A Tool to Capture Patient-Reported

Chronic Pain Medication Use.
Robinson-Papp J(1), George MC(2), Wongmek A(2), Nmashie A(2), Merlin JS(3), Ali
Y(4), Epstein L(5), Green M(2), Serban S(5), Sheth P(6), Simpson DM(2).
Author information:
(1)Department of Neurology, Icahn School of Medicine at Mount Sinai, New York,
New York, USA. Electronic address: jessica.robinson-papp@mssm.edu.
(2)Department of Neurology, Icahn School of Medicine at Mount Sinai, New York,
New York, USA.
(3)Department of Medicine, University of Alabama at Birmingham, Birmingham,
Alabama, USA.
(4)Department of Rheumatology, Icahn School of Medicine at Mount Sinai, New York,
New York, USA.
(5)Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New
York, New York, USA.
(6)Department of Rehabilitation Medicine, Icahn School of Medicine at Mount
Sinai, New York, New York, USA.
CONTEXT: The extent to which patients take chronic pain medications as prescribed
is not well studied, and there are no generally agreed-upon measures. The
Quantitative Analgesic Questionnaire (QAQ) is a new instrument designed to
comprehensively document patient-reported medication use, generate scores to
quantify it (by individual drug, class, and/or overall), and compare it
(qualitatively and/or quantitatively) to the regimen as prescribed.
OBJECTIVES: The aim of this study was to describe the development and preliminary
validation of the QAQ.
METHODS: The QAQ was studied in a convenience sample of 149 HIV-infected
participants.
RESULTS: We found that the QAQ scores computed for participants' chronic pain
medication regimens were valid based on their correlation with 1)
patient-reported pain intensity (r = 0.38; P < 0.001) and 2) experienced pain
management physicians' independent quantification of the regimens (r = 0.89;
P < 0.001). The QAQ also demonstrated high interrater reliability (r = 0.957;
P < 0.001). Detailed examination of the QAQ data in a subset of 34 participants
demonstrated that the QAQ revealed suboptimal adherence in 44% of participants
and contained information that would not have been gleaned from review of the
medical record alone in 94%, including use of over-the-counter medications and
quantification of "as needed" dosing. The QAQ also was found to be useful in
quantifying change in the medication regimen over time, capturing a change in 50%
of the participants from baseline to eight week follow-up.
CONCLUSION: The QAQ is a simple tool that can facilitate understanding of
patient-reported chronic pain medication regimens, including calculation of
percent adherence and generation of quantitative scores suitable for estimating
and tracking change in medication use over time.

PMCID: PMC4550505
1883. J Investig Allergol Clin Immunol. 2019;29(2):112-117. doi:

10.18176/jiaci.0287.
Epub 2018 Jun 29.
Prevalence of Drugs as Triggers of Exacerbations in Chronic Urticaria.
Sánchez J(1)(2), Sánchez A(1)(2)(3), Cardona R(1)(2).
Author information:
(1)Group of Clinical and Experimental Allergy, IPS Universitaria, University of
Antioquia, Medellin, Colombia.
(2)Foundation for the Development of Medical and Biological Sciences (FUNDEMEB),
Cartagena, Colombia.
(3)Faculty of Medicine, Corporation University Rafael Nunez, Cartagena, Colombia.
BACKGROUND AND OBJECTIVE: Many patients with chronic spontaneous urticaria (CSU)
report various drugs as triggers of their symptoms and often avoid medication
unnecessarily. Objective: To estimate the clinical impact of the drugs patients
most frequently suspect of inducing CSU exacerbations.
METHODS: The prevalence of self-reported drug reactions was evaluated by
questioning patients about their clinical history of urticaria and drug reactions
and performing challenge tests with the suspect drugs. A group of healthy persons
were included as controls to evaluate the prevalence of self-reported drug
reactions.
RESULTS: The study population comprised 245 patients with CSU and 127 healthy
individuals. At least 1 adverse drug reaction was reported by 92 (37.5%) patients
and 30 (23.6%) controls. Nonsteroidal anti-inflammatory drugs (NSAIDs) (27.7%)
and ß-lactams (9.4%) were the most commonly reported drugs in the CSU group and
the control group, respectively. Positive results in the challenge tests were
less common than self-reports in the CSU group (13%) and the control group
(0.7%).
CONCLUSIONS: Self-reporting is generally not sufficient to confirm a drug
reaction. Drug reactions to NSAIDs and ß-lactams are more frequent among patients
who experience CSU than in those who do not. Drug challenge tests should be
offered early during medical evaluation to avoid unnecessary restrictions.
DOI: 10.18176/jiaci.0287
1884. J Fam Plann Reprod Health Care. 2017 Jul;43(3):216-221. doi:

10.1136/jfprhc-2016-101502. Epub 2017 Mar 22.
"My friend who bought it for me, she has had an abortion before." The influence
of Ghanaian women's social networks in determining the pathway to induced
abortion.
Rominski SD(1), Lori JR(2), Morhe ES(3).
Author information:
(1)Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor,
MI, USA.
(2)Department of Health Behavior and Biological Sciences, University of Michigan
School of Nursing, Ann Arbor, MI, USA.
(3)Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
BACKGROUND: Even given the liberal abortion law in Ghana, abortion complications
are a large contributor to maternal morbidity and mortality. This study sought to
understand why young women seeking an abortion in a legally enabling environment
chose to do this outside the formal healthcare system.
METHODS: Women being treated for complications arising from a self-induced
abortion as well as for elective abortions at three hospitals in Ghana were
interviewed. Community-based focus groups were held with women as well as men,
separately. Interviews and focus group discussions were conducted until
saturation was reached.
RESULTS: A total of 18 women seeking care for complications from a self-induced
abortion and 11 seeking care for an elective abortion interviewed. The women
ranged in age from 13 to 35 years. There were eight focus groups; two with men
and six with women. The reasons women self-induce are: (1) abortion is illegal;
(2) attitudes of the healthcare workers; (3) keeping the pregnancy a secret; and
(4) social network influence. The meta-theme of normalisation of self-inducing'
an abortion was identified.
DISCUSSION: When women are faced with an unplanned and unwanted pregnancy, they
consult individuals in their social network whom they know have dealt with a
similar situation. Misoprostol is widely available in Ghanaian cities and is
successful at inducing an abortion for many women. In this way, self-inducing
abortions using medication procured from pharmacists and chemical sellers has
become normalised for women in Kumasi, Ghana.
© Faculty of Sexual and Reproductive Healthcare of the Royal College of

Obstetricians and Gynaecologists (unless otherwise stated in the text of the
article) 2017. All rights reserved. No commercial use is permitted unless
DOI: 10.1136/jfprhc-2016-101502
PMID: 28330856
1885. Patient. 2016 Aug;9(4):359-71. doi: 10.1007/s40271-016-0181-0.

Satisfaction, Adherence and Health-Related Quality of Life with Transdermal
Buprenorphine Compared with Oral Opioid Medications in the Usual Care of
Osteoarthritis Pain.
Conaghan PG(1), Serpell M(2), McSkimming P(3), Junor R(4), Dickerson S(5)(6).
Author information:
(1)Leeds Institute of Rheumatic and Musculoskeletal Medicine and National
Institute of Health Research (NIHR) Leeds Musculoskeletal Biomedical Research
Unit, University of Leeds, Leeds, UK.
(2)University Department of Anaesthesia, Gartnavel General Hospital, Glasgow, UK.
(3)Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
(4)Napp Pharmaceuticals Limited, Cambridge, UK.
(5)Napp Pharmaceuticals Limited, Cambridge, UK. Sara.Dickerson@mundipharma.co.uk.
(6)Mundipharma International Limited, Cambridge Science Park, Milton Road,
Cambridge, CB4 0GW, UK. Sara.Dickerson@mundipharma.co.uk.
BACKGROUND: Osteoarthritis (OA) causes substantial pain and reduced

health-related quality of life (HRQL). Although opioid analgesics are commonly
used, the relative benefits of different opioids are poorly studied. Transdermal
buprenorphine (TDB) offers an alternative to oral opioids for the treatment of
moderate-to-severe chronic pain. This observational study of people with OA pain
assessed satisfaction, HRQL and medication adherence.
METHODS: Patients in the UK with self-reported knee and/or hip OA who had been
receiving one or more of TDB, co-codamol (an oral paracetamol/codeine
combination) and tramadol for at least 1 month completed an online or telephone
questionnaire. Medication satisfaction scores, HRQL scores (Short-Form 36
[SF-36]), medication adherence (Morisky Medication Adherence Scale [MMAS™]),
adverse events and treatment discontinuations were recorded. Linear and logistic
regression models were used to compare the treatment effect of TDB with
co-codamol or tramadol.
RESULTS: Overall, 966 patients met the inclusion criteria; 701 were taking only
one of the target medications (TDB: 85; co-codamol: 373; tramadol: 243). The
largest age group was 50-59 years and 76.0 % of patients were female. The TDB
group was younger, with more male patients, therefore the statistical models were
adjusted for age and sex. Medication satisfaction scores were significantly
higher in the TDB group than the other two groups (TDB vs. co-codamol: 3.56, 95 %
confidence interval [CI] 1.90-6.68, p < 0.0001; TDB vs. tramadol: 3.22, 95 % CI
1.67-6.20, p = 0.0005). Physical Component Summary scores for HRQL and mean
adherence were also higher in the TDB group, while Mental Component Summary HRQL
scores were similar across the three groups.
CONCLUSIONS: Patients with knee and/or hip OA pain treated with TDB were more
satisfied and more adherent with their medication, and reported higher Physical
Component Summary HRQL scores than those treated with co-codamol or tramadol,
although demographic differences were observed between groups.
DOI: 10.1007/s40271-016-0181-0
PMCID: PMC4925685

eCollection 2014.
Associations between disease awareness and health-related quality of life in a

multi-ethnic Asian population.
Venkataraman K(1), Khoo C(2), Wee HL(3), Tan CS(1), Ma S(4), Heng D(4), Lee J(1),
Tai ES(2), Thumboo J(5).
Author information:
(1)Saw Swee Hock School of Public Health, National University of Singapore and
National University Health System, Singapore, Singapore.
of Singapore and National University Health System, Singapore, Singapore.
(3)Department of Pharmacy, National University of Singapore, Singapore,
Singapore; Department of Rheumatology & Immunology, Singapore General Hospital,
Singapore, Singapore.
(4)Epidemiology and Disease Control Division, Ministry of Health, Singapore,
Singapore.
of Singapore and National University Health System, Singapore, Singapore;
Department of Rheumatology & Immunology, Singapore General Hospital, Singapore,
Singapore.
BACKGROUND: Health related quality of life (HRQoL) is an important dimension of

individuals' well-being, and especially in chronic diseases like diabetes and
hypertension. The objective of this study was to evaluate the contributions of
disease process, comorbidities, medication or awareness of the disease to HRQoL
in diabetes mellitus, hypertension and dyslipidemia.
METHODS: This was a cross-sectional study of 3514 respondents from the general
community in Singapore, assessed for HRQoL, disease and comorbid conditions
through self-report, clinical and laboratory investigations. HRQoL was assessed
using SF-36 health survey version 2. For each condition, participants were
categorized as having 1) no disease, 2) undiagnosed, 3) diagnosed, not taking
medication, and 4) diagnosed, taking medication. Analysis used one-way ANOVA and
multiple linear regression.
RESULTS: Diagnosed disease was associated with lower physical health component
summary (PCS) scores across all three conditions. After adjustment for
comorbidities, this association remained significant only for those not on
medication in diabetes (-2.7±1.2 points, p = 0.03) and dyslipidemia (-1.3±0.4
points, p = 0.003). Diagnosed hypertension (no medication -2.6±0.9 points,
p = 0.002; medication -1.4±0.5 points, p = 0.004) and dyslipidemia (no medication
-0.9±0.4 points, p = 0.03; medication -1.9±0.5 points, p<0.001) were associated
with lower mental health component summary (MCS) scores. Undiagnosed disease was
associated with higher MCS in diabetes (2.4±1.0 points, p = 0.01) and
dyslipidemia (0.8±0.4 points, p = 0.045), and PCS in hypertension (1.2±0.4
points, p = 0.004).
CONCLUSIONS: Disease awareness was associated with lower HRQoL across the
diseases studied, with PCS associations partially mediated by comorbidities.
Equally importantly, undiagnosed disease was not associated with HRQoL deficits,
which may partly explain why these individuals do not seek medical care.
PMCID: PMC4245227
1887. J Gen Intern Med. 2017 Sep;32(9):990-996. doi: 10.1007/s11606-017-4079-x.

Epub
2017 May 26.
Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy

Substance Use in Primary Care.
Gryczynski J(1), McNeely J(2), Wu LT(3), Subramaniam GA(4), Svikis DS(5), Cathers
LA(5), Sharma G(6), King J(6), Jelstrom E(6), Nordeck CD(7), Sharma A(7),
Mitchell SG(7), O'Grady KE(8), Schwartz RP(7).
Author information:
(1)Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201,
USA. jgryczynski@friendsresearch.org.
(2)New York University School of Medicine, New York, NY, USA.
(3)Duke University School of Medicine, Durham, NC, USA.
(4)Center for Clinical Trials Network, National Institute on Drug Abuse, North
Bethesda, MD, USA.
(5)Virginia Commonwealth University, Richmond, VA, USA.
(6)Emmes Corporation, Rockville, MD, USA.
(7)Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD, 21201,
USA.
(8)University of Maryland, College Park, College Park, MD, USA.
Comment in
J Gen Intern Med. 2017 Sep;32(9):1026.
BACKGROUND: The Tobacco, Alcohol, Prescription Medication, and Other Substance

use (TAPS) tool is a combined two-part screening and brief assessment developed
for adult primary care patients. The tool's first-stage screening component
(TAPS-1) consists of four items asking about past 12-month use for four substance
categories, with response options of never, less than monthly, monthly, weekly,
and daily or almost daily.
OBJECTIVE: To validate the TAPS-1 in primary care patients.
DESIGN: Participants completed the TAPS tool in self- and
interviewer-administered formats, in random order. In this secondary analysis,
the TAPS-1 was evaluated against DSM-5 substance use disorder (SUD) criteria to
determine optimal cut-points for identifying unhealthy substance use at three
severity levels (problem use, mild SUD, and moderate-to-severe SUD).
PARTICIPANTS: Two thousand adult patients at five primary care sites.
MAIN MEASURES: DSM-5 SUD criteria were determined via the modified Composite
International Diagnostic Interview. Oral fluid was used as a biomarker of recent
drug use.
KEY RESULTS: Optimal frequency-of-use cut-points on the self-administered TAPS-1
for identifying SUDs were ≥ monthly use for tobacco and alcohol
(sensitivity = 0.92 and 0.71, specificity = 0.80 and 0.85, AUC = 0.86 and 0.78,
respectively) and any reported use for illicit drugs and prescription medication
misuse (sensitivity = 0.93 and 0.89, specificity = 0.85 and 0.91, AUC = 0.89 and
0.90, respectively). The performance of the interviewer-administered format was
similar. When administered first, the self-administered format yielded higher
disclosure rates for past 12-month alcohol use, illicit drug use, and
prescription medication misuse. Frequency of use alone did not provide sufficient
information to discriminate between gradations of substance use problem severity.
Among those who denied drug use on the TAPS-1, less than 4% had a drug-positive
biomarker.
CONCLUSIONS: The TAPS-1 can identify unhealthy substance use in primary care
patients with a high level of accuracy, and may have utility in primary care for
rapid triage.
DOI: 10.1007/s11606-017-4079-x
PMCID: PMC5570743
1888. Int J Chron Obstruct Pulmon Dis. 2016 Apr 27;11:881-90. doi:
Health behaviors and their correlates among participants in the Continuing to

Confront COPD International Patient Survey.
Müllerová H(1), Landis SH(1), Aisanov Z(2), Davis KJ(3), Ichinose M(4), Mannino
DM(5), Maskell J(1), Menezes AM(6), van der Molen T(7), Oh YM(8), Tabberer M(9),
Han MK(10).
Author information:
(1)GSK, Worldwide Epidemiology, Uxbridge, UK.
(2)Pulmonology Research Institute, Moscow, Russia.
(3)GSK, Worldwide Epidemiology, Upper Providence, PA, USA.
(4)Tohoku University Graduate School of Medicine, Sendai, Japan.
(5)University of Kentucky College of Public Health, Lexington, KY, USA.
(6)Federal University of Pelotas, Pelotas, Brazil.
(7)University of Groningen, University Medical Center Groningen, Groningen, the
Netherlands.
(8)University of Ulsan College of Medicine, Asan Medical Center, Seoul, South
Korea.
(9)GSK, Value Evidence Outcomes, Uxbridge, UK.
(10)Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor,
MI, USA.
Erratum in
Int J Chron Obstruct Pulmon Dis. 2017 Mar 15;12 :859.
BACKGROUND AND AIMS: We used data from the Continuing to Confront COPD
International Patient Survey to test the hypothesis that patients with COPD who
report less engagement with their disease management are also more likely to
report greater impact of the disease.
METHODS: This was a population-based, cross-sectional survey of 4,343 subjects
aged ≥40 years from 12 countries, fulfilling a case definition of COPD based on
self-reported physician diagnosis or symptomatology. The impact of COPD was
measured with COPD Assessment Test, modified Medical Research Council Dyspnea
Scale, and hospital admissions and emergency department visits for COPD in the
prior year. The 13-item Patient Activation Measure (PAM-13) instrument and the
8-item Morisky Medication Adherence Scale (MMAS-8) were used to measure patient
disease engagement and medication adherence, respectively.
RESULTS: Twenty-eight percent of subjects reported being either disengaged or
struggling with their disease (low engagement: PAM-13 levels 1 and 2), and 35%
reported poor adherence (MMAS-8 <6). In univariate analyses, lower PAM-13 and
MMAS-8 scores were significantly associated with poorer COPD-specific health
status, greater breathlessness and lower BMI (PAM-13 only), less satisfaction
with their doctor's management of COPD, and more emergency department visits. In
multivariate regression models, poor satisfaction with their doctor's management
of COPD was significantly associated with both low PAM-13 and MMAS-8 scores; low
PAM-13 scores were additionally independently associated with higher COPD
Assessment Test and modified Medical Research Council scores and low BMI
(underweight).
CONCLUSION: Poor patient engagement and medication adherence are frequent and
associated with worse COPD-specific health status, higher health care
utilization, and lower satisfaction with health care providers. More research
will be needed to better understand what factors can be modified to improve
medication adherence and patient engagement.
DOI: 10.2147/COPD.S102280
PMCID: PMC4853156

Latinos with diabetes and food insecurity in an agricultural community.
Moreno G(1), Morales LS, Isiordia M, de Jaimes FN, Tseng CH, Noguera C, Mangione
CM.
Author information:
(1)*UCLA Department of Family Medicine, Los Angeles, CA †School of Medicine
‡School of Public Health, University of Washington, Seattle, WA §Department of
Psychology at the University of California, Davis ∥Golden Valley Health Centers
Inc., Merced ¶UCLA Department of General Internal Medicine, Division of Health
Services, Los Angeles #Community Medical Centers Inc, Stockton **UCLA School of
Public Health, Los Angeles, CA.
BACKGROUND: Latinos from agricultural communities have a high prevalence of food

insecurity and are at increased risk of obesity and diabetes, yet little is known
about the associations between food insecurity and diabetes outcomes.
OBJECTIVE: To examine the associations between food insecurity and diabetes
outcomes among rural Latinos.
METHODS: Cross-sectional survey with medical chart abstraction of 250 Latinos
with diabetes. Primary outcomes are the control of 3 intermediate diabetes
outcomes (hemoglobin A1C ≤8.0%, LDL-cholesterol ≤100 mg/dL, and blood pressure
≤140/90 mm Hg), a composite of control of the 3, and receipt of 6 processes of
care. Secondary outcomes are cost-related medication underuse and participation
in self-care activities.
RESULTS: Fifty-two percent of patients reported food insecurity and 1-in-4
reported cost-related medication underuse. Patients with food insecurity were
more likely to report cost-related medication underuse [adjusted odds ratio
(AOR)=2.49; 95% confidence intervals (CI), 1.30, 4.98; P=0.003], less likely to
meet the composite measure for control of the 3 intermediate outcomes (AOR=0.24;
95% CI, 0.07, 0.84; P<0.05), and less likely to receive a dilated eye examination
(AOR=0.37; 95% CI, 0.18, 0.77; P<0.05) and annual foot examinations (AOR=0.42;
95% CI, 0.20, 0.84; P<0.05) compared with those who were food secure.
CONCLUSIONS: Among this rural Latino population, food insecurity was
independently associated with not having control of the intermediate diabetes
outcomes captured in the composite measure, not receiving dilated eye and foot
examinations, and with self-reporting cost-related medication underuse.
DOI: 10.1097/MLR.0000000000000348
PMCID: PMC4398630
1890. Clin Interv Aging. 2015 Jan 14;10:269-75. doi: 10.2147/CIA.S65980.

eCollection
2015.
Characterization of hepatic enzyme activity in older adults with dementia:

potential impact on personalizing pharmacotherapy.
Campbell NL(1), Skaar TC(2), Perkins AJ(3), Gao S(4), Li L(5), Khan BA(6),
Boustani MA(7).
Author information:
(1)College of Pharmacy, Purdue University, West Lafayette, IN, USA ; Indiana
University Center for Aging Research, Indiana University School of Medicine,
Indianapolis, IN, USA ; Regenstrief Institute, Indiana University School of
Medicine, Indianapolis, IN, USA ; Department of Pharmacy, Eskenazi Health
Services, Indiana University School of Medicine, Indianapolis, IN, USA.
(2)Division of Clinical Pharmacology, Department of Medicine, Indiana University
School of Medicine, Indianapolis, IN, USA.
(3)Indiana University Center for Aging Research, Indiana University School of
Medicine, Indianapolis, IN, USA.
Medicine, Indianapolis, IN, USA ; Regenstrief Institute, Indiana University
School of Medicine, Indianapolis, IN, USA ; Department of Biostatistics, Indiana
University School of Medicine, Indianapolis, IN, USA.
(5)Department of Medical and Molecular Genetics, Indiana University School of
Medicine, Indianapolis, IN, USA.
School of Medicine, Indianapolis, IN, USA ; Division of Clinical Pharmacology,
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN,
USA.
School of Medicine, Indianapolis, IN, USA ; Center for Innovation and
Implementation Science, Indiana University, Indianapolis, IN, USA.
OBJECTIVE: To determine the frequency of pharmacogenomic variants and concurrent

medications that may alter the efficacy and tolerability of acetylcholinesterase
inhibitors (AChEIs).
MATERIALS AND METHODS: A multisite cross-sectional study was carried out across
four memory care practices in the greater Indianapolis area. Participants were
adults aged 65 years and older with a diagnosis of probable or possible
Alzheimer's disease (AD) (n=105). Blood samples and self-reported medication data
were collected. Since two of the three AChEIs are metabolized by cytochrome P450
(CYP)-2D6, we determined the frequency of functional genetic variants in the
CYP2D6 gene and calculated their predicted CYP2D6-activity scores. Concurrent
medication data were collected from self-reported medication surveys, and their
predicted effect on the pharmacokinetics of AChEIs was determined based on their
known effects on CYP2D6 and CYP3A4/5 enzyme activities.
RESULTS: Among the 105 subjects enrolled, 72% were female and 36% were African
American. Subjects had a mean age of 79.6 years. The population used a mean of
eight medications per day (prescription and nonprescription). The CYP2D6 activity
score frequencies were 0 (3.8%), 0.5 (4.8%), 1.0 (36.2%), 1.5-2.0 (51.4%), and
>2.0 (3.8%). Nineteen subjects (18.1%) used a medication considered a strong or
moderate inhibitor of CYP2D6, and eight subjects (7.6%) used a medication
considered a strong or moderate inhibitor of CYP3A4/5. In total, 28.6% of the
study population was predicted to have reduced activity of the CYP2D6 or CYP3A4/5
enzymes due to either genetic variants or concomitant medications.
CONCLUSION: Both pharmacogenetic variants and concurrent drug therapies that are
predicted to alter the pharmacokinetics of AChEIs should be evaluated in older
adults with AD. Pharmacogenetic and drug-interaction data may help personalize AD
therapy and increase adherence by improving tolerability.
DOI: 10.2147/CIA.S65980
PMCID: PMC4298284
1891. Int J Infect Dis. 2018 Oct;75:52-59. doi: 10.1016/j.ijid.2018.08.006. Epub

2018
Aug 17.
Adherence to pre-exposure prophylaxis among men who have sex with men: A
prospective cohort study.
Qu D(1), Zhong X(2), Xiao G(1), Dai J(3), Liang H(4), Huang A(5).
Author information:
(1)Department of Epidemiology and Health Statistics, School of Public Health and
Management, Chongqing Medical University, Chongqing, China; Research Center for
Medicine and Social Development, Chongqing Medical University, Chongqing, China;
Innovation Center for Social Risk Governance in Health, Chongqing Medical
University, Chongqing, China.
(2)Department of Epidemiology and Health Statistics, School of Public Health and
Management, Chongqing Medical University, Chongqing, China; Research Center for
Medicine and Social Development, Chongqing Medical University, Chongqing, China;
Innovation Center for Social Risk Governance in Health, Chongqing Medical
University, Chongqing, China. Electronic address: 1932352920@qq.com.
Xinjiang Medical University, Xinjiang, China.
Guangxi Medical University, Nanning, Guangxi, China.
(5)Key Laboratory of Molecular Biology, Ministry of Molecular Biology, Infectious
Diseases, Chongqing Medical University, Chongqing, China.
OBJECTIVE: To evaluate adherence to pre-exposure prophylaxis (PrEP) in a clinical

trial of a population of men who have sex with men (MSM), to explore the
influence of social psychology and objective factors (e.g., forgetting, too busy)
on adherence, and to provide evidence for subsequent PrEP research.
METHODS: This study analyzed the data from the daily medication group within a
PrEP study (a randomized placebo-controlled trial of oral tenofovir among MSM in
Western China from April 2013 to March 2015). A total of 331 participants were
analyzed. PrEP adherence was self-reported by the subjects at every 3-month
follow-up visit for 24 months. AIDS-related information including HIV prevention,
transmission, and treatment knowledge, as well as PrEP-related motivation
(including personal and social motivation) and behavior skills, i.e.,
self-efficacy, were collected using questionnaires. The objective reasons for
non-adherence were collected during face-to-face follow-up visits every 3 months.
A theoretical model of information motivation behavior skills (IMB) was
constructed. Then confirmatory factor analysis was performed to test the fit of
each IMB construct. Finally, the structure equation model was used to evaluate
the IMB model.
RESULTS: The median adherence rate was 64.29%. During the follow-up period, the
percentage of high adherence (adherence ≥80%) was 32.33%, intermediate adherence
(adherence 40-80%) was 38.97%, and low adherence (adherence ≤40%) was 28.70%. The
final IMB model showed that there was no significant correlation between
adherence to PrEP and the psychological constructs: information, motivation, and
behavior skills. The main objective reasons for non-adherence were 'forgetting to
take medicine' (70.21%), 'too busy' (29.08%), 'worrying about side effects'
(28.01%), and 'too much trouble' (18.44%).
CONCLUSIONS: This study found no association between PrEP adherence and social
psychological factors, and the main objective factor in non-adherence was
forgetting to take the medicine. In the future, the MSM population could be
reminded to take their medicine regularly using electronic devices, which may
improve PrEP adherence to some extent and may further reduce the incidence of
HIV. The strategy to improve PrEP adherence requires further study.
DOI: 10.1016/j.ijid.2018.08.006
1892. Trop Med Health. 2018 Dec 22;46:44. doi: 10.1186/s41182-018-0125-6.

eCollection
2018.
Patients' adherence to artemisinin-based combination therapy and healthcare

workers' perception and practice in Savannakhet province, Lao PDR.
Takahashi E(1)(2), Nonaka D(1)(2), Iwagami M(2)(3)(4), Phoutnalong V(1)(2)(5),

Chanthakoumane K(6), Kobayashi J(1)(2), Pongvongsa T(2)(7)(8), Kounnavong S(6),
Hongvanthong B(2)(5), Brey PT(2)(4), Kano S(2)(3).
Author information:
(1)1Department of Global Health, School of Health Sciences, Faculty of Medicine,
University of the Ryukyus, Okinawa, 903-0215 Japan.
(2)SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic
Republic.
(3)3Department of Tropical Medicine and Malaria, Research Institute, National
Center for Global Health and Medicine, Tokyo, 162-8655 Japan.
(4)4Institut Pasteur du Laos, Ministry of Health, Vientiane, Lao People's
Democratic Republic.
(5)5Center of Malariology, Parasitology and Entomology, Ministry of Health,
Vientiane, Lao People's Democratic Republic.
(6)6Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao
People's Democratic Republic.
(7)Savannakhet Provincial Health Department, Savannakhet, Lao People's Democratic
Republic.
(8)8Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Background: Artemisinin resistance in Plasmodium falciparum has been spreading

across Southeast Asia. Patients' adherence to artemisinin-based combination
therapy (ACT) is critical to avoid expanding this resistance. The objectives of
this research were to examine patients' adherence to ACT for the treatment of
uncomplicated malaria and to examine the healthcare workers' perception of
medication adherence and their dispensing practices for malaria patients in
Savannakhet province, Lao PDR.
Methods: A prospective observational study of patients and a descriptive study of
healthcare workers were conducted in Xepon, Phin, and Nong districts. In the
patient study, patients aged 18 years old or older who were prescribed
artemether-lumefantrine (AL) at six healthcare facilities between October 2016
and August 2017 were examined. Patient interviews and tablet counts were
conducted on the first day of treatment (day 0) and the follow-up day (around day
3). In the healthcare workers study, a self-administered questionnaire survey was
conducted.
Results: Of the 54 patients examined, 51 (94.4%) were adherent to the AL regimen.
The other three patients stopped medication because they felt better, even though
the importance of completing the regimen was explained to all patients when it
was prescribed. Among 152 healthcare workers who had ever instructed a malaria
patient, 74.3% reported that they occasionally saw a malaria patient who adhered
poorly to medication instructions. The healthcare workers perceived the major
reasons for poor adherence to be illiteracy and poor understanding of medication
instructions by patients. In practice, 27.6% of the healthcare workers did not
regularly explain the importance of completing the regimen to patients, and 32.2%
did not often or always confirm the patients' understanding of medication
instructions.
Conclusions: Patient adherence to AL was high. The healthcare workers perceived
that poor adherence was attributable to the patients, i.e., their poor
understanding and illiteracy, which appeared to be related to linguistic
differences. However, poor adherence also appeared to be attributable to the
healthcare workers, who should tell patients of the importance of completing the
AL regimen regardless of their improvement in physical condition and also confirm
the patients' understanding of the instructions.
DOI: 10.1186/s41182-018-0125-6
PMCID: PMC6303952
PMID: 30607137
Conflict of interest statement: This study was approved by the National Ethics
Committee for Health Research, Ministry of Health, Lao PDR (No. 034/NECHR, 2016)
and the Ethics Review Committee for Epidemiological Study, University of Ryukyus,
Japan (No. 346). Before starting the study, surveyors explained the details of
the study to the participants, such as its purpose, voluntary participation,
information that would be collected and how the data would be stored and managed.
Written informed consent was obtained from each participant. For the healthcare
workers study, self-administered anonymous questionnaires were used.Not
applicable.The authors declare that they have no competing interests.Springer
1893. NPJ Prim Care Respir Med. 2017 Dec 8;27(1):64. doi: 10.1038/s41533-017-0064-
4.
Weekly self-measurement of FEV1 and PEF and its impact on ACQ (asthma control
questionnaire)-scores: 12-week observational study with 76 patients.
Werner CU(1), Linde K(2), Schäffner J(2), Storr C(2), Schneider A(2).
Author information:
(1)Technical University of Munich, TUM School of Medicine, Institute of General
Practice, Munich, Germany. christoph.werner@mri.tum.de.
(2)Technical University of Munich, TUM School of Medicine, Institute of General
Practice, Munich, Germany.
The "Asthma Control Questionnaire" (ACQ) is a very common questionnaire for

assessing asthma control. This study compares different ACQ versions in a
self-monitoring program over a 12-week period combining them with patients'
self-measurements of peak expiratory flow (PEF) and forced expiratory volume in
one second (FEV1). The objective was to test the feasibility of
FEV1-self-measurements and to compare ACQ versions regarding possible additional
information given by lung function. In this prospective multicenter observational
study 100 adult asthma patients, recruited at six family practices and two
pulmologists' private practices in Germany, completed the ACQ weekly, performing
self-measurements of PEF and FEV1. Seventy-six patients were included into final
analysis with only 3% missing values. Scores for all ACQ versions improved
significantly (all P-values < 0.05) with reductions of 32% for ACQ5, 31% for
ACQ6, 22% for ACQ7-FEV1, and 21% for ACQ7-PEF with high Pearson's correlation
coefficients of all scores (r between 0.96 and 0.99). ACQ7-FEV1 scores were
significantly higher than others. Separated courses of lung function parameters
showed nearly no change, but ACQ5 and ACQ6 as scores for symptoms and reliever
medication improved constantly. ACQ5 and ACQ6 revealed higher percentages of
patients classified as "controlled" than ACQ7-scores. In conclusion, with only a
few missing data points, our results suggest feasibility of
FEV1-self-measurements. Courses of symptom-related and lung function-related ACQ
items differ clearly. Our results support the GINA recommendations to consider
symptoms and lung function separately. FEV1-self-measurements for research
purposes may be included with the ACQ, but in clinical practice seem to measure a
different domain to symptomatic asthma control.
DOI: 10.1038/s41533-017-0064-4
PMCID: PMC5722863
1894. Patient Prefer Adherence. 2016 Sep 13;10:1787-1793. eCollection 2016.
Self-perception of knowledge and adherence reflecting the effectiveness of

antiretroviral therapy.
Dagli-Hernandez C(1), Lucchetta RC(1), de Nadai TR(2), Galduróz JC(3),

