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Relationship between exercise professionals' behavioral styles and clients' adherence to exercise.

Exercise professionals (n = 15) were tested to assess whether specific personal traits or behavioral styles were associated with their clients' adherence to exercise. Assessments with the Personal Profile and the Personal Strengths Profile yielded one trait, "Controlling," that showed a mean difference (z = 2.99, p < .01) between the high and low adherence groups of professionals. Controlling was also significantly correlated (rs = .66, p < .01) with clients' adherence. This trait may be consistent with the interpersonal delivery requirements of interventions known to support adherence to exercise. Limitations and practical implications across exercise venues and types of participants were discussed.

Adult↗

Knowledge, perceptions, and practice of nurses toward HIV+/AIDS patients diagnosed with tuberculosis.

BACKGROUND: Tuberculosis (TB) continues to be a major health problem in the United States. Nurses may be exposed to TB and not realize their risks for becoming infected. The presentation of HIV-associated TB is somewhat different from "standard TB." PURPOSE: The purpose of this study was to determine if an educational program could improve nurses' attitudes, level of knowledge, and compliance with infection control standards for HIV/AIDS patients diagnosed with TB. METHOD: Participants included 50 staff nurses. The experimental group (35) and control group (15) completed a knowledge test and an attitude survey. Researchers observed participants for compliance with infection control standards pretest and posttest. RESULTS: Following an educational program, the experimental group demonstrated a greater knowledge of TB than the control group who did not participate in the educational program (F [1.47] = 14.43, p = .000). In addition, the experimental group had a greater improvement in their Nursing Intervention Observation Tool adherence to respiratory isolation and universal precaution protocols scores as compared to the control group (F [1.47] = 8.95, p = .004). However, there was not a tangible increase in knowledge level of AIDS, attitudes or concerns about caring for these patients. CONCLUSION: This nursing research study supports the need for an ongoing educational program with continual monitoring of infection control practices to positively affect client and caregiver outcomes.

AIDS-Related Opportunistic Infections↗

Adherence to prescription medications among medical professionals.

BACKGROUND: We evaluated adherence to medication usage by health care professionals to estimate the expected upper limit of adherence among the general population. METHODS: In a self-administered survey, physicians and nurses were asked about their use of prescribed medications for acute and chronic illnesses. The settings were a teaching hospital, employee health service, medical college, and educational conferences. RESULTS: Among 435 respondents, 301 physicians and nurses had medications prescribed for acute and/or chronic illnesses within 2 years of the survey. Of 610 prescribed medications, > or =80% were taken as prescribed, with a 77% compliance rate for short-term medications and 84% for long-term medications. Older age was associated with better adherence, whereas a greater number of doses per day was associated with poorer adherence. CONCLUSIONS: Approximately 80% of respondents reported properly taking prescription medications > or =80% of the time. Given the nature of the study population, it is unlikely that a nonclinical trial population will consistently achieve better adherence without specific interventions.

Acute Disease↗

Review of treatments that can ameliorate nonadherence in patients with schizophrenia.

Nonadherence to medication is one of the major problems in treating patients with schizophrenia. Clinicians can use a variety of assessment strategies to identify patients who are nonadherent, although none of these is completely reliable. Interventions to improve adherence include psychosocial strategies, second-generation oral antipsychotics, and long-acting injectable antipsychotics. Because of the potential for reduced relapse and rehospitalization rates and the availability of second-generation antipsychotics in injectable form, a case is made for using long-acting injectable second-generation antipsychotics, when appropriate, to treat patients with schizophrenia.

Administration, Oral↗

[Surgical treatment of false post-traumatic aneurysm of the aortic arch with arteriovenous anastomosis].

