Beliefs about hydroxyurea in youth with sickle cell disease

Background

Hydroxyurea reduces complications and improves health-related quality of life (HRQOL) in sickle cell disease (SCD) patients, however adherence remains suboptimal. Understanding patients’ views of hydroxyurea is critical to optimize adherence, particularly in adolescents and young adults (AYA). Study objectives were to assess beliefs about hydroxyurea using the Beliefs about Medicines Questionnaire (BMQ), and to examine the relationship of patients’ beliefs to their hydroxyurea adherence and HRQOL.

Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis

Objective

Depression and anxiety are common in diabetes and are associated with lower diabetes self-care adherence. How this occurs is unclear. Our systematic review explored the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care.

Methods

Medline, Psycinfo, EMBASE, and CINAHL were searched from inception to June 2013. Data on associations between cognitive illness representations, poor emotional health, and diabetes self-care were extracted. Random effects meta-analysis was used to test the relationship between cognitive illness representations and poor emotional health. Their combined effect on diabetes self-care was narratively evaluated.

Results

Nine cross-sectional studies were included. Increased timeline cyclical, consequences, and seriousness beliefs were associated with poorer emotional health symptoms. Lower perceived personal control was associated with increased depression and anxiety, but not mixed anxiety and depressive symptoms. Remaining cognitive illness representation domains had mixed statistically significant and non-significant relationships across emotional states or were measured only once. Effect sizes ranged from small to large (r = ± 0.20 to 0.51). Two studies explored the combined effects of cognitions and emotions on diabetes self-care. Both showed that cognitive illness representations have an independent effect on diabetes self-care, but only one study found that depression has an independent effect also.

Conclusions

Associations between cognitive illness representations and poor emotional health were in the expected direction — negative diabetes perceptions were associated with poorer emotional health. Few studies examined the relative effects of cognitions and emotions on diabetes self-care. Longitudinal studies are needed to clarify directional pathways.     

Influence of perception of glucocorticoids on compliance of treatment in patients with rheumatoid arthritis and systemic lupus erythematosus

BackgroundGlucocorticoids (GCs) are alleged as hazardous medications among Egyptian patients and their relatives.Aim of the workTo highlight the beliefs held about GCs and the effect of these beliefs on adherence to GCs treatment.Patients and methodsThe study included 70 systemic lupus erythematosus (SLE) patients, 70 rheumatoid arthritis (RA) patients and 140 GC-naïve subjects as the control. The demographic and socioeconomic standards of the patients and control as well as the GCs use experience in patients were recorded. GCs perception was assessed by Beliefs about medication Questionnaire (BMQ). Adherence was assessed by Compliance Questionnaire of Rheumatology (CQR).ResultsGCs were significantly perceived as harmful and of low benefit by the control (p < 0.001, p < 0.001, respectively), a beneficial drug by SLE patients, while RA patients had significantly higher harm scores (p = 0.015 and p = 0.003 respectively). Most of SLE and RA patients were non-adherent (57.1% and 65.7%, respectively). Higher general-BMQ harm scores were significantly associated with a lower odd of adherence (OR: 0.25, 95%CI: 0.1–0.63). Reduced OR of necessity > concern was associated with higher socioeconomic standards and maximum oral GCs dose (OR:0.09 and 0.96, respectively). Increased OR of high necessity was significantly associated with number of currently used disease modifying anti-rheumatic drugs (DMARDs) (OR:5.54, p = 0.025). High OR of harm perception was significantly associated with higher socioeconomic standards (OR: 5.12, p = 0.016).ConclusionGCs are perceived as pillars in management by SLE and RA patients. Concerns about side effects and dependency are still troublesome. Improvement of patients’ GCs perception impacts level of adherence to treatment.     