Mastroianni PC(1).
Author information:
(1)Department of Drugs and Medications, School of Pharmaceutical Sciences of the
UNESP - Univ Estadual Paulista, Araraquara.
(2)Department of Surgery and Anatomy, Americo Brasiliense State Hospital.
(3)Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São
Paulo, Brazil.
OBJECTIVES: To evaluate which indirect method for assessing adherence best

reflects highly active antiretroviral therapy (HAART) effectiveness and the
factors related to adherence.
METHOD: This descriptive, cross-sectional study was performed in 2012 at a
reference center of the state of São Paulo. Self-report (simplified medication
adherence questionnaire [SMAQ]) and drug refill parameters were compared to the
viral load (clinical parameter of the effectiveness of pharmacotherapy [EP]) to
evaluate the EP. The "Cuestionario para la Evaluación de la Adhesión al
Tratamiento Antiretroviral" (CEAT-VIH) was used to evaluate factors related to
adherence and the EP and, complementarily, patient self-perception of adherence
was compared to the clinical parameter of the EP.
RESULTS: Seventy-five patients were interviewed, 60 of whom were considered as
adherent from the clinical parameter of the EP and ten were considered as
adherent from all parameters. Patient self-perception about adherence was the
instrument that best reflected the EP when compared to the standardized
self-report questionnaire (SMAQ) and drug refill parameter. The level of
education and the level of knowledge on HAART were positively correlated to the
EP. Forgetfulness, alcohol use, and lack of knowledge about the medications were
the factors most frequently reported as a cause of nonadherence.
CONCLUSION: A new parameter of patient self-perception of adherence, which is a
noninvasive, inexpensive instrument, could be applied and assessed as easily as
self-report (SMAQ) during monthly drug refill, since it allows monitoring
adherence through pharmaceutical assistance. Therefore, patient adherence to
HAART could be evaluated using self-perception (CEAT-VIH) and the viral load
test.
DOI: 10.2147/PPA.S112108
PMCID: PMC5028166
PMID: 27695297
1895. ARYA Atheroscler. 2017 Jan;13(1):20-28.
The impact of educational intervention on self-care behaviors in overweight

hypertensive women: A randomized control trial.
Daniali SS(1), Eslami AA(2), Maracy MR(3), Shahabi J(4), Mostafavi-Darani F(2).
Author information:
(1)PhD Candidate, Student Research Committee, Department of Health Education and
Health Promotion, School of Health, Isfahan University of Medical Sciences,
Isfahan, Iran.
(2)Associate Professor, Department of Health Education and Promotion, School of
(3)Professor, Department of Epidemiology and Biostatistics, School of Public
(4)Assistant Professor, Heart Failure Research Center, Cardiovascular Research
Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
BACKGROUND: The improper control of self-care in hypertension imposes a lot of

financial burden on the health-care system. On the other hand, the importance of
participatory care and high effectiveness of self-management programs have been
confirmed. This study was aimed to examine the effect of an educational
intervention on self-efficacy, self-care behaviors and blood pressure (BP) of
hypertensive obese or overweight women in the primary health-care setting in
Isfahan, Iran.
METHODS: This randomized controlled trial was an educational intervention
program. It was performed among 146 hypertensive women of 30-65 age range who
referred to 6 health care centers of Isfahan that randomly assigned to a control
and intervention groups. The interventional group participated in the 6 weekly
sessions including exercises, weight control, medication adherence, and home
self-monitoring based on goal setting, and promotion of self-efficacy. The
control group received routine care from health-care center and any special
intervention has been done for the control group. Output variables were analyzed
after intervention, and 6-month follow-up.
RESULTS: There are no significant differences between age, weight, body mass
index and BP and biochemical variables except lipids as well as behavioral
factors at the baseline. After 6 months intervention self-efficacy (< 0.001) and
physical activity (< 0.001) improvement of in the intervention group was
significantly different in comparison with the control group. After 6 months,
there was a significant reduction in systolic (P < 0.001) and diastolic BP (P =
0.010) in the intervention group.
CONCLUSION: Participatory method of education could help us to convince patients
to have better self-care to control disease. Furthermore, since adherence to the
treatment of hypertensive patients in our society is low, organizing such courses
can teach essential knowledge and skills to lifestyle change and prevention of
complications. Performing these courses is recommended for other chronic disease
patients in health-care centers to assess self-management programs on self-care
behavior.
PMCID: PMC5515187
PMID: 28761451
1896. J Allergy Clin Immunol. 2016 Dec;138(6):1593-1599.e3. doi:

10.1016/j.jaci.2016.08.043. Epub 2016 Oct 13.
A health care navigation tool assesses asthma self-management and health

literacy.
Perez L(1), Morales KH(2), Klusaritz H(3), Han X(2), Huang J(1), Rogers M(4),
Bennett IM(5), Rand CS(6), Ndicu G(1), Apter AJ(7).
Author information:
(1)Division of Pulmonary Allergy Critical Care Medicine, University of
Pennsylvania, Philadelphia, Pa; Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa.
(2)Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa;
Department of Biostatistics and Epidemiology, University of Pennsylvania,
Philadelphia, Pa.
Department of Family Medicine and Community Health, University of Pennsylvania,
Philadelphia, Pa.
Division of General Internal Medicine, University of Pennsylvania, Philadelphia,
Pa.
(5)Departments of Family Medicine & Psychiatry and Behavioral Sciences,
University of Washington, Seattle, Wash.
(6)Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of
Medicine, Baltimore, Md.
(7)Division of Pulmonary Allergy Critical Care Medicine, University of
Pennsylvania, Philadelphia, Pa; Perelman School of Medicine, University of
Pennsylvania, Philadelphia, Pa. Electronic address: apter@mail.med.upenn.edu.
BACKGROUND: Self-management of moderate-to-severe asthma depends on the patient's

ability to (1) navigate (access health care to obtain diagnoses and treatment),
(2) use inhaled corticosteroids (ICSs) properly, and (3) understand ICS function.
OBJECTIVE: We sought to test whether navigation skills (medication recall,
knowledge of copay requirements, and ability to provide information needed for a
medical visit about a persistent cough unresponsive to medication) are related to
other self-management skills and health literacy.
METHODS: A 21-item Navigating Ability (NAV2) questionnaire was developed,
validated, and then read to adults with moderate-to-severe asthma. ICS technique
was evaluated by using scales derived from instructions in national guidelines;
knowledge of ICS function was evaluated by using a validated 10-item
questionnaire. Spearman correlation was computed between NAV2 score and these
questionnaires and with numeracy (Asthma Numeracy Questionnaire) and print
literacy (Short Test of Functional Health Literacy in Adults).
RESULTS: Two hundred fifty adults participated: age, 51 ± 13 years; 72% female;
65% African American; 10% Latino; 50% with household income of less than
$30,000/y; 47% with no more than a 12th-grade education; and 29% experienced
hospitalizations for asthma in the prior year. A higher NAV2 score was associated
with correct ICS technique (ρ = 0.24, P = .0002), knowledge of ICSs (ρ = 0.35,
P < .001), better print literacy (ρ = 0.44, P < .001), and numeracy (ρ = 0.41,
P < .001).
CONCLUSIONS: Patients with poor navigational ability are likely to have poor
inhaler technique and limited understanding of ICS function, as well as limited
numeracy and print literacy. Clinicians should consider these elements of
self-management for their effect on asthma care and as a marker of more general
health literacy deficits.
Copyright Â© 2016 American Academy of Allergy, Asthma & Immunology. Published by

DOI: 10.1016/j.jaci.2016.08.043
PMCID: PMC5148700
1897. Can J Psychiatry. 2017 Jan;62(1):67-72. doi: 10.1177/0706743716648299. Epub

2016
Jul 9.
Baseline Psychological Treatment Reduces the Effect of Coaching in a Randomised

Trial of a Depression Self-Care Intervention.
McCusker J(1)(2), Cole M(3)(4), Lambert S(2)(5), Yaffe M(6)(7), Ciampi A(1)(2),
Belzile E(2).
Author information:
(1)1 Department of Epidemiology, Biostatistics and Occupational Health, McGill
University, Montreal, Quebec.
(2)2 St. Mary's Research Centre, Montreal, Quebec.
(3)3 Department of Psychiatry, McGill University, Montreal, Quebec.
(4)4 Geriatric Psychiatry Division, St. Mary's Hospital Center, Montreal, Quebec.
(5)5 Ingram School of Nursing, McGill University, Montreal, Quebec.
(6)6 Department of Family Medicine, McGill University, Montreal, Quebec.
(7)7 Family Medicine Centre, St. Mary's Hospital Center, Montreal, Quebec.
OBJECTIVE: To explore the effects of baseline psychological and antidepressant

medication treatment in a trial of lay telephone coaching in a low-intensity,
supported depression self-care intervention.
METHOD: A single blind, individually randomised, pragmatic trial was conducted
among primary care adults with chronic physical conditions and comorbid
depressive symptoms. Eligible subjects were randomised to receive a depression
self-care toolkit with (intervention group) or without (control group) telephone
coaching provided by trained lay coaches. For this brief communication, a
secondary analysis of the trial data focused on the effects of baseline
psychological and antidepressant treatments on mental health outcomes (Patient
Health Questionnaire 9 [PHQ-9], SF-12 Mental Component Summary [MCS], Generalized
Anxiety Disorder 7 [GAD-7]) and satisfaction with the intervention.
RESULTS: In total, 223 patients were randomised, and 165 (74.0%) completed both
3- and 6-month follow-ups. There were 2 significant interactions of baseline
treatment and study group for 6-month mental health outcomes. A significant
benefit of coaching on 6-month PHQ-9 was seen only among participants who were
not receiving baseline psychological treatment. A smaller interaction was found
for baseline antidepressant medications and 6-month mental health. There was a
significant main effect for baseline psychological treatment and lower 6-month
satisfaction.
CONCLUSIONS: Depressed patients receiving baseline psychological treatment may
not benefit from lay coaching offered as part of a low-intensity depression
self-care intervention.
DOI: 10.1177/0706743716648299
PMCID: PMC5302106

article.
1898. J Manag Care Spec Pharm. 2018 Sep;24(9):896-902. doi:

10.18553/jmcp.2018.24.9.896.
Variation in Medication Therapy Management Delivery: Implications for Health Care

Policy.
Snyder ME(1), Jaynes HA(1), Gernant SA(2), Lantaff WM(1), Hudmon KS(1), Doucette
WR(3).
Author information:
(1)1 Purdue University College of Pharmacy, Indianapolis, Indiana.
(2)2 Nova Southeastern University School of Pharmacy, Davie, Florida.
(3)3 University of Iowa College of Pharmacy, Iowa City.
BACKGROUND: Medication therapy management (MTM) program evaluations have revealed
mixed outcomes, with some studies finding favorable outcomes and others finding
no differences between patients who received MTM versus those who did not. One
possible reason for outcomes variability is differences in delivery of MTM
programs. The Chronic Care Model (CCM) provides a framework for how health care
organizations can improve care for the chronically ill through 6 elements:
organization of health care, delivery system design, clinical information
systems, decision support, self-management, and linkages to community resources.
OBJECTIVE: To apply the CCM to understand variation in MTM delivery and formulate
policy recommendations.
METHODS: This study used a mixed-methods descriptive analysis of MTM delivery.
Investigators conducted visits to a purposeful sample of MTM practices to observe
MTM and interview participants. The pharmacists and staff of these practices
completed a modified Assessment of Chronic Illness Care (ACIC). Pairs of
investigators analyzed interview transcripts to identify themes. Demographics and
ACIC scores were summarized using descriptive statistics. After analysis,
investigators discussed overarching themes and policy implications organized by
CCM elements.
RESULTS: Seven practices participated, and 87 participants were interviewed.
Based on ACIC scores, MTM patient volume, and payer mix, practices were
categorized as Early Maturity Level or Later Maturity Level. From the model,
organization of health care themes included whether MTM was the practice's core
competence, belief/confidence in the MTM process, lack of formal rewards, and the
influence of organizational goals and external environment. Delivery system
design themes pertained to the extent that MTM processes were formalized.
Clinical information systems themes were the extent to which systems were
influenced by payers, efficiency strategies, and the accuracy and availability of
information. In considering clinical decision support themes, alert design
limitations and variation in user approaches to alerts based on experience were
noted. We observed strong support for patient self-management; when present,
barriers were attributed to the patient, MTM provider, or payer. Referral to
community resources was minimal. Numerous policy implications were identified.
CONCLUSIONS: Our research identified numerous ways by which MTM delivery varies,
particularly by MTM practice maturity level. These findings provide evidence for
several policy changes that could be considered to optimize MTM delivery,
encourage alignment with the CCM, and promote practice maturation.
DISCLOSURES: This research and a portion of Snyder's salary were supported by
grant number K08HS022119 from the Agency for Healthcare Research and Quality. The
content is solely the responsibility of the authors and does not necessarily
represent the official views of the Agency for Healthcare Research and Quality.
Snyder reports consulting fees from Westat for an evaluation of the CMS Enhanced
MTM program. The other authors have nothing to disclose. Portions of this
research have been presented as abstracts at the following conferences: (a) 2017
Academy Health Annual Research Meeting; June 25-27, 2017; New Orleans, LA; (b)
2015 American Society of Health-System Pharmacists Clinical Midyear Meeting;
December 4-8, 2015; New Orleans, LA; and
(c) 2014 North American Primary Care Research Group (NAPCRG) Annual Meeting;
November 21-25, 2014; New York, NY.
DOI: 10.18553/jmcp.2018.24.9.896
1899. Drug Alcohol Depend. 2017 Nov 1;180:279-285. doi:

10.1016/j.drugalcdep.2017.08.019. Epub 2017 Sep 9.
The relationship between treatment accessibility and preference amongst

out-of-treatment individuals who engage in non-medical prescription opioid use.
Huhn AS(1), Tompkins DA(2), Dunn KE(2).
Author information:
Behavioral Sciences, Baltimore, MD, USA. Electronic address: ahuhn1@jhu.edu.
Behavioral Sciences, Baltimore, MD, USA.
BACKGROUND: Relatively little is known regarding the perception of

medication-assisted treatments (MATs) and other treatment options amongst
individuals that engage in non-medical prescription opioid use. This study
surveyed out-of-treatment individuals that misuse opioids to better understand
how perceived access to treatment shapes treatment preference.
METHODS: Participants (n=357) were out-of-treatment adults registered as workers
on the Amazon Mechanical Turk platform who reported current non-medical
prescription opioid use. Participants were surveyed regarding demographics,
insurance status, attitudes toward opioid use disorder (OUD) treatments, and
self-reported symptoms of OUD.
RESULTS: Participants who were male, did not have health insurance, and knew that
counseling-type services were locally available were most likely to first attempt
counseling/detox treatments (χ2(6)=30.19, p<0.001). Participants who met criteria
for severe OUD, used heroin in the last 30days, knew their insurance covered MAT,
and knew of locally available MAT providers were most likely to first attempt MAT
(χ2(4)=26.85, p<0.001). Participants with insurance and who knew of locally
available physicians were most likely to attempt physician visits without the
expressed purpose of MAT (χ2(3)=24.75, p<0.001).
CONCLUSION: Out-of-treatment opioid users were particularly interested in
counseling-based services and medical care that could be attained from a
primary-care physician. Results suggest that insurance coverage and perceived
access to OUD treatment modalities influences where out-of-treatment opioid users
might first seek treatment; understanding the factors that shape treatment
preference is critical in designing early interventions to effectively reach this
population.
DOI: 10.1016/j.drugalcdep.2017.08.019
PMCID: PMC5648596
1900. Patient Educ Couns. 2015 Jul 6. pii: S0738-3991(15)30010-0. doi:

10.1016/j.pec.2015.07.001. [Epub ahead of print]
Exploring the influence of patient-provider communication on intraocular pressure

in glaucoma patients.
Carpenter DM(1), Tudor GE(2), Sayner R(3), Muir KW(4), Robin AL(5), Blalock
SJ(6), Hartnett ME(7), Giangiacomo AL(8), Sleath BL(6).
Author information:
(1)Eshelman School of Pharmacy, University of North Carolina at Chapel Hill,
Asheville, USA. Electronic address: dmcarpenter@unc.edu.
(2)Department of Mathematics and Statistics, Husson University, Bangor, USA.
(3)School of Medicine, Stanford University, Stanford, CA, USA.
(4)School of Medicine, Duke University, & Durham VA Medical Center, Durham, USA.
(5)Wilmer Institute and Bloomberg School of Public Health; Johns Hopkins
University, & University of Maryland, Baltimore, MD, USA.
(6)Eshelman School of Pharmacy, University of North Carolina at Chapel Hill,
Chapel Hill, USA.
(7)John A. Moran Eye Center, University of Utah, Salt Lake City, USA.
(8)School of Medicine, Emory University, Atlanta, USA.
OBJECTIVE: We examined whether six patient-provider communication behaviors

directly affected the intraocular pressure (IOP) of glaucoma patients or whether
patient medication adherence and eye drop technique mediated the relationship
between self-efficacy, communication, and IOP.
METHODS: During an 8-month, longitudinal study of 279 glaucoma patients and 15
providers, two office visits were videotape-recorded, transcribed, and coded for
six patient-provider communication behaviors. Medication adherence was measured
electronically and IOP was extracted from medical records. We ran generalized
estimating equations to examine the direct effects of communication on IOP and
used bootstrapping to test whether medication adherence and eye drop technique
mediated the effect of communication on IOP.
RESULTS: Provider education about medication adherence (B=-0.50, p<0.05) and
inclusion of patient input into the treatment plan (B=-0.35, p<0.05) predicted
improved IOP. There was no evidence of significant mediation.
CONCLUSION: The positive effects of provider education and provider inclusion of
patient input in the treatment plan were not mediated by adherence and eye drop
technique.
PRACTICE IMPLICATIONS: Providers should educate glaucoma patients about the
importance of medication adherence and include patient input into their treatment
plan.
DOI: 10.1016/j.pec.2015.07.001
PMCID: PMC4703566
PMID: 26223851
1901. JMIR Diabetes. 2019 Apr 18;4(2):e11590. doi: 10.2196/11590.
Experiences of Patients With a Diabetes Self-Care App Developed Based on the

Information-Motivation-Behavioral Skills Model: Before-and-After Study.
Jeon E(1), Park HA(1).
Author information:
(1)College of Nursing, Seoul National University, Seoul, Republic of Korea.
BACKGROUND: Mobile phones have been actively used in various ways for diabetes
self-care. Mobile phone apps can manage lifestyle factors such as diet, exercise,
and medication without time or place restrictions. A systematic review has found
these apps to be effective in reducing blood glucose. However, the existing apps
were developed and evaluated without a theoretical framework to explain the
process of changes in diabetes self-care behaviors.
OBJECTIVE: This study aimed to evaluate the diabetes self-care app that we
developed by measuring differences in diabetes self-care factors between before
and after using the app with the Information-Motivation-Behavioral skills model
of Diabetes Self-Care (IMB-DSC).
METHODS: We conducted a single-group pre- and postintervention study with a
convenience sample of diabetes patients. A total of 38 adult patients with
diabetes who had an Android smartphone were recruited. After conducting a
preliminary survey of those who agreed to participate in the study, we provided
them with a manual and a tutorial video about the diabetes self-care app. The app
has functions for education, recommendations, writing a diary, recording, goal
setting, sharing, communication, feedback, and interfacing with a glucometer, and
it was applied for 4 weeks. We measured the general characteristics of
participants, their history of diabetes self-care app usage, IMB-DSC factors, and
blood glucose levels. The IMB-DSC factors of information, personal motivation,
social motivation, behavioral skills, and behaviors were measured using an
assessment tool consisting of 87 items extracted from the Diabetes Knowledge
Test, third version of the Diabetes Attitude Scale, Diabetes Family Behavior
Checklist, and Diabetes Self-Management Assessment Report Tool.
RESULTS: The mean age of the participants was 43.87 years. A total 30
participants out of 38 (79%) had type 2 diabetes and 8 participants (21%) had
type 1 diabetes. The most frequently used app function was recording, which was
used by 34 participants out of 38 (89%). Diabetes self-care behaviors (P=.02) and
diabetes self-care social motivation (P=.05) differed significantly between pre-
and postintervention, but there was no significant difference in diabetes
self-care information (P=.85), diabetes self-care personal motivation (P=.57), or
diabetes self-care behavioral skills (P=.89) between before and after using the
diabetes self-care app.
CONCLUSIONS: Diabetes self-care social motivation was significantly improved with
our diabetes self-care app by sharing experiences and sympathizing with other
diabetes patients. Diabetes self-care behavior was also significantly improved
with the diabetes self-care app by providing an interface with a glucometer that
removes the effort of manual input. Diabetes self-care information, diabetes
self-care personal motivation, and diabetes self-care behavioral skills were not
significantly improved. However, they will be improved with additional offline
interventions such as reflective listening and simulation.
©Eunjoo Jeon, Hyeoun-Ae Park. Originally published in JMIR Diabetes

(http://diabetes.jmir.org), 18.04.2019.
DOI: 10.2196/11590
PMCID: PMC6495295
PMID: 30998218
1902. Health Educ Res. 2015 Oct;30(5):693-705. doi: 10.1093/her/cyv034. Epub 2015
Sep
2.
Applying the resources and supports in self-management framework to examine

ophthalmologist-patient communication and glaucoma medication adherence.
Sleath B(1), Carpenter DM(2), Blalock SJ(2), Sayner R(2), Muir KW(3), Slota C(2),
Giangiacomo AL(4), Hartnett ME(5), Tudor G(6), Robin AL(7).
Author information:
(1)UNC Eshelman School of Pharmacy & Cecil G. Sheps Center for Health Services
Research, betsy_sleath@unc.edu.
Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA.
(3)Department of Ophthalmology, School of Medicine, Duke University, Durham VA
Medical Center, Health Services Research and Development, Durham, NC, USA.
(4)Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA
30322, USA.
University of Utah, Salt Lake City, UT 84132, USA.
(6)Department of Science and Mathematics, Director of Institutional Research,
Husson University, Bangor, ME 04401, USA.
(7)Department of Ophthalmology, University of Maryland, Baltimore, MD, USA,
Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA,
Department of International Health, Bloomberg School of Public Health, Johns
Hopkins University, Baltimore, MD, USA, Department of Ophthalmology, Johns
Hopkins School of Medicine, Baltimore, MD 21215, USA.
Little is known about how ophthalmologist-patient communication over time is

associated with glaucoma patient long-term adherence. The purpose of our study
was to examine the association between provider use of components of the
resources and supports in self-management model when communicating with patients
and adherence to glaucoma medications measured electronically over an 8-month
period. In this longitudinal prospective cohort study, the main variables studied
were ophthalmologist communication-individualized assessment, collaborative goal
setting and skills enhancement. Patients with glaucoma who were newly prescribed
or on glaucoma medications were recruited from six ophthalmology clinics.
Patients' baseline and next follow-up visits were videotape-recorded. Patients
were interviewed after their visits. Patients used medication event monitoring
systems (MEMS) for 8 months after enrollment into the study, and adherence was
measured electronically using MEMS for 240 days after their visits. Two hundred
and seventy-nine patients participated. Patient race and regimen complexity were
negatively associated with glaucoma medication adherence over an 8-month period.
Provider communication behaviors, including providing education and positive
reinforcement, can improve patient adherence to glaucoma medications over an
8-month period.
© The Author 2015. Published by Oxford University Press. All rights reserved. For
permissions, please email: journals.permissions@oup.com.
DOI: 10.1093/her/cyv034
PMCID: PMC4668753
1903. Health Promot Chronic Dis Prev Can. 2017 May;37(5):160-171. doi:
10.24095/hpcdp.37.5.04.
Use of medication and psychological counselling among Canadians with mood and/or
anxiety disorders.
[Article in English, French; Abstract available in French from the publisher]
O'Donnell S(1), Syoufi M(1), Jones W(2), Bennett K(3), Pelletier L(1).
Author information:
(1)Public Health Agency of Canada, Ottawa, Ontario, Canada.
(2)Centre for Applied Research in Mental Health and Addiction, Simon Fraser
University, Burnaby, British Columbia, Canada.
(3)Department of Health Research Methods, Evidence, and Impact (formerly
Department of Clinical Epidemiology and Biostatistics), McMaster University,
Hamilton, Ontario, Canada.
INTRODUCTION: This study describes the use of prescription medications and

psychological counselling in the past 12 months among Canadian adults with a
self-reported mood and/or anxiety disorder diagnosis; the sociodemographic and
clinical characteristics associated with their use; and reasons for not using
them.
METHODS: We used data from the 2014 Survey on Living with Chronic Diseases in
Canada-Mood and Anxiety Disorders Component. The study sample (n = 2916) was
divided into four treatment subgroups: (1) taking medication only; (2) having
received counselling only; (3) both; or (4) neither. We combined the first three
subgroups and carried out descriptive and multivariate logistic regression
analyses comparing those who are taking medication and/or have received
counselling in the past 12 months, versus those doing neither. Estimates were
weighted to represent the Canadian adult household population living in the 10
provinces with diagnosed mood and/or anxiety disorders.
RESULTS: The majority (81.8%) of Canadians with a mood and/or an anxiety disorder
diagnosis reported they are taking medications and/or have received counselling
(47.6% taking medications only; 6.9% received counselling only; and 27.3%
taking/having received both). Upon controlling for individual characteristics,
taking medications and/or having received counselling was significantly
associated with older age; higher household income; living in the Atlantic region
or Quebec versus Ontario; and having concurrent disorders or mood disorders only.
Symptoms controlled without medication was the most common reason for not taking
medications, while preferring to manage on their own and taking medications were
among the common reasons for not having received counselling.
CONCLUSION: The majority of Canadian adults with a mood and/or an anxiety
disorder diagnosis are taking medications, while few have received counselling.
Insights gained regarding the factors associated with these treatments, and
reasons for not using them, emphasize the importance of discussing treatment
options and perceived barriers with patients to ensure they receive the best
treatment according to their needs and preference.
Publisher: L’étude décrit le recours aux médicaments sur ordonnance et aux

consultations psychologiques au cours des 12 derniers mois chez les Canadiens
adultes ayant déclaré avoir reçu un diagnostic de trouble de l’humeur et/ou
d’anxiété, les caractéristiques sociodémographiques et cliniques associées à ce
recours et les raisons invoquées pour ne pas y recourir.L’Enquête sur les
personnes ayant une maladie chronique au Canada – Composante sur les troubles de
l’humeur et d’anxiété de 2014 a été utilisée. L’échantillon de l’étude (n = 2
916) a été divisé en quatre sous-groupes de traitement : (1) prend des
médicaments seulement; (2) a reçu des consultations psychologiques seulement; (3)
prend des médicaments et a reçu des consultations psychologiques; ou (4) n’a eu
recours à aucun de ces deux traitements. Nous avons combiné les trois premiers
sous-groupes et effectué des analyses descriptives et de régression logistique
multivariée pour comparer ceux qui prenaient des médicaments et/ou avaient reçu
des consultations psychologiques par rapport à ceux n’ayant pas eu recours à ces
deux traitements. Nous avons pondéré toutes les estimations afin que les données
soient représentatives de la population canadienne adulte vivant en logement
privé dans l'une des 10 provinces et ayant déclaré avoir reçu un diagnostic de
troubles de l’humeur et/ou d’anxiété.La majorité (81,8 %) des Canadiens adultes
ayant déclaré avoir reçu un diagnostic de trouble de l’humeur et/ou d’anxiété ont
indiqué prendre des médicaments et/ou avoir reçu des consultations psychologiques
(47,6 % prenaient des médicaments seulement, 6,9 % avaient reçu des consultations
psychologiques seulement et 27,3 % avaient eu recours aux deux modalités de
traitement). Après ajustement des caractéristiques individuelles, le recours aux
médicaments et/ou aux consultations psychologiques était significativement
associé à un âge plus avancé, à un revenu du ménage plus élevé, à une résidence
dans la région de l’Atlantique ou au Québec et à un trouble de l’humeur et
d’anxiété concomitants ou à un trouble de l’humeur seulement. Le contrôle des
symptômes sans l’utilisation de médicaments était la raison le plus souvent
invoquée pour ne pas prendre de médicaments, et le désir de se débrouiller seul
et la prise de médicaments figuraient parmi les raisons le plus souvent citées
pour ne pas avoir bénéficié de consultations psychologiques.La majorité des
Canadiens adultes atteints d’un trouble de l’humeur et/ou d’anxiété diagnostiqué
prenaient des médicaments, mais une moins grande proportion d’entre eux avaient
reçu des consultations psychologiques. En dégageant les facteurs associés au
recours à ces traitements et les raisons invoquées pour ne pas y recourir, cette
étude met en lumière l’importance de discuter avec les patients des options de
traitement et des obstacles perçus afin d’offrir un traitement adapté à leurs
besoins et leurs préférences.
DOI: 10.24095/hpcdp.37.5.04
PMCID: PMC5650021
Conflict of interest statement: The authors declare no conflict of interest. No

external financial or material support was obtained for this study.
1904. BMC Health Serv Res. 2016 Jul 28;16:314. doi: 10.1186/s12913-016-1573-5.
Measurement and valuation of health providers' time for the management of

childhood pneumonia in rural Malawi: an empirical study.
Bozzani FM(1)(2), Arnold M(3)(4), Colbourn T(5), Lufesi N(6), Nambiar B(5)(7),
Masache G(7), Skordis-Worrall J(5).
Author information:
(1)Department of Global Health and Development, London School of Hygiene &
Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
fiammetta.bozzani@lshtm.ac.uk.
(2)Institute for Global Health, University College London, London, UK.
fiammetta.bozzani@lshtm.ac.uk.
(3)Munich Center of Health Sciences, Ludwig-Maximilians-Universität München,
Munich, Germany.
(4)Institute of Health Economics and Health Care Management, Helmholtz Zentrum
München, Neuherberg, Germany.
(5)Institute for Global Health, University College London, London, UK.
(6)ARI Programme, Ministry of Health, Lilongwe, Malawi.
(7)Parent And Child Health Initiative (PACHI), Lilongwe, Malawi.
BACKGROUND: Human resources are a major cost driver in childhood pneumonia case
management. Introduction of 13-valent pneumococcal conjugate vaccine (PCV-13) in
Malawi can lead to savings on staff time and salaries due to reductions in
pneumonia cases requiring admission. Reliable estimates of human resource costs
are vital for use in economic evaluations of PCV-13 introduction.
METHODS: Twenty-eight severe and twenty-four very severe pneumonia inpatients
under the age of five were tracked from admission to discharge by paediatric ward
staff using self-administered timesheets at Mchinji District Hospital between
June and August 2012. All activities performed and the time spent on each
activity were recorded. A monetary value was assigned to the time by allocating a
corresponding percentage of the health workers' salary. All costs are reported in
2012 US$.
RESULTS: A total of 1,017 entries, grouped according to 22 different activity
labels, were recorded during the observation period. On average, 99 min (standard
deviation, SD = 46) were spent on each admission: 93 (SD = 38) for severe and 106
(SD = 55) for very severe cases. Approximately 40 % of activities involved
monitoring and stabilization, including administering non-drug therapies such as
oxygen. A further 35 % of the time was spent on injecting antibiotics. Nurses
provided 60 % of the total time spent on pneumonia admissions, clinicians 25 %
and support staff 15 %. Human resource costs were approximately US$ 2 per bed-day
and, on average, US$ 29.5 per severe pneumonia admission and US$ 37.7 per very
severe admission.
CONCLUSIONS: Self-reporting was successfully used in this context to generate
reliable estimates of human resource time and costs of childhood pneumonia
treatment. Assuming vaccine efficacy of 41 % and 90 % coverage, PCV-13
introduction in Malawi can save over US$ 2 million per year in staff costs alone.
DOI: 10.1186/s12913-016-1573-5
PMCID: PMC4964305
1905. J Pers Med. 2015 Nov 17;5(4):389-405. doi: 10.3390/jpm5040389.
Evaluation of an mHealth Medication Regimen Self-Management Program for African