Traumatic injuries to the thoracic aorta consequent on closed chest traumas present an extremely severe and unfavourable condition as regards natural history. One of the specific disease variants lies in the formation of false post-traumatic aortic aneurysm with an arteriovenous fistula. In the presence of post-traumatic aneurysm of the thoracic aorta with an arteriovenous fistula, the disease course may be complicated by the phenomena of circulatory decompensation. Taking into account certain features of the morphology and pathogenesis of the given disease, surgical interventions require strict adherence to a number of the rules which make it possible to avoid intraoperative aneurysmal rupture. The present paper describes a case of successful surgical treatment of acute false post-traumatic aneurysm of the aortic arch with an arteriovenous fistula under profound hypothermia and circulatory arrest. Presented herein is also a review of the literature concerned with the topic.

Aneurysm, False↗

[Surgical interventions in complicated chronic pancreatitis].

While analyzing the results of 594 direct operative interventions for various forms of complicated chronic pancreatitis, which were conducted in a specialized department, the author specifies the indications for various types of operations on the pancreas and adjoining organs. The elaboration of new and improvement of existing methods of operative interventions, their individualization, adherence to the organ-preserving principle in surgical pancreatology, purposeful prevention of postoperative complications, and persistent application of medical rehabilitation measures in the postoperative period made it possible to improve significantly the immediate and late-term results of surgical management of the complicated category of patients, to reduce the postoperative mortality from 4.6 to 1.7% in particular, and to gain good and satisfactory results of treatment in 91.2% of patients.

Adult↗

[Experience in the surgical treatment of 748 patients with lung cancer].

A series of 748 patients with lung cancer as treated by surgery from 1961 to 1984 is reported. Regular lobectomy was done in 445 (74%) patients, bronchoplastic lobectomy in 67 (11.2%), segmental or wedge excision in 15 (2.5%) and pneumonectomy in 74 (12.3%) in which the ratio of left to right pneumonectomy was 2.9:1. Overall resection rate was 80.4% (601/748) and resection mortality was 1.2% (7/601) (death within 30 days of operation). Overall 5 year survival rate was 42% (169/402). The 5 year survival rate was 35.3% for pneumonectomy, 54.1% for bronchoplastic lobectomy, 42.3% for regular lobectomy and 16.7% for segmental or wedge excision. In this analysis, emphasis is laid to the therapeutic validity of the different modes of surgery. Statistical data show that only when the indication of different surgical interventions are strictly adhered to and the reasonable procedures are carried out, could better results be obtained. In surgical treatment of lung cancer, it is an important principle to eradicate the tumor and its metastatic foci as thorough as possible and to conserve the respiratory function as much as possible. Regular lobectomy has now become the "standard" and first choice operation. Pneumonectomy should be reserved for the patients with absolute necessity due to the extent of the lesion, adequate cardiopulmonary function and possibility of a permanent cure. Pneumonectomy is substituted by bronchoplastic lobectomy to a certain degree, preserving more of the lung function and improving the living quality after operation and long term results. Extensive practice of this surgical modality is advised.

Adenocarcinoma↗

Indications for endoscopic sinus surgery.

Thus, if the patient has an appropriate history, appropriate physical findings, and appropriate CT, endoscopic sinus surgery typically will be indicated and beneficial. One should be especially wary of the patient who does not fit these criteria. Particularly worrisome is the patient whose symptoms fail to respond to antibiotics. A careful examination should be done for a non-infectious cause of the symptoms in this case. Another group of patients who should be cause for concern are those whose pain is out of proportion to the disease found. This is doubly true if their pain does not respond to antibiotics. These patients will usually not be helped by operative intervention. With careful adherence to the above criteria, the appropriate surgery will usually result in a very satisfied patient.

Anti-Bacterial Agents↗

The effect of routine use of computer-generated preventive reminders in a clinical practice.