Women’s views on and adherence to low‐molecular‐weight heparin therapy during pregnancy and the puerperium

Summary. Background: Non‐adherence to prescribed medication represents a significant factor associated with treatment failure. Pregnant women identified at risk of venous thromboembolism are increasingly being prescribed low‐molecular‐weight heparin (LMWH) during pregnancy and the puerperium. It is important to understand women’s views on and adherence to LMWH during pregnancy and the puerperium, so that women gain maximum benefit from the treatment. Objectives: To monitor women’s adherence to enoxaparin, when prescribed during pregnancy and the puerperium, and explore their beliefs about the enoxaparin therapy prescribed. Patients/Methods: A prospective cohort study involving 95 nullparous and multiparous women prescribed enoxaparin for recognized antenatal indications. Adherence to enoxaparin was assessed through self‐completion of a diary, additionally verified through laboratory tests. An adapted beliefs about medication questionnaire was administered to women during their pregnancy. Results: Women were highly adherent to enoxaparin: antenatally, mean percentage adherence 97.92%; postnatally, mean percentage adherence 93.37% (paired t‐test, P = 0.000). In the cohort of women we followed, their perceived necessity for enoxaparin therapy outweighed any concerns they had regarding enoxaparin antenatally, necessity‐concerns differential 2.20. In some women, however, this perceived necessity does decrease postnatally. Conclusions: Our results suggest that most women prescribed enoxaparin are highly adherent to their therapy during the antenatal period and that women’s antenatal beliefs about enoxaparin are able to predict a decrease in postnatal adherence. Our results have important clinical implications, particularly when women are initiated on LMWH just during the postnatal period.     

基于药物监控平台随访对乳腺癌患者服药依从性的影响

目的评价基于内分泌服药监控平台且由护士主导随访的干预措施对乳腺癌内分泌治疗患者服药信念和服药依从性的影响。方法选取2012年1—12月于复旦大学附属肿瘤医院乳腺中心行术后内分泌治疗的乳腺癌患者311例,随机分为观察组157例和对照组154例,对照组采用常规随访模式,参加医院的门诊常规随访,观察组由护士进行基于药物监控平台的随访。通过服药信念量表得分、服药依从性视觉模拟量表评分以及药物持有率等指标,评价两组患者入组时及入组3个月、6个月、18个月、24个月时的内分泌药物治疗依从性。结果在入组6个月、18个月时,观察组的服药信念量表必要性维度得分、服药依从性视觉模拟量表评分、药物持有率均高于对照组(P0.05)。结论由护士开展的基于药物监控平台的患者随访,可以提高乳腺癌术后辅助内分泌治疗患者的服药依从性。     

Beliefs About Medication and Uptake of Preventive Therapy in Women at Increased Risk of Breast Cancer: Results From a Multicenter Prospective Study

Introduction

Uptake of preventive therapies for breast cancer is low. We examined whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs, and whether belief group membership was prospectively associated with uptake of preventive therapy.

Belief in medication and adherence to antiepileptic drugs in people with epilepsy: a cross-sectional study from rural India

Abstract

Aim of the study: This study was aimed to assess belief in medication and non-adherence to antiepileptic drugs (AEDs) in people with epilepsy (PWE) from rural India. And furthermore to study the demographic and seizure attributes influencing the adherence.

Materials and methods: Present cross-sectional study included 230 adult PWE. Adherence level was assessed by using validated Morisky–Green test and patient’s beliefs towards usage of AEDs by utilizing Beliefs about Medicine Questionnaire (BMQ).

Results: On the Morisky–Green scale, 57% patients were reported non-adherent to treatment: 49.6% had moderate and 7.4% had low adherence levels. Non-adherence was considerably associated with lower socioeconomical status (p<.001), severity of seizures (p<.001), and duration of epilepsy (p<.041). The connection between seizures recurrence and non-adherence was measurably noteworthy (p<.001). Non-adherent patients had more concern about the potential adverse effects of AEDs (p<.0013).

Conclusions: Beliefs about medicines are a contributing factor to adherence towards AEDs and more concern was common among non-adherent patients. The reinforcement of epilepsy services in rural and underserved areas can be done by providing a regular, uninterrupted, and free supply of AEDs on monthly basis in the government hospitals. There is a need for awareness and educational programs by healthcare professionals at different levels, to support and encourage positive beliefs, and discourage myths against AEDs in order to increase patient’s adherence.