American and Hispanic Uncontrolled Hypertensives.
Davidson TM(1)(2), McGillicuddy J(3), Mueller M(4), Brunner-Jackson B(5), Favella

A(6), Anderson A(7), Torres M(8), Ruggiero KJ(9), Treiber FA(10)(11).
Author information:
(1)College of Medicine, Medical University of South Carolina, Charleston, SC
29425, USA. davidst@musc.edu.
29425, USA. davidst@musc.edu.
29425, USA. mcgillij@musc.edu.
29425, USA. muellerm@musc.edu.
29425, USA.
29425, USA. favela@musc.edu.
29425, USA. anderan@musc.edu.
29425, USA. torresma@musc.edu.
29425, USA. ruggierk@musc.edu.
African Americans and Hispanics have disproportionate rates of uncontrolled

essential hypertension (EH) compared to Non-Hispanic Whites. Medication
non-adherence (MNA) is the leading modifiable behavior to improved blood pressure
(BP) control. The Smartphone Medication Adherence Stops Hypertension (SMASH)
program was developed using a patient-centered, theory-guided, iterative design
process. Electronic medication trays provided reminder signals, and Short Message
Service [SMS] messaging reminded subjects to monitor BP with Bluetooth-enabled
monitors. Motivational and reinforcement text messages were sent to participants
based upon levels of adherence. Thirty-eight African-American (18) and Hispanic
(20) uncontrolled hypertensives completed clinic-based anthropometric and resting
BP evaluations prior to randomization, and again at months 1, 3 and 6.
Generalized linear mixed modeling (GLMM) revealed statistically significant
time-by-treatment interactions (p < 0.0001) indicating significant reductions in
resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the
SMASH group vs. the standard care (SC) control group across all time points.
70.6% of SMASH subjects vs. 15.8% of the SC group reached BP control (< 140/90
mmH) at month 1 (p < 0.001). At month 6, 94.4% of the SMASH vs. 41.2% of the SC
group exhibited controlled BP (p < 0.003). Our findings provide encouraging
evidence that efficacious mHealth, chronic disease, medical regimen,
self-management programs can be developed following principles of
patient-centered, theory-guided design.
DOI: 10.3390/jpm5040389
PMCID: PMC4695862
PMID: 26593951
1906. BMC Public Health. 2018 Feb 1;18(1):205. doi: 10.1186/s12889-018-5097-2.
Adherence to home fortification with micronutrient powders in Kenyan pre-school

children: self-reporting and sachet counts compared to an electronic monitoring
device.
Teshome EM(1)(2), Oriaro VS(3), Andango PEA(3), Prentice AM(4)(5), Verhoef

H(4)(6).
Author information:
(1)MRCG Keneba at MRC Unit The Gambia, and MRC International Nutrition Group,
London School of Hygiene and Tropical Medicine, London, UK.
Emily.Teshome@lshtm.ac.uk.
(2)Faculty of Epidemiology and Population Heath, London School of Hygiene and
Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Emily.Teshome@lshtm.ac.uk.
(3)Maseno University, School of Public Health and Community Development, Maseno,
Kenya.
(4)MRCG Keneba at MRC Unit The Gambia, and MRC International Nutrition Group,
London School of Hygiene and Tropical Medicine, London, UK.
(5)Faculty of Epidemiology and Population Heath, London School of Hygiene and
Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
(6)Cell Biology and Immunology Group and Division of Human Nutrition, Wageningen
University, Maseno, The Netherlands.
BACKGROUND: The efficacy of home fortification with iron-containing micronutrient

powders varies between trials, perhaps in part due to population differences in
adherence. We aimed to assess to what extent adherence measured by sachet count
or self-reporting forms is in agreement with adherence measured by electronic
device. In addition, we explored how each method of adherence assessment
(electronic device, sachet count, self-reporting forms) is associated with
haemoglobin concentration measured at the end of intervention; and to what extent
baseline factors were associated with adherence as measured by electronic device.
METHODS: Three hundred thirty-eight rural Kenyan children aged 12-36 months were
randomly allocated to three treatment arms (home fortification with two different
iron formulations or placebo). Home fortificants were administered daily by
parents or guardians over a 30 day-intervention period. We assessed adherence
using an electronic device that stores and provides information of the time and
day of opening of the container that was used to store the fortificants sachets
in each child's residence. In addition, we assessed adherence by self-reporting
and sachet counts. We also measured haemoglobin concentration at the end of
intervention.
RESULTS: Adherence, defined as having received at least 24 sachets (≥ 80%),
during the 30-day intervention period was attained by only 60.6% of children as
assessed by the electronic device. The corresponding values were higher when
adherence was assessed by self-report (83.9%; difference: 23.3%, 95% CI: 18.8% to
27.8%) or sachet count (86.3%; difference: 25.7%, 95% CI: 21.0% to 30.4%). Among
children who received iron, each 10 openings of the electronic cap of the sachet
storage container were associated with an increase in haemoglobin concentration
at the end of intervention by 1.2 g/L (95% CI: 0.0 to 1.9 g/L). Adherence was
associated with the age of the parent but not with intervention group; with age,
sex or anthropometric indices of the child; or with age or sex of the parent or
guardian.
CONCLUSIONS: The use of self -reporting and sachet count may lead to
overestimates of adherence to home fortification.
TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov (
NCT02073149 ) on 25 February 2014.
DOI: 10.1186/s12889-018-5097-2
PMCID: PMC5796300
1907. J Am Soc Hypertens. 2016 Nov;10(11):857-864.e2. doi:

10.1016/j.jash.2016.08.009.
Epub 2016 Sep 7.
The association between Self-Reported Medication Adherence scores and systolic

blood pressure control: a SPRINT baseline data study.
Haley WE(1), Gilbert ON(2), Riley RF(3), Newman JC(4), Roumie CL(5), Whittle
J(6), Kronish IM(7), Tamariz L(8), Wiggers A(9), Morisky DE(10), Conroy MB(11),
Kovalik E(12), Kressin NR(13), Muntner P(14), Goff DC Jr(15); SPRINT Study
Research Group.
Author information:
(1)Mayo Clinic, Jacksonville, FL, USA. Electronic address:
haley.william@mayo.edu.
(2)Section on Cardiovascular Medicine, Wake Forest University Health Sciences,
Winston-Salem, NC, USA.
(3)Division of Cardiology, University of Washington, Seattle, WA, USA.
(4)Medical University of South Carolina, Charleston, SC, USA.
(5)VA Tennessee Valley Healthcare System Geriatric Research and Education
Clinical Center Nashville and Vanderbilt University Medical Center, Nashville,
TN, USA.
(6)Milwaukee VA Medical Center, Milwaukee, WI, USA.
(7)Columbia University Medical Center, New York, NY, USA.
(8)Miami Veterans Affairs and University of Miami Health System, Miami, FL, USA.
(9)University Hospitals, Cleveland, OH, USA.
(10)UCLA School of Public Health, Los Angeles, CA, USA.
(11)Department of Medicine, University of Pittsburgh School of Medicine,
Pittsburgh, PA, USA.
(12)Duke University Medical Center, Durham, NC, USA.
(13)Department of Veterans Affairs, Boston University School of Medicine, Boston,
MA, USA.
(14)University of Alabama School of Public Health, Birmingham, AL, USA.
(15)Colorado School of Public Health, Denver, CO, USA.
We examined baseline data from the Systolic Blood Pressure Intervention Trial
(SPRINT) to investigate whether medication adherence, measured by the 8-item
Morisky Medication Adherence Scale (MMAS-8), was associated with systolic blood
pressure (SBP) and whether MMAS-8 score and number of antihypertensive
medications interacted in influencing SBP. A total of 8435 SPRINT participants
were included: 21.2% had low adherence (MMAS-8: <6); 40.0% had medium adherence
(6 to <8); and 38.8% had high adherence (8). SBP was <140 mm Hg in 54.6%;
140-160 mm Hg in 36.6%; and >160 mm Hg in 8.8%. In multivariable regression,
medium vs. low adherence weakly associated with lower SBP (odds ratio: 1.17;
confidence interval: 1.04, 1.31). SPRINT eligibility criteria should be
considered when interpreting results. Efforts to understand and enhance adherence
are crucial to improve population health, and using self-report instruments might
be considered for predicting treatment adherence and response in future efficacy
trials and for identifying patients for adherence support in clinical practice.

rights reserved.
DOI: 10.1016/j.jash.2016.08.009
PMCID: PMC5107135
1908. BMC Geriatr. 2018 Jan 11;18(1):9. doi: 10.1186/s12877-018-0704-8.
Costs of potentially inappropriate medication use in residential aged care

facilities.
Harrison SL(1)(2), Kouladjian O'Donnell L(3)(4), Milte R(5)(3)(6), Dyer SM(5)(3),

Gnanamanickam ES(5)(3), Bradley C(5)(3)(7), Liu E(5)(3)(8), Hilmer SN(3)(4),
Crotty M(5)(3).
Author information:
(1)Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine,
Nursing and Health Sciences, School of Health Sciences, Flinders University,
Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive,
Bedford park, SA, 5042, Australia. Stephanie.harrison@flinders.edu.au.
(2)NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW,
Australia. Stephanie.harrison@flinders.edu.au.
(3)NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW,
Australia.
(4)Kolling Institute of Medical Research, University of Sydney and Royal North
Shore Hospital, St Leonards, NSW, 2065, Australia.
(5)Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine,
Nursing and Health Sciences, School of Health Sciences, Flinders University,
Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive,
Bedford park, SA, 5042, Australia.
(6)Institute for Choice, University of South Australia, GPO Box 2471, Adelaide,
SA, 5001, Australia.
(7)Infection & Immunity - Aboriginal Health, SAHMRI, PO Box 11060, Adelaide, SA,
5001, Australia.
(8)Mary MacKillop Institute for Health Research, Australian Catholic University,
215 Spring Street, Melbourne, VIC, 3000, Australia.
BACKGROUND: The potential harms of some medications may outweigh their potential
benefits (inappropriate medication use). Despite recommendations to avoid the use
of potentially inappropriate medications (PIMs) in older adults, the prevalence
of PIM use is high in different settings including residential aged care.
However, it remains unclear what the costs of these medications are in this
setting. The main objective of this study was to determine the costs of PIMs in
older adults living in residential care. A secondary objective was to examine if
there was a difference in costs of PIMs in a home-like model of residential care
compared to an Australian standard model of care.
METHODS: Participants included 541 participants from the Investigation Services
Provided in the Residential Environment for Dementia (INSPIRED) Study. The
INSPIRED study is a cross-sectional study of 17 residential aged care facilities
in Australia. 12 month medication costs were determined for the participants and
PIMs were identified using the 2015 updated Beers Criteria for older adults.
RESULTS: Of all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4%
of the participants had been exposed to a PIM. Log-linear models showed exposure
to a PIM was associated with higher total medication costs (Adjusted β = 0.307,
95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs
that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per
participant exposed to a PIM). The largest PIM costs arose from proton-pump
inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds
of incurring costs from PIMs were 52% lower for those residing in a home-like
model of care compared to a standard model of care.
CONCLUSIONS: The use of PIMs for older adults in residential care facilities is
high and these medications represent a substantial cost which has the potential
to be lowered. Further research should investigate whether medication reviews in
this population could lead to potential cost savings and improvement in clinical
outcomes. Adopting a home-like model of residential care may be associated with
reduced prevalence and costs of PIMs.
DOI: 10.1186/s12877-018-0704-8
PMCID: PMC5765623
1909. J Pain. 2017 Nov;18(11):1287-1294. doi: 10.1016/j.jpain.2017.03.015. Epub

2017
May 4.
Measures That Identify Prescription Medication Misuse, Abuse, and Related Events
in Clinical Trials: ACTTION Critique and Recommended Considerations.
Smith SM(1), Jones JK(2), Katz NP(3), Roland CL(4), Setnik B(5), Trudeau JJ(6),
Wright S(7), Burke LB(8), Comer SD(9), Dart RC(10), Dionne R(11), Haddox JD(12),
Jaffe JH(13), Kopecky EA(14), Martell BA(15), Montoya ID(16), Stanton M(17),
Wasan AD(18), Turk DC(19), Dworkin RH(20).
Author information:
(1)Department of Anesthesiology, University of Rochester School of Medicine and
Dentistry, Rochester, New York. Electronic address:
shannon1_smith@urmc.rochester.edu.
(2)The Degge Group, Fairfax, Virginia; Departments of Pharmacology and Health
Sciences, Georgetown University School of Medicine, Washington, DC; School of
Public Health, University of Michigan School of Public Health, Ann Arbor,
Michigan.
(3)Analgesic Solutions, Natick, Massachusetts; Departments of Anesthesiology and
Public Health and Community Medicine, Tufts University, Boston, Massachusetts.
(4)Pfizer Inc, Cary, North Carolina.
(5)INC Research, Raleigh, North Carolina.
(6)Boehringer Ingelheim, Ridgefield, Connecticut.
(7)GW Pharmaceuticals, plc, London, United Kingdom.
(8)LORA Group, LLC, Royal Oak, and School of Pharmacy, University of Maryland,
(9)Department of Psychiatry, Columbia University, New York State Psychiatric
Institute, New York, New York.
(10)Division of Clinical Pharmacology and Toxicology, University of Colorado
School of Medicine and Rocky Mountain Poison & Drug Center, Denver Health,
Denver, Colorado.
(11)Department of Pharmacology and Toxicology, Brody School of Medicine, East
Carolina University, Greenville, North Carolina.
(12)Departments of Anesthesiology and Public Health and Community Medicine, Tufts
University, Boston, Massachusetts; Purdue Pharma LP, Stamford, Connecticut.
(13)Department of Psychiatry, University of Maryland School of Medicine,
(14)Collegium Pharmaceutical, Inc, Canton, Massachusetts.
(15)BAM Consultants, Guilford, Connecticut; Department of Internal Medicine, Yale
University School of Medicine, New Haven, Connecticut.
(16)National Institute on Drug Abuse, Bethesda, Maryland.
(17)Horizon Pharma, Inc, Deerfield, Illinois.
(18)Departments of Anesthesiology and Psychiatry, University of Pittsburgh School
of Medicine, Pittsburgh, Pennsylvania.
(19)Department of Anesthesiology and Pain Medicine, University of Washington,
Seattle, Washington.
(20)Department of Anesthesiology, Neurology, and Center for Human Experimental
Therapeutics, University of Rochester School of Medicine and Dentistry,
Rochester, New York.
Accurate assessment of inappropriate medication use events (ie, misuse, abuse,

and related events) occurring in clinical trials is an important component in
evaluating a medication's abuse potential. A meeting was convened to review all
instruments measuring such events in clinical trials according to previously
published standardized terminology and definitions. Only 2 approaches have been
reported that are specifically designed to identify and classify misuse, abuse,
and related events occurring in clinical trials, rather than to measure an
individual's risk of using a medication inappropriately: the Self-Reported
Misuse, Abuse, and Diversion (SR-MAD) instrument and the Misuse, Abuse, and
Diversion Drug Event Reporting System (MADDERS). The conceptual basis, strengths,
and limitations of these methods are discussed. To our knowledge, MADDERS is the
only system available to comprehensively evaluate inappropriate medication use
events prospectively to determine the underlying intent. MADDERS can also be
applied retrospectively to completed trial data. SR-MAD can be used
prospectively; additional development may be required to standardize its
implementation and fully appraise the intent of inappropriate use events.
Additional research is needed to further demonstrate the validity and utility of
MADDERS as well as SR-MAD.PERSPECTIVE: Identifying a medication's abuse potential
requires assessing inappropriate medication use events in clinical trials on the
basis of a standardized event classification system. The strengths and
limitations of the 2 published methods designed to evaluate inappropriate
medication use events are reviewed, with recommended considerations for further
development and current implementation.
Copyright © 2017 American Pain Society. Published by Elsevier Inc. All rights
reserved.
DOI: 10.1016/j.jpain.2017.03.015
PMCID: PMC5660635
1910. JAMA Intern Med. 2017 Mar 1;177(3):371-379. doi:

Adherence to Newly Prescribed Diabetes Medications Among Insured Latino and White
Patients With Diabetes.
Fernández A(1), Quan J(1), Moffet H(2), Parker MM(2), Schillinger D(1), Karter
AJ(2).
Author information:
(1)Division of General Internal Medicine, San Francisco General Hospital, San
Francisco, California2Department of Medicine, University of California-San
Francisco, San Francisco3Center for Vulnerable Populations, San Francisco General
Hospital, San Francisco, California.
(2)Division of Research, Kaiser Permanente, Oakland, California.
Importance: Medication adherence is essential to diabetes care. Patient-physician

language barriers may affect medication adherence among Latino individuals.
Objective: To determine the association of patient race/ethnicity, preferred
language, and physician language concordance with patient adherence to newly
prescribed diabetes medications.
Design, Setting, and Participants: This observational study was conducted from
January 1, 2006, to December 31, 2012, at a large integrated health care delivery
system with professional interpreter services. Insured patients with type 2
diabetes, including English-speaking white, English-speaking Latino, or limited
English proficiency (LEP) Latino patients with newly prescribed diabetes
medication.
Exposures: Patient race/ethnicity, preferred language, and physician
self-reported Spanish-language fluency.
Main Outcomes and Measures: Primary nonadherence (never dispensed), early-stage
nonpersistence (dispensed only once), late-stage nonpersistence (received ≥2
dispensings, but discontinued within 24 months), and inadequate overall
medication adherence (>20% time without sufficient medication supply during 24
months after initial prescription).
Results: Participants included 21 878 white patients, 5755 English-speaking
Latino patients, and 3205 LEP Latino patients with a total of 46 131
prescriptions for new diabetes medications. Among LEP Latino patients, 50.2%
(n = 1610) had a primary care physician reporting high Spanish fluency. For oral
medications, early adherence varied substantially: 1032 LEP Latino patients
(32.2%), 1565 English-speaking Latino patients (27.2%), and 4004 white patients
(18.3%) were either primary nonadherent or early nonpersistent. Inadequate
overall adherence was observed in 1929 LEP Latino patients (60.2%), 2975
English-speaking Latino patients (51.7%), and 8204 white patients (37.5%). For
insulin, early-stage nonpersistence was 42.8% among LEP Latino patients
(n = 1372), 34.4% among English-speaking Latino patients (n = 1980), and 28.5%
among white patients (n = 6235). After adjustment for patient and physician
characteristics, LEP Latino patients were more likely to be nonadherent to oral
medications and insulin than English-speaking Latino patients (relative risks
from 1.11 [95% CI, 1.06-1.15] to 1.17 [95% CI, 1.02-1.34]; P < .05) or white
patients (relative risks from 1.36 [95% CI, 1.31-1.41] to 1.49 [95% CI,
1.32-1.69]; P < .05). English-speaking Latino patients were more likely to be
nonadherent compared with white patients (relative risks from 1.23 [95% CI,
1.19-1.27] to 1.30 [95% CI, 1.23-1.39]; P < .05). Patient-physician language
concordance was not associated with rates of nonadherence among LEP Latinos
(relative risks from 0.92 [95% CI, 0.71-1.19] to 1.04 [95% CI, 0.97-1.1];
P > .28).
Conclusions and Relevance: Nonadherence to newly prescribed diabetes medications
is substantially greater among Latino than white patients, even among
English-speaking Latino patients. Limited English proficiency Latino patients are
more likely to be nonadherent than English-speaking Latino patients independent
of the Spanish-language fluency of their physicians. Interventions beyond access
to interpreters or patient-physician language concordance will be required to
improve medication adherence among Latino patients with diabetes.
PMCID: PMC5814298
1911. Parkinsonism Relat Disord. 2015 Feb;21(2):138-41. doi:

10.1016/j.parkreldis.2014.12.001. Epub 2014 Dec 6.
Medication non-adherence in essential tremor.
Louis ED(1).
Author information:
(1)GH Sergievsky Center, College of Physicians and Surgeons, Columbia University,
New York, NY, USA; Department of Neurology, College of Physicians and Surgeons,
Columbia University, New York, NY, USA; Department of Epidemiology, Mailman
School of Public Health, Columbia University, New York, NY, USA; Taub Institute
for Research on Alzheimer's Disease and the Aging Brain, College of Physicians
and Surgeons, Columbia University, New York, NY, USA. Electronic address:
EDL2@columbia.edu.
BACKGROUND: There are numerous studies of medication adherence in a variety of

chronic diseases including Parkinson's disease; however, there are no such
studies in patients with essential tremor (ET). This study aimed to (1) present
self-report data on medication adherence in ET cases, (2) examine the demographic
and clinical factors that might be associated with lower medication adherence.
METHODS: 151 ET cases were enrolled in a clinical-epidemiological study at
Columbia University. An 11-item medication adherence questionnaire, modeled after
the Morisky medication adherence questionnaire, was administered.
RESULTS: Seventy-three (48.3%) of 151 cases were taking daily medication for ET.
One-third (24/73; 32.9%) of cases reported that they sometimes forgot to take
their medication, and 1 in 5 (15/73; 20.5%) reported missed doses within the past
week. Most striking was that nearly 1 in 4 (17/73; 23.3%) reported that there
were whole days in the past two weeks in which they had not taken their
medication. A factor analysis revealed four factors that captured different
aspects of non-adherence. Higher non-adherence was associated with more
depressive symptoms, younger age, and less severe tremor but was not associated
with type or number of ET medications.
CONCLUSIONS: Approximately one in four ET patients reported whole days in the
past two weeks in which they had not taken their medication. It is possible that
this relatively high rate of non-adherence could be a function of the poor
therapeutic efficacy of the medications currently available to treat ET.
DOI: 10.1016/j.parkreldis.2014.12.001
PMCID: PMC4306620

eCollection 2015.
Motivational Modulation of Self-Initiated and Externally Triggered Movement Speed

Induced by Threat of Shock: Experimental Evidence for Paradoxical Kinesis in
Parkinson's Disease.
McDonald LM(1), Griffin HJ(1), Angeli A(1), Torkamani M(1), Georgiev D(1),
Jahanshahi M(1).
Author information:
(1)Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute
of Neurology, London, United Kingdom.
BACKGROUND: Paradoxical kinesis has been observed in bradykinetic people with

Parkinson's disease. Paradoxical kinesis occurs in situations where an individual
is strongly motivated or influenced by relevant external cues. Our aim was to
induce paradoxical kinesis in the laboratory. We tested whether the motivation of
avoiding a mild electric shock was sufficient to induce paradoxical kinesis in
externally-triggered and self-initiated conditions in people with Parkinson's
disease tested on medication and in age-matched controls.
METHODS: Participants completed a shock avoidance behavioural paradigm in which
half of the trials could result in a mild electric shock if the participant did
not move fast enough. Half of the trials of each type were self-initiated and
half were externally-triggered. The criterion for avoiding shock was a maximum
movement time, adjusted according to each participant's performance on previous
trials using a staircase tracking procedure.
RESULTS: On trials with threat of shock, both patients with Parkinson's disease
and controls had faster movement times compared to no potential shock trials, in
both self-initiated and externally-triggered conditions. The magnitude of
improvement of movement time from no potential shock to potential shock trials
was positively correlated with anxiety ratings.
CONCLUSIONS: When motivated to avoid mild electric shock, patients with
Parkinson's disease, similar to healthy controls, showed significant speeding of
movement execution. This was observed in both self-initiated and
externally-triggered versions of the task. Nevertheless, in the ET condition the
improvement of reaction times induced by motivation to avoid shocks was greater
for the PD patients than controls, highlighting the value of external cues for
movement initiation in PD patients. The magnitude of improvement from the no
potential shock to the potential shock trials was associated with the
threat-induced anxiety. This demonstration of paradoxical kinesis in the
laboratory under both self-initiated and externally-triggered conditions has
implications for motivational and attentional enhancement of movement speed in
Parkinson's disease.
PMCID: PMC4540447
Positive STEPS - a randomized controlled efficacy trial of an adaptive

intervention for strengthening adherence to antiretroviral HIV treatment among
youth: study protocol.
Mimiaga MJ(1)(2)(3)(4), Kuhns LM(5)(6), Biello KB(7)(8)(9), Olson J(7), Hoehnle