Computer-generated reminders for patients and physicians can increase provision of preventive services. On July 1, 1989, the Department of Family Medicine at the Medical University of South Carolina extended a computerized prevention reminder system to all physicians and adult patients in the department's clinical practice. The prevention program consisted of computer-generated physician reminders for any deficiencies in five preventive services at the time of patient visits, a personalized patient reminder letter sent just before a patient's birthday, and educational interventions. We defined adherence using a population-based approach, that is, the percentage of all eligible patients who had received the preventive services within the recommended period of time. The data revealed that the percentage of patients who received preventive services either increased or remained stable during the 12-month study period, which ended July 1, 1990. Adherence was greater for women, for older patients, and for those with Medicare/Medicaid and HMO insurance. We noted higher rates of adherence for all five preventive services, compared with baseline rates of adherence recorded on July 1, 1988. A population-based approach to prevention allows physicians to become more active in providing preventive care to patients. Computer-based reminder and tracking systems can integrate population-based prevention into practice.

Adult↗

[The consensual approach in geriatrics].

Caregivers are often ill-equipped to cope with repeated verbal and physical aggression by geriatric residents with cognitive deficits. Cooperation from other members of the health care team is rarely automatic and there is little adherence to established interventions. This article offers valuable insights on patient care to caregivers who work with aggressive individuals in geriatric settings. With the consensual approach, nursing assistants and attendants who are assigned to these patients daily are able to participate in the problem-solving process. They help design the approach and willingly become stakeholders in the actions presented by the patient care plans. By the end of the process they are able to view the aggressive person as someone worthy of attention and love, rather than a disruptive element to be endured.

Aged↗

Factors determining the outcome of treatment of adult smear-positive tuberculosis cases in The Gambia.

SETTING: Health centres in The Gambia, West Africa. OBJECTIVES: To identify factors determining the outcome of treatment of adult tuberculosis cases in a Tuberculosis Control Programme using directly observed treatment. DESIGN: Information on the outcome of treatment was collected on all tuberculosis cases registered with the Tuberculosis Control Programme in 1994 and 1995 and treated under supervision by tuberculosis control staff, nurses or village health workers. Treatment outcome was recorded as cured, completed treatment, failed, defaulted or died. Transferred-out patients were traced and their treatment outcome recorded at the health centre where they had last been seen. RESULTS: Data were analysed for 1357 adult smear-positive tuberculosis cases. Sputum smear conversion 2 months after the start of treatment was observed in 90% of smear-positive cases and was more likely to occur if the initial bacterial load in the sputum was low. The total cure rate was 74.6%. Female tuberculosis patients were more likely to achieve cure than males. Adjusting for sex, the cure rate was higher when treatment was provided by tuberculosis control staff in the main health centres rather than by nurses or village health workers at the peripheral level (odds ratio [OR] = 1.60, 95% confidence interval [CI] 1.23-2.09). The absence of sputum smear conversion after 2 months of chemotherapy was associated with defaulting later during treatment (OR = 2.0, 95% CI 1.15-3.57). Adjusting for age and sex, the death rate during treatment was higher in human immunodeficiency virus (HIV) positive than in HIV-negative tuberculosis patients. CONCLUSION: Directly observed treatment is an effective intervention for improving adherence of tuberculosis patients to treatment in a resource-poor country, provided that drugs are effectively delivered to the most peripheral level, and that health staff are adequately trained and regularly supervised. Patients with high bacterial load in initial sputum smears need to be closely supervised, as they are more likely to default from treatment.

Adult↗

Efficacy of a transtheoretical model-based expert system for antihypertensive adherence.

Blood pressure is not controlled in as many as 50%-75% of hypertensive patients, primarily because of inadequate adherence to treatment. This paper examines the efficacy of a Transtheoretical Model (TTM)-based expert system intervention designed to improve adherence with antihypertensives in a sample of 1,227 adults. Participants were proactively recruited and randomly assigned to receive usual care or three individualized expert system reports and a stage-matched manual over 6 months. Participants were surveyed at baseline, and 6, 12, and 18 months. Significantly more of the intervention group participants reported being in Action and Maintenance at follow-up time points (ie, 73.1% of the treatment group versus 57.6% of the control group at 12 months and 69.1% of the treatment group versus 59.2% of the control group at 18 months). Scores on a behavioral measure of nonadherence differed significantly at follow-up time points. TTM-based expert system interventions have the potential for a significant impact on entire populations of individuals who fail to adhere, regardless of their readiness to change.