S(5)(6), Santostefano CM(7), Hughto JMW(7)(8)(9), Safi H(5)(6), Salhaney P(7),
Chen D(5)(6), Garofalo R(5)(6).
Author information:
(1)Center for Health Equity Research, Brown University, 121 South Main Street,
Providence, RI, 02903, USA. matthew_mimiaga@brown.edu.
(2)Departments of Behavioral & Social Health Sciences and Epidemiology, Brown
University School of Public Health, Providence, RI, USA.
matthew_mimiaga@brown.edu.
(3)Department of Psychiatry and Human Behavior, Brown University Alpert Medical
School, Providence, RI, USA. matthew_mimiaga@brown.edu.
(4)The Fenway Institute, Fenway Health, Boston, MA, USA.
matthew_mimiaga@brown.edu.
(5)Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of
Chicago, Chicago, IL, USA.
(6)Feinberg School of Medicine, Department of Pediatrics, Northwestern
University, Chicago, IL, USA.
(7)Center for Health Equity Research, Brown University, 121 South Main Street,
Providence, RI, 02903, USA.
(8)Departments of Behavioral & Social Health Sciences and Epidemiology, Brown
University School of Public Health, Providence, RI, USA.
(9)The Fenway Institute, Fenway Health, Boston, MA, USA.
BACKGROUND: HIV infection among youth in the United States is on the rise. A high
level of antiretroviral therapy (ART) adherence is crucial to treatment success
and can minimize the population burden of the disease. However, the overall rate
of ART adherence among youth is generally suboptimal and no published efficacious
interventions exist to address the specific needs of this population. This paper
describes the design of a stepped-care, "adaptive" ART adherence intervention
protocol for HIV-infected adolescents and young adults.
METHODS: This is a randomized controlled trial (RCT) to establish the efficacy of
"Positive STEPS," a behavioral and technology-based intervention to optimize ART
adherence and viral suppression among HIV-infected youth, ages 16 to 29.
Participants are equally randomized to 1) the Positive STEPS intervention, which
begins with two-way daily text messaging as a reminder system to take their
medications; participants progress to a more intensive in-person counseling
intervention if text messaging is not sufficient to overcome barriers; or 2) or
standard of care (SOC). At randomization, all participants receive standardized
ART adherence education. During the 4 major study assessment visits (baseline,
4-, 8-, and 12-months), participants have their blood drawn to measure HIV viral
load and complete a mix of computer-based self-administered and
interviewer-administered behavioral and psychosocial measures. The primary
outcomes are improvements in viral load and ART adherence measured via a
medication-tracking device (i.e., Wisepill) and self-report.
DISCUSSION: Behavioral interventions are greatly needed to improve ART adherence
among HIV-infected adolescents and young adults and prevent onward transmission.
If effective, the intervention tested here will be one of the first
rigorously-designed efficacy trials to promote ART adherence in this population,
using an approach that holds promise for being readily integrated into real-world
clinical settings.
TRIAL REGISTRATION: ClinicalTrials.gov number NCT03092531 , registered March 28,
2017.
DOI: 10.1186/s12889-018-5815-9
PMCID: PMC6043988
1914. Ann Fam Med. 2015 Aug;13 Suppl 1:S36-41. doi: 10.1370/afm.1756.
Are Low-Income Peer Health Coaches Able to Master and Utilize Evidence-Based
Health Coaching?
Goldman ML(1), Ghorob A(1), Hessler D(1), Yamamoto R(1), Thom DH(1), Bodenheimer
T(2).
Author information:
(1)Center for Excellence in Primary Care, Department of Family and Community
Medicine, University of California, San Francisco, San Francisco, California.
(2)Center for Excellence in Primary Care, Department of Family and Community
Medicine, University of California, San Francisco, San Francisco, California
TBodenheimer@fcm.ucsf.edu.
PURPOSE: A randomized controlled trial found that patients with diabetes had
lower HbA1c levels after 6 months of peer health coaching than patients who did
not receive coaching. This paper explores whether the peer coaches in that trial,
all low-income patients with diabetes, mastered and utilized an evidence-based
health coaching training curriculum. The curriculum included 5 core features:
ask-tell-ask, closing the loop, know your numbers, behavior-change action plans,
and medication adherence counseling.
METHODS: This paper includes the results of exams administered to trainees, exit
surveys performed with peer coaches who completed the study and those who dropped
out, observations of peer coaches meeting with patients, and analysis of in-depth
interviews with peer coaches who completed the study.
RESULTS: Of the 32 peer coach trainees who completed the training, 71.9% lacked a
college degree; 25.0% did not graduate from high school. The 26 trainees who
passed the exams attended 92.7% of training sessions compared with 80.6% for the
6 trainees who did not pass. Peer coaches who completed the study wanted to
continue peer coaching work and had confidence in their abilities despite their
not consistently employing the coaching techniques with their patients.
Quotations describe coaches' perceptions of the training.
CONCLUSIONS: Of low-income patients with diabetes who completed the
evidenced-based health coaching training, 81% passed written and oral exams and
became effective peer health coaches, although they did not consistently use the
techniques taught.
© 2015 Annals of Family Medicine, Inc.
DOI: 10.1370/afm.1756
PMCID: PMC4648140
Examining the relationship between therapeutic self-care and adverse events for
home care clients in Ontario, Canada: a retrospective cohort study.
Sun W(1)(2), Doran DM(3), Wodchis WP(4), Peter E(3).
Author information:
(1)Faculty of Health Sciences, University of Ontario Institute of Technology,
2000 Simcoe St N, Oshawa, ON, L1H 7K4, Canada. winnie.sun@mail.utoronto.ca.
(2)Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College
Street, Suite 130, Toronto, ON, M5T 1P8, Canada. winnie.sun@mail.utoronto.ca.
(3)Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College
Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
(4)Institute of Health Policy Management and Evaluation, University Toronto, 155
College Street, 4th floor, Toronto, ON, M5T 3M6, Canada.
BACKGROUND: In an era of a rapidly aging population who requires home care

services, clients must possess or develop therapeutic self-care ability in order
to manage their health conditions safely in their homes. Therapeutic self-care is
the ability to take medications as prescribed and to recognize and manage
symptoms that may be experienced, such as pain. The purpose of this research
study was to investigate whether therapeutic self-care ability explained
variation in the frequency and types of adverse events experienced by home care
clients.
METHODS: A retrospective cohort design was used, utilizing secondary databases
available for Ontario home care clients from the years 2010 to 2012. The data
were derived from (1) Health Outcomes for Better Information and Care; (2)
Resident Assessment Instrument-Home Care; (3) National Ambulatory Care Reporting
System; and (4) Discharge Abstract Database. Descriptive analysis was used to
identify the types and prevalence of adverse events experienced by home care
clients. Logistic regression analysis was used to examine the association between
therapeutic self-care ability and the occurrence of adverse events in home care.
RESULTS: The results indicated that low therapeutic self-care ability was
associated with an increase in adverse events. In particular, logistic regression
results indicated that low therapeutic self-care ability was associated with an
increase in clients experiencing: (1) unplanned hospital visits; (2) a decline in
activities of daily living; (3) falls; (4) unintended weight loss, and (5)
non-compliance with medication.
CONCLUSIONS: This study advances the understanding about the role of therapeutic
self-care ability in supporting the safety of home care clients. High levels of
therapeutic self-care ability can be a protective factor against the occurrence
of adverse events among home care clients. A clear understanding of the nature of
the relationship between therapeutic self-care ability and adverse events helps
to pinpoint the areas of home care service delivery required to improve clients'
health and functioning. Such knowledge is vital for informing health care leaders
about effective strategies that promote therapeutic self-care, as well as
providing evidence for policy formulation in relation to risk mitigation in home
care.
DOI: 10.1186/s12913-017-2103-9
PMCID: PMC5351056
1916. Respir Res. 2016 Apr 5;17:38. doi: 10.1186/s12931-016-0354-3.
Innovations in health information technologies for chronic pulmonary diseases.
Himes BE(1), Weitzman ER(2)(3).
Author information:
(1)Department of Biostatistics and Epidemiologyok, University of Pennsylvania,
Philadelphia, PA, 19104, USA. bhimes@upenn.edu.
(2)Computational Health Informatics Program, Boston Children's Hospital, Boston,
MA, 02115, USA.
(3)Division of Adolescent Medicine, Boston Children's Hospital, Boston, MA,
02115, USA.
Asthma and chronic obstructive pulmonary disease (COPD) are common chronic
obstructive lung disorders in the US that affect over 49 million people. There is
no cure for asthma or COPD, but clinical guidelines exist for controlling
symptoms that are successful in most patients that adhere to their treatment
plan. Health information technologies (HITs) are revolutionizing healthcare by
becoming mainstream tools to assist patients in self-monitoring and
decision-making, and subsequently, driving a shift toward a care model
increasingly centered on personal adoption and use of digital and web-based
tools. While the number of chronic pulmonary disease HITs is rapidly increasing,
most have not been validated as clinically effective tools for the management of
disease. Online communities for asthma and COPD patients are becoming sources of
empowerment and support, as well as facilitators of patient-centered research
efforts. In addition to empowering patients and facilitating disease
self-management, HITs offer promise to aid researchers in identifying chronic
pulmonary disease endotypes and personalized treatments based on patient-specific
profiles that integrate symptom occurrence and medication usage with
environmental and genomic data.
DOI: 10.1186/s12931-016-0354-3
PMCID: PMC4822326
1917. BMC Health Serv Res. 2015 Sep 26;15:419. doi: 10.1186/s12913-015-1089-4.
The prevalence of self-reported underuse of medications due to cost for the

elderly: results from seven European urban communities.
Stankuniene A(1), Stankunas M(2), Avery M(3), Lindert J(4)(5), Mikalauskiene

R(6), Melchiorre MG(7), Torres-Gonzalez F(8), Ioannidi-Kapolou E(9), Barros
H(10), Savickas A(11), Radziunas R(12), Soares JJ(13).
Author information:
Health Sciences, Kaunas, Lithuania. aurimastan@gmail.com.
(2)Department of Health Management, Lithuanian University of Health Sciences,
Kaunas, Lithuania. mindaugas.stankunas@lsmuni.lt.
(3)Health Service Management Department, Centre for Health Innovation, School of
Medicine, Griffith University, Gold Coast, Queensland, Australia.
mark.avery@griffith.edu.au.
(4)Department of Public Health, University of Emden, Emden, Germany.
Jutta.lindert@hs-emden-leer.de.
(5)Brandeis University, Waltham, USA. Jutta.lindert@hs-emden-leer.de.
Health Sciences, Kaunas, Lithuania. ritusinka@gmail.com.
(7)Scientific Technological Area, Centre for Socio Economic Research on Ageing,
Italian National Institute of Health and Science on Aging (INRCA), Ancona, Italy.
g.Melchiorre@inrca.it.
(8)Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM),
University of Granada, Granada, Spain. ftorres@ugr.es.
(9)Department of Sociology, National School of Public Health, Athens, Greece.
ioanel@otenet.gr.
(10)Department of Hygiene and Epidemiology, Faculty of Medicine, University of
Porto, Porto, Portugal. hbarros@med.up.pt.
Health Sciences, Kaunas, Lithuania. arunas.savickas@lsmuni.lt.
Health Sciences, Kaunas, Lithuania. raimondas.radziunas@lsmuni.lt.
(13)Department of Health Sciences, Section of Public Health Science, Mid Sweden
University, Sundsvall, Sweden. Joaquim.Soares@miun.se.
BACKGROUND: The aim of this study was to evaluate the prevalence of self-reported
underuse of medications due to procurement costs amongst older persons from seven
European urban communities.
METHODS: The data were collected in a cross-sectional study ("ABUEL, Elder abuse:
A multinational prevalence survey") in 2009. Randomly selected people aged 60-84
years (n = 4,467) from seven urban communities: Stuttgart (Germany), Athens
(Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain)
and Stockholm (Sweden) were interviewed. Response rate - 45.2%. Ethical
permission was received in each country.
RESULTS: The results indicate that 3.6% (n = 162) of the respondents
self-reported refraining from buying prescribed medications due to cost. The
highest prevalence of this problem was identified in Lithuania (15.7%, n = 99)
and Portugal (4.3%, n = 28). Other countries reported lower percentages of
refraining from buying medications (Germany - 2.0%, Italy - 1.6%, Sweden - 1.0%,
Greece - 0.6%, Spain - 0.3%). Females refrained more often from buying
medications than males (2.6% vs. 4.4%, p < 0.0001). The prevalence of this
refraining tended to increase with economic hardship.
DISCUSSION: These differences between countries can be only partly described by
the financing of health-care systems. In spite of the presence of cost
reimbursement mechanisms, patients need to make co-payments (or in some cases to
pay the full price) for prescribed medications. This indicates that the
purchasing power of people in 10.1186/s12913-015-1089-4 the particular country
can play a major role and be related with the economic situation in the country.
Lithuania, which has reported the highest refrain rates, had the lowest gross
domestic product (at the time of conducting this study) of all participating
countries in the study.
CONCLUSIONS: Refraining from buying the prescribed medications due to cost is a
problem for women and men in respect to ageing people in Europe. Prevalence
varies by country, sex, and economic hardship.
DOI: 10.1186/s12913-015-1089-4
PMCID: PMC4583739
1918. Neurol Res Int. 2018 Sep 9;2018:5109615. doi: 10.1155/2018/5109615.

eCollection
2018.
Assessment of Patients' Adherence to Antiepileptic Medications at Dessie Referral

Hospital, Chronic Follow-Up, South Wollo, Amhara Region, North East Ethiopia.
Kassahun G(1), Moges G(2), Demessie Y(3).
Author information:
(1)Department of Pharmacognosy, School of Pharmacy, College of Medicine and
Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
(2)Department of Pharmaceutics and Pharmacoepidemiology, School of Pharmacy,
College of Health Sciences, Wollo University, Dessie, Ethiopia.
(3)Department of Biomedical Sciences, College of Veterinary Medicine and Animal
Sciences, University of Gondar, Gondar, Ethiopia.
An epileptic seizure is a clinical event presumed to result from an abnormal and

excessive neuronal discharge. The clinical symptoms are paroxysmal and may
include impaired consciousness and motor, sensory, autonomic, or psychic events
perceived by the subject or an observer. Epilepsy occurs when 2 or more epileptic
seizures occur unprovoked by any immediately identifiable cause. And in the
majority of patients with epilepsy, antiepileptic drugs effectively control their
illness. However, more than 30% of people with epilepsy do not attain full
seizure control, even with the best available treatment regimen. The aim of this
study is to assess self-reported adherence in adult patients with epilepsy and to
identify potential barriers for nonadherence to antiepileptic drug treatment in
Dessie Referral Hospital. A hospital based cross-sectional study was conducted
using structured questionnaires including Morisky medication adherence scale and
analysis was conducted descriptively using SPSS version 20. The level of
nonadherence to antiepileptic medication regimens was 34.1%. The major reason for
missing medication was forgetfulness 53.5%. And the most common side effect was
sedation 56.2%. Conclusion. Majority of epileptic patients in Dessie Referral
Hospital was adherent to their AEDs treatment and among the determinants of
adherence assessed the level of education and the side effect of drugs showed
statistical significance.
DOI: 10.1155/2018/5109615
PMCID: PMC6151205
PMID: 30271635
1919. J Infect Dev Ctries. 2016 Nov 24;10(11):1258-1264. doi: 10.3855/jidc.7129.
Malaria knowledge and treatment adherence in a Brazilian Amazon community.
Souza TG(1), Reiners AA, Azevedo RC, Fontes CJ, Ferreira RG, Do Carmo PU.
Author information:
(1)Federal University of Mato Grosso, Cuiabá, Brasil. taisa_guima@hotmail.com.
INTRODUCTION: Malaria remains an important public health problem despite recent

scientific breakthroughs regarding knowledge about malaria and treatment
strategies. The objective of this study was to analyze malaria patients'
knowledge about the disease, its treatment and prevention, linking it to drug
treatment adherence.
METHODOLOGY: A descriptive, cross-sectional, epidemiological survey study was
conducted in the district of Três Fronteiras-MT. The study included 618
individuals who were interviewed and examined for Plasmodium infection. Of the 52
patients diagnosed with malaria, 27 were visited at home for an interview about
malaria knowledge and treatment adherence. Treatment adherence was evaluated by
self-reports and drug conference.
RESULTS: A total of 18 patients had satisfactory knowledge (66.6%) and 9 were
evaluated as having unsatisfactory knowledge (33.4%) about malaria. Of the 27
malaria patients, 21 (77.8%) reported having taken all the medication as
prescribed, in the correct period of time and dosage, and had no medication
tablets remaining. The majority (72.2%) of patients who had satisfactory
knowledge, as well as the majority (88.8%) of those who had unsatisfactory
knowledge, adhered to the malaria treatment.
CONCLUSIONS: This study revealed a high proportion of patients with satisfactory
prior knowledge about malaria and revealed that this knowledge was not related to
disease treatment adherence. These results have implications for planning
strategies for malaria control in the region and could contribute to the
reduction in the cases of non-adherence to malaria treatment.
DOI: 10.3855/jidc.7129
1920. West Indian Med J. 2014 Dec;63(7):744-51. doi: 10.7727/wimj.2013.222. Epub

2014
Aug 29.
3Ps--Pharmacist, Physician and Patient: Proposal for Joint Cooperation to

Increase Adherence to Medication.
Leppée M(1), Culig J(2)(3), Mandic K(4), Eric M(5).
Author information:
(1)Department of Pharmacoepidemiology, Andrija Stampar Institute of Public
Health, Mirogojska 16, 10000 Zagreb, Croatia. marcel.leppee@stampar.hr.
(2)Department of Pharmacoepidemiology, Andrija Stampar Institute of Public
Health, Mirogojska 16, 10000 Zagreb, Croatia.
(3)Department of Pharmacology, School of Medicine, Josip Juraj Strossmayer
University Osijek, J. Huttlera 4, 31000 Osijek, Croatia.
(4)University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
(5)Department of Anatomy, School of Medicine, University of Novi Sad, Hajduk
Veljkova 1-3, 21000 Novi Sad, Serbia.
OBJECTIVE: Older people receive medications for chronic diseases and therefore
adherence is an important health and economic concern. The objective of the study
is to determine relationships between pharmacist, patient and patient's family
physician with special emphasis on the comparison of adherent and non-adherent
patients.
METHODS: The study was designed as a cross-sectional survey by use of a
self-administered 33-item questionnaire. The study included 635 individuals
collecting or buying drugs for the treatment of chronic diseases and 84
pharmacists dispensing drugs for chronic diseases to patients.
RESULTS: The study included 265 (41.7%) adherent and 370 (58.3%) non-adherent
patients. Comparison of particular answers between patients and pharmacists
revealed a discrepancy, with a significant difference in five of eight answers.
The highest difference was recorded in answers to the question whether a
pharmacist offered thorough advice to the patient on how to take the drug; an
affirmative answer to this question was given by 90.5% of pharmacists and only
57.2% of patients. The analysis of respondents' claims about their relation with
one doctor shows that in the first place, with the highest number of positive
responses, is the claim of the respondents that their doctor always explains the
results of laboratory tests and other specialized findings (n = 489, 77.0%).
CONCLUSION: Enhancing communication between the physician, the pharmacist and the
patient is a key in boosting the patient's ability to follow a medication
regimen. Pharmacist-physician-patient relationship can improve adherence to
medication. It is very important to empower pharmacists to offer and allow time
for patient counselling.
DOI: 10.7727/wimj.2013.222
PMCID: PMC4668963
PMID: 25867560
1921. Psychol Health Med. 2015;20(4):488-94. doi: 10.1080/13548506.2014.953962.

Epub
2014 Aug 28.
Experiences of participating in an antiretroviral treatment adherence club.
Dudhia R(1), Kagee A.
Author information:
(1)a Department of Psychology , Stellenbosch University , Matieland , South
Africa.
In an effort to streamline the management of large numbers of patients receiving

antiretroviral therapy (ART) in South Africa, adherence clubs were introduced in
some districts in the Western Cape since 2008. Adherence clubs are group clinic
visits of approximately 30 ART users who receive group adherence counselling and
obtain a supply of medication. We sought to document the experiences of patients
attending adherence clubs and health care workers (HCW's) at clinics where clubs
were operating. Participants were six ART adherence club members and seven HCW's,
which included HIV nurses, medical doctors, pharmacists and counsellors. Data in
the form of one-on-one interviews were collected at the Infectious Diseases
Clinic of a large district hospital in a peri-urban area in the Western Cape
region of South Africa. The interviews covered ART users' experiences of the
clubs, advantages and challenges that arose in the context of the club-based
method of providing treatment, and the concerns faced by ART users and HCW's with
regard to the clubs. The data were analysed using thematic analysis. There were
clear benefits to the introduction of adherence clubs, most importantly the
reduced amount of time ART users needed to spend at the clinic. Yet, various
problems also emerged, the most important one being the logistical problems
associated with the timely and correct delivery of drugs. These benefits and
disadvantages are discussed in the context of providing ART services to large
numbers of patients in post-apartheid South Africa.
DOI: 10.1080/13548506.2014.953962
PMCID: PMC4550101
1922. Behav Brain Res. 2016 Jan 15;297:165-79. doi: 10.1016/j.bbr.2015.10.017. Epub
2015 Oct 20.
Adolescent D-amphetamine treatment in a rodent model of ADHD: Pro-cognitive

effects in adolescence without an impact on cocaine cue reactivity in adulthood.
Jordan CJ(1), Taylor DM(1), Dwoskin LP(2), Kantak KM(3).
Author information:
(1)Department of Psychological and Brain Sciences, Boston University, Boston, MA
02215, USA.
(2)Department of Pharmaceutical Sciences, College of Pharmacy, University of
Kentucky, Lexington, KY 40536, USA.
(3)Department of Psychological and Brain Sciences, Boston University, Boston, MA
02215, USA. Electronic address: kkantak@bu.edu.
Attention-deficit/hyperactivity disorder (ADHD) is comorbid with cocaine abuse.

Whereas initiating ADHD medication in childhood does not alter later cocaine
abuse risk, initiating medication during adolescence may increase risk.
Preclinical work in the Spontaneously Hypertensive Rat (SHR) model of ADHD found
that adolescent methylphenidate increased cocaine self-administration in
adulthood, suggesting a need to identify alternatively efficacious medications
for teens with ADHD. We examined effects of adolescent d-amphetamine treatment on
strategy set shifting performance during adolescence and on cocaine
self-administration and reinstatement of cocaine-seeking behavior (cue
reactivity) during adulthood in male SHR, Wistar-Kyoto (inbred control), and
Wistar (outbred control) rats. During the set shift phase, adolescent SHR needed
more trials and had a longer latency to reach criterion, made more regressive
errors and trial omissions, and exhibited slower and more variable lever press
reaction times. d-Amphetamine improved performance only in SHR by increasing
choice accuracy and decreasing errors and latency to criterion. In adulthood, SHR
self-administered more cocaine, made more cocaine-seeking responses, and took
longer to extinguish lever responding than control strains. Adolescent
d-amphetamine did not alter cocaine self-administration in adult rats of any
strain, but reduced cocaine seeking during the first of seven reinstatement test
sessions in adult SHR. These findings highlight utility of SHR in modeling
cognitive dysfunction and comorbid cocaine abuse in ADHD. Unlike methylphenidate,
d-amphetamine improved several aspects of flexible learning in adolescent SHR and
did not increase cocaine intake or cue reactivity in adult SHR. Thus, adolescent
d-amphetamine was superior to methylphenidate in this ADHD model.
DOI: 10.1016/j.bbr.2015.10.017
PMCID: PMC4679481
1923. J Prev Med Public Health. 2019 Mar;52(2):131-139. doi: 10.3961/jpmph.18.257.

Epub
2019 Mar 29.
Validity of Self-reported Hypertension and Factors Related to Discordance Between

Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study
in Iran.
Najafi F(1)(2), Pasdar Y(1)(3), Shakiba E(4), Hamzeh B(1)(5), Darbandi M(6),
Moradinazar M(1)(2), Navabi J(4), Anvari B(4), Saidi MR(2), Bazargan-Hejazi S(7).
Author information:
(1)Research Center for Environmental Determinants of Health, Kermanshah
(2)Kermanshah Cardiovascular Research Center, Kermanshah University of Medical
Sciences, Kermanshah, Iran.
(3)Nutritional Sciences Department, School of Public Health, Kermanshah
(4)School of Medicine, Kermanshah University of Medical Sciences, Kermanshah,
Iran.
(5)Department of Public Health, Kermanshah University of Medical Sciences,
Kermanshah, Iran.
(6)Students Research Committee, Kermanshah University of Medical Sciences,
Kermanshah, Iran.
(7)Department of Psychiatry, Charles Drew University of Medicine and Science
(CDU), Los Angeles, CA, USA.
OBJECTIVES: Self-reporting can be used to determine the incidence and prevalence

of hypertension (HTN). The present study was conducted to determine the validity
of self-reported HTN and to identify factors affecting discordance between
self-reported and objectively measured HTN in participants in the Ravansar
Non-Communicable Diseases (RaNCD) cohort.
METHODS: The RaNCD cohort included permanent residents of Ravansar, Iran aged
35-65 years. Self-reported data were collected before clinical examinations were
conducted by well-trained staff members. The gold standard for HTN was
anti-hypertensive medication use and blood pressure measurements. The
sensitivity, specificity, positive and negative predictive values, and overall
accuracy of self-reporting were calculated. Univariate and multivariate logistic
regression were used to examine the discordance between self-reported HTN and the
gold standard.
RESULTS: Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The
prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical
history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no
knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN
despite receiving treatment. The sensitivity, specificity, and kappa for
self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives
became more likely with age, body mass index (BMI), low socioeconomic status, and
female sex, whereas false negatives became more likely with age, BMI, high
socioeconomic status, smoking, and urban residency.
CONCLUSIONS: The sensitivity and specificity of self-reported HTN were
acceptable, suggesting that this method can be used for public health initiatives
in the absence of countrywide HTN control and detection programs.
DOI: 10.3961/jpmph.18.257
PMCID: PMC6459766
1924. J Manag Care Spec Pharm. 2015 Nov;21(11):993-1003.
Potential Health Implications of Medication Therapy Management Eligibility

Criteria in the Patient Protection and Affordable Care Act Across Racial and
Ethnic Groups.
Wang J(1), Qiao Y, Shih YC, Jarrett-Jamison J, Spivey CA, Wan JY, White-Means SI,
Dagogo-Jack S, Cushman WC, Chisholm-Burns M.
Author information:
(1)University of Tennessee College of Pharmacy, 881 Madison Ave., Rm. 221,
Memphis, TN 38163. jwang26@uthsc.edu.
BACKGROUND: The Medicare Prescription Drug, Improvement, and Modernization Act

requires Part D plans to establish programs to provide medication therapy
management (MTM) services starting from 2006. MTM services have been found to
improve patient outcomes from pharmacotherapy, reduce emergency room visits and
hospitalizations, and reduce health care costs in a cost-effective fashion.
However, previous research found that non-Hispanic blacks (blacks) and Hispanics
may be less likely to be eligible for MTM services than non-Hispanic whites
(whites) among the Medicare population, according to current Medicare MTM
eligibility criteria. This finding is because Medicare MTM eligibility criteria
are predominantly based on medication use and costs, and blacks and Hispanics
tend to use fewer prescription medications and incur lower prescription
medication costs. The Patient Protection and Affordable Care Act (PPACA) laid out
a set of MTM eligibility criteria for eligible entities to target patients for
MTM services: "(1) take 4 or more prescribed medications ...; (2) take any 'high
risk' medications; (3) have 2 or more chronic diseases ... or (4) have undergone
a transition of care, or other factors ... that are likely to create a high risk
of medication-related problems."
OBJECTIVES: To (a) examine racial/ethnic disparities in meeting the eligibility
criteria for MTM services in PPACA among the Medicare population and (b)
determine whether there would be greater disparities in health and economic
outcomes among MTM-ineligible than MTM-eligible groups.
METHODS: This was a retrospective cross-sectional analysis of the Medicare
Current Beneficiaries Survey (2007-2008). To determine medication
characteristics, the U.S. Food and Drug Administration's Electronic Orange Book
was also used. Proportions of the population eligible for MTM services based on
PPACA MTM eligibility criteria were compared across racial and ethnic groups
using a chi-square test; a logistic regression model was used to adjust for
population sociodemographic and health characteristics. Health and economic
outcomes examined included health status (self-perceived good health status,
number of chronic diseases, activities of daily living [ADLs], and instrumental
activities of daily living [IADLs]), health services utilization and costs
(physician visits, emergency room visits, and total health care costs), and
medication use patterns (generic dispensing ratio). To determine difference in
disparities across MTM eligibility categories, difference-in-differences
regressions of various functional forms were employed, depending on the nature of
the dependent variables. Interaction terms between the dummy variables for
minority groups (e.g., blacks or Hispanics) and MTM eligibility were included to
test whether disparity patterns varied between MTM-ineligible and MTM-eligible
individuals.
RESULTS: The sample consisted of 12,966 Medicare beneficiaries, of which 11,161
were white, 930 were black, and 875 were Hispanic. Of the study sample, 9,992
whites (86.4%), 825 blacks (86.3%), and 733 Hispanics (80.6%) were eligible for
MTM. The difference between whites and Hispanics was significant (P less than
0.050), and the difference between whites and blacks was not significant (P
greater than 0.050). In multivariate analyses, significant disparity in
eligibility for MTM services was found only between Hispanics and whites (odds
ratio [OR] = 0.59; 95% CI = 0.43-0.82) but not between blacks and whites
(OR = 0.78; 95% CI = 0.55-1.09). Disparities were greater among the
MTM-ineligible than the MTM-eligible populations in self-perceived health status,
ADLs, and IADLs for both blacks and Hispanics compared with whites. When
analyzing the number of chronic conditions, the number and costs of physician
visits, and total health care costs, the authors of this study found lower racial
and ethnic disparities among the ineligible population than the eligible
population.
CONCLUSIONS: Hispanics are significantly less likely than whites to qualify for
MTM among the Medicare population, according to MTM eligibility criteria
stipulated in the PPACA. PPACA MTM eligibility criteria may aggravate existing
racial and ethnic disparities in health status but may remediate racial and
ethnic disparities in health services utilization. Alternative MTM eligibility
criteria other than PPACA MTM eligibility criteria may be needed to improve the
efficiency and equity of access to Medicare Part D MTM programs.
DOI: 10.18553/jmcp.2015.21.11.993
PMCID: PMC4631076
1925. J Clin Med Res. 2018 Nov;10(11):806-814. doi: 10.14740/jocmr3557w. Epub 2018
Oct
9.
Drug-Drug Interaction Assessment and Identification in the Primary Care Setting.
Peabody J(1)(2)(3), Acelajado MC(4), Robert T(5), Hild C(5), Schrecker J(5),
Paculdo D(3), Tran M(3), Jeter E(5).
Author information:
(1)University of California, San Francisco, CA, USA.
(2)University of California, Los Angeles, CA, USA.
(3)QURE Healthcare, San Francisco, CA, USA.
(4)Athens Limestone Hospital, Athens, AL, USA.
(5)Aegis Sciences Corporation, Nashville, TN, USA.
Background: Drug-drug interactions (DDIs) are ubiquitous, harmful and a leading

cause of morbidity and mortality. With an aging population, growth in
polypharmacy, widespread use of supplements, and the rising opioid abuse
epidemic, primary care physicians (PCPs) are increasingly challenged with
identifying and preventing DDIs. We set out to evaluate current clinical
practices related to identifying and treating DDIs and to determine if
opportunities to increase prevention of DDIs and their adverse events could be
identified.
Methods: In a nationally representative sample of 330 board-certified family and
internal medicine practitioners, we evaluated whether PCPs assessed DDIs in the
care they provided for three simulated patients. The patients were taking common
prescription medications (e.g. opioids and psychiatric medications) along with
other common ingestants (e.g. supplements and food) and presented with symptoms
of DDIs. Physicians were scored on their ability to inquire about the patient's
medications, investigate possible DDIs, evaluate the patient, and provide
treatment recommendations. We scored the physicians' care recommendations against
evidence-based criteria, including overall care quality and treatment for DDIs.
Results: Average overall quality of care score was 50.5% ± 12.0%. Despite >99%
self-reported use of medication reconciliation practices and tools, physicians
identified DDIs in only 15.3% of patients, with 15.5% ± 20.3% of DDI-specific
treatment by the physicians.
Conclusions: PCPs in this study did not recognize or adequately treat DDIs.
Better methods are needed to screen for DDIs in the primary care setting.
DOI: 10.14740/jocmr3557w
PMCID: PMC6188027
PMID: 30344815
1926. Appl Clin Inform. 2018 Apr;9(2):450-466. doi: 10.1055/s-0038-1660516. Epub

2018
Jun 20.
A Systematic Review on Promoting Adherence to Antiretroviral Therapy in

HIV-infected Patients Using Mobile Phone Technology.
Quintana Y(1)(2), Gonzalez Martorell EA(2), Fahy D(1), Safran C(1)(2).
Author information:
(1)Division of Clinical Informatics, Department of Medicine, Beth Israel
Deaconess Medical Center, Boston, Massachusetts, United States.
(2)Harvard Medical School, Boston, Massachusetts, United States.
OBJECTIVE: Adherence to antiretroviral therapy (ART) is paramount to successful

long-term suppression of human immunodeficiency virus (HIV). For poorly adherent
patients with HIV, barriers to remaining adherent may be overcome by the
implementation of targeted interventions delivered via mobile devices. This
systematic review is focused specifically on mobile phone technologies to deliver
adherence interventions in HIV/acquired immunodeficiency syndrome (AIDS)
populations.
METHODS: This review (PROSPERO #CRD42017065131) systematically extracted data
from published literature from five databases on mobile phone interventions to
improve adherence to ART for HIV. The reported studies had been conducted between
2007 and 2017. Risk of bias was assessed using the Cochrane method ranking each
criterion as low, high, or unclear risk of bias.
RESULTS: Of the 835 articles returned, we identified 26 randomized controlled
trials (RCTs), retrospective and prospective cohort trials, or mixed method
studies with a comparison group that fit criteria for inclusion. No standard
measure of adherence was consistent throughout the examined studies, and
assessments by self-report, pill counting, and medication event monitoring system
(MEMS) were utilized. The studies reported mixed results, with 17 reporting
significant improvements to adherence, 3 reporting improvements without supplying
p-values, and 6 reporting no significant change or a reduction in adherence.
CONCLUSION: The mixed nature of the results exemplifies the need for more
comprehensive approaches and larger scale trials to confirm results observed in
limited cohort sizes. To better retain satisfactory adherence within the HIV
population, and especially in low-resource settings, we recommend that future
interventions incorporate multiple strategies: mobile-based reminders, social
support structures, and personalized content.
Schattauer GmbH Stuttgart.
DOI: 10.1055/s-0038-1660516
PMCID: PMC6010354
1927. Neurol Res. 2015 Aug;37(8):662-73. doi: 10.1179/1743132815Y.0000000036. Epub

2015
Apr 23.
Medication use in a large international sample of people with multiple sclerosis:

associations with quality of life, relapse rate and disability.
Jelinek GA, Weiland TJ, Hadgkiss EJ, Marck CH, Pereira N, van der Meer DM.
OBJECTIVES: To examine associations between medication use and health-related

quality of life (HRQOL), relapse rate and disability in an international cohort
of people with multiple sclerosis (PwMS).
METHODS: Using Web 2.0 platforms, the authors recruited PwMS who completed survey
items on demographics, medication use, HRQOL, relapse rate and disability.
RESULTS: Of 2276 respondents from 56 countries, approximately half were taking a
disease-modifying drug (DMD), most commonly glatiramer acetate or an interferon.
Use of DMDs was not consistently associated with HRQOL. Individually, glatiramer
acetate was associated with better HRQOL when compared with other DMDs or no DMD
use. Overall, DMD use was neither associated with disability nor lower relapse
rate, although those taking a DMD >12 months had 23.9% fewer relapses than those
not taking a DMD. Polypharmacy, defined as those taking five or more over the
counter, prescription or herbal medications, irrespective of DMD use, was
associated with markedly worse HRQOL across all domains.
DISCUSSION: There was no consistent association of DMD use with better health
outcomes in this large international \sample of PwMS, although relapse rate
appears lower for those taking a DMD for >12 months. Glatiramer acetate had
associations with better HRQOL compared with other DMDs.
DOI: 10.1179/1743132815Y.0000000036
PMCID: PMC4507477
1928. Am J Mens Health. 2019 Mar-Apr;13(2):1557988319847088. doi:

10.1177/1557988319847088.
Influencing Factors of Pre-Exposure Prophylaxis Self-Efficacy Among Men Who Have

Sex With Men.
Qu D(1)(2)(3), Zhong X(1)(2)(3), Lai M(1)(2)(3), Dai J(4), Liang H(5), Huang
A(6).
Author information:
(1)1 Department of Epidemiology and Health Statistics, School of Public Health
and Management, Chongqing Medical University, China.
(2)2 Research Center for Medicine and Social Development, Chongqing Medical
University, China.
(3)3 Innovation Center for Social Risk Governance in Health, Chongqing Medical
University, China.
(4)4 Department of Epidemiology and Health Statistics, School of Public Health,
Xinjiang Medical University, China.
(5)5 Department of Epidemiology and Health Statistics, School of Public Health,
Guangxi Medical University, Nanning, China.
(6)6 Key Laboratory of Molecular Biology, Ministry of Molecular Biology,
Infectious Diseases, Medical University of Chongqing, China.
This research examines the level of pre-exposure prophylaxis (PrEP) self-efficacy

among HIV-negative men who have sex with men (MSM) in China and identifies the
influencing factors associated with the level of PrEP self-efficacy in terms of
social-demographic characteristics and social psychological factors. The data
were gathered from a baseline assessment of a longitudinal randomized controlled
intervention trial. From April 2013 to March 2015, nonprobability sampling was
used to recruit HIV-negative MSM at Chongqing, Guangxi, Xinjiang, and Sichuan in
west China. A total of 1884 HIV-negative MSM were analyzed. Chi-square test and
nonparametric rank sum test were used for univariate analysis. Multivariable
linear regression analysis was used to discuss the factors that influence the
level of PrEP self-efficacy. Overall levels of PrEP self-efficacy were low, and
five factors were found to effect PrEP self-efficacy: age, residence,
AIDS-related knowledge, PrEP-related motivation, and anxiety. Age and anxiety
score were negatively related to PrEP self-efficacy. The higher the age and
anxiety score, the lower the PrEP self-efficacy. AIDS-related knowledge and
PrEP-related motivation were actively related to PrEP self-efficacy. The higher
the knowledge and motivation score, the higher the PrEP self-efficacy. In
addition, the PrEP self-efficacy level of MSM in rural areas is lower than that
in urban areas. The lower level of self-efficacy in the MSM population needs to
be improved. Pertinent interventions should be taken to promote the self-efficacy
of PrEP in MSM, to enhance their willingness to take medicine, improve their
medication adherence, and thus reduce HIV infection among MSM.
DOI: 10.1177/1557988319847088
PMCID: PMC6488787
PMID: 31030626
Self-Management Strategies for Coping with Adverse Symptoms in Persons Living

with HIV with HIV Associated Non-AIDS Conditions.
Iribarren S(1)(2), Siegel K(3), Hirshfield S(4), Olender S(5), Voss J(6),
Krongold J(1), Luft H(1), Schnall R(7).
Author information:
(1)School of Nursing, Columbia University, New York, NY, USA.
(2)Department of Biobehavioral Nursing and Health Informatics, School of Nursing,
University of Washington, Seattle, WA, USA.
(3)Department of Sociomedical Sciences, Mailman School of Public Health, Columbia
University, New York, NY, USA.
(4)Research and Evaluation Unit, Public Health Solutions, New York, NY, USA.
(5)College of Physicians and Surgeons, Columbia University, New York, NY, USA.
(6)Frances Payne Bolton School of Nursing, Case Western Reserve University,
Cleveland, OH, USA.
(7)School of Nursing, Columbia University, New York, NY, USA. rb897@columbia.edu.
People living with HIV (PLWH) are living longer, but many are now affected by
HIV-associated non-AIDS (HANA) conditions and their associated adverse symptoms.
An online survey was conducted with 769 PLWH with HANA conditions in the US.
Information was elicited on symptoms experienced, self-management strategies
employed, and the helpfulness of these strategies. Open ended responses were
collected for self-management strategies. A qualitative data analytic approach
was used to organize the 4036 self-management strategies into thematic
categories, with eight main categories emerging, including: taking medication,
modifying activity, altering diet, seeking help, waiting, substance use, managing
thoughts and attitudes, and altering the physical environment. Of the
self-management strategy subcategories, social support was the most helpful
self-management strategy with waiting/doing nothing being the least helpful
approach. Findings can be used to inform the development of self-management
interventions and to support health care professionals in recommending symptom
self-management strategies to their patients.
DOI: 10.1007/s10461-017-1786-6
PMCID: PMC5738289
1930. BMC Health Serv Res. 2018 Feb 12;18(1):105. doi: 10.1186/s12913-018-2895-2.
Information about management of chronic drug therapies prescribed at hospital

discharge: does it affect patients' knowledge and self-confidence?
Pileggi C(1), Caligiuri E(1), Nobile CGA(2), Pavia M(3).
Author information:
(1)Department of Health Sciences, University of Catanzaro "Magna Græcia", Via
Tommaso Campanella, 88100, Catanzaro, Italy.
(2)Department of Pharmacy, Health and Nutritional Sciences, University of
Calabria, Arcavacata di Rende, 87036, Cosenza, Italy.
(3)Department of Health Sciences, University of Catanzaro "Magna Græcia", Via
Tommaso Campanella, 88100, Catanzaro, Italy. pavia@unicz.it.
BACKGROUND: Hospital stay represents the opportunity for a change of therapy,

about which patients may not know indications, contraindications, and mode of
administration, which may lead to dosing errors, drug interactions, side effects,
etc. It is therefore vital to communicate appropriate information to the
discharged patient with a new prescription drug. The purpose of the study was to
evaluate: 1) how communication about new chronic therapies is managed at hospital
discharge and what kind of information is provided to patients; 2) to what extent
patients are aware and confident in the management of these medications; 3)
whether the way communication is provided affects patients' awareness and
self-confidence in the management of these therapies.
METHODS: Participants were adult patients who were prescribed at least one new
chronic medication at hospital discharge. A telephone interview after hospital
discharge was performed to assess whether or not hospital healthcare personnel
had given information about prescribed therapies and which aspects of therapies
had been object of information.
RESULTS: Five hundred thirty patients were interviewed. 67.7% reported having
received counseling by the hospital physician, while 32.3% by discharge form.
Basic information on treatment was provided to the great majority of patients,
whereas only few patients reported to have been informed about eventual side
effects and related behavior in case of side effects.
CONCLUSIONS: Several aspects of patients' knowledge and self-confidence on long
term medications prescribed at hospital discharge need to be improved and the way
communication is provided has a crucial role in the empowerment of patients in
the management of these medications.
DOI: 10.1186/s12913-018-2895-2
PMCID: PMC5809870
1931. Suicide Life Threat Behav. 2017 Apr;47(2):177-192. doi: 10.1111/sltb.12274.

Epub
2016 Jul 13.
Suicidality in Bipolar Disorder: The Role of Emotion-Triggered Impulsivity.
Johnson SL(1), Carver CS(2), Tharp JA(1).
Author information:
(1)Department of Psychology, University of California, Berkeley, Berkeley, CA,
USA.
(2)Department of Psychology, University of Miami, Coral Gables, FL, USA.
A growing body of research suggests that impulsive responses to emotion more

robustly predict suicidality than do other forms of impulsivity. This issue has
not yet been examined within bipolar disorder, however. Participants diagnosed
with bipolar I disorder (n = 133) and control participants (n = 110) diagnosed
with no mood or psychotic disorder completed self-report measures of
emotion-triggered impulsivity (Negative and Positive Urgency Scales) and
interviews concerning lifetime suicidality. Analyses examined the effects of
emotion-triggered impulsivity alone and in combination with gender, age of onset,
depression severity, comorbid anxiety, comorbid substance use, and medication. A
history of suicide ideation and attempts, as well as self-harm, were
significantly more common in the bipolar disorder group compared with the control
group. Impulsive responses to positive emotions related to suicide ideation,
attempts, and self-harm within the bipolar group. Findings extend research on the
importance of emotion-triggered impulsivity to a broad range of key outcomes
within bipolar disorder. The discussion focuses on limitations and potential
clinical implications.
© 2016 The American Association of Suicidology.
DOI: 10.1111/sltb.12274
PMCID: PMC5788807
1932. Indian J Endocrinol Metab. 2015 Apr;19(Suppl 1):S18-21. doi:

10.4103/2230-8210.155355.
Type 1 diabetes guidelines: Are they enough?
Zargar AH(1).
Author information:
(1)Consultant Endocrinologist, Advanced Centre for Diabetes and Endocrine Care,
Srinagar, Jammu and Kashmir, India.
The discovery of insulin by Banting and Best in 1922 changed the landscape of
type 1 diabetes mellitus (T1DM). Guidelines on T1DM should be evidence based and
should emphasize comprehensive risk management. Guidelines would improve
awareness amongst governments, state health care providers and the general public
about the serious long-term implications of poorly managed diabetes and of the
essential resources needed for optimal care. T1DM requires lifelong daily
medication, regular control as well as access to facilities to manage acute and
chronic complications. American Diabetes Association 2014 guidelines recommends
annual nephropathy screening for albumin levels; random spot urine sample for
albumin-to-creatinine ratio at start of puberty or age ≥10 years, whichever is
earlier, once the child has had diabetes for 5 years. Hypertension should be
screened for in T1DM patients by measuring blood pressure at each routine visit.
Dyslipidemia in T1DM patients is important and patients should be screened if
there is a family history of hypercholesterolemia or a cardiovascular event
before the age of 55 years exists or if family history is unknown. Retinopathy is
another important complication of diabetes and patients should be subjected to an
initial dilated and comprehensive eye examination. Basic diabetes training should
be provided for school staff, and they should be assigned with responsibilities
for the care of diabetic children. Self-management should be allowed at all
school settings for students.
DOI: 10.4103/2230-8210.155355
PMCID: PMC4413379
PMID: 25941640
1933. J Behav Med. 2017 Dec;40(6):864-874. doi: 10.1007/s10865-017-9856-9. Epub

2017
May 12.
Delay discounting and parental monitoring in adolescents with poorly controlled

type 1 diabetes.
Lansing AH(1), Stanger C(2), Crochiere R(2), Carracher A(3), Budney A(2).
Author information:
(1)Geisel School of Medicine at Dartmouth, 46 Centerra Pkwy., Suite 301, Lebanon,
NH, 03766, USA. amy.hughes.lansing@dartmouth.edu.
(2)Geisel School of Medicine at Dartmouth, 46 Centerra Pkwy., Suite 301, Lebanon,
NH, 03766, USA.
(3)Dartmouth College, Hanover, NH, USA.
In a sample of adolescents with poorly controlled type 1 diabetes, this study

examined if delay discounting, the extent to which individuals prefer immediate
over delayed rewards, was associated with severity of non-adherence and poor
glycemic control, and if parental monitoring of diabetes management moderated
those associations. Sixty-one adolescents (M age = 15.08 years, SD 1.43) with
poorly controlled type 1 diabetes completed a delayed discounting task and an
HbA1c blood test. Adherence was assessed via self-monitoring of blood glucose
(SMBG) data from adolescents' glucometers. Parents completed a parental
monitoring questionnaire. Greater delay discounting was associated with higher
HbA1c, but not SMBG. Direct parent observation of diabetes tasks, but not
indirect parental monitoring, moderated the link between greater delay
discounting and higher HbA1c, with higher direct parent observation buffering the
link between greater discounting and poorer glycemic control. Delay discounting
may be a target for future interventions to improve HbA1c in youth with type 1
diabetes.
DOI: 10.1007/s10865-017-9856-9
PMCID: PMC5681872
1934. Pain Med. 2014 Oct;15(10):1757-64. doi: 10.1111/pme.12416. Epub 2014 Mar 10.
The association between catastrophizing and craving in patients with chronic pain
prescribed opioid therapy: a preliminary analysis.
Martel MO(1), Jamison RN, Wasan AD, Edwards RR.
Author information:
(1)Department of Anesthesiology, Harvard Medical School, Brigham & Women's
Hospital, Boston, Massachusetts, USA.
BACKGROUND: A growing number of studies have shown that opioid craving (i.e., the
perceived need or desire to consume opioids) is one of the strongest determinants
of prescription opioid misuse in patients with chronic pain prescribed opioid
therapy. To date, however, the factors that are associated with craving in
patients with pain remain largely unexplored. Based on previous research, there
is reason to believe that catastrophizing might be associated with heightened
opioid craving.
OBJECTIVES: To test the hypothesis that catastrophizing would be associated with
heightened craving in patients with chronic pain prescribed long-term opioid
therapy.
DESIGN AND SUBJECTS, AND METHODS: In this cross-sectional study, 109 patients
with chronic pain were asked to provide self-reports of catastrophizing and
craving. Patients also provided self-reports of pain intensity and depressive
symptoms.
RESULTS: We found that higher levels of catastrophizing were associated with
higher levels of craving. Importantly, results of a regression analysis revealed
that the association between catastrophizing and craving remained significant
even after controlling for a host of demographic (i.e., age, sex), psychological
(i.e., depressive symptoms), medical (i.e., pain intensity, pain duration), and
medication regimen (i.e., opioid doses) variables.
CONCLUSIONS: Our preliminary findings provide valuable new insights into the
determinants of craving in patients with pain. The finding that catastrophizing
was associated with craving even after controlling for a host of demographic,
psychological, medical, and medication regimen variables is particularly
striking, and raises questions concerning the factors that underlie the
association between catastrophizing and craving in patients prescribed opioid
therapy.
DOI: 10.1111/pme.12416
PMCID: PMC4160420
1935. Front Neurol. 2017 Nov 3;8:586. doi: 10.3389/fneur.2017.00586. eCollection

2017.
Long-term Treatment Benefits and Prolonged Efficacy of OnabotulinumtoxinA in

Patients Affected by Chronic Migraine and Medication Overuse Headache over
3 Years of Therapy.
Guerzoni S(1), Pellesi L(1), Baraldi C(1), Cainazzo MM(1), Negro A(2),
Martelletti P(2), Pini LA(1)(3).
Author information:
(1)Headache and Drug Abuse Research Centre, Policlinico Hospital, Department of
Diagnostic Medicine, Clinical and Public Health, University of Modena e Reggio
Emilia, Modena, Italy.
(2)Regional Referral Headache Centre, Sant'Andrea Hospital, Department of
Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
(3)Center for Neuroscience and Neurotechnology, Department of Biomedical,
Metabolic and Neural Sciences, University of Modena e Reggio Emilia, Modena,
Italy.
Background: Chronic migraine (CM) affects about the 2% of the general population
and it has been recognized as one of the most-disabling conditions worldwide by
the World Health Organization. CM is often associated with the overuse of
abortive medication, which determines the worsening of headache itself and the
development of a secondary headache called medication overuse headache. The
management of these associated conditions is difficult, but a growing amount of
evidence is pointing out the effectiveness and the good safety profile of
OnabotulinumtoxinA (OnabotA). Despite this, data on OnabotA effects and safety in
long-term use lack. The purpose of the present article is to retrospectively
assess the efficacy and safety of OnabotA in a cohort of chronic migraineurs with
drug overuse from the 18th month of treatment until the third year.
Materials and methods: 90 chronic migraineurs with medication overuse were
enrolled between January 2013 and February 2017. All patients were treated with
OnabotA according to PREEMPT dictates. Before every injection session the
headache index, the analgesic consumption, the visual analog scale for pain
score, the 36-items short form health survey questionnaire score, the 6-items
headache impact test (HIT-6) score and the Zung self-rating anxiety and
depression scale scores were collected. Adverse events were carefully registered.
A simple linear regression was performed to explore the mean changes in the
abovementioned parameters for a single injection session and mean comparison
tests were performed using the one-way analysis of variance followed by
Tukey-Kramer post-hoc test.
Results: A significantly improvement for a single injection was registered for
all the above-mentioned parameters. Headache index, analgesic consumption, visual
analog pain scale, and 6-items HIT-6 scores were significantly lower than
baseline from the 18th month of treatment onwards. The 36-items short form health
survey questionnaire scores were significantly higher than baseline at every
injections session from the 18th months onwards. Zung scales did not change. No
serious adverse events were assessed and no adverse events-related drop-outs were
seen.
Conclusion: OnabotA effectiveness and safety last until 3 years of therapy,
raising the possibility of the use of this therapy even for many years in CM
prevention.
DOI: 10.3389/fneur.2017.00586
PMCID: PMC5676047
PMID: 29163347
1936. Epilepsy Behav. 2015 Feb;43:61-5. doi: 10.1016/j.yebeh.2014.11.017. Epub 2015

Jan
2.
An evaluation of the impact of memory and mood on antiepileptic drug adherence.
McAuley JW(1), Passen N(2), Prusa C(2), Dixon J(2), Cotterman-Hart S(3), Shneker
BF(4).
Author information:
(1)Ohio State University College of Pharmacy, Columbus, OH 43210, USA; Ohio State
University College of Medicine, Columbus, OH 43210, USA. Electronic address:
McAuley.5@osu.edu.
(2)Ohio State University College of Pharmacy, Columbus, OH 43210, USA.
(3)Ohio State University College of Medicine, Columbus, OH 43210, USA.
(4)Ohio State University College of Medicine, Columbus, OH 43210, USA; Ohio State
University College of Pharmacy, Columbus, OH 43210, USA.
RATIONALE: Antiepileptic drugs are the mainstay of treatment for patients with
epilepsy. Adherence to the prescribed regimen is a major factor in achieving a
reduced seizure burden, which can decrease morbidity and mortality. Patients with
epilepsy oftentimes complain about difficulty with memory. Because little is
known about the relationship between memory and mood and adherence, the purpose
of this project was to determine the impact of the confounding factors of memory
and mood on antiepileptic drug adherence in patients with epilepsy.
METHODS: One hundred adult patients with epilepsy were recruited from the
outpatient neurology clinic for this cross-sectional study. Patients who met the
inclusion criteria completed measures of subjective memory (subset of 6 memory
questions from the QOLIE-89) and objective memory (Hopkins Verbal Learning Test -
Revised), subjective adherence (Morisky scale) and objective adherence
(medication possession ratio), and mood (Neurological Disorders Depression
Inventory for Epilepsy). Refill records from each patient's community pharmacy
were used to objectively assess adherence. Medication possession ratios were
calculated based on the antiepileptic drug refill records over the previous
6months. Patients were considered adherent if their MPR was >80%.
RESULTS: Women made up the majority of the sample (n=59), and, on average,
patients had been living with epilepsy for nearly 20years. Approximately 40% of
the sample were on antiepileptic drug monotherapy; most patients (>70%) took
their antiepileptic drugs twice daily, and the mean number of total medications
was 4.25±2.98. Based on the objective measure of adherence, 35% of the patients
were nonadherent. Patients self-reported better adherence than what was
objectively measured. Only the retention metric of the objective memory measure
differentiated adherent patients from nonadherent patients. Patients in the
adherent group had significantly lower depression scores (indicating better mood)
compared with those in the nonadherent group (p=0.04).
CONCLUSIONS: Objective memory measures were not robustly correlated with
adherence. However, we observed that patients with higher depressed mood scores
were more likely to be nonadherent. By targeting patients with epilepsy and
comorbid depression, practitioners may identify patients at greatest risk of
nonadherence and subsequent harm.
DOI: 10.1016/j.yebeh.2014.11.017
1937. Aten Primaria. 2014 Nov;46 Suppl 5:101-6. doi: 10.1016/S0212-6567(14)70074-5.
Patients' beliefs about medicines and adherence to medication in ischemic heart

disease.
Dias A(1), Pereira C(2), Monteiro MJ(3), Santos C(4).
Author information:
(1)CI&DETS (PEst-OE/CED/UI4016/2014) - Escola Superior de Saúde, Instituto
Politécnico de Viseu, Viseu, Portugal. Electronic address:
madureiradias@gmail.com.
(2)CI&DETS (PEst-OE/CED/UI4016/2014) - Escola Superior de Saúde, Instituto
Politécnico de Viseu, Viseu, Portugal.
(3)Escola Superior de Enfermagem de Vila Real - Escola Superior de Enfermagem de
Vila Real, Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
(4)Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Escola
Superior de Enfermagem do Porto, Porto, Portugal.
INTRODUCTION: The phenomenon of adherence to treatment is a motive of worry from

the scientific community, since it is considered as a worldwide problem of high
magnitude. The implications are of great relevance in morbidity, mortality, in
the significant increase in the consumption of health care and in the costs to
the health system, particularly in patients with ischemic heart disease. We
intend to evaluate adherence to treatment and relate beliefs about medicines with
adherence to treatment.
MATERIAL AND METHODS: This study is descriptive-correlational and
cross-sectional. It was performed on 254 patients with ischemic heart disease who
were in follow-up consultation in the hospital at the time of the questionnaire
application. Data collection was performed through a self-administered
questionnaire, integrating the following scales: Measure Adherence to Treatment
and Beliefs about Medicines Questionnaire.
RESULTS: The patients had a mean age of 66.94 years (SD=11.62), 74% were male,
73.2% were married, 69.3% had education up to the "4th grade", 57.1% lived in the
village, 70.1% were retired and 49.6% had an income below "one minimum wage". We
found that 50.4% of patients did not adhere to treatment. Women had a strong
belief in the specific needs of the prescribed medication, while men expressed
greater belief in relation to long-term side effects (P>.05). Patients who
expressed a low belief about the harmful potential of medicines revealed
predictors of adherence to medication.
CONCLUSION: The results are consistent with previous studies in which individuals
with lower beliefs in specific concerns reported higher rates of adherence to
medication.
Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
DOI: 10.1016/S0212-6567(14)70074-5
eCollection 2019.
Association of medication adherence and depression with the control of

low-density lipoprotein cholesterol and blood pressure in patients at high
cardiovascular risk.
Katzmann JL(1), Mahfoud F(2), Böhm M(2), Schulz M(3)(4), Laufs U(1).
Author information:
(1)Department of Cardiology, Universitätsklinikum Leipzig, Leipzig, Germany,
julius.katzmann@medizin.uni-leipzig.de.
(2)Medical Clinic III, Cardiology, Angiology, Intensive Care,
Universitätsklinikum des Saarlandes, Homburg, Germany.
(3)Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie
Universität Berlin, Berlin, Germany.
(4)Department of Medicine, ABDA - Federal Union of German Associations of
Pharmacists, Berlin, Germany.
Background: Many patients at high cardiovascular risk do not reach targets for
low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP). Depression
is a frequent comorbidity in these patients and contributes to poor medication
adherence.
Objective: The aim of this study was to elucidate the associations between
adherence to lipid-and BP-lowering drugs, the diagnosis of depression, and the
control of LDL-C and BP.
Patients and methods: This study was conducted as multicenter, single-visit
cross-sectional study in Germany. Adherence was assessed by the Morisky
Medication Adherence Scale-8 (MMAS-8), and depression was assessed as documented
in the patient chart.
Results: A total of 3,188 ambulatory patients with hypercholesterolemia (39.8%),
stable coronary artery disease (CAD; 7.4%), or both (52.9%) were included.
Patients had a history of myocardial infarction (30.8%), diabetes (42.0%), were
smokers (19.7%), and 16.1% had the investigator-reported diagnosis of depression.
High or moderate adherence to lipid-lowering medication compared to low adherence
was associated with lower LDL-C levels (105.5±38.3 vs 120.8±42.4 mg/dL) and lower
BP (systolic BP 133.4±14.5 vs 137.9±13.9 mmHg, diastolic BP 78.3±9.6 vs 81.8±9.6
mmHg) and with a higher proportion of patients achieving the
guideline-recommended LDL-C (16.9% vs 10.1%) and BP target (52.2% vs 40.8%, all
comparisons P<0.0001). Adherence was worse in patients with depression.
Correspondingly, patients with depression showed higher LDL-C levels, higher BP,
and a lower probability of achieving the LDL-C and BP goal. Medication adherence
correlated between BP- and lipid-lowering medications.
Conclusion: Self-reported medication adherence can be easily obtained in daily
practice. A low adherence and the diagnosis of depression identify patients at
risk for uncontrolled LDL-C and BP who likely benefit from intensified care.
DOI: 10.2147/PPA.S182765
PMCID: PMC6302826
PMID: 30587940
Conflict of interest statement: Disclosure Julius L Katzmann reports grants from

Servier Deutschland GmbH, Germany, non-financial support from Pharmalog, Institut
für klinische Forschung GmbH, Oskar-Messter-Straße 29, Ismaning, Germany, during
the conduct of the study; Michael Böhm reports personal fees from Amgen, personal
fees from Bayer, personal fees from Servier, personal fees from Medtronic,
personal fees from Boehringer Ingelheim, nothing from Vifor, personal fees from
Bristol Myers Squibb, outside the submitted work; and Ulrich Laufs report other
from Servier, during the conduct of the study. The authors report no other
1939. J Cancer Educ. 2018 Apr;33(2):436-439. doi: 10.1007/s13187-017-1180-0.
Understanding Breast Cancer Survivors' Beliefs and Concerns About Adjuvant

Hormonal Therapy: Promoting Adherence.
Hurtado-de-Mendoza A(1), Jensen RE(2), Jennings Y(3), Sheppard VB(3).
Author information:
(1)Cancer Prevention and Control Program, Department of Oncology, Lombardi
Comprehensive Cancer Center, 3300 Whitehaven St., NW Suite 4100, Washington, DC,
20007, USA. ahd28@georgetown.edu.
(2)Cancer Prevention and Control Program, Department of Oncology, Lombardi
Comprehensive Cancer Center, 3300 Whitehaven St., NW Suite 4100, Washington, DC,
20007, USA.
(3)Department of Health Behavior and Policy, Virginia Commonwealth University,
School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA.
Adjuvant hormonal therapy is recommended for women with hormone receptor

(HR)-positive breast cancer. Though critical, many patients are non-adherent to
this therapy. Few scales have been developed to specifically address beliefs
about adjuvant hormonal therapy. This study explores the clarity and relevance of
the Beliefs about Medicine Questionnaire (BMQ) in the context of adherence
behaviors to hormonal therapy in Black and White breast cancer survivors. We
recruited women diagnosed with HR-positive cancer from the Washington, DC, area.
An interviewer administered a standardized survey and conducted a cognitive
interview. Participants rated the BMQ across three areas: relevance, difficulty,
and clarity. We coded whether the comments identified item level issues: limited
applicability, unclear reference, unclear perspective, or wording or tone.
In-depth interviews were conducted with women who prematurely discontinued
hormone therapy. The sample (n = 30) was equally split between Black and White
survivors. On average, women were 57.9 years old (SD = 9.0). Overall 77% rated
scale as relevant. Cognitive interviews revealed areas of perceived limited
acceptability such as the notion of becoming too dependent or the notion of
becoming worse if not taking the medication. Women who discontinued hormonal
therapy (n = 2) felt ambivalent towards hormonal therapy as they reported having
both positive and negative beliefs about the medication. Our study findings
suggest new areas for further research and instrument development to accurately
measure self-reported beliefs about hormonal therapy by HR-positive breast cancer
survivors.
DOI: 10.1007/s13187-017-1180-0
PMCID: PMC5557694
1940. Patient Educ Couns. 2015 Feb;98(2):191-8. doi: 10.1016/j.pec.2014.10.014.

Epub
2014 Oct 27.
Brief provider communication skills training fails to impact patient hypertension

outcomes.
Manze MG(1), Orner MB(2), Glickman M(3), Pbert L(4), Berlowitz D(3), Kressin
NR(5).
Author information:
(1)Hunter College, City University of New York (CUNY) School of Public Health,
New York, USA. Electronic address: meredith.manze@hunter.cuny.edu.
(2)Center for Healthcare Organization and Implementation Research, Bedford VAMC,
Bedford, USA.
(3)Center for Healthcare Organization and Implementation Research, Bedford VAMC,
Bedford, USA; Health Policy and Management Department, Boston University School
of Public Health, Boston, USA.
(4)University of Massachusetts Medical School, Worcester, USA.
(5)VA Boston Healthcare System, Boston, USA; Section of General Internal
Medicine, Boston University School of Medicine, Boston, USA.
OBJECTIVES: Hypertension remains a prevalent risk factor for cardiovascular

disease, and improved medication adherence leads to better blood pressure (BP)
control. We sought to improve medication adherence and hypertension outcomes
among patients with uncontrolled BP through communication skills training
targeting providers.
METHODS: We conducted a randomized controlled trial to assess the effects of a
communication skills intervention for primary care doctors compared to usual care
controls, on the outcomes of BP (systolic, diastolic), patient self-reported
medication adherence, and provider counseling, assessed at baseline and
post-intervention. We enrolled 379 patients with uncontrolled BP; 203 (54%) with
follow-up data comprised our final sample. We performed random effects least
squares regression analyses to examine whether the provider training improved
outcomes, using clinics as the unit of randomization.
RESULTS: In neither unadjusted nor multivariate analyses were significant
differences in change detected from baseline to follow-up in provider counseling,
medication adherence or BP, for the intervention versus control groups.
CONCLUSION: The intervention did not improve the outcomes; it may have been too
brief and lacked sufficient practice level changes to impact counseling,
adherence or BP.
PRACTICE IMPLICATIONS: Future intervention efforts may require more extensive
provider training, along with broader systematic changes, to improve patient
outcomes.
DOI: 10.1016/j.pec.2014.10.014
PMCID: PMC4282944
1941. Sports Health. 2018 Jul/Aug;10(4):345-354. doi: 10.1177/1941738118779762.