Adult↗

A worksite intervention to enhance social cognitive theory constructs to promote exercise adherence.

UNLABELLED: The results suggest social cognitive theory variables associated with the adoption of exercise are changeable in a brief worksite intervention. Self-regulation techniques and outcome-expectancy value improved, but self-efficacy did not improve for the treatment group. One possible explanation is, the intervention did not adequately address the ability to overcome barriers to exercise faced by participants in the intervention. Another explanation may be the effect of experiencing the barriers to exercise faced by subjects during the first 4 weeks of a self-regulated exercise program. Before engaging in exercise, the participants had a perceived level of confidence to overcome barriers to exercise. Once faced with real barriers to exercise, the subjects may have reevaluated their ability to overcome these barriers. It is interesting that the comparison group reported small decreases in all social cognitive theory variables measured in this study. The comparison group received a program of assessment, instruction, and access to facilities that is common to many worksite-based fitness promotion programs. Clearly, this approach did not have a favorable impact on psychosocial variables associated with exercise adherence. These results may be explained by a reevaluation of beliefs and perceived capabilities to exercise, once faced with the real experiences and barriers related to the adoption of an exercise program. The small decreases in social cognitive theory variables in the comparison group may explain high dropout rates in many fitness center programs and warrant further study. IMPLICATIONS: Health promotion specialists at the worksite need intervention programs that are safe, effective, and efficient for their employees. This intervention was based in the classroom, and no exercise was performed during class. This is appealing to employees who do not have access to shower facilities at the worksite. Moreover, in many interventions, subjects exercise during class and have limited time to learn specific skills to help them adopt and maintain exercise outside the structure of the intervention. Having established favorable changes in social cognitive theory constructs attributable to the intervention, a follow-up study should be conducted to determine the extent to which these changes predict adherence to regular exercise. These studies would establish the causal linkages between social cognitive theory constructs and regular exercise. LIMITATIONS: There were specific limitations, and the results should be interpreted cautiously. The sample size was relatively small, although similar to other exercise intervention research reviewed by Dishman. Another limitation of the sample was no random assignment to treatment or comparison group. The results apply only to the subjects who volunteered for this study. The measure of outcome-expectancy value is the most vulnerable of those used to measure outcome expectations and outcome expectancies. It is possible that the results of the study would be substantially altered if a better measure were available. The data were collected through self-administered questionnaires. It was assumed the subjects would provide accurate information, but reliance on self-reported data introduces potential sources of error.

Adult↗

Injury rehabilitation: a goal-setting intervention study.

The study examined the effects of a 5-week goal-setting intervention on athletes' rehabilitation adherence, self-efficacy, treatment efficacy, and the psychological response variables: dispirited and reorganization. Participants were matched across six variables and randomly assigned to one of three groups: goal-setting intervention, social support control, and control. The results confirmed some of the hypothesized effects of the goal-setting intervention: (a) athlete self-report of adherence showed the goal-setting group adhered significantly more to the rehabilitation program than the other two groups; (b) the goal-setting intervention resulted in significant group differences for self-efficacy (the goal-setting group having the highest level of self-efficacy); and (c) there was a significant increase across time for reorganization and decrease across time for dispirited (between specific time phases).

Adolescent↗

A gender perspective on parents' answers to a questionnaire on children's asthma.