Epub
2018 Jun 4.
Examination of Early Functional Recovery After ACL Reconstruction: Functional

Milestone Achievement and Self-Reported Function.
Obermeier MC, Sikka RS, Tompkins M, Nelson BJ, Hamilton A, Reams M, Chmielewski
TL.
BACKGROUND: Few studies have documented early functional recovery after anterior
cruciate ligament (ACL) reconstruction.
PURPOSE: To quantify the time to early functional milestone achievement and
change in function over 12 weeks after ACL reconstruction and to identify
demographic characteristic predictors of the outcomes.
STUDY DESIGN: Prospective, longitudinal, observational study.
LEVEL OF EVIDENCE: Level 4.
METHODS: A total of 182 patients (95 females, 87 males; mean ± SD age, 28 ± 12
years; mean ± SD body mass index [BMI], 25 ± 4 kg/m2) who received primary,
unilateral, ACL reconstruction were included. Testing occurred before surgery as
well as 1, 2, 4, 8, and 12 weeks postsurgery. Outcomes included demographic
characteristics, self-reported functional milestone achievements and responses on
the Short Musculoskeletal Function Assessment (SMFA) questionnaire. Time to
functional milestone achievement was calculated, and patients were categorized
into "faster" or "prolonged" recovery groups based on the median value.
Longitudinal change in SMFA subscale scores (daily activities and mobility) as
well as demographic predictors of functional recovery group assignment and
postsurgical change in SMFA subscale scores were examined.
RESULTS: Median time for discontinuing narcotic pain medication was 9 days, while
that for discontinuing crutches was 15 days. Time to return to work occurred at a
median of 11 days, return to school at 7 days, and return to driving at 11 days.
Both SMFA subscale scores significantly decreased (improved) over time, with the
greatest change occurring between 1 and 4 weeks postsurgery. The demographic
predictor of faster functional recovery for discontinuation of narcotic pain
medication was surgery with allograft; those for return to work were higher age,
male sex, decreasing BMI, and sedentary/light occupational demand; and those for
return to driving were higher age, male sex, and surgery on the left side of the
body.
CONCLUSION: Functional recovery occurs rapidly over the first month after ACL
reconstruction for most patients. Nonmodifiable demographic characteristics may
influence recovery time for specific functional milestones.
CLINICAL RELEVANCE: Results can be used to counsel patients on early functional
recovery after ACL reconstruction.
DOI: 10.1177/1941738118779762
PMCID: PMC6044123
1942. Pharmacy (Basel). 2018 Jan 22;6(1). pii: E11. doi: 10.3390/pharmacy6010011.
An Exploratory Study of Student Pharmacists' Self-Reported Pain, Management

Strategies, Outcomes, and Implications for Pharmacy Education.
Axon DR(1), Hernandez C(2), Lee J(3), Slack M(4).
Author information:
(1)Department of Pharmacy Practice and Science, University of Arizona College of
Pharmacy, Tucson, AZ 85721, USA. axon@pharmacy.arizona.edu.
Pharmacy, Tucson, AZ 85721, USA. chernandez@pharmacy.arizona.edu.
Pharmacy, Tucson, AZ 85721, USA. jlee@pharmacy.arizona.edu.
Pharmacy, Tucson, AZ 85721, USA. slack@pharmacy.arizona.edu.
The objective of this study was to describe the prevalence, management

strategies, and outcomes of pain experienced by student pharmacists, and to
discuss implications for pharmacy education. A questionnaire administered to
student pharmacists collected data about their experience, management strategies,
and outcomes of pain. Data were analyzed using t-tests, chi-square or Fisher's
tests, and logistic regression. Of the 218 student pharmacists who completed the
survey, 79% experienced pain in the past five years. Chronic pain impacted
students' ability to work (15%) and attend school (9%). Respondents most commonly
used prescription (38%) and over-the-counter (OTC, 78%) non-steroidal
anti-inflammatory drugs (NSAIDs), and rest (69%) to manage pain. Men used more
opioids, whereas women used more OTC NSAIDs (p < 0.05). Emergency department
visits were associated with increased prescription drug use to manage pain. This
study found that 15% of student pharmacists had chronic pain in the past five
years, which was managed with medical and non-medical strategies.
DOI: 10.3390/pharmacy6010011
PMCID: PMC5874550
PMID: 29361750
1943. Heart Lung. 2016 Jul-Aug;45(4):311-8. doi: 10.1016/j.hrtlng.2016.04.001. Epub

2016 May 9.
Family partnership and education interventions to reduce dietary sodium by

patients with heart failure differ by family functioning.
Dunbar SB(1), Clark PC(2), Stamp KD(3), Reilly CM(1), Gary RA(1), Higgins M(1),
Kaslow N(4).
Author information:
(1)Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
(2)Georgia State University, Byrdine F. Lewis School of Nursing, Atlanta, GA,
USA.
(3)Boston College, School of Nursing, Chestnut Hill, MA 02467, USA. Electronic
address: stampk@bc.edu.
(4)School of Medicine, Emory University, Atlanta, GA, USA.
OBJECTIVES: Determine if family functioning influences response to family-focused

interventions aimed at reducing dietary sodium by heart failure (HF) patients.
BACKGROUND: Lowering dietary sodium by HF patients often occurs within the home
and family context.
METHODS: Secondary analysis of 117 dyads randomized to patient and family
education (PFE), family partnership intervention (FPI) or usual care (UC).
Dietary sodium measures were obtained from 3-day food record and 24-h urine
samples.
RESULTS: In the poor family functioning groups, FPI and PFE had lower mean urine
sodium than UC (p < .05) at 4 months, and FPI remained lower than UC at 8 months
(p < .05). For good family functioning groups, FPI and PFE had lower mean sodium
levels by 3-day food record at 4 and 8 months compared to the UC group.
CONCLUSION: Optimizing family-focused interventions into HF clinical care maybe
indicated.
DOI: 10.1016/j.hrtlng.2016.04.001
PMCID: PMC4935570
1944. AIDS Behav. 2015 May;19(5):743-51. doi: 10.1007/s10461-014-0859-z.
Accuracy of Self-Report and Pill-Count Measures of Adherence in the FEM-PrEP

Clinical Trial: Implications for Future HIV-Prevention Trials.
Agot K(1), Taylor D, Corneli AL, Wang M, Ambia J, Kashuba AD, Parker C, Lemons A,
Malahleha M, Lombaard J, Van Damme L.
Author information:
(1)Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu,
Kenya, mamagifto@yahoo.com.
Oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) has been evaluated as

pre-exposure prophylaxis (PrEP). We describe the accuracy of self-reported
adherence to FTC/TDF and pill counts when compared to drug concentrations in the
FEM-PrEP trial. Using drug concentrations of plasma tenofovir (TFV) and
intracellular tenofovir diphosphate (TFVdp) among a random sub-sample of 150
participants assigned to FTC/TDF, we estimated the positive predictive value
(PPV) of four adherence measures. We also assessed factors associated with
misreporting of adherence using multiple drug-concentration thresholds and
explored pill use and misreporting using semi-structured interviews (SSIs).
Reporting use of ≥1 pill in the previous 7 days had the highest PPV, while
pill-count data consistent with missing ≤1 day had the lowest PPV. However, all
four measures demonstrated poor PPV. Reported use of oral contraceptives (OR
2.26; p = 0.014) and weeks of time in the study (OR 1.02; p < 0.001) were
significantly associated with misreporting adherence. Although most SSI
participants said they did not misreport adherence, participant-dependent
adherence measures were clearly unreliable in the FEM-PrEP trial. Pharmacokinetic
monitoring remains the measure of choice until more reliable
participant-dependent measures are developed.
DOI: 10.1007/s10461-014-0859-z
PMCID: PMC4415940
1945. Intern Med. 2018 Sep 1;57(17):2443-2450. doi: 10.2169/internalmedicine.0492-

17.
Epub 2018 Mar 30.
Efficacy of Vonoprazan for Gastroesophageal Reflux Symptoms in Patients with

Proton Pump Inhibitor-resistant Non-erosive Reflux Disease.
Niikura R(1), Yamada A(1), Hirata Y(1), Hayakawa Y(1), Takahashi A(2), Shinozaki
T(3), Takeuchi Y(3), Fujishiro M(1)(4), Koike K(1).
Author information:
(1)Department of Gastroenterology, Graduate School of Medicine, The University of
Tokyo, Japan.
(2)Department of Gastroenterology, The Japan Association for Development of
Community Medicine Nerimahikarigaoka Hospital, Japan.
(3)Department of Biostatistics, School of Public Health, Graduate School of
Medicine, The University of Tokyo, Japan.
(4)Department of Endoscopy and Endoscopic Surgery, The University of Tokyo
Hospital, Japan.
Objective Clinically, patients with proton pomp inhibitor (PPI)-resistant

gastroesophageal reflux disease (GERD) are very challenging to treat. The aim of
this study was to determine the rates of symptom relief and adverse events among
PPI-resistant GERD patients that changed their therapy from a PPI to vonoprazan.
Methods Patients with severe gastroesophageal reflux symptoms (total GERD-Q score
≥8) without endoscopic findings of mucosal breaks who changed their medication
from a PPI to vonoprazan during a 12-week period from 2015 to 2016 at 2 hospitals
were selected. The primary outcome was the self-reported relief of
gastroesophageal reflux symptoms. The odds ratio (OR) for the improvement of
symptoms was calculated based on an exact binomial distribution using a
matched-pair analysis. The secondary outcome was the GERD-Q score and adverse
events. Results Twenty-six patients (6 men) with a mean age of 67.5 years were
analyzed. After the therapy was changed from a PPI to vonoprazan, 18 patients
(69.2%) reported an improvement, 6 (23.1%) reported no change, and 2 (7.7%)
reported an exacerbation of symptoms. A change in therapy was significantly
associated with improved self-reported symptoms (OR 9.0, p<0.001). The mean total
GERD-Q score during vonoprazan treatment was significantly lower than that during
PPI therapy (11.96 vs. 8.92). There were no significant differences in the
incidence of adverse events between the therapies. Conclusion Changing the
medication from a PPI to vonoprazan was significantly associated with an
improvement in gastroesophageal reflux symptoms. Vonoprazan is one of the most
promising treatment options for patients with PPI-resistant GERD.
DOI: 10.2169/internalmedicine.0492-17
PMCID: PMC6172555
1946. Neuropsychopharmacology. 2016 Oct;41(11):2772-81. doi: 10.1038/npp.2016.91.

Epub
2016 Jun 14.
Lack of Specific Involvement of (+)-Naloxone and (+)-Naltrexone on the

Reinforcing and Neurochemical Effects of Cocaine and Opioids.
Tanda G(1), Mereu M(1), Hiranita T(2), Quarterman JC(1), Coggiano M(1), Katz
JL(2).
Author information:
(1)Medication Development Program, Molecular Targets and Medication Discovery
Branch, NIDA-IRP, NIH/DHHS, Baltimore, MD, USA.
(2)Psychobiology Section, Molecular Neuropsychiatry Research Branch, NIDA-IRP,
NIH/DHHS, Baltimore, MD, USA.
Comment in
J Alcohol Drug Depend. 2016 Dec;4(6):.
Effective medications for drug abuse remain a largely unmet goal in biomedical
science. Recently, the (+)-enantiomers of naloxone and naltrexone, TLR4
antagonists, have been reported to attenuate preclinical indicators of both
opioid and stimulant abuse. To further examine the potential of these compounds
as drug-abuse treatments, we extended the previous assessments to include a wider
range of doses and procedures. We report the assessment of (+)-naloxone and
(+)-naltrexone on the acute dopaminergic effects of cocaine and heroin determined
by in vivo microdialysis, on the reinforcing effects of cocaine and the opioid
agonist, remifentanil, tested under intravenous self-administration procedures,
as well as the subjective effects of cocaine determined by
discriminative-stimulus effects in rats. Pretreatments with (+)-naloxone or
(+)-naltrexone did not attenuate, and under certain conditions enhanced the
stimulation of dopamine levels produced by cocaine or heroin in the nucleus
accumbens shell. Furthermore, although an attenuation of either cocaine or
remifentanil self-administration was obtained at the highest doses of
(+)-naloxone and (+)-naltrexone, those doses also attenuated rates of
food-maintained behaviors, indicating a lack of selectivity of TLR4 antagonist
effects for behaviors reinforced with drug injections. Drug-discrimination
studies failed to demonstrate a significant interaction of (+)-naloxone with
subjective effects of cocaine. The present studies demonstrate that under a wide
range of doses and experimental conditions, the TLR4 antagonists, (+)-naloxone
and (+)-naltrexone, did not specifically block neurochemical or behavioral
abuse-related effects of cocaine or opioid agonists.
DOI: 10.1038/npp.2016.91
PMCID: PMC5026747
1947. J Int Assoc Provid AIDS Care. 2016 May;15(3):248-55. doi:

10.1177/2325957416642019. Epub 2016 Apr 12.
Correlates of Antiretroviral Therapy Adherence among HIV-Infected Older Adults.
McCoy K(1), Waldrop-Valverde D(2), Balderson BH(3), Mahoney C(3), Catz S(4).
Author information:
(1)University of Washington Bothell, School of Nursing & Health Studies, Bothell,
WA, USA kmccoy@uw.edu.
(2)Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
(3)Group Health Research Institute, Seattle, WA, USA.
(4)Group Health Research Institute, Seattle, WA, USA University of California
Davis Health System, Sacramento, CA, USA.
BACKGROUND: Despite the success of antiretroviral therapy (ART), HIV-infected

older African Americans experience higher mortality rates compared to their white
counterparts. This disparity may be partly attributable to the differences in ART
adherence by different racial and gender groups. The purpose of this study was to
describe demographic, psychosocial, and HIV disease-related factors that
influence ART adherence and to determine whether race and gender impact ART
adherence among HIV-infected adults aged 50 years and older.
METHODS: This descriptive study involved a secondary analysis of baseline data
from 426 participants in "PRIME," a telephone-based ART adherence and
quality-of-life intervention trial. Logistic regression was used to examine the
association between independent variables and ART adherence.
RESULTS: Higher annual income and increased self-efficacy were associated with
being ≥95% ART adherent. Race and gender were not associated with ART adherence.
CONCLUSION: These findings indicated that improvements in self-efficacy for
taking ART may be an effective strategy to improve adherence regardless of race
or gender.
DOI: 10.1177/2325957416642019
PMCID: PMC4869721
1948. Cardiovasc Diagn Ther. 2019 Feb;9(1):94-99. doi: 10.21037/cdt.2018.08.01.
Self-monitoring of blood pressure to guide titration of antihypertensive

medication-a new era in hypertension management?
Ho JK(1), Carnagarin R(1), Matthews VB(1), Schlaich MP(1)(2)(3).
Author information:
(1)Dobney Hypertension Centre, School of Medicine - Royal, Perth Hospital
Unit/Medical Research Foundation, University of Western Australia, Crawley WA,
Australia.
(2)Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth,
Australia.
(3)Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and
Diabetes Institute, Melbourne, Australia.
Comment on
Lancet. 2018 Mar 10;391(10124):949-959.
DOI: 10.21037/cdt.2018.08.01
PMCID: PMC6382658
PMID: 30881886
Conflict of interest statement: Conflicts of Interest: MP Schlaich is supported

by an NHMRC Research Fellowship and has received consulting fees, and/or travel
and research support from Medtronic, Abbott, Novartis, Servier, Pfizer and
Boehringer-Ingelheim. The other authors have no conflicts of interest to declare.
1949. J Rehabil Med. 2018 Jul 17;50(7):643-651. doi: 10.2340/16501977-2353.
Self-reported activity of Swedish persons with haemophilia: Change over 2.5

years.
Brodin E(1), Hadzibajramovic E, Baghaei F, Sunnerhagen KS, Lundgren-Nilsson Å.
Author information:
(1)Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska
Academy, University of Gothenburg, Institute of Neuroscience and Physiology, ,
413 45 Göteborg, Sweden. elisabeth.brodin@gu.se.
OBJECTIVES: To describe self-reported activity using the Haemophilia Activity

List (HAL) for Swedish adults with haemophilia and to detect any changes over
time.
METHOD: The HAL was sent to the adult population with haemophilia A and B,
moderate and severe form, living in Sweden (n = 260). Participants completed the
HAL and a questionnaire on sociodemographic and medical information. From a
previous study cohort, 61 persons had responded twice to the HAL. The
investigated group was divided into early and later treatment onset groups with
regard to access to medication.
RESULTS: The response rate was 50%. There was a significant difference
(p < 0.001) between the early and later treatment groups in all domains in HAL.
When analysing HAL "question by question" from the 2 reported time-points, the
most prominent outcome was that the reported ability in activities was stable
over time at the group level, except for participants who had no access to the
clotting factor early in life. They reported greater limitations in some of the
activities in the challenging domain "leisure activities and sport".
CONCLUSION: The early treatment group reported a significantly better ability in
all activities compared with the late treatment group.
DOI: 10.2340/16501977-2353
1950. Drug Discov Ther. 2019 Jul 22;13(3):128-132. doi: 10.5582/ddt.2019.01007.

Epub
2019 Jun 14.
A survey on awareness of the "finger-tip unit" and medication guidance for the
use of topical steroids among community pharmacists.
Oishi N(1), Iwata H(1), Kobayashi N(1), Fujimoto K(1), Yamaura K(1).
Author information:
(1)Division of Social Pharmacy, Center for Social Pharmacy and Pharmaceutical
Care Sciences, Faculty of Pharmacy, Keio University.
Atopic dermatitis (AD) is a common chronic, pruritic inflammatory skin condition.

AD is most commonly treated with topical corticosteroids, and the finger-tip unit
(FTU) should be used as a guideline for the amount to be used per application. In
this study, we investigated the adequacy of pharmacists' instructions on the
amount of topical steroids to be applied and the way in which they enhance the
effect of pharmaceutical interventions. A self- administered anonymous
questionnaire was distributed using QLifePro to 300 pharmacists working in
insurance pharmacies that filled at least one dermatologist's prescription per
month on average in Japan. Out of 300 pharmacists, 196 (65.3%) recognized the
Japanese Dermatological Association's 2016 guidelines for the treatment AD, 107
(35.6%) gave instructions using the FTU as an index of external dose of topical
steroids, 157 (52.3%) explained the amount of steroid application using an index
other than FTU, and 61 (38.9% of 157) had inadequately instructed AD patients to
apply steroids as a thin layer. Pharmacists who had read the guidelines for AD
tended to give an appropriate instruction using FTU as an index of external dose
of topical steroids (p < 0.001). We found that many pharmacists in pharmacies
gave inadequate instructions on the amount of topical steroid application and
deviated from the guidelines for AD, mainly because of inadequate knowledge of
the guidelines.
DOI: 10.5582/ddt.2019.01007
PMID: 31204366
1951. AIDS Educ Prev. 2014 Dec;26(6):521-37. doi: 10.1521/aeap.2014.26.6.521.
Adherence to antiretroviral therapy among HIV-infected adults in the United

States.
Beer L, Skarbinski J.
Erratum in
AIDS Educ Prev. 2015 Oct;27(5):489-91.
National estimates of antiretroviral therapy (ART) adherence and adherence

support services utilization are needed to inform efforts to improve the health
of HIV-infected persons in the United States. In a nationally representative
sample of HIV-infected adults receiving medical care, 86% self-reported taking
all ART doses in the past 72 hours. Overall, 20% reported using adherence support
services and 2% reported an unmet need for services. If all nonadherent persons
not receiving adherence support and all persons with a self-perceived unmet need
for adherence support accessed services, resources to support ∼42,673 additional
persons would be needed. Factors associated with lower adherence included younger
age, female gender, depression, stimulant use, binge alcohol use, greater than
once-daily dosing, longer time since HIV diagnosis, and patient beliefs.
Predictors of adherence are multifactorial so multiple targeted strategies to
improve adherence are warranted. Providing adherence support services to all
those in need may require additional resources.
DOI: 10.1521/aeap.2014.26.6.521
PMCID: PMC4579321
1952. Ann Intern Med. 2017 Nov 21;167(10):689-697. doi: 10.7326/M17-1150. Epub 2017
Nov
7.
Self-administered Versus Directly Observed Once-Weekly Isoniazid and Rifapentine

Treatment of Latent Tuberculosis Infection: A Randomized Trial.
Belknap R(1), Holland D(1), Feng PJ(1), Millet JP(1), Caylà JA(1), Martinson
NA(1), Wright A(1), Chen MP(1), Moro RN(1), Scott NA(1), Arevalo B(1), Miró
JM(1), Villarino ME(1), Weiner M(1), Borisov AS(1); TB Trials Consortium iAdhere
Study Team.
Author information:
(1)From Denver Health and Hospital Authority and the University of Colorado
Health Sciences Center, Denver, Colorado; Emory University and Fulton County
Department of Health and Wellness, Atlanta, Georgia; Centers for Disease Control
and Prevention, Atlanta, Georgia; Public Health Agency of Barcelona and CIBER de
Epidemiología y Salud Pública, Barcelona, Spain; University of the Witwatersrand,
Johannesburg, South Africa; Vanderbilt University, Nashville, Tennessee; Westat,
Fort Lauderdale, Florida; University of Barcelona, Barcelona, Spain; and
University of Texas Health Science Center and Veterans Administration Medical
Center, San Antonio, Texas.
Comment in
Ann Intern Med. 2017 Nov 21;167(10 ):742-743.
Background: Expanding latent tuberculosis treatment is important to decrease

active disease globally. Once-weekly isoniazid and rifapentine for 12 doses is
effective but limited by requiring direct observation.
Objective: To compare treatment completion and safety of once-weekly isoniazid
and rifapentine by self-administration versus direct observation.
Design: An open-label, phase 4 randomized clinical trial designed as a
noninferiority study with a 15% margin. Seventy-five percent or more of study
patients were enrolled from the United States for a prespecified subgroup
analysis. (ClinicalTrials.gov: NCT01582711).
Setting: Outpatient tuberculosis clinics in the United States, Spain, Hong Kong,
and South Africa.
Participants: 1002 adults (aged ≥18 years) recommended for treatment of latent
tuberculosis infection.
Intervention: Participants received once-weekly isoniazid and rifapentine by
direct observation, self-administration with monthly monitoring, or
self-administration with weekly text message reminders and monthly monitoring.
Measurements: The primary outcome was treatment completion, defined as 11 or more
doses within 16 weeks and measured using clinical documentation and pill counts
for direct observation, and self-reports, pill counts, and medication
event-monitoring devices for self-administration. The main secondary outcome was
adverse events.
Results: Median age was 36 years, 48% of participants were women, and 77% were
enrolled at the U.S. sites. Treatment completion was 87.2% (95% CI, 83.1% to
90.5%) in the direct-observation group, 74.0% (CI, 68.9% to 78.6%) in the
self-administration group, and 76.4% (CI, 71.3% to 80.8%) in the
self-administration-with-reminders group. In the United States, treatment
completion was 85.4% (CI, 80.4% to 89.4%), 77.9% (CI, 72.7% to 82.6%), and 76.7%
(CI, 70.9% to 81.7%), respectively. Self-administered therapy without reminders
was noninferior to direct observation in the United States; no other comparisons
met noninferiority criteria. A few drug-related adverse events occurred and were
similar across groups.
Limitation: Persons with latent tuberculosis infection enrolled in South Africa
would not routinely be treated programmatically.
Conclusion: These results support using self-administered, once-weekly isoniazid
and rifapentine to treat latent tuberculosis infection in the United States, and
such treatment could be considered in similar settings when direct observation is
not feasible.
Primary Funding Source: Centers for Disease Control and Prevention.
DOI: 10.7326/M17-1150
PMCID: PMC5766341
Using the Theory of Planned Behavior to Understand Factors Influencing South

Asian Consumers' Intention to Seek Pharmacist-Provided Medication Therapy
Management Services.
Hasan SA(1), Muzumdar JM(2), Nayak R(2), Wu WK(2).
Author information:
(1)Department of Pharmacy Administration and Public Health, College of Pharmacy
and Health Sciences, St. John's University, 8000 Utopia Parkway, Jamaica, NY
11439, USA. shaquib.hasan111@gmail.com.
(2)Department of Pharmacy Administration and Public Health, College of Pharmacy
and Health Sciences, St. John's University, 8000 Utopia Parkway, Jamaica, NY
11439, USA.
The study purpose was to use the theory of planned behavior to understand factors
influencing South Asian consumers' intention to seek pharmacist-provided
medication therapy management services (MTMS). Specific objectives were to assess
effects of attitude, subjective norm (SN), perceived behavioral control (PBC),
and socio-demographics on South Asian consumers' intention to seek MTMS.
Participants who were ≥18 years of age, of South Asian origin, with a previous
visit to a pharmacy in the US for a health-related reason, and with ability to
read and comprehend English were recruited from independent pharmacies in New
York City. Responses were obtained through a self-administered survey.
Descriptive statistics were performed, and multiple linear regression analysis
was conducted to assess the study objective. SPSS was used for data analyses. Out
of 140 responses, 133 were usable. Mean scores (standard deviation) were 4.04
(0.97) for attitude, 3.77 (0.91) for SN, 3.75 (0.93) for PBC, and 3.96 (0.94) for
intention. The model explains 80.8% of variance and is a significant predictor of
intention, F (14,118) = 35.488, p < 0.05. While attitude (β = 0.723, p < 0.05)
and PBC (β = 0.148, p < 0.05) were significant predictors of intention, SN (β =
0.064, p = 0.395) was not. None of the socio-demographics were significant
predictors of intention. Strategies to make South Asians seek MTMS should focus
on creating positive attitudes and removing barriers in seeking MTMS.
DOI: 10.3390/pharmacy7030088
PMID: 31373281
1954. J Manag Care Spec Pharm. 2018 Jan;24(1):56-64. doi:

10.18553/jmcp.2018.24.1.56.
Recent Trends in Cost-Related Medication Nonadherence Among Cancer Survivors in

the United States.
Lee MJ(1), Khan MM(1), Salloum RG(2).
Author information:
(1)1 Arnold School of Public Health, University of South Carolina, Columbia.
(2)2 University of Florida College of Medicine, Gainesville.
BACKGROUND: Cancer survivors avoid necessary medications due to costs.

OBJECTIVE: To estimate the prevalence of cost-related medication non-adherence
(CRN) by age and insurance status over a number of years in a national sample of
U.S. cancer survivors.
METHODS: Using the 1999-2012 National Health Interview Survey, we examined the
prevalence and correlates of self-reported CRN, that is, patient-reported
inability to afford prescribed medications within the past 12 months, resulting
in nonadherence among cancer survivors. Descriptive statistics and multivariate
logistic regression models were used to identify time trends in CRN among cancer
survivors.
RESULTS: In a nationally representative sample of 20,517 cancer survivors from
1999 to 2012, 1,788 (8.7%) survivors reported CRN, representing approximately
436,498 individuals nationally. CRN increased significantly from 11.8%
(1999-2005) to 16.9% (2006-2012) among younger cancer survivors (P < 0.001).
Among young cancer survivors (aged 45-64 years), the uninsurance rate was higher
for those reporting CRN in the years 2006-2012 (48.5%) than in the earlier period
(42.5%; P = 0.043). Among older cancer survivors, insurance coverage through
Medicare only was lower for individuals reporting CRN in the years 2006-2012
(5.8%) than in the earlier period (7.8%; P = 0.0210). In adjusted models, younger
cancer survivors without health insurance were more likely to report CRN than
those with supplemental private insurance with Medicare, and older cancer
survivors with Medicare only were more likely to report CRN than those with
supplemental private insurance with Medicare.
CONCLUSIONS: Increasing trends in CRN were evident among younger cancer
survivors.
DISCLOSURES: No external funding was received for this work. The authors have no
conflicts of interest to report. Study concept and design were contributed by
Lee, along with Khan and Salloum. Lee collected the data, and data interpretation
was performed by Lee, Khan, and Salloum. The manuscript was written primarily by
Lee, with assistance from Khan and Salloum, and revised by Lee, Khan, and
Salloum.
DOI: 10.18553/jmcp.2018.24.1.56
1955. J Ayub Med Coll Abbottabad. 2016 Apr-Jun;28(2):302-307.
Drug Non-Adherence In Type 2 Diabetes Mellitus; Predictors And Associations.
Shams N(1), Amjad S(2), Kumar N(3), Ahmed W(1), Saleem F(4).
Author information:
(1)Department of Medicine, Rawal Institute of Health Sciences, Islamabad,
Pakistan.
(2)Benazir Bhutto Shaheed Hospital, Rawalpindi, Pakistan.
(3)Dow University of Health Sciences, Karachi, Pakistan.
(4)International Medical City Hospital, East Riffa, Bahrain.
BACKGROUND: Diabetes being a serious health issue faced by developing countries

with drug adherence having pivot role for recommended glycaemic target. This
study aims to determine drug non-adherence in type 2 diabetics and its predictors
and associations.
METHODS: This cross sectional study was conducted after ethical approval at
Medicine Dept. Rawal Institute of Health Sciences Islamabad over 10 months
duration. Demographic details, duration of diabetes, education, socioeconomic
class, glycaemic control, mode of anti-diabetic therapy, number of medications
and other modes of therapy documented. Michigan Diabetes Knowledge Questionnaire
applied with outcome as good, acceptable and poor knowledge. Drug adherence was
assessed by Morisky Medication Adherence Scale (non-adherence at <6 points). Data
analysed via SPSS version 17 with significant p-value <0.05.
RESULTS: Among 183 diabetics there were 43 (23.5%) males and 140 (76.5%) females.
Mean age was 56.6±10.6 years and mean duration of diabetes 8.4±6.57 years. One
hundred and fourteen (62%) cases were non-adherent. Diabetes knowledge was poor
in 76 (41.5 %), acceptable in 76 (41.5 %) and good in 31 (16.9%). Un-satisfactory
glycaemic control present in 149 (81.4%). Non-adherence was found to be
associated with poor glycaemic control, poor dietary adherence, poly-pharmacy,
illiteracy, practicing other modes of therapy and poor diabetes knowledge
(p<0.05).
CONCLUSIONS: Nonadherence to medication in type 2 diabetics needs to be
addressed. Suggested contributory factors are illiteracy, practicing other modes
of therapy, poor diabetes knowledge and poly-pharmacy. Public awareness programs,
self-monitoring of blood sugars, regular follow-up visits with focus at patient
education may improve glycaemic control and diabetes related complications.
1956. BMC Res Notes. 2014 Nov 26;7:844. doi: 10.1186/1756-0500-7-844.
Knowledge and disclosure of HIV status among adolescents and young adults
attending an adolescent HIV clinic in Accra, Ghana.
Kenu E(1), Obo-Akwa A, Nuamah GB, Brefo A, Sam M, Lartey M.
Author information:
(1)Korle-Bu Teaching Hospital, Accra, Ghana. Ernest_kenu@yahoo.com.
BACKGROUND: In Ghana it is estimated that 1.2% of HIV infections occur in young

people aged 15-24 but the representation in our clinics is small. Adherence to
treatment, appointment keeping and knowledge of HIV status remains a challenge.
Disclosure has been shown to result in better adherence to therapy, good clinical
outcomes, psychological adjustment and reduction in the risk of HIV transmission
when the young person becomes sexually active. A baseline study was conducted to
ascertain if adolescents and young adults knew their HIV status and their
knowledge on HIV. Informed consent and assent were obtained from willing
participants. Self-administered questionnaires on general knowledge of HIV, HIV
treatment and disclosure were collected and analyzed.
RESULTS: Thirty-four young persons participated in the study. The mean age was
16.9±SD 2.5 and 62% (21/32) were female. All of them were still in school.
Eighty-five percent were aware that young people their age could fall sick, 91%
had heard of HIV, 70% knew someone with HIV and 45% thought that adolescents were
not at risk of HIV. On modes of HIV transmission, 66.7% knew HIV was transmitted
through sex and 63.6% knew about mother to child transmission. Fifty three
percent (18/34) knew their HIV status, 50% (17/34) were on antiretroviral and 35%
(6/17) of them admitted to missing ARV doses. One person who said he was HIV
negative and another who did not know his status were both on ARVs.
CONCLUSION: Disclosure of HIV status to adolescents and young people is dependent
on a complex mix of factors and most practitioners recommend an age and
developmentally appropriate disclosure. Thus it is highly individualized. The
knowledge and awareness of HIV was 91% compared to 97% of adults in the most
recent Ghana Demographic and Health Survey however only about two thirds had
acceptable in depth knowledge on HIV. Only half knew their HIV status which was
not the best considering their ages. There is the need to strengthen education to
young persons with HIV, support adhere to ARVs for better outcomes and assist
care givers to disclose HIV status to them.
DOI: 10.1186/1756-0500-7-844
PMCID: PMC4256736
1957. J Thromb Haemost. 2014 Dec;12(12):2024-33. doi: 10.1111/jth.12743. Epub 2014

Oct
29.
Relevance of depression for anticoagulation management in a routine medical care

setting: results from the ThrombEVAL study program.
Michal M(1), Prochaska JH, Ullmann A, Keller K, Gobel S, Coldewey M, Münzel T,

Wiltink J, Beutel ME, Wild PS.
Author information:
(1)Department of Psychosomatic Medicine and Psychotherapy, University Medical
Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; German Center
for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.
BACKGROUND: Depressive symptoms have detrimental effects on quality of life and

mortality. Poor adherence to a treatment regimen is a potential mechanism for the
increased risk of adverse medical events associated with depression. Regarding
oral anticoagulation with vitamin K antagonists, adherence is crucial for the
outcome. Little is known about the clinical relevance of current depressiveness
for anticoagulation treatment.
OBJECTIVES: To examine the impact of current depressiveness on anticoagulation
treatment in regular medical care.
PATIENTS/METHODS: We examined the association between clinically significant
depressiveness as assessed by the Patient Health Questionnaire-2 ≥ 2 (PHQ-2 ≥ 2)
with the percentage of time in the therapeutic range (TTR), self-rated
compliance, several aspects of health literacy, anticoagulation side-effects and
treatment satisfaction in a cross-sectional study of 1790 oral anticoagulation
outpatients.
RESULTS: Seven hundred and sixteen participants (40.0%) had clinically
significant depressive symptoms. Depressed persons reported lower compliance with
intake of prescribed medication and regular visits for control of
anticoagulation, more unspecific side-effects (e.g. pruritus) and lower
satisfaction with the anticoagulation treatment and their doctors' expertise and
empathy. Depressed as compared with non-depressed individuals had a lower TTR
(-4.67; 95% CI, -8.39 to -0.95). Increasing severity of depressiveness was
related with decreasing TTR. However, depressiveness lost its significant impact
on TTR after multivariable adjustment (-3.11; 95% CI, -6.88 to 0.66).
CONCLUSIONS: Clinically significant depressiveness was highly prevalent and
impaired several aspects of anticoagulation treatment. Depressiveness should be
regarded as a clinically significant condition that needs to be addressed in the
management of anticoagulation patients.
© 2014 International Society on Thrombosis and Haemostasis.
DOI: 10.1111/jth.12743
1958. Health Psychol. 2016 Dec;35(12):1373-1382. doi: 10.1037/hea0000406. Epub 2016

Aug
11.
A model of parental distress and factors that mediate its link with parental
monitoring of youth diabetes care, adherence, and glycemic control.
Robinson EM(1), Weaver P(2), Chen R(3), Streisand R(4), Holmes CS(5).
Author information:
(1)Department of Psychology, Virginia Commonwealth University.
(2)Department of Psychology, Eastern Michigan University.
(3)Center For New Designs In Learning and Scholarship, Georgetown University.
(4)Department of Psychiatry and Behavioral Sciences, Division of Behavioral
Medicine and Clinical Psychology, Children's National Medical Center.
(5)Department of Pediatrics, Virginia Commonwealth University.
OBJECTIVE: Parental monitoring of adolescents' diabetes self-care is associated

with better adherence and glycemic control (A1c). A number of parent-level
factors are associated with higher levels of parental monitoring, including lower
levels of parental distress (depressive symptoms, stress, anxiety), as well as
higher levels of parental self-efficacy for diabetes management and authoritative
parenting. Often studied in isolation, these factors may be best considered
simultaneously as they are interrelated and are associated with parental
monitoring and youth adherence.
METHOD: Structural equation modeling with a cross-sectional sample of 257
parent/youth (aged 11-14) dyads: (a) examined a broad model of parental factors
(i.e., parental distress, parental diabetes self-efficacy, authoritative
parenting), and (b) assessed their relation to parental monitoring, youth
adherence, and A1c. Post hoc analyses of variance (ANOVAs) evaluated clinical
implications of daily parental monitoring.
RESULTS: Parental distress was not related directly to parental monitoring.
Instead less distress related indirectly to more monitoring via higher parental
self-efficacy and more authoritative parenting which, in turn, related to better
adherence and A1c. Higher parental self-efficacy also related directly to better
youth adherence and then to better A1c. Clinically, more parental monitoring
related to more daily blood glucose checks and to better A1c (8.48% vs. 9.17%).
CONCLUSIONS: A broad model of parent-level factors revealed more parental
distress was linked only indirectly to less monitoring via lower parental
self-efficacy and less authoritative parenting. Behaviorally, more parental
monitoring related to better adherence and to clinically better A1c in
adolescents. Further study of parent-level factors that relate to parental
distress and monitoring of adherence appears warranted. (PsycINFO Database Record
DOI: 10.1037/hea0000406
PMCID: PMC5118052
1959. J Atten Disord. 2016 Jan 28. pii: 1087054715624227. [Epub ahead of print]
Comparison of Performance on ADHD Quality of Care Indicators: Practitioner

Self-Report Versus Chart Review.
Gordon MK(1), Baum RA(2), Gardner W(3), Kelleher KJ(4), Langberg JM(5), Brinkman
WB(6), Epstein JN(6).
Author information:
(1)University of Illinois at Chicago, IL, USA megangordon448@gmail.com.
(2)The Ohio State University, Columbus, USA.
(3)Children's Hospital of Eastern Ontario, Ottawa, Canada.
(4)Nationwide Children's Hospital, Columbus, OH, USA.
(5)Virginia Commonwealth University, Richmond, USA.
(6)Cincinnati Children's Hospital Medical Center, OH, USA.
OBJECTIVE: This study compared practitioner self-report of ADHD quality of care

measures with actual performance, as documented by chart review.
METHOD: In total, 188 practitioners from 50 pediatric practices completed
questionnaires in which they self-reported estimates of ADHD quality of care
indicators. A total of 1,599 charts were reviewed.
RESULTS: The percentage of patients for whom practitioners self-reported that
they used evidence-based care was higher in every performance category when
compared with chart review, including higher use of parent and teacher rating
scales during assessment and treatment compared with chart review. Self-reported
use of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV)
criteria during assessment was also higher than by chart review. The actual
number of days until the first contact after starting medication was nearly three
times longer than self-report estimates.
CONCLUSION: Practitioners overreport performance on quality of care indicators.
These differences were large and consistent across ADHD diagnostic and treatment
monitoring practices. Practitioner self-report of ADHD guideline adherence should
not be considered a valid measure of performance.
DOI: 10.1177/1087054715624227
PMCID: PMC5019953
PMID: 26823383

eCollection 2018.
Consumer-related factors influencing antidepressant adherence in unipolar

depression: a qualitative study.
Srimongkon P(1), Aslani P(1), Chen TF(1).
Author information:
(1)The University of Sydney School of Pharmacy, Sydney, NSW, Australia,
psri6621@uni.sydney.edu.au.
Purpose: To explore factors which facilitate and negatively impact adherence, at

initiation, implementation and discontinuation phases of adherence to
antidepressant medicines.
Patients and methods: Semi-structured, face-to-face interviews were conducted
with patients suffering from unipolar depression. The digitally audio-recorded
and transcribed verbatim were used. Transcripts were thematically content
analyzed and data managed using N-Vivo software.
Results: Twenty-three interviews were conducted. The predominant factors
facilitating initiation of therapy included self-motivation and severity of
depression. Factors aiding persistence with therapy included belief in, and
effectiveness of, antidepressants. Stigma and fear of adverse events inhibited
initiation of therapy, whilst adverse events and ineffectiveness of
antidepressants contributed to discontinuation. Patients with strong perceptions
of the necessity and few concerns about antidepressants were more likely to
adhere to treatment at all phases of adherence.
Conclusion: Different factors influence medication adherence at the different
phases of adherence. These factors were based on individual perceptions about
depression and its treatment, and actual experiences of antidepressant treatment.
This information should be considered by health care professionals in delivering
targeted and tailored interventions to foster adherence. Strategies to address
medication non-adherence in unipolar depression patients should consider the
phase of adherence and individual perceptions about depression and its treatment,
along with previous experiences with treatment for depression.
DOI: 10.2147/PPA.S160728
PMCID: PMC6159805
PMID: 30288027

1961. Toxins (Basel). 2019 Aug 29;11(9). pii: E504. doi: 10.3390/toxins11090504.
A Prospective Observational Cohort Study on Pharmacological Habitus,

Headache-Related Disability and Psychological Profile in Patients with Chronic
Migraine Undergoing OnabotulinumtoxinA Prophylactic Treatment.
Gandolfi M(1)(2), Donisi V(3), Marchioretto F(4), Battista S(5), Smania N(5)(6),
Del Piccolo L(3).
Author information:
(1)Department of Neurosciences, Biomedicine and Movement Sciences, University of
Verona, 37134 Verona, Italy. marialuisa.gandolfi@univr.it.
(2)UOC Neurorehabilitation, AOUI Verona, 37134 Verona, Italy.
marialuisa.gandolfi@univr.it.
(3)Section of Clinical Psychology, Department of Neurosciences, Biomedicine and
Movement Sciences, University of Verona, 37134 Verona, Italy.
(4)Unit of Neurology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024
Verona, Italy.
(5)Department of Neurosciences, Biomedicine and Movement Sciences, University of
Verona, 37134 Verona, Italy.
(6)UOC Neurorehabilitation, AOUI Verona, 37134 Verona, Italy.
Chronic Migraine (CM) is a disabling neurologic condition with a severe impact on

functioning and quality of life. Successful therapeutic management of patients
with CM is complex, and differences in therapeutic response could be attributable
to genetically determined factors, sensitivity to pharmacological treatment,
psychosocial and relational factors affecting the patient's compliance and
approach on the therapeutic treatment. The aim of this prospective observational
study was to explore self-efficacy, coping strategies, psychological distress and
headache-related disability in a cohort of 40 patients with CM (mean age: 46.73;
standard deviation 13.75) treated with OnabotulinumtoxinA and the relationship
between these clinical and psychological aspects and acute medication consumption
during OnabotulinumtoxinA prophylactic treatment. Patients presented an overall
significant reduction in the Headache Index (HI) (p < 0.001), HI with severe
intensity (p = 0.009), and total analgesic consumption (p = 0.003) after the
prophylactic treatment. These results are in line with the literature. Despite
this, higher nonsteroidal anti-inflammatory drugs consumption was associated with
higher psychological distress, higher HI with severe and moderate intensity, and
worse quality of life. Conversely, triptans consumption was correlated with HI of
mild intensity, and problem-focused coping strategies. To conclude, the
psychological profile, and in particular, the psychological distress and specific
coping strategies might influence the self-management of acute medication.
DOI: 10.3390/toxins11090504
PMID: 31470654
Conflict of interest statement: The authors declare no conflicts of interest. The

funders had no role in the design of the study; in the collection, analyses, or
interpretation of data; in the writing of the manuscript, or in the decision to
publish the results.
Impact of a Policy Change on Pharmacists' Reporting of Adverse Drug Reactions.
Roy R(1), Ma J(2).
Author information:
(1), PharmD, MSc, is a Pharmacist with the Hôpital général juif Sir Mortimer B.
Davis, Montréal, Quebec.
(2), BScPharm, PharmD, is a Drug Use Evaluation Pharmacist with Canadian Forces
Health Services Group Headquarters, Ottawa, Ontario.
Background: Spontaneous reports of adverse drug reactions (ADRs) form an

essential component of both drug safety monitoring and patient safety
initiatives. Pharmacists are well positioned to report ADRs, but many barriers
exist to their doing so. Over the past decade, substantial changes have occurred
with regard to drug regulations and medication safety initiatives, and it is
possible that knowledge-based interventions may be needed to enhance ADR
reporting by pharmacists.
Objective: To determine whether ADR reporting behaviours of pharmacists improved
after release of a revised policy on the reporting of medication incidents.
Methods: A telephone survey was administered to pharmacists practising in the
Canadian Forces Health Services Group. Self-reported behaviours and perceived
barriers related to ADR reporting were compared before and 3 months after the
updated policy was released. Accuracy in participants' self-assessed ADR
reporting was evaluated using independently derived workload statistics.
Results: During the second survey phase (after release of the revised policy), a
greater proportion of respondents reported awareness of institutional policies on
ADR reporting and declared that they were able to complete all necessary ADR
reports during their assigned work hours. However, the number of ADR reports
submitted did not increase. Participants' recall of their ADR reporting behaviour
was corroborated by workload data. During the second survey phase, there was a
noticeable reduction in the number of free-form comments mentioning lack of staff
as a barrier to ADR reporting.
Conclusions: Release of a more comprehensive policy was not associated with an
increase in the number of ADR reports generated by pharmacists in the study
setting. Interventions to strengthen the organization's work processes for
detection of ADRs and submission of individual ADR reports should be strongly
considered, to reinforce and enhance existing ADR reporting behaviours among
pharmacists.
Publisher: Les déclarations spontanées des réactions indésirables aux médicaments

(RIM) sont essentielles à la pharmacovigilance et aux initiatives au profit de la
sécurité des patients. Les pharmaciens sont bien placés pour déclarer des RIM,
mais divers éléments y font obstacle. Au cours de la dernière décennie,
d’importants changements ont eu lieu en ce qui touche aux règlements sur les
médicaments et aux initiatives en sécurité des médicaments, et il est possible
que des interventions fondées sur le savoir soient nécessaires pour améliorer
dans l’ensemble les déclarations des RIM par les pharmaciens.Déterminer si les
habitudes des pharmaciens relatives à la déclaration des RIM se sont améliorées
après la mise à jour d’une politique portant sur la déclaration des incidents
liés aux médicaments.Les pharmaciens qui exerçaient dans le Groupe des Services
de santé des Forces canadiennes ont été sondés par téléphone. On a comparé les
réponses des pharmaciens quant à leurs propres habitudes de déclaration et aux
éléments perçus comme des obstacles à la déclaration des RIM, avant la mise à
jour de la politique et trois mois après sa mise à jour. L’exactitude des
réponses des participants à propos de leurs propres habitudes de déclaration des
RIM a été vérifiée à l’aide de statistiques sur la charge de travail obtenues
indépendamment.Pendant la deuxième phase de l’enquête (après la mise à jour de la
politique), une plus grande proportion de répondants ont indiqué être conscients
des politiques institutionnelles sur la déclaration des RIM et ils ont soutenu
qu’ils étaient en mesure de remplir tous les rapports de déclaration des RIM
nécessaires pendant leurs heures normales de travail. Cependant, le nombre de
déclarations de RIM soumises n’a pas crû. Les habitudes de déclaration de RIM que
les participants ont affirmé avoir ont été corroborées par les données sur la
charge de travail. Dans la deuxième phase de l’enquête, il y a eu une baisse
notable du nombre de commentaires libres indiquant le manque de personnel comme
obstacle à la déclaration des RIM.La mise en place d’une politique plus détaillée
n’a pas été associée à une augmentation du nombre de déclarations de RIM
produites par des pharmaciens dans le contexte de cette étude. Des interventions
visant à améliorer, au sein de l’organisme, les méthodes de travail pour la
détection des RIM et le dépôt de déclarations de RIM individuelles doivent être
fortement envisagées afin de consolider et d’améliorer les habitudes de
déclaration des RIM chez les pharmaciens.
PMCID: PMC6118825
PMID: 30185996
Conflict of interest statement: Competing interests: Development of the study

protocol was initiated by Renaud Roy in partial fulfilment of the academic
requirements for the entry-level PharmD degree at the Université de Montréal. No
other competing interests were declared.
1963. Psychiatr Serv. 2017 Mar 1;68(3):299-302. doi: 10.1176/appi.ps.201500468.

Epub
2016 Dec 1.
Consumer Outcomes After Implementing CommonGround as an Approach to Shared

Decision Making.
Salyers MP(1), Fukui S(1), Bonfils KA(1), Firmin RL(1), Luther L(1), Goscha R(1),
Rapp CA(1), Holter MC(1).
Author information:
(1)Dr. Salyers, Ms. Bonfils, Ms. Firmin, and Ms. Luther are with the Department
of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis
(e-mail: mpsalyer@iupui.edu ). Dr. Fukui, Dr. Goscha, and Dr. Rapp are with the
School of Social Welfare, University of Kansas, Lawrence, where Dr. Holter was
affiliated when this work was done.
OBJECTIVE: The authors examined consumer outcomes before and after implementing
CommonGround, a computer-based shared decision-making program.
METHODS: Consumers with severe mental illness (N=167) were interviewed prior to
implementation and 12 and 18 months later to assess changes in active treatment
involvement, symptoms, and recovery-related attitudes. Providers also rated
consumers on level of treatment involvement.
RESULTS: Most consumers used CommonGround at least once (67%), but few used the
program regularly. Mixed-effects regression analyses showed improvement in
self-reported symptoms and recovery attitudes. Self-reported treatment
involvement did not change; however, for a subset of consumers with the same
providers over time (N=83), the providers rated consumers as more active in
treatment.
CONCLUSIONS: This study adds to the growing literature on tools to support shared
decision making, showing the potential benefits of CommonGround for improving
recovery outcomes. More work is needed to better engage consumers in CommonGround
and to test the approach with more rigorous methods.
DOI: 10.1176/appi.ps.201500468
PMCID: PMC5658777
1964. Pain Res Manag. 2015 Sep-Oct;20(5):241-8. Epub 2015 Jun 30.
Modifiable lifestyle factors are associated with lower pain levels in adults with
knee osteoarthritis.
Connelly AE, Tucker AJ, Kott LS, Wright AJ, Duncan AM.
BACKGROUND: With no cure or effective treatments for osteoarthritis (OA), the

need to identify modifiable factors to decrease pain and increase physical
function is well recognized.
OBJECTIVE: To examine factors that characterize OA patients at different levels
of pain, and to investigate the relationships among these factors and pain.
METHODS: Details of OA characteristics and lifestyle factors were collected from
interviews with healthy adults with knee OA (n=197). The Western Ontario and
McMaster Universities Osteoarthritis Index was used to assess pain. Factors were
summarized across three pain score categories, and χ(2) and Kruskal-Wallis tests
were used to examine differences. Multiple linear regression analysis using a
stepwise selection procedure was used to examine associations between lifestyle
factors and pain.
RESULTS: Multiple linear regression analysis indicated that pain was
significantly higher with the use of OA medications and higher body mass index
category, and significantly lower with the use of supplements and meeting
physical activity guidelines (≥ 150 min/week). Stiffness and physical function
scores, bilateral knee OA, body mass index category and OA medication use were
significantly higher with increasing pain, whereas self-reported health, servings
of fruit, supplement use and meeting physical activity guidelines significantly
lower. No significant differences across pain categories were found for sex, age,
number of diseases, duration of OA, ever smoked, alcoholic drinks/week,
over-the-counter pain medication use, OA supplement use, physical therapy use,
servings of vegetables or minutes walked/week.
CONCLUSIONS: Healthy weight maintenance, exercise for at least 150 min/week and
appropriate use of medications and supplements represent important modifiable
factors related to lower knee OA pain.
DOI: 10.1155/2015/389084
PMCID: PMC4596631
1965. Rev Saude Publica. 2017;51:109. doi: 10.11606/S1518-8787.2017051006932. Epub

2017
Nov 17.
Regular access and adherence to medications of the specialized component of

pharmaceutical services.
Fritzen JS(1), Motter FR(1), Paniz VMV(1).
Author information:
(1)Universidade do Vale do Rio dos Sinos. Programa de Pós-Graduação em Saúde
Coletiva. São Leopoldo, RS, Brasil.
OBJECTIVE : To investigate the prevalence of the adherence to the medications of

the Specialized Component of Pharmaceutical Services and its association with
regular access in users of these medications in the municipality of São Leopoldo,
State of Rio Grande do Sul, Brazil.
METHODS : This is a cross-sectional study with adults aged 20 years and over, who
are users of medications of the Specialized Component of Pharmaceutical Services.
Sampling was carried out consecutively for users who accessed the service of the
Specialized Component of Pharmaceutical Services during the period from December
2014 to March 2015. Adherence was measured by the Brief Medication Questionnaire,
and adherents were defined as those who did not present barriers to adherence in
the three domains. Regular access was defined as getting all medications in the
last three months, regardless of how it was obtained (paying or for free). Data
analysis was performed using Poisson regression with robust variance.
RESULTS : We interviewed 414 subjects, being them mostly women (60.9%), with mean
age of 55 years (SD = 13), and using a single medication of the Specialized
Component of Pharmaceutical Services (68.1%). The prevalence of adherence to the
medications used in the last seven days was 28.3% and the prevalence of free
regular access was 46.1%, and 25.7% did not have access to all treatment. After
adjusting for the number of medications in the Specialized Component of
Pharmaceutical Services and the number of medications of continuous use, users
who had free regular access in the last three months were 60% more likely to show
adherence. For individuals with paid regular access, no association was found
between access and adherence.
CONCLUSIONS : The regularity in the free access to the medications of the
Specialized Component of Pharmaceutical Services has an impact on the behavior of
users, contributing to their commitment to treatment and self-care. The
Specialized Component of Pharmaceutical Services needs programming in order to
avoid irregular access, which suggests a significant limitation of the drug
policies in Brazil.
DOI: 10.11606/S1518-8787.2017051006932
PMCID: PMC5697919
1966. BMC Fam Pract. 2016 Nov 5;17(1):152.
Factors influencing deprescribing for residents in Advanced Care Facilities:

insights from General Practitioners in Australia and Sweden.
Bolmsjö BB(1), Palagyi A(2), Keay L(2), Potter J(3), Lindley RI(2).
Author information:
(1)Department for Clinical Sciences, Lund University, Malmö, Sweden.
beata.borgstrom-bolmsjo@med.lu.se.
(2)The George Institute for Global Health, Sydney Medical School, University of
Sydney, Sydney, NSW, Australia.
(3)Illawarra Health and Medical Research Institute, University of Wollongong,
Wollongong, NSW, Australia.
BACKGROUND: General Practitioners (GPs) are responsible for primary prescribing
decisions in most settings. Elderly patients living in Advanced Care Facilities
(ACFs) often have significant co-morbidities to consider when selecting an
appropriate drug therapy. Careful assessment is required when considering
appropriate medication use in frail older patients as they have multiple diseases
and thus multiple medication. Many physicians seem reluctant to discontinue other
physicians' prescriptions, resulting in further polypharmacy. Therefore it is
relevant to ascertain and synthesise the GP views from multiple settings to
understand the processes that might promote appropriate deprescribing medications
in the elderly. The aims of this study were to 1) compare and contrast
behavioural factors influencing the deprescribing practices of GPs providing care
for ACF residents in two separate countries, 2) review health policy and ACF
systems in each setting for their potential impact on the prescribing of
medications for an older person in residential care of the elderly, and 3) based
on these findings, provide recommendations for future ACF deprescribing
initiatives.
METHODS: A review and critical synthesis of qualitative data from two interview
studies of knowledge, attitudes, and behavioural practices held by GPs towards
medication management and deprescribing for residents of ACFs in Australia and
Sweden was conducted. A review of policies and health care infrastructure was
also carried out to describe the system of residential aged care in the both
countries.
RESULTS: Our study has identified that deprescribing by GPs in ACFs is a complex
process and that there are numerous barriers to medication reduction for aged
care residents in both countries, both with similarities and differences. The
factors affecting deprescribing behaviour were identified and divided into:
intentions, skills and abilities and environmental factors.
CONCLUSIONS: In this study we show that the GPs' behaviour of deprescribing in
two different countries is much dependent on the larger health care system. There
is a need for more education to both GPs and ACF staff as well as better
cooperation between the different health care systems and appropriate monetary
incentives for elderly care to achieve better conditions for deprescribing
practice.
DOI: 10.1186/s12875-016-0551-7
PMCID: PMC5097406
1967. MMWR Morb Mortal Wkly Rep. 2019 Jan 4;67(5152):1405-1409. doi:
10.15585/mmwr.mm675152a1.
Behavioral and Clinical Characteristics of American Indian/Alaska Native Adults

in HIV Care - Medical Monitoring Project, United States, 2011-2015.
Baugher AR, Beer L, Bradley HM, Evans ME, Luo Q, Shouse RL.
The rate of diagnosis of human immunodeficiency virus (HIV) infection among

American Indians and Alaska Natives (AI/ANs) in 2016 (10.2 per 100,000
population) was the fourth highest among seven racial/ethnic groups in the United
States (1); the number of diagnoses of HIV infection among AI/AN persons
increased by 70%, from 143 in 2011 to 243 in 2016 (1). However, little has been
published about the sociodemographic, behavioral, and clinical characteristics of
AI/AN patients with HIV infection in care because small sample sizes have led to
infrequent analysis of AI/AN-specific estimates (2) and because of
underestimation of AI/AN race/ethnicity in surveillance and other data sources
(3). CDC analyzed data from the Medical Monitoring Project (MMP), a surveillance
system that collects information about the experiences and needs of persons with
diagnosed HIV infection, collected during 2011-2015 among AI/AN adults receiving
HIV medical care. The results indicated that 64% of AI/AN patients with HIV
infection in care achieved sustained viral suppression, and 76% achieved viral
suppression at their most recent viral load test within the past 12 months, which
is below the national HIV prevention goal of 80%, but comparable to or better
than some other racial/ethnic groups (4). Based on self-report, 51% of AI/AN
patients with HIV infection had incomes at or below the U.S. Department of Health
and Human Services' (HHS) annual poverty limit, 27% had symptoms of depression,
78% reported internalized HIV-related stigma, and 20% reported binge drinking in
the past 30 days. To improve the health of AI/AN patients with HIV infection, it
is important that health care providers, tribal organizations, and state and
local health departments consider the sociodemographic and behavioral barriers to
AI/AN patients with HIV infection achieving viral suppression and design care
plans that seek to eliminate those barriers.
DOI: 10.15585/mmwr.mm675152a1
PMCID: PMC6334823
Conflict of interest statement: All authors have completed and submitted the
ICMJE form for disclosure of potential conflicts of interest. No potential
conflicts of interest were disclosed.
1968. Clinicoecon Outcomes Res. 2018 Aug 10;10:433-442. doi: 10.2147/CEOR.S168145.

eCollection 2018.
Cost of opioid medication abuse with and without tampering in the USA.
Vietri J(1), Masters ET(2), Barsdorf AI(2), Mardekian J(3).
Author information:
(1)Health Outcomes Practice, Kantar Health, Horsham, PA, USA,
jeffrey.vietri@pfizer.com.
(2)Health Economics & Outcomes Research, Pfizer Inc., New York, NY, USA.
(3)Statistical Research & Data Science Center, Pfizer Inc., New York, NY, USA.
Objective: To provide per-patient estimates of the economic burden for opioid

medication abuse with and without tampering.
Patients and methods: Adults in the US who participated in the 2010 and/or 2011
National Health and Wellness Survey were resurveyed to provide information on use
and abuse of prescription opioids in the previous 3 months. Participants
(N=20,885) were categorized as those who abused and tampered (n=107), abused
without tampering (n=118), those who reported using of opioids as prescribed
(n=981), and non-opioid controls (n=19,679). Average wages from the Bureau of
Labor Statistics and health care unit costs from the Truven MarketScan database
were applied to self-reported work impairment (absenteeism, presenteeism, and
overall work impairment) and health care resource utilization (health care
provider visits, emergency room visits, hospitalizations, and drug
rehabilitation) to estimate indirect and direct medical costs, respectively.
Estimated mean costs for these groups were compared using analysis of variance,
and generalized linear models were used to compare costs adjusted for
confounders.
Results: Those who abused and tampered had significantly higher mean indirect
(work impairment: $3,614 vs $2,938, p<0.05) and direct (health care use: $23,328
vs $4,514, p<0.001) costs over 3 months than those who abused without tampering.
This included higher mean incremental costs for non-opioid-related medical visits
($14,180 vs $2,236, p<0.001), opioid-related medical visits ($8,790 vs $2,223,
p<0.001), and drug rehabilitation ($358 vs $55, p<0.001). Increased total direct
costs were associated with tampering after adjusting for confounders (p<0.001).
Median incremental costs were also higher among those who tampered.
Conclusion: Tampering with prescription opioid medications is associated with
significantly increased medical costs compared to abuse without tampering.
Reducing tampering may provide net health care savings.
DOI: 10.2147/CEOR.S168145
PMCID: PMC6089114
PMID: 30127632
Conflict of interest statement: Disclosure Jeffrey Vietri was an employee of

Kantar Health during the development of this paper, Kantar Health are paid
consultants to Pfizer in connection with this study and the development of this
paper. Jeffrey Vietri, Elizabeth Masters, Alexandra Barsdorf, and Jack Mardekian
are employees of and hold stock options for Pfizer. The authors report no other
1969. Glob Adv Health Med. 2018 Apr 10;7:2164956118769557. doi:

10.1177/2164956118769557. eCollection 2018.
Acupuncture for Chronic Pain in the Vermont Medicaid Population: A Prospective,

Pragmatic Intervention Trial.
Davis RT(1), Badger G(1), Valentine K(2), Cavert A(2), Coeytaux RR(3).
Author information:
(1)Acupuncture Vermont, South Burlington, Vermont.
(2)2Larner College of Medicine, University of Vermont, South Burlington, Vermont.
(3)3Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Introduction: In response to the opioid crisis, the 2016 Vermont legislature

commissioned a study to assess acupuncture for patients with chronic pain in the
Vermont Medicaid population.
Objective: To assess the feasibility, acceptability, and effectiveness of
acupuncture provided by licensed acupuncturists for Vermont Medicaid patients
with chronic pain.
Methods: A total of 156 Medicaid patients with chronic pain were offered up to 12
acupuncture treatments within a 60-day period at the offices of 28 Vermont
licensed acupuncturists. PROMIS® questionnaires were administered prior to and at
the end of the treatment period to assess changes in pain intensity, pain
interference, physical function, fatigue, anxiety, depression, sleep disturbance,
and social isolation. Questionnaires also captured patients' overall impressions
of treatments as well as self-reported changes in medication use and work
function.
Results: One hundred eleven women (71%) and 45 men (29%) with a wide range of
pain complaints received a mean of 8.2 treatments during the intervention period.
Measurements captured prior to and at the end of the treatment period showed
significant improvements in group mean pain intensity, pain interference,
physical function, fatigue, anxiety, depression, sleep disturbance, and social
isolation as assessed by Patient-Reported Outcomes Measurement Information System
(PROMIS) measures (paired t tests, P < .01). Fifty-seven percent of patients
using analgesic (nonopioid) medication reported reductions in use. Thirty-two
percent of patients using opioid medication reported reductions in use of opioid
medication following the intervention. Seventy-four percent of employed patients
reported improved capacity to work. Ninety-six percent of patients said that they
would recommend acupuncture to others with chronic pain, and 91% reported
qualitative improvements, including physical (31%), functional/behavioral (29%),
and psycho-emotional (24%) improvements.
Conclusions: Our findings demonstrate that acupuncture treatment for chronic pain
is feasible and well received by patients in the Vermont Medicaid population.
Receiving care from Licensed Acupuncturists was associated with significant
improvements in physical, functional, psycho-emotional, and occupational outcomes
compared with before receiving acupuncture treatments.
DOI: 10.1177/2164956118769557
PMCID: PMC5896847
PMID: 29662722
1970. Patient Educ Couns. 2015 Apr;98(4):512-7. doi: 10.1016/j.pec.2014.12.010.