BACKGROUND: Is there a difference in the answers of mothers and fathers to the Paediatric Caregiver's Quality of Life Questionnaire (PACQLQ)? If so, does this reflect a perception that has any consequence for the medication and health of the child? METHODS: We performed a randomised prospective intervention study with extra support and education in the form of group discussions with half of the parents of 60 pre-school children with newly diagnosed asthma. Parents answered separately the PACQLQ at inclusion, and after 6 and 18 months. RESULTS: There were no major gender differences in indices at any occasion, but mothers were more disturbed at night, felt more helpless and frightened and the child's asthma interfered more with their work at inclusion. After 6 months the mothers in the intervention group showed improvements in all indices. After 18 months the children in the intervention group had better adherence and their exacerbation rate was half that of the control group. In the region where this method now is standard the in-hospital days with asthma are the lowest in the country. CONCLUSION: There are differences in the answers of fathers and mothers to the PACQLQ. In the intervention group the mothers reported that they were less worried and less restricted in their activities. This equalisation of the parent's roles in handling their child's asthma might be part of the explanation as to why the children in the intervention group had better adherence and were healthier.

Adult↗

Adherence beliefs among breast cancer patients taking tamoxifen.

Information about the reasons for non-adherence among breast cancer patients taking tamoxifen is essential for the development of interventions that may increase adherence. The present study investigated treatment experiences and perceptions among women taking tamoxifen and how these related to adherence behaviour. Hundred and ten women completed questionnaires including the Women's Health Questionnaire, Hot Flushes and Night Sweats Questionnaire, Beliefs about Medicine Questionnaire and a self-report measure of adherence. Non-adherers were more likely to report a belief that there was nothing to be gained from taking tamoxifen whereas adherers were more likely to report that tamoxifen would stop them from developing breast cancer. The main reason for not taking tamoxifen was reported to be side effects. There were no differences between adherers with regard to the strategies used to remember to take tamoxifen or with regard to the time of day tamoxifen was taken. The results have implications for the role of health professionals in informing patients of the purpose of their treatment and for the development of symptom-management interventions for this patient group.

Adult↗

Family interventions in schizophrenia: an analysis of non-adherence.

OBJECTIVE: The aim of this study was to identify baseline factors which may make it possible to predict non-adherence to prescribed treatment. METHOD: A total of 87 schizophrenic patients in a catchment area of Valencia (Spain) were randomly assigned to two family strategies. The characteristics associated with lack of adherence to the programmes were analysed in both the patients and their families. RESULTS: Older patients, those with a higher number of previous hospital admissions, those living in small households and those having relatives with little knowledge of schizophrenia at the time of the initial assessment were the main factors associated with a higher risk of dropping out of the interventions. CONCLUSIONS: The findings of this study offer some guidance on suggesting intervention strategies that might reduce drop-out rates in these types of programmes.

Adult↗

Which patients are able to adhere to tuberculosis treatment? A study in a rural area in the northwest part of Turkey.

The purpose of this study was to investigate various factors, including demographical, socioeconomical, clinical and radiological features, of adherent and nonadherent patients with tuberculosis (TB) who were admitted to a university hospital between 1998 and 2003. One hundred and one patients (65.5%) and 53 patients (34.5%) met the criteria of adherence and nonadherence, respectively. A higher rate of adherence was observed among females than males (79.2 versus 58.4%, respectively, P = 0.012). Older patients were more nonadherent (P = 0.008). The adherence rate in non-smokers was significantly higher than that of smokers (81.4 and 52.4%, respectively, P = 0.000). Patients who underwent "family screening" were more adherent (75.7%) than those (39.5%) who did not (P = 0.000). Patients with pleurisy had higher adherence rates (81.3%), followed by patients with pulmonary TB (65.0%), while patients with extrarespiratory TB had the lowest adherence rates (45.5%) (P = 0.024). The presence of cough was significantly associated with adherence (P = 0.049). A significantly higher adherence rate was observed in patients without hemoptysis (P = 0001). A univariate logistic regression confirmed that age, smoking, family screening, type of TB, cough and hemoptysis had significant independent effects on the adherence to treatment of TB. High-risk patients may be identified and interventions tailored to promote adherence before concluding that the patient is willfully refusing treatment.

Adolescent↗