Epub
2015 Jan 14.
Medical reconciliation of dietary supplements: don't ask, don't tell.
Gardiner P(1), Sadikova E(2), Filippelli AC(2), White LF(3), Jack BW(2).
Author information:
(1)Department of Family Medicine, Boston University School of Medicine, Boston
Medical Center, Boston, USA. Electronic address: Paula.gardiner@bmc.org.
(2)Department of Family Medicine, Boston University School of Medicine, Boston
Medical Center, Boston, USA.
(3)Department of Biostatistics, Boston University School of Public Health,
Boston, USA.
OBJECTIVE: To explore inpatient reconciliation of dietary supplement (DS) use and

determine characteristics associated with DS documentation.
METHODS: We analyzed DS use among 558 inpatients recruited from the Re-Engineered
Discharge clinical trial to identify: (1) if patients self-reported DS and (2) if
DS use was documented at admission. We examined socio-demographics for
association with documentation using chi squares and t-tests. Logistic regression
was performed to assess adjusted associations with DS documentation.
RESULTS: Sixty percent reported DS use (n=333). Among users, 36% had admission DS
documentation, 20% were asked about use at admission, 18% reported disclosing use
to a provider, and 48% reported they would continue to use DS. Overall, 6% of
participants were asked, disclosed, and had documentation of DS. Logistic
regression revealed increased age associated with lower odds of DS documentation.
Identifying as Hispanic or African American reduces DS documentation odds
compared to those identifying as white.
CONCLUSIONS: There is lack of consistent DS medical reconciliation in the
inpatient setting. While more than half of patients used DS prior to
hospitalization, most were not asked about use on admission.
PRACTICE IMPLICATIONS: This study adds to literature on medical reconciliation
which requires that providers inquire and document patient DS use.
DOI: 10.1016/j.pec.2014.12.010
PMCID: PMC4404157
1971. Qual Life Res. 2017 Sep;26(9):2333-2349. doi: 10.1007/s11136-017-1571-z. Epub

2017 Apr 9.
Impact of an electronic monitoring device and behavioral feedback on adherence to

multiple sclerosis therapies in youth: results of a randomized trial.
Yeh EA(1)(2), Grover SA(3), Powell VE(4), Alper G(5), Banwell BL(6), Edwards
K(7), Gorman M(8), Graves J(9), Lotze TE(10), Mah JK(11), Mednick L(8), Ness
J(12), Obadia M(13)(14), Slater R(7), Waldman A(6), Waubant E(9), Schwartz
CE(4)(15); Pediatric MS Adherence Study Group.
Collaborators: Aaen G, Alper G, Banwell BL, Belsole C, Berenbaum T, Breiner P,

Camposano S, Chohan H, Darrell C, Dowdy S, Edwards K, Gorman M, Graves J, Grayson
J, Grover SA, Haig T, Hamer S, Hart J, Jenkins K, Lavery A, Liu G, Lotze T, Mah
JK, Mahabir R, Mar S, Mednick L, Mendoza ER, Moodley M, Ness J, Noguera A, Obadia
M, Petty M, Pope SP, Pohl D, Pontifes M, Powell VE, Quon E, Rensel M, Resto J,
Rossman I, Rundquist M, Sanchez K, Schreiner T, Schwartz CE, Slater R, Smith M,
Sorum J, Stein A, Stosic M, Tillema JM, Venkateswaran S, Vincent J, Waldman A,
Waubant E, Yeh EA.
Author information:
(1)Pediatric MS and Neuroinflammatory Disorders Program, Division of Neurology,
Department of Pediatrics, Neuroscience and Mental Health, Hospital for Sick
Children Research Institute, Hospital for Sick Children, 555 University Avenue,
Rm 6D33, Toronto, ON, M5G1X8, Canada. ann.yeh@sickkids.ca.
(2)Faculty of Medicine, The University of Toronto, 1 King's College Circle #3172,
Toronto, ON, M5S 1A8, Canada. ann.yeh@sickkids.ca.
(3)Pediatric MS and Neuroinflammatory Disorders Program, Division of Neurology,
Department of Pediatrics, Neuroscience and Mental Health, Hospital for Sick
Children Research Institute, Hospital for Sick Children, 555 University Avenue,
Rm 6D33, Toronto, ON, M5G1X8, Canada.
(4)DeltaQuest Foundation Inc., 31 Mitchell Road, Concord, MA, 01742, USA.
(5)Children's Hospital of Pittsburgh, University of Pittsburgh School of
Medicine, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
(6)Division of Neurology, Children's Hospital of Philadelphia, 3401 Civic Center
Blvd., Philadelphia, PA, 19104, USA.
(7)Department of Psychiatry, The Hospital for Sick Children, 555 University
Avenue, Toronto, ON, M5G1X8, Canada.
(8)Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue,
Boston, MA, 02115, USA.
(9)University of California San Francisco, 505 Parnassus Avenue, San Francisco,
CA, 94143, USA.
(10)Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street,
Houston, TX, 77030, USA.
(11)Alberta Children's Hospital, 2888 Shanganappi Trail NW, Calgary, AB, T3B 6A8,
Canada.
(12)University of Alabama at Birmingham, 1720 2nd Avenue, Birmingham, AL, 35294,
USA.
(13)ELLICSR: Health, Wellness, and Cancer Survivorship Centre, University Health
Network, 585 University Avenue, Toronto, ON, M5G 2C4, Canada.
(14)Department of Psychology, Faculty of Medicine, University of Toronto, 1
King's College Circle #3172, Toronto, ON, M5S 1A8, Canada.
(15)Departments of Medicine and Orthopaedic Surgery, Tufts University Medical
School, 800 Washington Street, Boston, MA, 02111, USA.
Erratum in
Qual Life Res. 2017 Dec 23;:.
PURPOSE: To report the results of a randomized controlled trial using an

electronic monitoring device (EM) plus a motivational interviewing (MI)
intervention to enhance adherence to disease-modifying therapies (DMT) in
pediatric MS.
METHODS: Fifty-two youth with MS (16.03 ± 2.2 years) were randomized to receive
either MI (n = 25) (target intervention) or a MS medication video (n = 27)
(attention control). Primary endpoint was change in adherence. Secondary outcomes
included changes in quality of life, well-being and self-efficacy. Random effects
modeling and Cohen's effect size computation evaluated intervention impact.
RESULTS: Longitudinal random effect models revealed that the MI group decreased
their EM adherence (GroupxTime interaction = -0.19), while increasing frequency
of parental DMT reminder (26.01)/administration (11.69). We found decreased EM
use in the MI group at 6 months (Cohen's d = -0.61), but increased pharmacy
refill adherence (d = 0.23). Parental reminders about medication increased in MI
subjects vs controls (d = 0.59 at 3 months; d = 0.70 at 6 months). We found
increases in self-reported adherence (d = 0.21) at 3 but not 6 months, fewer
barriers to adherence at three (d = -0.58) and six months (d = -0.31), better
physical (d = 0.23 at 3 months; d = 0.45 at 6 months), emotional (d = 0.25 at
3 months) and self-efficacy function (d = 0.55 at 3 months; 0.48 at 6 months),
but worse well-being, including self-acceptance (d = -0.53 at 6 months) and
environmental mastery (d = -0.42 at 3 and 6 months) in intervention as compared
to control patients.
CONCLUSIONS: Participants receiving MI + EM experienced worsening on objective
measures of adherence and increased parental involvement, but improved on some
self- and parent-reported measures. MI participants reported improvements in
quality of life and self-efficacy, but worsened well-being.
DOI: 10.1007/s11136-017-1571-z
PMCID: PMC6149210
1972. Afr Health Sci. 2018 Dec;18(4):852-864. doi: 10.4314/ahs.v18i4.3.
Audit of insulin prescription patterns and associated burden among diabetics in a

tertiary health institution in Nigeria.
Olamoyegun MA(1), Akinlade AT(2), Ala OA(3).
Author information:
(1)Department of Internal Medicine, Endocrinology, Diabetes & Metabolism Unit,
Ladoke Akintola University of Technology, & LAUTECH Teaching Hospital, Ogbomoso,
Oyo State, Nigeria.
(2)Department of Medicine, General Hospital Odan, Lagos Nigeria.
(3)Department of Medicine, BOWEN University & BOWEN University Teaching Hospital,
Ogbomoso.
Background: Insulin is one of the most important anti-diabetic agents in the

management of diabetes even among type 2 diabetic.
Objective: There was need to assess insulin adherence, mode of insulin delivery
and burden of insulin usage among diabetics.
Methods: A cross-sectional, prospective questionnaire, orally administered at a
Diabetes Clinic of a University Teaching Hospital, SouthWest, Nigeria.
Participants were consecutive patients with diabetes who were 18 years or older
presently on insulin either alone or in combination with other anti-diabetic
agents for at least 3 months. Baseline demographic and insulin treatment
information were obtained.
Results: Two hundred and thirteen (213) participants were studied. Of these, 21
(9.9%) had T1DM and 192 (90.1%) had T2DM, (means age, 58.6 ± 13.1 years, mean
duration of diabetes, 7.0 ± 6.9 years). Insulin adherence was noted in 72.8% with
better adherence among those who self-injected insulin compared to those who were
injected by health care professionals (HCPs) or relations. Among the respondents,
80.8% were on human insulin and pre-mixed insulin was the most commonly used form
of insulin (52.6%). Most participants (52.6%) were taking 10-20 units per day,
only 22 (10.3%) were on >40units/day. Reuse of insulin needle was found in 74.6%
of the participants. Major reasons for insulin omission were non-availability of
insulin and patients being tired of insulin injection.
Conclusion: The insulin adherence among diabetics in this study was high.
Non-availability of insulin, insulin injection pain and being tired of continual
insulin usage were some of the reasons for non-adherent to insulin usage.
DOI: 10.4314/ahs.v18i4.3
PMCID: PMC6354893
1973. J Diabetes Res. 2018 Dec 27;2018:1471808. doi: 10.1155/2018/1471808.

eCollection
2018.
Socioeconomic Factors and Inequality in the Prevalence and Treatment of Diabetes

among Middle-Aged and Elderly Adults in China.
Wang Z(1)(2), Li X(3), Chen M(1)(2).
Author information:
(1)School of Health Policy & Management, Nanjing Medical University, 211166
Nanjing, China.
(2)Creative Health Policy Research Group, Nanjing Medical University, 211166
Nanjing, China.
(3)School of Health Economics and Management, Nanjing University of Chinese
Medicine, 210023 Nanjing, China.
Background: In China, the prevalence of diabetes has increased significantly over

recent decades, owing to the county's rapidly aging population. Although many
studies have examined the prevalence of diabetes worldwide, there has been little
analysis of the inequalities in its prevalence and treatment among middle-aged
and elderly people.
Objectives: This study evaluates influence factors and inequality in respect to
the prevalence of diabetes and medication treatment among middle-aged and elderly
Chinese adults.
Methods: Data were obtained from the China Health and Retirement Longitudinal
Study, a nationally representative household survey of middle-aged and elderly
people (i.e., 45 years of age or older). Logistic regression models and the
concentration index were used to estimate socioeconomic factors and inequalities
in diabetes prevalence and treatment.
Results: The prevalence of self-reported diabetes among middle-aged and elderly
Chinese adults was 8.4%; this figure was significantly higher in urban areas than
in rural areas. Concentrations of prevalence were observed among the poor in
urban areas and among the rich in rural areas. Overall, the incidence of
receiving antidiabetic medication among diabetes patients was 64.3%; this was
significantly higher for individuals in urban areas than those in rural areas,
suggesting that awareness of diabetes treatment in urban areas is better than
that in rural areas. A disproportionate concentration of incidence of receiving
antidiabetic medication was observed among the rich in both urban and rural
areas. Socioeconomic factors significantly affected the prevalence of diabetes
and the likelihood of receiving medication and are major contributors to
inequality.
Conclusion: In China, policies and strategies regarding diabetes prevention and
control should further focus on associated socioeconomic factors and major
contributors to reduce diabetes prevalence, improve diabetes treatment and
management, and alleviate current inequality in the prevalence and treatment of
diabetes among middle-aged and elderly adults.
DOI: 10.1155/2018/1471808
PMCID: PMC6327275
PMID: 30687763

The practice of OTC counseling by community pharmacists in Parana, Brazil.
Halila GC(1), Junior EH(2), Otuki MF(3), Correr CJ(4).
Author information:
(1)Pharmacy Department, Federal University of Parana , Curitiba; & Pharmaceutical
Sciences Department, State University of Ponta Grossa, Ponta Grossa, PR ( Brazil
). gerusach@hotmail.com.
(2)Pharmacy Department, Federal University of Parana , Curitiba, PR ( Brazil ).
edsonhipolitojr@gmail.com.
(3)Pharmacy Department, Federal University of Parana , Curitiba; & Pharmaceutical
Sciences Department, State University of Ponta Grossa, Ponta Grossa, PR ( Brazil
). michelotuki@yahoo.com.br.
(4)Pharmacy Department, Federal University of Parana , Curitiba, PR ( Brazil ).
cassyano.correr@gmail.com.
BACKGROUND: In order to provide appropriate advice to the patient at the time of

dispensing and over-the-counter (OTC) medication counseling, community
pharmacists need access to current and reliable information about medicines.
Brazilian pharmacists have assumed new functions such as prescribing medication,
in a dependent model, based in protocols.
OBJECTIVE: To examine the practice of community pharmacists in a Brazilian State,
focusing on OTC recommendation.
METHOD: A cross-sectional survey of community pharmacists in a state of Brazil
was conducted from October 2013 to January 2014, with data collection through a
pre-piloted self-administered anonymous survey via Survey Monkey(®) platform.
Following ethical approval, the online instrument was sent to 8,885 pharmacists
registered in Parana State, Brazil, focusing on professionals working in
community pharmacies. The questionnaire assessed the community pharmacy setting,
the search for information, the knowledge of the evidence-based practice, the
important factors to consider when recommending an OTC medicine, and the
pharmacist prescribing. Responses were imported into SPSS(®) (version 22.0) for
analysis. Nonparametric tests were used to assess the association between
responses and demographic information with a significance level less than 5%
(p<0.05).
RESULTS: Of the pharmacists, 97.4% dispensed medications and counseled patients
for a median of six hours per day. Product's efficacy (97%) and adverse effects
(62.3%) were the most important factors taken into account when counseling a
nonprescription medicine. Few pharmacists knew the meaning of terms related to
evidence-based health. Most respondents agreed that pharmacists have the
necessary training to prescribe.
CONCLUSION: Over-the-counter medication counseling is a daily practice among
Brazilian pharmacists. Learning needs exist for community pharmacists in relation
to evidence-based practice. Thus, sources of information with good evidence could
be used daily by community pharmacists, especially as regards nonprescription
medication counseling.
DOI: 10.18549/PharmPract.2015.04.597
PMCID: PMC4696117
PMID: 26759614
eCollection 2017.
Patient experience with intravenous biologic therapies for ankylosing

spondylitis, Crohn's disease, psoriatic arthritis, psoriasis, rheumatoid
arthritis, and ulcerative colitis.
Bolge SC(1), Eldridge HM(2), Lofland JH(3), Ravin C(3), Hart PJ(4), Ingham MP(1).
Author information:
(1)Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC,
Raritan.
(2)Payer Provider Insights & Analytics, Janssen Services, LLC, Titusville, NJ.
(3)Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC,
Horsham, PA.
(4)Value Communications, Medaxial Group, New York, NY, USA.
OBJECTIVE: The objective of this study was to describe patient experience with
intravenous (IV) biologics for ankylosing spondylitis, Crohn's disease, psoriatic
arthritis, psoriasis, rheumatoid arthritis, or ulcerative colitis.
METHODS: Semi-structured telephone interviews were conducted in 405 patients with
these autoimmune diseases who were receiving an IV biologic to treat their
disease.
RESULTS: On a 7-point scale (1= not at all satisfied; 7= very satisfied), mean
satisfaction with IV medication was rated 6.1; 77% of patients rated satisfaction
as 6 or 7. The most frequently perceived benefits of IV therapy were related to
supervision provided by health care professionals. Most patients (82%, n=332)
preferred their IV medication to subcutaneous injection. The three most common
reasons for preferring IV were not wanting to self-inject (43%), less frequent
dosing (34%), and preference for administration by a health care professional
(24%). African-American/black patients had a stronger preference for IV
administration than Caucasian/white patients (97% vs 80%, P<0.05) and a greater
dislike of needles/self-injection (71% vs 40%, P<0.05). Hospital outpatient
departments were not rated as well as physician in-office infusion. Only half
(49%) of the patients reported that both they and their physician equally
influenced the choice to switch from subcutaneous to IV therapy, and only 30%
were given a choice of infusion center.
CONCLUSION: Users of IV biologics are highly satisfied with their medications and
perceive the opportunity for health care provider interaction at their infusion
facilities as an advantage of their regimen. These findings support continued
need for IV therapeutic options and shared decision-making between patients and
physicians while selecting biologic treatments.
DOI: 10.2147/PPA.S121032
PMCID: PMC5378465
PMID: 28405158
Conflict of interest statement: Disclosure At the time of the research SC Bolge,

JH Lofland, C Ravin, and MP Ingham were employees of Janssen Scientific Affairs,
LLC and H Eldridge was an employee of Janssen Services, LLC. SC Bolge, JH
Lofland, MP Ingham, and H Eldridge are stockholders of parent company Johnson &
Johnson. PJ Hart was an employee of the Medaxial Group. The authors report no
other conflicts of interest in this work.
1976. Behav Res Ther. 2015 Aug;71:90-100. doi: 10.1016/j.brat.2015.06.001. Epub

2015
Jun 3.
Guided internet cognitive behavioral therapy for insomnia compared to a control
treatment - A randomized trial.
Kaldo V(1), Jernelöv S(2), Blom K(3), Ljótsson B(4), Brodin M(3), Jörgensen M(3),
Kraepelien M(3), Rück C(3), Lindefors N(3).
Author information:
(1)Karolinska Institutet, Department of Clinical Neuroscience, Division of
Psychiatry, Stockholm, Sweden. Electronic address: viktor.kaldo@ki.se.
(2)Karolinska Institutet, Department of Clinical Neuroscience, Section of
Psychology, Stockholm, Sweden.
Psychiatry, Stockholm, Sweden.
Psychiatry, Stockholm, Sweden; Karolinska Institutet, Department of Clinical
Neuroscience, Section of Psychology, Stockholm, Sweden.
AIM: To evaluate if internet-delivered Cognitive Behavioral Therapy for insomnia

(ICBT-i) with brief therapist support outperforms an active control treatment.
METHOD: Adults diagnosed with insomnia were recruited via media (n = 148) and
randomized to either eight weeks of ICBT-i or an active internet-based control
treatment. Primary outcome was the insomnia severity index (ISI) assessed before
and after treatment, with follow-ups after 6 and 12 months. Secondary outcomes
were use of sleep medication, sleep parameters (sleep diary), perceived stress,
and a screening of negative treatment effects. Hierarchical Linear Mixed Models
were used for intent-to-treat analyses and handling of missing data.
RESULTS: ICBT-i was significantly more effective than the control treatment in
reducing ISI (Cohen's d = 0.85), sleep medication, sleep efficiency, sleep
latency, and sleep quality at post-treatment. The positive effects were
sustained. However, after 12 months the difference was no longer significant due
to a continuous decrease in ISI among controls, possibly due to their
significantly higher utilization of insomnia relevant care after treatment.
Forty-six negative effects were reported but did not differ between
interventions.
CONCLUSIONS: Supported ICBT-i is more effective than an active control treatment
in reducing insomnia severity and treatment gains remain stable one year after
treatment.
DOI: 10.1016/j.brat.2015.06.001
1977. Psychol Psychother. 2015 Mar;88(1):71-86. doi: 10.1111/papt.12036. Epub 2014

Jul
15.
Changing from a traditional psychodynamic treatment programme to

mentalization-based treatment for patients with borderline personality
disorder--does it make a difference?
Kvarstein EH(1), Pedersen G, Urnes Ø, Hummelen B, Wilberg T, Karterud S.
Author information:
(1)Department of Personality Psychiatry, Clinic of Mental Health and Addiction,
Oslo University Hospital, Oslo, Norway.
OBJECTIVES: Few studies outside United Kingdom have documented effects of

mentalization-based treatment (MBT) for patients with borderline personality
disorder (BPD). This study aimed to investigate outcomes for BPD patients treated
in an MBT programme in a Norwegian specialist treatment unit and compare benefits
of the implemented MBT with the unit's former psychodynamic treatment programme.
DESIGN: A naturalistic, longitudinal, comparison of treatment effects for BPD
patients before and after transition to MBT.
METHODS: The sample consisted of 345 BPD patients treated in the period
1993-2013. Before 2008, patients were admitted to a psychodynamic treatment
programme (n = 281), after 2008 patients received MBT (n = 64). Symptom distress,
interpersonal problems, and global functioning were assessed repeatedly
throughout the treatment. Suicidal/self-harming acts, hospital admissions,
medication, and occupational status were assessed at the start and end of
treatment. Therapists' competence and adherence to MBT was rated and found
satisfactory. The statistical method for longitudinal analyses was mixed models.
RESULTS: BPD patients in MBT and in the former psychodynamic treatment programme
had comparable baseline severity and impairments of functioning. BPD patients in
MBT had a remarkably low drop-out rate (2%), significantly lower than the former
treatment. Improvements of symptom distress, interpersonal, global and
occupational functioning were significantly greater for MBT patients. Large
reductions in suicidal/self-harming acts, hospital admissions, and use of
medication were evident in the course of both treatments.
CONCLUSIONS: The study confirms the effectiveness of MBT for BPD patients and
indicates greater clinical benefits than in traditional psychodynamic treatment
programmes.
PRACTITIONER POINTS: MBT is an effective treatment for patients with BPD. MBT can
successfully be implemented in therapeutic settings outside United Kingdom and
may be more beneficial than psychodynamic treatment programmes for BPD patients.
© 2014 The Authors. Psychology and Psychotherapy published by John Wiley & Sons
Ltd on behalf of the British Psychological Society.
DOI: 10.1111/papt.12036
PMCID: PMC4344810
1978. BMC Med Inform Decis Mak. 2015 Jun 18;15:46. doi: 10.1186/s12911-015-0171-5.
Using a mobile health application to support self-management in chronic

obstructive pulmonary disease: a six-month cohort study.
Hardinge M(1), Rutter H(2), Velardo C(3), Shah SA(4), Williams V(5), Tarassenko
L(4), Farmer A(5).
Author information:
(1)Oxford University Hospitals NHS Trust, Oxford, UK.
(2)Oxford Health Foundation Trust, Oxford, UK.
(3)Department of Engineering Science, University of Oxford, Oxford, UK.
carmelo.velardo@eng.ox.ac.uk.
(4)Department of Engineering Science, University of Oxford, Oxford, UK.
Oxford, UK.
BACKGROUND: Self-management strategies have the potential to support patients

with chronic obstructive pulmonary disease (COPD). Telehealth interventions may
have a role in delivering this support along with the opportunity to monitor
symptoms and physiological variables. This paper reports findings from a
six-month, clinical, cohort study of COPD patients' use of a mobile telehealth
based (mHealth) application and how individually determined alerts in oxygen
saturation levels, pulse rate and symptoms scores related to patient
self-initiated treatment for exacerbations.
METHODS: The development of the mHealth intervention involved a patient focus
group and multidisciplinary team of researchers, engineers and clinicians.
Individual data thresholds to set alerts were determined, and the relationship to
exacerbations, defined by the initiation of stand-by medications, was measured.
The sample comprised 18 patients (age range of 50-85 years) with varied levels of
computer skills.
RESULTS: Patients identified no difficulties in using the mHealth application and
used all functions available. 40% of exacerbations had an alert signal during the
three days prior to a patient starting medication. Patients were able to use the
mHealth application to support self- management, including monitoring of clinical
data. Within three months, 95% of symptom reporting sessions were completed in
less than 100 s.
CONCLUSIONS: Home based, unassisted, daily use of the mHealth platform is
feasible and acceptable to people with COPD for reporting daily symptoms and
medicine use, and to measure physiological variables such as pulse rate and
oxygen saturation. These findings provide evidence for integrating telehealth
interventions with clinical care pathways to support self-management in COPD.
DOI: 10.1186/s12911-015-0171-5
PMCID: PMC4472616
1979. Psychopharmacol Bull. 2018 Feb 5;48(2):18-28.
A Pilot Evaluating Clinical Pharmacy Services in an Ambulatory Psychiatry

Setting.
Lindell VA(1), Stencel NL(1), Ives RC(1), Ward KM(1), Fluent T(1), Choe HM(1),
Bostwick JR(1).
Author information:
(1)Lindell, PharmD, BCACP, Clinical Ambulatory Pharmacist, Michigan Medicine, Ann
Arbor, MI. Stencel, PharmD Candidate 2018, Pharmacy Student, University of
Michigan College of Ph

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1. PLoS One. 2017 Dec 14;12(12):e0189199. doi: 10.1371/journal.pone.0189199.

Inappropriate self-medication among adolescents and its association with lower

BACKGROUND: While self-medication is common, inappropriate self-medication has

2. Patient Prefer Adherence. 2017 Mar 1;11:401-413. doi: 10.2147/PPA.S131496.

Self-medication practice in Ethiopia: a systematic review.

BACKGROUND: Self-medication patterns vary among different populations, and are

Conflict of interest statement: Disclosure The author reports no conflicts of

3. Pan Afr Med J. 2017 Jul 7;27:183. doi: 10.11604/pamj.2017.27.183.10030.

Ebrahimi H(1), Atashsokhan G(2), Amanpour F(3), Hamidzadeh A(2).

INTRODUCTION: Self-medication can cause significant challenges for the

4. BMC Geriatr. 2017 Sep 1;17(1):198. doi: 10.1186/s12877-017-0596-z.

Self-medication among the elderly in Iran: a content analysis study.

BACKGROUND: Self-medication is described as the use of drugs without a

5. Rev Saude Publica. 2016 Dec;50(suppl 2):13s. doi:

Prevalence of self-medication in Brazil and associated factors.

[Article in English, Portuguese]

Conflict of interest statement: The authors declare no conflict of interest.

6. J Environ Public Health. 2017;2017:9145193. doi: 10.1155/2017/9145193. Epub 2017

Self-Medication in University Students from the City of Mansoura, Egypt.

Helal RM(1), Abou-ElWafa HS(1).

Background. Self-medication is a common practice in developed and developing

7. BMC Public Health. 2015 Aug 1;15:742. doi: 10.1186/s12889-015-2109-3.

Household antimicrobial self-medication: a systematic review and meta-analysis of

BACKGROUND: Antimicrobial self-medication is common in most low and middle income

8. Indian J Dermatol. 2017 Mar-Apr;62(2):178-183. doi: 10.4103/ijd.IJD_243_16.

Self-medication for Acne among Undergraduate Medical Students.

Karamata VV(1), Gandhi AM(1), Patel PP(1), Desai MK(1).

Conflict of interest statement: There are no conflicts of interest. What is new?

9. Curr Opin Behav Sci. 2016 Jun;9:78-83.

Self-medication with sucrose.

10. Rev Gaucha Enferm. 2017 May 18;38(1):e65111. doi:

Self-medication among nursing students in the state of Amazonas - Brazil.

[Article in English, Portuguese]

Gama ASM(1), Secoli SR(2).

Objective: To determine the prevalence of self-medication and associated factors

11. Pharmacol Res Perspect. 2017 Aug;5(4). doi: 10.1002/prp2.323.

Self-medication misuse in the Middle East: a systematic literature review.

Khalifeh MM(1)(2), Moore ND(1), Salameh PR(2).

Regulations usually distinguish between prescription-only (POM) and

12. BMC Res Notes. 2017 Jul 27;10(1):337. doi: 10.1186/s13104-017-2688-4.

Pharmacology education and antibiotic self-medication among medical students: a

OBJECTIVE: Pharmacology teaches rational prescribing. Self-medication among

Antibiotic Self-Medication among Non-Medical University Students in Punjab,

Gillani AH(1)(2)(3)(4), Ji W(5)(6)(7)(8), Hussain W(9), Imran A(10), Chang

Background: Antibiotic resistance is a global threat. Scarce knowledge about safe

Conflict of interest statement: The authors disclose no conflict of interests.

14. Saudi J Biol Sci. 2017 May;24(4):808-812. doi: 10.1016/j.sjbs.2017.01.004. Epub

Self-medication and antibiotic resistance: Crisis, current challenges, and

Rather IA(1), Kim BC(2), Bajpai VK(1), Park YH(1)(2).

Self-medication and self-prescription with antibiotics in the Middle East-do they

16. J Pharm (Cairo). 2017;2017:8680714. doi: 10.1155/2017/8680714. Epub 2017 Jan

Self-Medication Pattern among Social Science University Students in Northwest

Background. Inappropriate self-medication causes wastage of resources among

Conflict of interest statement: The author declares that there is no conflict of

17. Saudi Pharm J. 2018 Jul;26(5):719-724. doi: 10.1016/j.jsps.2018.02.018. Epub

Self-medication with antibiotics in Saudi Arabia.

Introduction: Despite of the global dilemma of antibiotics resistance, this issue

18. East Mediterr Health J. 2017 Mar 30;23(2):87-93.

Prevalence of self-medication among university students in Baghdad: a

Al-Ameri RJ(1), Abd Al-Badri HJ(2), Lafta RK(3).

PMID: 28383097 [Indexed for MEDLINE]

Self-medication practices among parents in Italy.

Garofalo L(1), Di Giuseppe G(1), Angelillo IF(1).